Search Results (718)

Background and objectives: Trismus is a frequent and debilitating complication in people with head and neck cancer (HNC) which leads to significant functional limitations and reduced quality of life. Rehabilitation interventions are commonly recommended to manage or prevent trismus. However, in many randomized controlled trials (RCTs), the theoretical justification for these interventions is poorly articulated, and the underlying biological or physiological mechanisms are not described in detail, limiting our understanding of why certain treatments may (or may not) work. This review aimed to identify and analyze how RCTs report the rationale for rehabilitation interventions and the explanations used to manage this population. Materials and Methods: A scoping review was conducted in accordance with the PRISMA-ScR guidelines. Five databases (PubMed, PEDro, Web of Science, Scopus, and EMBASE) were searched up to May 2025 for RCTs evaluating rehabilitation interventions for the management or prevention of treatment-induced trismus in patients with HNC. Data were extracted and synthesized narratively, focusing on the type of intervention, the rationale for its use, and the proposed mechanisms of action. Results: Of 2215 records identified, 24 RCTs met the inclusion criteria. Thirteen studies focused on preventive interventions—primarily exercise therapy—while the remainder addressed established trismus using exercise, manual therapy, electrotherapy, or combined treatment modalities. The rationales provided for intervention selection were heterogeneous and often lacked depth, with most studies justifying interventions based on their potential to improve mouth opening or reduce fibrosis but rarely grounding these claims in detailed pathophysiological models. Only half of the studies provided any mechanistic explanation for the intervention’s effects, and these were typically generic or speculative. Conclusions: RCTs investigating rehabilitation interventions for treatment-induced trismus in patients with HNC frequently lack comprehensive rationales and mechanistic explanations for their interventions. This gap limits the ability to refine and optimize treatment approaches, as the underlying processes driving clinical improvements remain poorly understood. Future research should be guided by theoretical models and include objective outcomes to better elucidate the mechanisms of action of interventions to inform clinical practice. Full article

According to the National Institutes of Health, approximately 465 million individuals are affected by type II diabetes mellitus (T2DM) and could benefit from managing their condition with a high-quality diet based on proper, nutrient-rich food choices. A plant-based diet not only has health benefits but also helps mitigate climate change by reducing greenhouse gas emissions, but the Mediterranean diet has the most beneficial effect on overall health. In contrast, ultra-processed foods have a negative impact on T2DM outcomes. Reviewing the nutritional profile of different meals, snacks and desserts would be helpful in enhancing their quality, strengthening the role of dietitians and doctors and protecting against T2DM complications. This approach would also increase simplification and education for consumers. The PubMed-Medline, Web of Science, Scopus and Cochrane Library databases were searched for relevant articles published up to May, from 2000 (based on publication date). The results support the need to reinforce health claims and highlight public demand for food choices while also improving patient quality of life. Full article

Moringa oleifera (MO), a nutritionally and pharmacologically potent species, is emerging as a sustainable candidate for applications across bioenergy, agriculture, textiles, pharmaceuticals, and biomedicine. This review explores recent advances in MO-based biotechnologies, highlighting novel extraction methods, green nanotechnology, and clinical trial findings. Although MO’s resilience offers promise for climate-smart agriculture and public health, challenges remain in standardizing cultivation and verifying therapeutic claims. This work underscores MO’s translational potential and the need for integrative, interdisciplinary research. MO is used in advanced materials, like electrospun fibers and biopolymers, showing filtration, antibacterial, anti-inflammatory, and antioxidant properties—important for the biomedical industry and environmental remediation. In textiles, it serves as an eco-friendly alternative for wastewater treatment and yarn sizing. Biotechnological advancements, such as genome sequencing and in vitro culture, enhance traits and metabolite production. MO supports green biotechnology through sustainable agriculture, nanomaterials, and biocomposites. MO shows potential for disease management, immune support, metabolic health, and dental care, but requires further clinical trials for validation. Its resilience is suitable for land restoration and food security in arid areas. AI and deep learning enhance Moringa breeding, allowing for faster, cost-effective development of improved varieties. MO’s diverse applications establish it as a key element for sustainable development in arid regions. Full article

The global coffee supply chain is a complex multi-stakeholder ecosystem plagued by fragmented records, unverifiable origin claims, and limited real-time visibility. These limitations pose risks to ethical sourcing, product quality, and consumer trust. To address these issues, this paper proposes a blockchain and IoT-enabled framework for secure and transparent coffee supply chain management. The system integrates simulated IoT sensor data such as Radio-Frequency Identification (RFID) identity tags, Global Positioning System (GPS) logs, weight measurements, environmental readings, and mobile validations with Ethereum smart contracts to establish traceability and automate supply chain logic. A Solidity-based Ethereum smart contract is developed and deployed on the Sepolia testnet to register users and log batches and to handle ownership transfers. The Internet of Things (IoT) data stream is simulated using structured datasets to mimic real-world device behavior, ensuring that the system is tested under realistic conditions. Our performance evaluation on 1000 transactions shows that the model incurs low transaction costs and demonstrates predictable efficiency behavior of the smart contract in decentralized conditions. Over 95% of the 1000 simulated transactions incurred a gas fee of less than ETH 0.001. The proposed architecture is also scalable and modular, providing a foundation for future deployment with live IoT integrations and off-chain data storage. Overall, the results highlight the system’s ability to improve transparency and auditability, automate enforcement, and enhance consumer confidence in the origin and handling of coffee products. Full article

Coinfections with hepatitis C virus (HCV) or human immunodeficiency virus (HIV) among individuals with chronic hepatitis B (CHB) are associated with worse clinical outcomes but remain understudied due to their low prevalence and the sensitivity of associated data. This nationwide, cross-sectional study utilized claims data from the Korean Health Insurance Review and Assessment Service (2014–2021) to investigate the prevalence, comorbidities, treatment patterns, and liver-related complications among patients with HBV monoinfection, HBV/HIV, HBV/HCV, or triple coinfection. Among over 4.5 million patients with chronic hepatitis B, the prevalence of HIV and HCV coinfection ranged from 0.05 to 0.07% and 0.77 to 1.00%, respectively. Patients with HBV/HCV coinfection were older and had significantly higher rates of hypertension, diabetes, dyslipidemia, and major adverse liver outcomes, including hepatocellular carcinoma and liver transplantation, compared to other groups. HBV/HIV coinfection was more common in younger males and was associated with higher dyslipidemia. The use of HBV antivirals increased over time across all groups. These findings highlight the distinct clinical characteristics and unmet needs of coinfected populations, underscoring the importance of tailored screening and management strategies in HBV-endemic settings. Full article

Background/Objectives: Weight loss and its subsequent regain pose significant challenges for those dealing with overweight and obesity. This study explores weight loss strategies among adults in Saudi Arabia and evaluates factors linked to weight regain. Methods: This cross-sectional study focused on adults residing in Jazan, located in southwest Saudi Arabia. Data collection was conducted using a self-administered questionnaire that assessed participants’ demographics, medical history, perceptions of body weight, weight loss methods, and the incidence of weight regain. Logistic regression was used to determine whether there were statistically significant differences related to the occurrence of weight regain. Results: A total of 368 participants reported efforts to lose weight over the past 3 years. The average age of these participants was 32.7 years (standard deviation: 11.3), and the gender distribution was almost equal. The majority of the sample (65%) voiced dissatisfaction with their body weight. Some participants employed a combination of weight loss methods, with exercise, reduced food intake, and intermittent fasting being the most frequently mentioned. The findings also indicate that a minority sought professional help, whether from a physician or a nutritionist. Over 90% claimed to have successfully lost weight at least once during their attempts, but more than half (139 individuals) experienced weight regain following their weight loss efforts. Within the univariate logistic regression, higher odds ratios of weight regain were detected among men, older participants, those living in rural areas, individuals with higher levels of education, employed persons or business owners, those with higher monthly incomes, smokers, khat chewers, and those diagnosed with a chronic condition (p values < 0.05). However, the multivariate logistic regression revealed that only residence, monthly income, smoking status, and being diagnosed with a chronic disease remained statistically significant as predictors of weight regain after adjusting for other variables (p values < 0.05). Conclusions: These findings highlight the significance of incorporating weight regain prevention into body weight management for individuals dealing with overweight and obesity. Further research is needed to evaluate specific dietary, physical activity, and psychological factors that may increase the risk of weight regain in certain participants. Full article

The paper introduces EVOCA—Explainable Verification Of Claims by Graph Alignment—a hybrid approach that combines NLP (Natural Language Processing) techniques with the structural advantages of knowledge graphs to manage and reduce the amount of evidence required to evaluate statements. The approach leverages the explicit and interpretable structure of semantic graphs, which naturally represent the semantic structure of a sentence—or a set of sentences—and explicitly encodes the relationships among different concepts, thereby facilitating the extraction and manipulation of relevant information. The primary objective of the proposed tool is to condense the evidence into a short sentence that preserves only the salient and relevant information of the target claim. This process eliminates superfluous and redundant information, which could impact the performance of the subsequent verification task and provide useful information to explain the outcome. To achieve this, the proposed tool called EVOCA—Explainable Verification Of Claims by Graph Alignment—generates a sub-graph in AMR (Abstract Meaning Representation), representing the tokens of the claim–evidence pair that exhibit high semantic similarity. The structured representation offered by the AMR graph not only aids in identifying the most relevant information but also improves the interpretability of the results. The resulting sub-graph is converted back into natural language with the SPRING AMR tool, producing a concise but meaning-rich “sub-evidence” sentence. The output can be processed by lightweight language models to determine whether the evidence supports, contradicts, or is neutral about the claim. The approach is tested on the 4297 sentence pairs of the Climate-BERT-fact-checking dataset, and the promising results are discussed. Full article

The HoReCa (Hotels, Restaurants, and Cafes) sector plays a pivotal role in the economy due to its strong connections with various other industries, including agriculture, food and beverage, construction, packaging, waste management, water, and textiles. Given its broad impact, understanding the perceptions of students—emerging consumers and future professionals—could provide valuable insights for businesses seeking to enhance sustainable practices in ways that resonate with younger generations and improve their competitiveness. However, there is still limited understanding of how students perceive and engage with sustainability in this sector. This study explores student perceptions of sustainability practices within the HoReCa sector, examining their awareness levels, expectations, and behavior. The objective is to assess how effectively current business approaches align with student values regarding sustainability initiatives and identify key factors influencing their engagement. A structured questionnaire was distributed among university students, and the collected data was analyzed using statistical techniques to identify meaningful trends and correlations. Findings revealed a notable disconnect between students’ professed sustainability values and their actual behavior. Primary obstacles included price sensitivity, skepticism toward environmental marketing claims, and insufficient access to clear sustainability information from businesses. Despite supporting sustainable initiatives in principle, students often struggle to translate their values into purchasing decisions. The research suggests that greater business transparency, enhanced sustainability education, and incentive programs could foster increased student engagement. Full article

The imperative to decarbonize global energy systems and enhance energy security necessitates a transition towards ecofuels, broadly classified as biofuels, waste-derived fuels, and electrofuels (e-Fuels). The primary goal of this review is to provide a holistic and comparative evaluation of these three pivotal ecofuel pillars under a unified framework, identifying their strategic niches in the energy transition by critically assessing their interconnected technical, economic, and policy challenges. It offers a comparative dissection of inherent resource constraints, spanning biomass availability, the immense scale of renewable electricity required for e-Fuels, sustainable carbon dioxide (CO₂) sourcing, and the complexities of utilizing non-biodegradable wastes, identifying that true feedstock sustainability and holistic lifecycle management are paramount, cross-cutting limitations for all pathways. This review critically highlights how the current global reliance on fossil fuels for electricity production (approx. 60%) and the upstream emissions embodied in renewable energy infrastructure challenge the climate neutrality claims of ecofuels, particularly e-Fuels, underscoring the necessity for comprehensive well-to-wheels (WtW) lifecycle assessments (LCAs) over simpler tank-to-wheels (TtW) approaches. This perspective is crucial as emerging regulations demand significant greenhouse gas (GHG) emission reductions (70–100%) compared to fossil fuels. Ultimately, this synthesis argues for a nuanced, technologically neutral deployment strategy, prioritizing specific ecofuels for hard-to-abate sectors, and underscores the urgent need for stable, long-term policies coupled with robust and transparent LCA methodologies to guide a truly sustainable energy transition. Full article

Purpose: The acquirer’s corporate environmental performance (CEP) in mergers and acquisitions has been a subject of debate, yielding mixed results. This paper uses the US firm-level data of 1437 M&A deals from 2002–2019 to examine the impact of overall CEP, resource use, emissions, and innovation on the acquirers’ post-merger market value. Design/methodology/approach: This study employs multi-level fixed effects panel regression using Ordinary Least Squares (OLS) and the instrumental variable (IV) 2SLS method to estimate the models and compare the results with those from robust estimation. Absorbing the multiple levels of fixed effects (i.e., firm, industry, and year) offers a novel and robust algorithm for efficiently accounting for unobserved heterogeneity. The results from IV (2SLS) are more convincing, as the method overcomes the problem of endogeneity due to reverse causality and sample selection bias. Findings: The authors find that CEP has a significant impact on market value, particularly in the long term. While both resource use and emissions performance have positive effects, emissions performance has a stronger impact, presumably because external stakeholders and market participants are more concerned about emissions reduction. The performance of environmental innovation is relatively weak compared to other pillars. Descriptive analysis shows low average scores in environmental innovation compared to the resource use and emissions performance of the acquirers. However, large deals yield significant returns from investing in environmental innovation in both the short and long term compared to small deals. Practical implications: This paper offers several practical implications. First, environmental performance can help improve the acquirer’s long-term market value. Second, managers can focus on the strategic side of environmental performance, based on its pillars, and benchmark their relative position against peers. Third, environmental innovation can be considered a new potential, as the market as a whole in this area is still lagging. Given the growing pressure to improve environmental technology and innovation, prospective acquirers should confidently prioritise actions on green revenue, product innovation, and capital expenditure now rather than ticking these boxes later. Originality value: The key contribution is offering valuable insights into the impact of acquirers’ environmental performance on long-term value creation in mergers and acquisitions (M&A). These results fill the gap in the literature focusing mainly on the effect of environmental pillar and sub-pillar scores on acquirer’s firm value. The authors claim that analysing sub-pillar-level granularity is crucial for accurately measuring the effects on firm-level performance. Full article

This study evaluates the current Spanish insurance framework for catastrophic flood risk, administered by the Consorcio de Compensación de Seguros (CCS), based on nationwide loss data reported by the CCS for the period 1996–2020. The analysis of historical claims data enables a clear differentiation between frequent, low-cost events and infrequent, high-impact catastrophes. While the CCS has fulfilled a critical role in post-disaster compensation, the findings highlight the parallel need for ex ante risk mitigation strategies. The study proposes a more efficient, two-tier risk coverage model. Events whose impacts can be managed through standard insurance mechanisms should be underwritten by private insurers using actuarially fair premiums. In contrast, events with catastrophic implications—due to their scale or financial impact—should be addressed through general solidarity mechanisms, centrally managed by the CCS. Such a risk segmentation would improve the financial sustainability of the system and create fiscal space for prevention-oriented incentives. The current design of the CCS scheme may generate moral hazard, as flood exposure is not explicitly priced into the premium structure. Empirical findings support a shift towards a more transparent, incentive-aligned model that combines collective risk sharing with individual risk responsibility—an essential balance for effective climate adaptation and long-term resilience. Full article

Potyviruses (family Potyviridae, genus Potyvirus), including emerging ones, pose a growing threat to cucurbit production. This study presents the first virome analysis of severely symptomatic cucurbits in continental Croatia, combining high-throughput sequencing (HTS) and RT-PCR diagnostics. Zucchini, cucumber, and butternut squash plants with severe virus-like symptoms sampled in 2021–2022 were found to consistently host a complex of potyviruses, including watermelon mosaic virus (WMV), zucchini yellow mosaic virus (ZYMV), and Moroccan watermelon mosaic virus (MWMV)—the latter being newly reported in Croatia and representing likely its northernmost detection in Europe. Phylogenetic analysis classified WMV isolates as emerging strains of subgroup EM3 and ZYMV as subgroup A1, consistent with European lineages. Croatian MWMV isolates formed a distinct subclade within the Mediterranean group, raising questions about its diversification trajectory. The findings highlight the expanding range of MWMV and underscore the value of HTS for early detection of emerging threats. These results have critical implications for cucurbit disease management, indicating the need to re-evaluate resistance claims in commercial cultivars and implement stricter phytosanitary surveillance in Croatia. The potential role of climate change in facilitating virus spread via aphid vectors is discussed, warranting further risk assessment and international monitoring efforts. Full article

Rapidly decarbonizing the electricity grid is crucial for achieving net-zero greenhouse gas (GHG) emissions by mid-century and mitigating climate change impacts. Hydropower facilities can directly support grid decarbonization; however, like all energy systems, they emit GHGs throughout their lifecycle, with reservoirs being an important source. Further research is urgently needed to improve the accounting and mitigation of hydropower reservoir GHG emissions to ensure that this technology is accurately considered in decarbonization policies and to allow project owners and energy buyers to make credible emission claims regarding this energy source. To this end, this paper reviews over seven dozen studies and emerging research to synthesize the current state of the science on reservoir GHG emission pathways as well as advancements in emission measurement tools to identify areas where further research is needed. This paper presents a research roadmap for government agencies, research institutions, and funding organizations covering four action areas: understanding and reducing uncertainties in reservoir GHG estimation and associated publicly accessible estimation tools; reducing the technical and economic barriers for reservoir managers to use GHG estimation tools; setting common standards to enable consistent monitoring, allocation, and reporting of reservoir GHG emissions; and supporting work on reservoir GHG emission mitigation strategies, including watershed-scale strategies. Progress in these areas will enable robust accounting of hydropower reservoir GHG emissions and targeted mitigation efforts to advance grid decarbonization. Full article

Knowledge extraction and sharing is one of the biggest challenges organizations face to ensure successful and long-lasting knowledge repositories. The North Carolina Department of Transportation (NCDOT) commissioned a web-based knowledge management program called Communicate Lessons, Exchange Advice, Record (CLEAR) for end-users to promote employee-generated innovation and to institutionalize organizational knowledge. Reusing knowledge from an improperly managed database is problematic and potentially causes substantial financial loss and reduced productivity for an organization. Poorly managed databases can hinder effective knowledge dissemination across the organization. Data-driven dashboards offer a promising solution by facilitating evidence-driven decision-making through increased information access to disseminate, understand and interpret datasets. This paper describes an effort to create data visualizations in Tableau for CLEAR’s gatekeeper to monitor content within the knowledge repository. Through the three web-based strategic dashboards relating to lessons learned and best practices, innovation culture index, and website analytics, the information displays will aid in disseminating useful information to facilitate decision-making and execute appropriate time-critical interventions. Particular emphasis is placed on utility-related issues, as data from the NCDOT indicate that approximately 90% of projects involving utility claims experienced one or two such incidents. These claims contributed to an average increase in project costs of approximately 2.4% and schedule delays averaging 70 days. The data dashboards provide key insights into all 14 NCDOT divisions, supporting the gatekeeper in effectively managing the CLEAR program, especially relating to project performance, cost savings, and schedule improvements. The chronological analysis of the CLEAR program trends demonstrates sustained progress, validating the effectiveness of the dashboard framework. Ultimately, these data dashboards will promote organizational innovation in the long run by encouraging end-user participation in the CLEAR program. Full article

Nanofluids—engineered suspensions of nanometer-sized particles—have attracted significant attention due to their reportedly enhanced thermal properties, making them promising candidates for advanced heat transfer applications. However, despite extensive studies, uncertainties remain regarding the magnitude and origin of these effects, limiting their practical implementation. To address this, we present a comprehensive study on nanofluid formulations based on the commercial refrigerant HFE-7500, incorporating surfactant-stabilized dispersions of several metal oxide and nitride nanoparticles. We measured key physicochemical properties, including zeta potential, particle size, viscosity, and thermal conductivity. Our results show that while the nanofluids exhibited high stability, their particle sizes in suspension were significantly larger than the primary nanoparticle sizes measured by TEM. Notably, alumina-based suspensions demonstrated the greatest enhancement, exhibiting approximately 10–15% increases in thermal conductivity as a function of volume percentage. These surpassed the 5–10% improvements observed with other metal oxides, an effect that may be linked to their comparatively larger particle sizes. However, the observed enhancements were lower than some previously reported values that claimed anomalously high thermal conductivity increases. Furthermore, steady shear viscosity increased with particle concentration, showing enhancements of 10–20%, which suggests a potential trade-off for practical implementation. Our findings refine the understanding of nanofluid behavior in refrigerants and establish a foundation for optimizing their performance in thermal management applications. However, viscosity increases must be carefully considered when designing next-generation nanofluids for real-world use. Full article