Search Results (1,360)

Rheumatoid arthritis (RA) remains a recalcitrant clinical challenge, as modern therapies are often hampered by adverse effects, suboptimal responses, and failure to achieve radical cure. Traditional Chinese Medicine (TCM) and Tujia ethnomedicine, with centuries of accumulated experience in managing RA (classified as “Bi Syndrome” in TCM), offer distinct theoretical frameworks and abundant therapeutic resources. TCM emphasizes syndrome differentiation-based holistic regulation, while Tujia ethnomedicine relies on indigenous medicinal plants and empirically derived therapies shaped by its unique geographical context. This review aims to accelerate the integration of traditional wisdom with contemporary pharmacology for the development of novel RA therapies. A comprehensive literature search was performed across PubMed, Web of Science, CNKI, and ethnomedical monographs to synthesize data on their theoretical underpinnings, therapeutic strategies, mechanisms of action, and clinical efficacy. TCM and Tujia ethnomedicine possess significant anti-RA effects, characterized by multi-component, multi-target synergistic mechanisms that complement modern medicine. However, they face common challenges including unclear material bases of active components, insufficient standardized clinical evidence, and inadequate quality control protocols. This review provides a critical foundation for integrating TCM/Tujia ethnomedicine with modern pharmacology, highlighting the urgent need for further research to clarify active constituents, establish standardized protocols, and validate clinical efficacy—ultimately facilitating the development of safer, more effective RA therapies. Full article

Returning to work (RTW) following sickness absence due to common mental disorder (CMD) symptoms, such as anxiety, depression and stress, is increasingly recognised as a critical yet complex phase of recovery. Despite this, individuals do not always experience the process as supportive or straightforward. This study explored the factors shaping RTW by examining the perspectives of service users, employment advisors (EAs) and human resource (HR) professionals. In a qualitative study, using purposive sampling, we recruited 17 participants across the three stakeholder groups. Data were collected through semi-structured interviews and analysed using thematic analysis. The findings suggest that RTW is shaped by a dynamic interplay between individual experiences, workplace relationships and organisational structures. Participants described returning to work as an ongoing and often uncertain process, influenced by shifts in confidence, expectations of support and the extent to which workplaces were able to respond flexibly to individual needs. While some accounts reflected collaborative and supportive environments, others highlighted disconnection, misalignment and unmet expectations across stakeholders. Overall, the findings point to RTW as a negotiated process, requiring alignment between employees, managers and organisational systems. The study highlights the importance of consistent, flexible and context-sensitive approaches to support sustainable RTW following CMD-related absence. Full article

Neolissochilus heterostomus, a cyprinid fish endemic to Yunnan Province, China, is highly valued for both ornamental and edible purposes, yet its wild populations are currently declining and classified as endangered. In this study, we present a chromosome-level genome assembly of N. heterostomus, utilizing the PacBio HiFi and Hi-C strategies. The assembled genome spans 1793.99 Mb and is anchored to 50 chromosomes, comprising a total of 50,203 genes. Genomic features and chromosomal karyotype data recorded in the present study are consistent with an allotetraploid origin for N. heterostomus. Comparative genomics shows that N. heterostomus shares a close phylogenetic relationship with another allotetraploid fish, the common carp Cyprinus carpio. In total, 4687 expanded and 1365 contracted gene families were identified in N. heterostomus. Further enrichment analyses indicated an overrepresentation of metabolism-related pathways among the expanded and positively selected gene families, whereas the contracted gene families were enriched in reproduction- and embryonic development-related pathways. Reproductive observations further indicate that N. heterostomus produces fewer eggs than other cyprinid species characterized by relatively long embryonic development periods (106.1 h; accumulated temperature: 2260.6 °C·h), including common carp, goldfish (Carassius auratus), grass carp (Ctenopharyngodon idella), pond loach (Misgurnus anguillicaudatus), and blunt snout bream (Megalobrama amblycephala). These findings suggest a potential association between metabolism-related genomic features and reproductive traits, although functional validation remains necessary. Overall, this study may offer insights into the polyploidization, metabolic, and reproductive traits of N. heterostomus, thereby providing genomic and biological resources that may support future studies relevant to the conservation and management of this endangered species. Full article

Background/Objectives: Alarm fatigue is common in clinical settings and can impair nursing performance. Guided by the job demands–resources framework, this cross-sectional study examined the associations among alarm fatigue, nursing performance, perceived stress, and patient safety culture, including an indirect association through perceived stress and moderation by patient safety culture. Methods: Self-report questionnaires completed by 218 registered nurses from two general hospitals in South Korea were used to assess alarm fatigue, perceived stress, patient safety culture, and nursing performance. Data were analyzed using descriptive statistics, Pearson’s correlations, and Hayes’ PROCESS macro with 5000 bootstrap samples controlling for covariates. Results: Alarm fatigue was positively correlated with perceived stress and negatively correlated with nursing performance. Patient safety culture was positively correlated with nursing performance. Alarm fatigue was positively associated with perceived stress, and perceived stress was negatively associated with nursing performance. The indirect association through perceived stress was significant. Patient safety culture moderated the association between perceived stress and nursing performance. The index of the moderated indirect association was significant. Conclusions: These findings suggest that alarm-related problems should be addressed in clinical and assistive nursing practice by integrating strategies aimed at reducing unnecessary alarms, strengthening training in alarm prioritization and interruption management, supporting nurses’ stress responses, and promoting a patient safety culture characterized by open communication and teamwork. Considering the cross-sectional design of this study, the findings should be interpreted as associations, rather than causal evidence. Full article

Industrial systems such as lean practices, quality systems, workplace safety, and organisational culture are often managed as separate systems; however, in practice, they are interdependent. This study presents a preliminary survey instrument (CiE II) to assess organisational conditions commonly associated with effectiveness in manufacturing systems. A multi-stage refinement process was applied to an initial 107-item survey using pilot data (n = 127) collected from engineering students with work-integrated industry experience. The methodology combined exploratory factor analysis, item response theory, and thematic analysis to improve both statistical and conceptual coherence. The resulting instrument comprised 28 items, making it more suitable for industrial deployment. Analysis of responses (N = 127) identified three common facets that support lean, quality, safety, and culture. These are (i) Integrated Quality and Workflow Management (α = 0.960), referring to workers perceptions that quality standards exist and that they are resourced to meet them; (ii) Safe and Collaborative Work Culture (α = 0.901), referring to perceptions of behavioural norms and that workers will be treated fairly within the team; (iii) Supportive Leadership and Professional Growth (α = 0.852), referring to perceptions that management supports workers’ ongoing professional development. The potential benefit is the provision of a candidate survey that economically covers four key domains of relevance for manufacturing organisations. This has the potential to allow cross-domain correlations and larger-span regression models that integrate the four domains. Full article

Wildlife is a common asset to which the local community has the right to consume. To achieve sustainable management of this resource, a community forest (CF) with a wildlife vocation has been set up as part of the “Sustainable management of wildlife and the bushmeat sector in Central Africa” project. Given the constraints faced by these community forests (CFs), we conducted a study to assess their governance in Gabon. Our objective was to examine whether their current mode of operation would allow them to survive in the long term, with a view to integrating sustainable hunting practices. To do this, we constructed a SWOT matrix (strengths, weaknesses, opportunities and threats) to determine their strengths and weaknesses, from which we carried out a factorial correspondence analysis (FCA) to identify potentially viable CFs. This enabled us to understand that most of the difficulties encountered by these CFs stem from the low level of appropriation of this concept by local communities, which is due to the low level of intervention by the forestry administration in raising awareness of CF management. This study shows that local communities must first take ownership of how CFs work so that they can better apply their success factors. Full article

Although small and medium enterprises (SMEs) anchor employment and output across Sub-Saharan Africa, their uptake of artificial intelligence (AI) lags global benchmarks, and prevailing explanations dwell on capital, infrastructure, and institutional voids while overlooking the leadership competencies that determine whether available resources are mobilised at all. Addressing this gap, the present study asks how the digital leadership capabilities of SME owner-managers shape their intention to adopt AI in Nigeria, and through what organisational mechanisms and under what boundary conditions this influence operates. Anchored in the Diffusion of Innovation Theory and the Tigre–Henriques–Curado model of digital leadership, a cross-sectional survey was administered to owner-managers of registered SMEs drawn from six states; a sample of 390 was derived from a population of 23,290 firms using the Taro Yamane formula with proportionate allocation, and 306 valid responses were retained. Partial Least Squares Structural Equation Modelling (WarpPLS 8.0) was applied after confirming reliability (Cronbach’s $\alpha$: 0.69–0.84; composite reliability: 0.83–0.88), convergent validity (AVE: 0.56–0.67), and common method bias control. Strategic ($\beta$ = 0.298), interpersonal ($\beta$ = 0.245), and personal attribute ($\beta$ = 0.129) capabilities each significantly raised AI adoption intention. In contrast, delivery-related capabilities ($\beta$ = 0.090, p = 0.057) did not, indicating that pre-adoption intention is governed by cognitive-strategic and relational competencies rather than execution skills. Organisational innovation climate partially transmitted the effects of strategic and interpersonal capabilities, and firm size amplified the interpersonal pathway in medium-sized firms. The study contributes a leadership-centred account of AI adoption in an under-researched African setting and, by estimating mediation and moderation within a single framework, clarifies both why and when digital leadership translates into AI readiness, yielding capability-specific guidance for owner-managers and SME support policy. Full article

Diospyros comorensis Hiern is a medicinal plant traditionally utilized in the management of cardiovascular disorders. Despite its common use, the pharmacological properties and phytochemical composition remain unexplored. This study aimed to evaluate the vasorelaxant, diuretic, and antioxidant activities, as well as toxicity and phytochemical profiling, of a methanol–water extract of D. comorensis leaves (MDCR) and a decoction of D. comorensis leaf (DDCR) extract. The main phytochemicals were quantified using High-Performance Liquid Chromatography (HPLC). Antioxidant capacity was assessed using DPPH and FRAP assays. The vasorelaxant effect was evaluated in vitro on phenylephrine-precontracted aortic rings. Diuretic activity was determined by measuring Wistar rats’ urine output and electrolyte levels (Na⁺, Cl⁻, and K⁺). Toxicity was assessed using Swiss mice. The extracts showed a total phenolic content (TPC) of 29,693.02 ± 3493.75 mg GAE/100 g DW (Folin–Ciocalteu method), which was markedly higher than the total phenolics quantified by HPLC (3743.12 ± 457.32 mg/100 g DW, representing 76.38% of the total bioactive fraction). Among the quantified constituents, ellagic acid (56.36%) was the main compound. Both extracts exhibited marked antioxidant capacity along with significant vasorelaxant effects on phenylephrine-precontracted rat aorta rings, with EC50 values of 3.83 ± 0.81 µg/mL for MDCR and 4.87 ± 0.79 µg/mL for DDCR. Acute toxicity was not observed with either extract. The identified compounds may be involved in the observed antioxidant and pharmacological effects. These results show experimental evidence useful to support the traditional use of D. comorensis leaves in managing high blood pressure and highlight the antihypertensive potential of this Comorian endemic species. Further studies are necessary to characterize the biological mechanisms involved and relative bioactive substances. Reporting the pharmacological activities of D. comorensis may contribute to the sustainable use of natural resources in the Comoros Islands and Madagascar. Full article

Traumatic injury is one of the most common causes of disorders of consciousness (DoC) worldwide, but the management and prognosis of DoC remain enigmatic. The uncertainty surrounding the natural course of DoC, the tendency of consciousness to wax and wane, and a lack of effective treatments outside of avoiding additional insults renders trauma-associated DoC complex for both providers and patient surrogates to navigate. This review explores the acute clinical course of DoC after traumatic injury chronologically and aims to compile recommendations based on the current best practices for diagnosis, management, and prognostication when caring for these patients during their acute hospitalization. Updates from trauma and Traumatic Brain Injury (TBI) resources, such as the American College of Surgeons, as well as new recommendations in the field of DoC are summarized. Serial clinical assessment with a standardized neurobehavioral battery such as the CRSR-FAST remains the mainstay of clinical care and research for DoC. Accurate diagnosis, multifaceted management, and humility surrounding prognostic discussions are all critical to caring for patients with DoC after trauma. Most of the care for trauma patients with a DoC remains supportive and aimed at avoiding secondary insults while allowing time for the patient’s recovery. In the same way that clinical care focuses on a cycle of diagnosis, treatment, and prognosis with each providing insight for the next, ongoing and future DoC research will compound on itself and hopefully lead to more advances in the future. Full article

United States (U.S.) specialty crop growers face myriad decisions regarding substrate selection as sustainability, market demands, and resource limitations influence soilless production systems. Peat is a common component in container substrates despite public concerns about its limited availability, finite supply, and associations with greenhouse gas emissions and environmental impacts, which have prompted growers to seek alternative materials. However, limited research has focused on the experiences, challenges, and research needs of U.S. specialty crop growers related to substrate transitions. The purpose of this mixed-methods study was to explore growers’ key considerations, research interests, and preferred communication methods associated with substrate transitions. An online survey and three focus groups were used to gain insights into growers’ experiences, concerns, and perceived impacts of peat replacement, research needs, and preferred communication channels. Results indicated that financial costs, peat availability, access to peat alternative substrates, and environmental considerations were the main factors influencing potential changes in substrate use. Growers identified key research priorities to assist decision-making, including (1) irrigation and nutrient management strategies, (2) the economic performance of alternative substrates, and (3) locally validated trials demonstrating system compatibility. They preferred practical communication methods for sharing results, including websites, YouTube videos, in-person meetings, on-farm demonstrations, and short podcasts accessible during routine work hours. The findings implied that research, outreach, and communication efforts tailored to growers’ operational contexts will support informed substrate transitions. Full article

The transition toward sustainable agricultural systems requires the optimization of harvesting technologies. This study evaluates the performance of an advanced stripper header in cereal harvesting, focusing on its role in reducing grain losses and fuel consumption under different crop conditions. Field experiments were conducted on spelt wheat, rye, triticale, and common wheat to assess the interaction between harvesting parameters and crop characteristics. The results indicate substantial variability in harvesting performance across crops. The highest proportional grain losses were observed in spelt wheat and rye, accounting for 45.8% and 42.1% of total losses, respectively, while triticale and common wheat exhibited significantly lower loss shares of 5.4% and 6.7%. From a resource-efficiency perspective, triticale harvesting demonstrated the most sustainable performance, combining the lowest fuel consumption (6.8 L ha⁻¹) with minimal grain losses (0.01%), followed by common wheat (14.2 L ha⁻¹; 0.02%). In contrast, spelt wheat showed the highest fuel demand (22.81 L ha⁻¹) and grain losses (0.13%). Economic analysis further revealed that grain losses translated into the highest cost per hectare in spelt wheat (0.18 EUR ha⁻¹), highlighting the economic dimension of sustainable resource management. Overall, the findings demonstrate that advanced stripper header technology can improve harvesting efficiency by reducing fuel consumption and harvest-related losses when appropriately adapted to crop type. Full article

Background: Birth defects remain a major global public health concern, particularly in low-resource settings where awareness and preventive practices are limited. Maternal knowledge, attitudes, and practices (KAP) are critical in the prevention and management of birth defects. This study explored contextual factors influencing maternal KAP using a mixed-methods approach in three rural districts of the Eastern Cape, South Africa. Methods: A convergent mixed-methods cross-sectional study was conducted among 72 mothers selected through purposive sampling. Quantitative data were collected using a structured questionnaire administered in English only, covering socio-demographic characteristics, obstetric history, knowledge, and preventive practices. Qualitative data were obtained through interviews exploring beliefs, perceptions, and cultural explanations of birth defects. Quantitative data were analysed using descriptive statistics and linear regression analysis to identify factors associated with birth defects, while qualitative data were thematically analysed to provide contextual understanding. Results: Most participants resided in the Amathole district (63.89%), followed by Alfred Nzo (18.06%) and Joe Gqabi (18.06%). Most women were aged between 20 and 35 years (52.78%), while 15.28% were younger than 20 years and 6.94% were older than 45 years. Over half of the respondents were single (55.56%), 34.72% were married, and the remainder were either separated (4.17%) or divorced (5.56%). Numerous participants had primary education (56; 77.78%), followed by secondary (11; 15.28%) and tertiary education (5; 6.94%). The majority were unemployed (56; 77.78%), while smaller proportions were employed (10; 13.89%) or engaged in other income-generating activities (6; 8.33%), indicating limited participation in formal employment among respondents. Nearly all participants (95.83%) had experienced pregnancy, with 70.83% reporting pregnancy-related complications. Only 2.78% reported having a child with a birth defect, while 90.28% reported a family history of birth defects. Knowledge of genetic causes was relatively high (69.23%), but awareness of modifiable risk factors was limited. Although 93.06% recognized alcohol use during pregnancy as harmful, fewer participants identified smoking or medication use (18.06%) and advanced maternal age (26.39%) as risk factors. Only 13.89% acknowledged the preventive role of antenatal care. Qualitative findings revealed strong cultural influence on perceptions of birth defects, with causes attributed to medical factors (38.89%), supernatural beliefs such as witchcraft or curses (18.06%), immoral behaviour (12.50%), and dietary taboos (11.11%). Traditional health-seeking behaviour was common, with 91.67% consulting traditional healers during pregnancy. Linear regression analysis identified significant predictors of birth defects, including family history (β = 1.36, p = 0.008), alcohol use during pregnancy (β = 1.13, p = 0.050), and inadequate antenatal care attendance (β = 0.99, p = 0.040). Advanced maternal age showed a weaker and non-significant association (β = 0.79, p = 0.080). Conclusions: The study highlights substantial gaps in maternal knowledge and the strong influence of cultural beliefs on birth defect prevention. Strengthening culturally sensitive health education, improving antenatal care services, and engaging traditional healers in community-based interventions are essential to improve maternal health outcomes in rural South Africa. Full article

Content Management Systems (CMS) have fundamentally transformed the digital landscape, powering a substantial majority of the modern web. However, the ubiquity of platforms such as WordPress, Joomla, and Drupal has made them primary targets for cybercriminals. The central security weakness lies not within the core software but within the complex ecosystem of third-party extensions and themes, which account for the vast majority of reported vulnerabilities. This article presents a comprehensive analysis of the current CMS security landscape, synthesizing empirical data on the prevalence of outdated components and the efficacy of existing scanning tools. Based on a critical review of recent literature and an analysis of common attack vectors, the study identifies the fundamental limitations of traditional, reactive security paradigms that rely on signature-based detection. To address the critical gap in detecting zero-day threats, this research proposes and implements a proactive vulnerability detection system—SentinelCMS—combining static Taint Analysis with a Bidirectional LSTM neural network classifier. The system was validated on an augmented dataset of 600 PHP code samples using 5-fold cross-validation. An experimental proof of concept validates that static analysis of plugin source code can extract semantic features to accurately classify vulnerabilities into specific categories (SQL Injection, Cross-Site Scripting, Remote Code Execution) with an overall accuracy of 93%. The implementation of this system aims to shift the cybersecurity paradigm from incident response to threat prevention, thereby significantly enhancing the resilience of web resources. Full article

The COVID-19 pandemic exposed vulnerabilities in global blood supply systems and accelerated the adoption of patient blood management (PBM) strategies aimed at optimizing transfusion practices in surgical care. Perioperative anemia is a key contributor to adverse outcomes and is frequently treated with allogeneic blood transfusion (ABT), which carries infectious and immunologic risks. Iron deficiency remains the most common and potentially correctable cause of perioperative anemia. This narrative review examines various approaches to perioperative anemia, strategies to minimize reliance on ABT, and alternatives within the PBM paradigm. Evidence supports the use of iron therapy, erythropoiesis-stimulating agents, antifibrinolytic strategies, and blood conservation techniques to reduce transfusion requirements and improve clinical outcomes. Lessons from the COVID-19 pandemic highlight PBM as a framework to enhance transfusion safety and sustainability. Broader implementation of PBM may improve patient outcomes, reduce unnecessary transfusions, and preserve scarce blood resources. Full article

Background: Cardiovascular disease remains the leading global cause of morbidity and mortality. Mental health disorders are common comorbidities that significantly influence how patients access and navigate specialist care. Increasingly, mental illness is recognized not merely as a comorbidity but as a potential driver of inequities in cardiovascular care, affecting diagnosis, referral, procedural management, and long-term secondary prevention. These concerns are particularly relevant in cardiac surgery, where care pathways are complex and resource-intensive. Aims and Objectives: This narrative review examines recent evidence on inequalities in access to cardiac surgery and postoperative outcomes among patients with mental health disorders. Particular emphasis is placed on severe mental illness, mood disorders, anxiety-related conditions, and mixed psychiatric cohorts. Materials and Methods: A structured narrative review approach was employed. PubMed and ScienceDirect were systematically searched for peer-reviewed studies published between 2020 and 2025, including cohort studies, registry analyses, systematic reviews, and meta-analyses. The evidence was synthesized thematically, focusing on access to care, perioperative management, clinical outcomes, underlying mechanisms, ethical considerations, policy implications, and future research directions. Results: Evidence suggests that patients with mental health disorders are more likely to undergo cardiac surgery via emergency pathways, experience longer hospital stays, and have higher rates of readmission. Individuals with severe mental illness are less likely to receive invasive coronary procedures compared to the general population and exhibit higher short- and long-term mortality following acute coronary syndromes. Among psychiatric subgroups, psychosis-spectrum disorders appear to be associated with the greatest excess risk of morbidity, mortality, and adverse long-term surgical outcomes. Conclusions: Patients with mental health disorders face inequities across the entire surgical pathway, including preoperative, perioperative, and postoperative phases. Key contributing factors include stigma, diagnostic overshadowing, fragmented healthcare systems, socioeconomic disadvantage, and insufficiently developed models of integrated care. Addressing these disparities requires redesigned referral pathways, strengthened multidisciplinary collaboration (including cardiology, cardiac surgery, psychiatry, and primary care), and a shift toward interventional research aimed at reducing inequities rather than solely documenting them. Full article