Search Results (302)

Urban accessibility is commonly evaluated using static spatial indicators, which assume stable travel conditions throughout the day. Road congestion, network saturation, and service variability change the function and experience of the built environment (BE). This study tests the Temporal City Framework (TCF) by examining how time of day (TOD) reshapes urban accessibility and travel behaviour with varying levels of congestion. Using 30,288 trip records from the 2022 US National Household Travel Survey (NHTS), duration is operationalised as a sixth dimension of the BE. A time-normalised impedance metric, measured in minutes per mile (MPM), is used that captures realised congestion independently of distance. Temporal impedance (TI) varies strongly with TOD, with substantially higher MPM during peak and midday periods than at night. Compared with nighttime conditions, midday travel requires approximately 19% more time per mile. This indicates a measurable contraction in functional accessibility under identical BE conditions. The TI model outperforms duration-only models, with impedance remaining dominant when both measures are included. These results support interpreting duration as a structural dimension of urban accessibility. TI significantly increases the relative likelihood of active and public transport compared to private cars, even after accounting for absolute trip duration. Hired transport modes (taxi and ride-hailing services) are most prevalent at night, reflecting a greater reliance on on-demand services outside regular daytime schedules. This study tests duration as a structural dimension of the BE by operationalising time-normalised TI. Associations are interpreted as trip-level behavioural constraints rather than causal effects. Planning frameworks based on static travel times systematically misrepresent exposure, equity, and travel mode feasibility. Time-stratified accessibility metrics should therefore be integrated into transport and land-use evaluation and associated policies. Full article

A deeper understanding of the relationships between the local and landscape scales in herbivore foraging should place the management of rangeland production systems on a firmer footing. The objective was to test whether local-scale landscape features modulate the coupling between locomotion and eating, thereby altering the pattern of landscape-scale grazing pressure. We studied shepherded small-ruminant herds on hilly semiarid rangeland by integrating acoustic monitoring to detect jaw movements, GPS to track location and movement, and GIS to link location to landscape attributes. Based on 69 one-day foraging routes, minutely rate of jaw movement (RJM) as a function of time-into-foraging-route showed a unimodal concave shape but did not respond to path angle. Minutely movement velocity responded convexly to time-into-foraging-route, and the quadratic term for path angle was negative and highly significant. The response to path angle was concave and symmetrical for uphill and downhill travel. Based on the empirical evidence that increasing path angle reduces velocity but not RJM and a set of reasonable associated assumptions, it is inferred that more jaw movements are performed per unit area scanned by the animal. It is further inferred abductively that more bites are removed per unit area and that more mass is removed per unit area, and hence, grazing pressure is more intense on sloping terrain than on level areas. For a given duration of foraging route, an increase in density of bite placement at the local behavioral scale implies a contraction in the surface area of the daily herd footprint at the landscape scale. This has implications for how carrying capacity of such areas should be defined. Full article

The rapid proliferation of large language models has created significant opportunities for personalized education, yet existing systems rarely account for user competency as a determinant of interaction quality. This study introduces Persona in The Loop (PITL), a dual-mode adaptive framework that recommends AI personas for blockchain and smart contract education applications. PITL employs 100 AI personas organized across two domains, ten sub-specialties, and five Dreyfus competency levels, recommending personas via either similarity-based mode grounded in Cognitive Load Theory or complementary mode grounded in the Zone of Proximal Development, with an adaptive switching mechanism driven by NASA-TLX cognitive load feedback. A mixed-method study with 150 participants using a 2 × 5 factorial design showed that the complementary mode produced higher learning gains, while the similarity-based mode yielded lower cognitive load and higher code quality. The adaptive mechanism outperformed both fixed-mode conditions on learning gain and code quality. The Mode × Dreyfus interaction was significant for cognitive load and task duration but not for learning gains, suggesting mode effects on learning outcomes are consistent across competency levels. Qualitative interviews with 20 participants corroborated quantitative findings. PITL offers a theoretically grounded and empirically validated approach to competency-based AI persona recommendation in educational contexts. Full article

Electronic Medical Records (EMRs) are mandatory in Indonesia following the Ministry of Health regulation, which raises significant challenges in data security and patient-centric access control. Current implementations rely on centralized healthcare systems or third-party vendors, creating risks of unauthorized access, data leakage, and uncertain data integrity. To address these issues, this study proposes DecMed, a decentralized EMR management framework built on IOTA Distributed Ledger Technology (DLT). DecMed integrates Capability-Based Access Control (CapBAC), Proxy Re-Encryption (PRE), and the InterPlanetary File System (IPFS) to enforce patient ownership of medical data. Patients actively grant or revoke access, define access duration, and selectively share data with healthcare personnel. The system is implemented using smart contracts in the Move programming language on the IOTA ledger, while encrypted clinical data is stored on IPFS. Evaluation through unit testing of various unauthorized access scenarios demonstrates that DecMed effectively enforces fine-grained access rules, preserves data confidentiality and integrity, and ensures compliance with national healthcare requirements. Full article

Cancer is frequently accompanied by thrombotic complications, but conventional coagulation tests often fail to adequately detect cancer-associated hypercoagulability. In this study, blood from 34 patients with colorectal or gastric cancers (before, during and after 3 months of chemotherapy) and 21 healthy controls was analyzed to obtain a coagulation–fibrinolysis profile (by thromboelastometry) and determine the kinetics of clot contraction (CCR). Patients demonstrated hypercoagulable profiles characterized by shortened clotting time, enhanced clot strength, reduced CCR, and impaired fibrinolysis compared to healthy controls, which was more pronounced in colorectal cancer patients. Parameters related to increased clot formation, impaired CC and delayed fibrinolysis correlated with disease stage. Chemotherapy meaningfully prolonged fibrinolysis, which was further evident in vitro with platinum-based drugs. Our findings reveal, for the first time, a significant inhibition of CCR in cancer patients. Integrating thromboelastometry with CCR measurements may improve stratification of cancer-associated thrombotic risk, which appears to arise from the hemostatic disturbances identified in our study. These may extend the duration of clot presence due to reduced fibrinolysis, while decreasing clot stability through diminished CCR. Therefore, careful monitoring of the precarious balance between thrombotic and bleeding tendencies may hold important implications for the fate of cancer patients. Full article

Background/Objectives: The calf muscles are vital for generating propulsive force during walking. This power is produced from calf muscle contractions and elastic strain energy release. However, the impact of walking speed on these power-generation mechanisms is understudied. This study aimed to investigate how different walking speeds affect calf muscle activation and ankle power generation. Methods: In this study, we analyzed electromyography (EMG) signals from the gastrocnemius (GAS) and soleus (SOL) muscles of 55 healthy individuals walking at various speeds. C1: household ambulators (0–0.4 m·s⁻¹), C2: limited community ambulators (0.4–0.8 m·s⁻¹), C3: community ambulators (0.8–1.2 m·s⁻¹), C4: self-selected usual speed, and C5: self-selected fast speed. Results: Deviating from a participant’s self-chosen pace led to increased cumulative muscle activity and prolonged plantar flexor activation. Optimal muscle activation was observed at speeds between 0.8–1.2 m·s⁻¹. A second-degree polynomial mixed model best captured the relationship between muscle activation duration and integrated EMG in the ankle power generation phase in late stance, demonstrating the nonlinear relationship between walking speed and calf muscle activation in this phase. Statistically significant models (p < 0.001) explained over 50% of the variability in GAS activation duration (R² = 0.55) and integrated EMG (R² = 0.56), as well as SOL activation duration (R² = 0.52) and integrated EMG (R² = 0.72). Conclusions: The nonlinear relationship between walking speed and calf muscle activation indicates that normal walking speed optimizes the utilization of elastic strain energy in the ankle power generation phase. Full article

Background: Type 1 diabetes (T1D) is associated with metabolic and neuromuscular impairments that may influence fatigue mechanisms and limit exercise tolerance. Although previous investigations have characterized muscle performance in T1D, the peripheral fatigue threshold, defined as the maximal sustainable level of peripheral fatigue, remains poorly understood in this population. This study aimed to compare the amplitude of the maximal peripheral fatigue threshold between individuals with T1D and healthy controls to elucidate the effects of T1D on neuromuscular function. Methods: Twenty-two participants (11 with T1D and 11 healthy controls) completed two randomized experimental sessions. In each session, 60 quadriceps maximal voluntary contractions (MVCs) were completed, performed for 3 s with 2 s of rest between contractions. One session was conducted under a non-fatigued control condition (CTRL), and the other followed a fatiguing neuromuscular electrical stimulation (FNMES) protocol. Central and peripheral fatigue were evaluated from the pre- to post-exercise changes in potentiated twitch force (ΔPtw) and voluntary activation (ΔVA), respectively. Critical torque (CT) was calculated as the average torque produced during the last 12 contractions, whereas the curvature constant of the torque–duration relationship (W′) was quantified as the area above CT. Results: Although both groups exhibited a decline in pre-exercise Ptw following the FNMES condition, no significant within-group differences in ΔPtw were observed between sessions (T1D: p = 0.34; controls: p = 0.23). Nevertheless, the extent of peripheral fatigue was significantly lower in participants with T1D than in controls (ΔPtw = −38 ± 11% vs. −52 ± 17%; p < 0.05). Additionally, W′ values were reduced by 24% in the T1D group relative to controls during the CTRL condition (p = 0.02), and CT was significantly lower in T1D participants (262 ± 49 N) compared to controls (353 ± 71 N; p < 0.01). A significant positive correlation was observed between ΔPtw and W′ across groups (r² = 0.62, p < 0.001), suggesting a mechanistic link between peripheral fatigue tolerance and work capacity. Conclusions: The present results indicate that, although individuals with T1D retain the capacity to develop peripheral fatigue, their fatigue threshold and critical torque are markedly attenuated relative to those of healthy individuals. This reduction reflects impaired neuromuscular efficiency and diminished tolerance to sustained contractile activity. The strong relationship between peripheral fatigue and work capacity underscores the contribution of peripheral mechanisms to exercise intolerance in T1D. These results enhance current understanding of fatigue physiology in diabetes and emphasize the need for tailored exercise and rehabilitation strategies to improve fatigue resistance and functional performance in this population. Full article

Objective: Homeless individuals are vulnerable, and a high burden of mental health problems is suspected. We aim to identify the prevalence and key predictors of probable depression and anxiety among homeless individuals in Germany during the Coronavirus disease-2019 (COVID-19) pandemic. Study Design: Nationwide multicentre cross-sectional study including clinical, laboratory, and questionnaire-based data on the health of homeless individuals in Germany. Methods: Data were used from the National Survey on the psychiatric and somatic health of homeless individuals during the COVID-19 pandemic. Probable depression and anxiety were determined using the Patient Health Questionnaire 9 and the General Anxiety Disorder 2 questionnaire. Logistic regression analysis was used to identify key predictors of probable depression and anxiety. Results: A high prevalence of probable depression (26.8% [95% CI: 23.2–30.3]) and anxiety (27.2% [95% CI: 23.7–30.7]) was found. Logistic regressions showed both probable depression and anxiety associated with being female (depression: OR 1.80 [95% CI: 1.06–3.03]; anxiety: OR: 1.69 [95% CI: 1.03–2.76]), daily use of any illegal substances (depression: OR 3.20 [95% CI: 1.87–5.49]; anxiety: OR 2.04 [95% CI: 1.21–3.45]), and fear of contracting COVID-19 (little fear, depression: OR: 1.81 [95% CI 1.01–3.23], some fear, anxiety: OR: 2.52 [95% CI: 1.31–4.83]). Probable depression was associated with longer durations of homelessness (OR: 1.004, [95% CI: 1.001–1.007]. Conclusions: Probable depression and anxiety are highly prevalent in homeless individuals throughout. Key predictors may help to identify individuals in need and design targeted interventions. Full article

Background: Neuromodulation encompasses a range of methods aimed at selectively modifying nervous system function to enhance motor and neurophysiological processes. Although neuromodulation suits have shown benefits in clinical populations, their application in sports remains unexplored. Therefore, the aim of this case study was to examine the acute effects of a neuromodulation suit on the contractile properties of the rectus femoris muscle in an elite football player. Methods: The subject was an 18.8-year-old male professional football player. After conducting an anthropometric evaluation, initial tensiomyography (TMG) was carried out to evaluate the contractile properties of the rectus femoris, such as delay time (Td), contraction time (Tc), sustain time (Ts), relaxation time (Tr), and maximum radial displacement (Dm), in both legs. The athlete then donned a neuromodulation suit set to 20 Hz for a duration of 60 min. Following this, the same TMG measurements were repeated to assess post-intervention changes. Results: The right leg showed a reduction in Tc from 33.33 to 31.93 milliseconds (ms); Dm increased from 6.61 to 11.17 millimeters (mm). Conversely, the left rectus femoris exhibited prolonged Tc from 26.84 to 29.45 ms. Conclusions: A single 60 min session of neuromodulation suit application produced acute changes in muscle contractile properties. Findings suggest a potential positive effect on rapid force production and reduced muscle stiffness, alongside notable inter-limb variability. Full article

Background: Although the relationship between androgen deprivation therapy (ADT) for prostate cancer (PC) and the biological mechanisms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains unequivocally unclear, it is possible that exposure to the virus may influence PC evolution by altering TMPRSS2 expression. This study aims to evaluate the long-term oncological outcomes of patients with metastatic PC who were undergoing medical therapy at the time of contracting SARS-CoV-2 and who resumed/continued anticancer treatment after recovery. Methods: We retrospectively evaluated a consecutive series of 151 metastatic PC patients who developed SARS-CoV-2 infection while receiving one active systemic anticancer therapy (125 metastatic castration-resistant PC (mCRPC) patients and 26 metastatic hormone-sensitive PC (mHSPC) patients). We evaluated variables that influence the ability to maintain or resume the ongoing therapy. For the maintained/resumed therapies, we calculated the post-infection overall survival (piOS) and the overall survival (OS). Results: Of the patients, 12.6% died due to SARS-CoV-2 infection, 10.6% recovered from the infection but failed to maintain/resume the ongoing anticancer treatment, and the remaining 76.8% maintained/resumed the treatment after recovery. Hospitalization, duration of infection, and the type of ongoing anticancer agent influenced these treatment changes. In the cohort of mCRPC patients, the median piOS was 32 months, and the median OS was 67.8 months. The median piOS was not achieved in the cohort of mHSPC patients, while the median OS was 122 months. The outcomes of single anticancer agents were in line with those of pivotal trials. Conclusions: Although observed in a highly selected population of PC patients who survived SARS-CoV-2 infection and were able to resume/maintain anticancer therapy, the survival outcomes of this study appear to be in line with those reported in pivotal studies, and SARS-CoV-2 infection does not seem to have adversely affected long-term oncological outcomes. Full article

Greece’s National Climate Law, enacted under L. 4936, mandates the development of Municipal Emission Reduction Plans (MERPs) by local authorities. Publicly available MERP procurement data contains valuable information that can be utilized to provide an overview and insights into MERP procurement and development. The main objective of this study is to perform a comparative analysis of Greek MERP procurement data and identify patterns in the contract cost estimation of mitigation action plans in Greek municipalities. For this purpose, MERP procurement data was collected from the official procurement register, KIMDIS, and subsequently analyzed through a bivariate approach comparing the collected data with selected independent variables. The results are stratified by population range and official municipal classification to enable comparison between different sizes and types of municipalities. The results indicate that a total of 44% of municipalities in Greece procured their MERP, with significant delays in adherence to official deadlines and only after the MERP became a prerequisite for funding-related matters. Additionally, the procurement process was highly characterized by single bidding. Average contract duration ranged from 110 to 220 days, with an average contract value between EUR 18,000 and EUR 33,000. The difference between tender budget and contract value averaged between 0 and 5%. Full article

Beetroot juice (BRJ), a concentrated dietary source of nitrate alongside betalains and polyphenols, influences physiology through enhanced nitrate–nitrite–NO bioavailability, antioxidant activity, and interactions with oral and gut nitrate-reducing microbiota. The efficiency of these mechanisms depends on dose, timing, and preservation of oral bacteria, with antibacterial mouthwash or thiocyanate-rich foods potentially blunting NO₂⁻ generation. Acute BRJ ingestion consistently elevates circulating nitrate and nitrite, yet its impact on glucose, insulin, and lipid regulation is modest; chronic intake may reinforce nitrate-reduction capacity, improve redox balance, and shift microbial composition, though long-term metabolic outcomes remain variable. Cardiovascular adaptations appear more coherent, with acute reductions in systolic blood pressure and improved endothelial function complemented in some cases by microvascular enhancements during multi-week supplementation. Neuromuscular and cognitive effects are less uniform; BRJ does not reliably increase maximal strength or global cognition but may support electrophysiological recovery after muscle-damaging exercise and improve executive performance under fatigue. In exercise settings, dose and timing are critical, as BRJ most consistently benefits endurance performance by reducing oxygen cost, improving exercise economy, and enhancing time-trial or time-to-exhaustion outcomes, whereas effects on sprint, power, and team-sport tasks are more sensitive to contraction duration, recovery intervals, and athlete training status. Overall, available evidence supports a role for NO-mediated vascular and metabolic pathways in the physiological effects of BRJ, although marked inter-individual variability highlights the need for responder-focused dosing strategies and further mechanistic investigation integrating metabolic, microbial, and performance-related outcomes. Full article

Background: Maternal obesity may influence the efficacy and course of induction of labor (IoL). Misoprostol, a prostaglandin E1 analogue, is widely used for cervical ripening, but evidence regarding its effectiveness in obese women remains limited. This study aimed to evaluate the efficacy and safety of oral misoprostol for IoL across different body mass index (BMI) categories. Methods: This prospective study was conducted at a tertiary center. Term singleton pregnancies with medical indications for IoL and an unfavorable cervix (Bishop score < 6) received oral misoprostol 50 μg every 4 h to a maximum of 200 μg. Primary outcomes were vaginal delivery (VD) rates. Secondary outcomes included cesarean section (CS) rate, oxytocin use, labor duration, analgesia, adverse events, and neonatal outcomes. Results: Among 291 participants (43.0% overweight; 40.2% obese), the Bishop score increased from 2.3 to 6.2 (p < 0.0001). VD occurred in 77.3%, and CS in 22.7%. Most women delivered within 48 h (96.6%). Higher BMI correlated with longer time to contractions, pain onset, and delivery, as well as with more misoprostol doses. Neonatal outcomes were uniformly favorable, with median Apgar scores of 10 at 1, 5, and 10 min, and mean umbilical pH values ranging from 7.2 to 7.3. Adverse events were infrequent, with tachysystole observed in 1.7% of cases. Conclusions: Oral misoprostol is an effective and safe IoL method across BMI categories, achieving high vaginal delivery rates and favorable neonatal outcomes. Obesity modestly prolongs induction and increases dose requirements, supporting individualized dosing and close monitoring. Full article

(1) Background: Ventricular arrhythmias (VAs) are a leading cause of morbidity and mortality in ischemic and non-ischemic heart disease. While automated implantable cardioverter–defibrillators (AICDs) are standard treatment for high-risk patients, predicting future VA post-implantation remains limited. This study evaluated echocardiographic and strain parameters for predicting VA risk in AICD recipients. (2) Methods: This retrospective cohort study included patients who underwent AICD implantation at Westmead Hospital, New South Wales, Australia (January 2014–May 2024). Pre-implant transthoracic echocardiograms (TTEs) were analysed for structural and functional parameters, including left-ventricular (LV) ejection fraction (LVEF), LV global longitudinal strain (GLS), mechanical dispersion (MD), and delta contraction duration (DCD). VA events, defined as appropriate AICD shock or anti-tachycardia pacing, were identified from electronic medical records and device checks. Univariate and multivariate Cox regression analyses were performed. (3) Results: Among 242 patients, 98 experienced VA events. Increased LV end-diastolic diameter, indexed LV mass, and right-ventricular basal diameter were associated with VA events (p < 0.05), whilst LVEF and GLS were not. LV dyssynchrony was greater in affected patients (MD 69.2 ms vs. 63 ms, p = 0.036; DCD 288.8 ms vs. 246.4 ms, p = 0.010). DCD was an independent predictor of VA events (HR 1.003; 95% CI: 1.000–1.006; p = 0.022). (4) Conclusions: DCD may improve risk stratification in AICD patients. Full article