Search Results (3,115)

The disproportionately severe disease course of diabetic patients with SARS-CoV-2 infection was repeatedly observed by clinicians during the COVID-19 pandemic. The overlap between metabolic impairment, viral pathophysiology, and chronic inflammation created a pattern that urged deeper examination. The aim of this paper was to review and synthesize evidence regarding the interaction between diabetes mellitus and COVID-19. We synthesized evidence across mechanistic pathways (immune dysregulation, chronic inflammation, ACE2/DPP-4-related signaling, endothelial dysfunction, and pancreatic involvement) and key clinical outcomes (severity, intensive care unit (ICU) admission, mortality, dysglycaemia/new-onset diabetes, and DKA). This systematic search was conducted in PubMed, Clinical Key, and Google Scholar. The eligibility criteria included papers on adults (≥18 years) with pre-existing diabetes mellitus (type 1 or type 2) or newly diagnosed diabetes/hyperglycemia and confirmed SARS-CoV-2 infection, published between January 2020 and October 2025, in English language. The PRISMA guidelines were used for data extraction. We identified 412 articles, out of which only 30 met all the inclusion criteria. Diabetes was consistently evoked as a major risk factor for severe COVID-19, being associated with higher susceptibility to pneumonia, respiratory failure, ICU admission, and mortality. The explanation lies in the impaired immune system, endothelial dysfunction, and metabolic repercussions imposed by hyperglycemia. Several antidiabetic drugs appeared protective in multiple cohorts. In conclusion, the accumulated evidence underscores the tight interplay between metabolic disease and COVID-19. Essentially, the clinical management of these patients would be a thoughtful selection of antidiabetic therapy and close metabolic monitoring. Full article

Background and Objectives: represents a major public health challenge in rapidly aging societies. While lifestyle behaviors are established modifiable risk factors for frailty, the longitudinal impact of composite lifestyle trajectories—particularly by sex—remains poorly understood. This study examined sex-stratified associations between Healthy Lifestyle Score Trajectories (HLSTs) and frailty among community-dwelling middle-aged and older adults in South Korea. Using 19 years of nationally representative panel data from the Korean Longitudinal Study of Aging (2006–2024), we analyzed 6603 participants (2684 males; 3919 females). Materials and Methods: Group-Based Trajectory Modeling was applied to Waves 1–6 to derive sex-specific HLSTs based on smoking, alcohol consumption, physical activity, and body mass index. Generalized Estimating Equations were used to assess longitudinal associations between HLSTs and Frailty Index (FI) scores across Waves 6–10, adjusting for sociodemographic covariates. Results: Five distinct HLSTs were identified in both sexes. In both males and females, persistently poor or deteriorating trajectories were independently associated with higher FI scores relative to the Favorable HLST reference group. The effect size for Poor HLST was more than twice as large in females (B = 0.039) than in males (B = 0.018), consistent with the sex-frailty paradox. Among females, the Improving HLST group did not demonstrate a statistically significant frailty benefit (B = 0.014, p = 0.091). Stratified analyses revealed that the lifestyle–frailty association among males was significant only in rural-dwelling participants, whereas in females the association was consistent across both urban and rural settings. Conclusions: Persistently unfavorable composite lifestyle trajectories were independently associated with higher frailty burden, with disproportionately greater impact in women. Late-life lifestyle improvement was not significantly associated with reduced frailty in women, reinforcing the importance of early and sustained behavioral maintenance. The rural-specific association in men highlights the role of structural disadvantage in amplifying lifestyle-related frailty risk. However, given the observational design of this study, the possibility of reverse causality cannot be excluded, and these findings should be interpreted as associative rather than causal. These findings support sex-sensitive, trajectory-based, and geographically tailored frailty prevention strategies. Full article

Objective: To quantify the gap between oral cancer disease burden and public awareness in Germany, and to characterize research dissemination patterns across social media platforms. Methods: We conducted a multi-dimensional analysis integrating: (1) Robert Koch Institut cancer registry data for oral and maxillofacial malignancies (ICD-10: C00–C06) from 2015 to 2023; (2) Google Trends search interest for cancer-related German terms; (3) Altmetric data for 2581 PubMed-indexed oral cancer publications; and (4) sentiment analysis of 10,308 social media posts. Age-standardized incidence rates were calculated using the European Standard Population. Results: Over the study period, 65,757 oral cavity cancer cases were registered. Google Trends analysis revealed a 64% attention deficit for “Mundkrebs” (oral cancer; mean: 17) compared to “Brustkrebs” (breast cancer; mean: 47). Case numbers declined from 7577 (2019) to 6870 (2023; −9.3%), while age-standardized rates decreased by 15.5% (11.6 to 9.8 per 100,000), with males disproportionately affected (−17.7%). Research dissemination was dominated by X/Twitter (86.2%), with minimal policy document (0.3%) or clinical guideline (0.3%) citations. Sentiment analysis revealed 77% positive public reception. Regional analysis identified an East–West divide, with Eastern German states showing 22% higher search interest. Conclusions: A substantial public awareness deficit exists for oral cancer in Germany, paradoxically widening during a period of declining diagnoses potentially associated with COVID-19-related diagnostic delays. The positive public sentiment toward oral cancer research suggests a favorable environment for targeted awareness campaigns, particularly in Western German states where search interest is lowest. These findings have practical implications for designing regionally tailored awareness campaigns prioritizing anatomically specific terminology. Future research should evaluate the effectiveness of such targeted interventions and assess whether post-pandemic diagnoses present at more advanced stages. Full article

This article examines how platform-mediated crisis policy shaped inclusion and exclusion outcomes for small, medium, and micro enterprises (SMMEs) in the Western Cape during COVID-19. Integrating a market-failure perspective with entrepreneurial ecosystem theory, we present a theory-driven secondary analysis of 16 qualitative interviews and policy documents. We map five crisis-amplified failures—finance, markets, digital, institutions, and human capital—onto Isenberg’s six ecosystem domains and analyze how provincial interventions, particularly digital marketplaces, voucher schemes, and online coordination tools, functioned as governance mechanisms regulating access, visibility, and participation. The findings show that platform-mediated interventions accelerated coordination and digital market access but disproportionately benefited already connected firms, leaving institutional and inclusion gaps largely unresolved. We conceptualize sub-national crisis response as a form of platform governance and discuss implications for designing more inclusive digital policy infrastructures in middle-income contexts. Full article

Upper-tract urothelial carcinoma (UTUC) represents a biologically distinct and clinically challenging subset of urothelial malignancies, accounting for only 5–10% of urothelial cancers but carrying a disproportionately high risk of advanced disease and recurrence. Historically, management strategies for UTUC have been extrapolated from bladder cancer data, with limited prospective evidence specific to the upper urinary tract. However, recent years have witnessed an expanding number of UTUC-focused clinical trials that are reshaping treatment paradigms across localized, locally advanced, and metastatic disease states. This review examines the evolving landscape of clinical trials in UTUC, highlighting pivotal and ongoing studies that will inform contemporary management. We summarize evidence supporting perioperative systemic therapy, including neoadjuvant and adjuvant chemotherapy, and discuss the expanding role of immune checkpoint inhibitors in both perioperative and metastatic settings. Additionally, we review trials evaluating kidney-sparing approaches, intraluminal therapies, and novel drug-delivery platforms aimed at preserving renal function while maintaining oncologic control. Emerging trial designs incorporating molecular profiling, fibroblast growth factor receptor (FGFR)-targeted therapies, and biomarker-driven patient selection are also explored. Despite meaningful progress, significant gaps remain, including the underrepresentation of UTUC patients in large urothelial cancer trials, heterogeneity in risk stratification, and challenges in trial accrual for this rare disease. We conclude by outlining future directions for UTUC-specific clinical research, emphasizing the need for collaborative, multicenter trials, innovative endpoints, and integrated translational studies to further refine personalized treatment strategies. As the clinical trial ecosystem for UTUC continues to mature, these efforts hold promises for improving outcomes while balancing oncologic efficacy with renal preservation. Full article

The inception of Jamaica’s education system was built based on European settler colonial ideologies and White supremacist logic. Almost two centuries after the abolition of slavery and over six decades after independence from British rule, colonial vestiges pervade Jamaican education policy and practice, resulting in the continued marginalisation of Black students from low-income backgrounds. Despite the commissioning of multiple reports on the state of the education system, these racist and classist injustices persist. In this article, we examine social justice issues at the nexus of national education policy and school leadership practice in Jamaican public schools based on our reflexive thematic analysis of semi-structured interviews conducted with two Jamaican education policymakers, five education researchers and four public school leaders, alongside Jamaica’s National Student Dress and Grooming Policy Guidelines 2018. Our findings highlight a hierarchical relationship among stakeholder groups in the creation and implementation of Jamaican education policy. Our findings also highlight four themes suggesting that this results from deeply ingrained valorisation of Eurocentric values in policy design that leads to heightened tensions between the Ministry of Education and Youth (MOEY) and school administrators at the level of policy implementation, distraction of school staff from teaching and learning, and disproportionate exclusion of Black students from low-income backgrounds. Implications from our study are the need for stronger cohesion among education policy stakeholders, the incorporation of social justice in teacher and leader preparation and the integration of critical pedagogies at all levels of the Jamaican education system. Full article

Background: Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality among individuals with type 2 diabetes mellitus (T2DM). Although women generally exhibit a more favorable cardiovascular risk profile than men in the general population, this protection is substantially reduced in the presence of diabetes, resulting in a disproportionately greater relative increase in CVD risk among women. Objective: This review aims to integrate the roles of metabolic phenotypes, dietary exposures, and genetic susceptibility in shaping cardiovascular risk in women with T2DM, with a focus on diet–gene and diet–epigenetic interactions across critical stages of the female life course. Methods: A narrative review of epidemiological, clinical, and mechanistic evidence from recent literature was conducted to synthesize current knowledge on sex-specific cardiometabolic pathways and nutritional determinants of vascular risk in T2DM. Results: Current evidence indicates that several interconnected mechanisms contribute to enhanced cardiovascular vulnerability in diabetic women, including (i) adipose tissue dysfunction and ectopic fat accumulation; (ii) insulin resistance with metabolic inflexibility and lipotoxicity; and (iii) endothelial and microvascular dysfunction driven by impaired nitric oxide signaling. Dietary patterns modulate these pathways through effects on inflammation, oxidative stress, postprandial lipid metabolism, and vascular function. Emerging evidence highlights that genetic variants (e.g., APOE; CETP; TCF7L2) significantly modify metabolic responses to dietary exposures in patients with T2DM; supporting a role for nutrigenetic interactions in shaping cardiovascular risk. In parallel, diet-related epigenetic mechanisms—including metabolic memory and early-life programming—may contribute to long-term and potentially intergenerational cardiometabolic risk. Conclusions: Integrating dietary patterns with genetic susceptibility and epigenetic regulation provides a mechanistic framework for understanding the disproportionate cardiovascular risk in diabetic women and supports the development of sex-specific, life-course-oriented precision nutrition strategies for cardiovascular risk reduction Full article

High energy consumption in winter greenhouses poses a challenge to agricultural sustainability in Northern China, where heating costs typically account for 40–60% of total operating expenses. This study integrated a non-linear cost–volume–profit (CVP) analysis and data envelopment analysis (DEA) to balance cucumber yields with escalating energy costs. A single-season, single-factor experiment was conducted using insulated greenhouse compartments to evaluate four night temperature gradients (10 °C, 13 °C, 16 °C, and 19 °C). Results showed that although the 19 °C treatment (T3) achieved the highest marketable yield, it was associated with lower economic return because heating costs increased disproportionately. Among the four tested nighttime temperatures, the 16 °C treatment (T2) showed the most favorable observed combination of yield, net profit, and DEA-based efficiency indicators under the present experimental conditions. However, because the experiment was conducted in a single season within a compartment-based greenhouse system and the CVP relationship was fitted using treatment-level means, this result should be interpreted as a preliminary and condition-specific finding rather than as definitive evidence of a universal optimum temperature. Accordingly, the integrated bio-economic framework presented here is best viewed as an analytical prototype that merits further validation across multiple seasons, cultivars, and greenhouse systems. Full article

Raphidiopsis raciborskii is one of the most widely reported cyanobacteria worldwide, responsible for dense blooms and cyanotoxin production. Classified as invasive, it has been documented across all continents except Antarctica. While its distribution has been extensively studied, abiotic factors have consistently emerged as the main determinants of its success, which are therefore the focus of the present study. The objective of the present review is to synthesize findings from both experimental and field-based studies to identify which are the key drivers of its dominance. In total, 30 abiotic factors were reported, reflecting the broad strategies of the species. Results show the temperature as a consistent universal factor (11–35 °C), while differences were found regarding nutrient dynamics. Particularly, nitrogen forms and N/P ratios predominated in field-based evidence, whereas photosynthetically active radiation was disproportionately emphasized within experimental studies under controlled conditions. Factors such as salinity and micronutrients, and synergistic interactions remain critically understudied, limiting predictive capacity under global change scenarios. Understanding which combinations of these drivers create favorable conditions is essential for anticipating bloom dynamics in order to establish management strategies for avoiding or mitigating the negative impact of them. Full article

Background/Objectives: Cognitive dysfunction, or “brain fog”, following COVID-19 viral infection is strongly associated with diminished work capacity which disproportionality affects working-age adults. This study examined an existing method of cognitive rehabilitation training applied to adults struggling with workplace functioning and self-efficacy due to post-COVID-19 brain fog. Methods: Nine adults with post-COVID-19 cognitive dysfunction participated in this single arm pilot trial of a severity-adaptive cognitive training program. The participants completed 45–90 h of clinician-delivered cognitive training exercises delivered remotely in 60- to 90-min sessions, two or three times per week. The primary outcome measure was overall workplace self-efficacy with subskills of perceived workplace functioning, perception of cognitive functioning, and perception of home functioning assessed through pre and post surveys and qualitative interviews. The secondary outcome was cognitive function operationalized by an IQ score administered before and after the intervention. Results: The participants achieved significant improvements in workplace self-efficacy and cognition following cognitive training. The main qualitative themes of self-reported improvements were in executive function, health and energy, daily living activities, productivity, and socioemotional functioning. A cross-case synthesis of pre-intervention struggles, and post-intervention improvements revealed subthemes at work or school in cognitive processing and comprehension, memory, executive function, fatigue, emotional distress, confidence in work or academics, and work/academic performance impairment. As a group, the mean gain in IQ score was 10.5 points. Conclusions: This study adds to the growing body of literature examining the possibility of using cognitive rehabilitation for post-COVID-19 cognitive dysfunction impacting workplace self-efficacy and work functioning. Full article

Industrial predictive maintenance programs often rely on SCADA historian signals characterized by low-frequency sampling and asynchronous reporting intervals. These data constraints, specifically non-uniform scan rates and inter-tag time misalignment, limit the applicability of high-resolution or sensor-intensive prognostic models. This study proposes a lightweight, physics-informed health proxy, the temperature-weighted work (TWW) index, designed to monitor motor stator-winding degradation within these industrial limitations. The TWW index accumulates mechanical work derived from torque and speed measurements, weighted by an adaptive exponential temperature-emphasis function that penalizes operation at elevated temperatures. The formulation is inspired by practical thermal-aging heuristics such as Montsinger’s rule in the qualitative sense that higher temperatures are treated as disproportionately more damaging, but it is not intended as a direct implementation of a fixed absolute-temperature life law. Instead, it is designed as a lightweight adaptive index suitable for online SCADA-based implementation. To address SCADA-specific irregularities, the framework incorporates data synchronization and resampling techniques to align heterogeneous tags, alongside power-thresholding to isolate degradation-relevant load periods. The resulting cumulative index is mapped to a normalized health/RUL proxy using failure-referenced thresholds identified from historical events. Validation using field data from industrial three-phase motors demonstrates that the TWW index provides a monotonic degradation profile that is consistent with documented winding-related failures and proactive removals. Case studies confirm that the model enabled proactive maintenance interventions by signaling the terminal phase of insulation life before catastrophic breakdown, offering a hardware-free and scalable solution for real-time asset management. Full article

Climate change disproportionately threatens low- and middle-income countries, yet integrated assessments combining socio-economic fragility with physical hazards remain limited. This study quantifies multi-dimensional climate vulnerability and derives optimized adaptation policies for six representative nations (Bangladesh, Colombia, Kenya, Morocco, Pakistan, Vietnam) by fusing socio-economic indicators with climate risk data (2000–2024). A computational framework integrating unsupervised learning, dimensionality reduction, and predictive modeling was employed. Principal Component Analysis synthesized eight indicators into a Compound Vulnerability Score (CVS), while K-Means and DBSCAN identified distinct vulnerability regimes. XGBoost quantified driver importance, and Graph Neural Networks captured systemic interconnections. XGBoost identified projected drought risk (31.2%), precipitation change (18.1%), and poverty headcount (14.3%) as primary drivers. Graph networks demonstrated significant risk amplification in African nations (Morocco SRS: 0.728–0.874; Kenya SRS: 0.504–0.641) versus damping in Asian countries. A Reinforcement Learning (RL) agent was trained using Deep Q-Networks with experience replay to optimize intervention portfolios under budget constraints. The RL policy achieved a 23% reduction in systemic risk compared to uniform allocation baselines, generating context-specific priorities: drought management for Morocco (score 50) and Pakistan (40); poverty alleviation for Kenya (40); coastal protection for Bangladesh (40); agricultural resilience for Vietnam (35); and institutional capacity building for Colombia (50). In conclusion, socio-economic fragility non-linearly amplifies climate hazards, with poverty and drought risk constituting critical vulnerability multipliers. The AI-driven framework demonstrates that targeted interventions in high-sensitivity systems maximize systemic risk reduction. This integrated approach provides a replicable, evidence-based foundation for strategic adaptation finance allocation in an increasingly uncertain climate future. Full article

Social wasps are frequently associated with fruit injuries in agroecosystems, but the diversity of species involved and the ecological context of these interactions remain poorly synthesized in Brazil. This study aimed to compile and analyze records of social wasp interactions with fruits in Brazil, combining opportunistic field observations, iNaturalist records, and published studies. In total, 19 field observations, 87 iNaturalist records, and 11 published studies were incorporated into the dataset, resulting in 2443 records involving 51 social wasp species in 10 genera and 36 plant species. Most records involved fruits still attached to the plant (1853; 75.8%), whereas 590 records (24.2%) were associated with fallen fruits. Large-bodied wasps were disproportionately associated with fruits on the plant, while small- and medium-sized species were more frequent on fallen fruits, and this association was significant (χ² = 554.71; p < 0.001). Records also varied significantly throughout the year (χ² = 5693.28; p < 0.001), with peaks in February, March, and July. The interactions were strongly concentrated in a few genera, especially Polybia, Polistes, and Agelaia, and in a few fruit species, particularly Psidium guajava, Anacardium occidentale, and Mangifera indica. Overall, the compiled evidence indicates that fruit exploitation by social wasps in Brazil is structured by body size, resource accessibility, and seasonality. However, because the study compiles heterogeneous records rather than directly measuring economic losses, the agricultural significance of these interactions remains context-dependent and requires further evaluation. Full article

Wildfire occurrence in temperate Europe is increasingly shaped by the interaction of human activities and short-term climatic anomalies rather than by natural ignition processes alone. This study analyses national wildfire statistics from Slovakia covering the period 2010–2025 to investigate temporal trends in wildfire occurrence, ignition causes, and fire-related impacts, including economic damages and human casualties. Official fire records provided by the Fire Research Institute of the Ministry of the Interior of the Slovak Republic were analyzed using descriptive and exploratory statistical methods. The dataset includes annual information on wildfire frequency, detailed ignition cause classifications, direct economic losses, fatalities, and injuries. European-scale wildfire patterns were considered for contextual comparison using data from the European Forest Fire Information System (EFFIS). Results show that wildfire occurrence in Slovakia is overwhelmingly dominated by human-caused ignitions, with negligence-related activities forming a persistent baseline of ignition pressure throughout the study period. The extreme wildfire year 2012, during which more than 11,000 wildfire events were recorded, illustrates how routine human behaviors can be strongly amplified under climatically favorable conditions without altering the underlying cause structure. Importantly, wildfire impacts were found to be weakly correlated with fire frequency, as years with moderate numbers of fires occasionally generated disproportionately high economic damages and casualties. These findings demonstrate that wildfire risk in Slovakia is primarily driven by behavioral ignition patterns modulated by short-term climatic variability. The results support a shift towards prevention-oriented and impact-focused wildfire risk management strategies, consistent with current European policies emphasizing integrated risk assessment, early warning, and targeted prevention in temperate regions. Full article

Background: Inflammation is central to myocardial injury and repair after ST-segment elevation myocardial infarction (STEMI). C-reactive protein (CRP) is an established biomarker of systemic inflammation, but its prognostic thresholds across patient subgroups are not well defined. Methods: In this retrospective cohort study, admission CRP was analyzed in 958 consecutive STEMI patients admitted to University Hospital Salzburg 2018–2020 and categorized into four groups (Serum CRP < 5.0, 5.0–9.9, 10.0–15, and >15.0 mg/dL). Mortality was assessed during short- (30, 90, and 180 days) and long-term (1, 3, and 5 years) follow-up. Kaplan–Meier analyses compared survival, Cox regression tested associations, and receiver operating characteristic (ROC) curves determined discriminatory value and optimal cut-offs. Results: Elevated admission CRP was associated with larger infarct size, impaired left ventricular function, and increased mortality. Kaplan–Meier curves showed progressively poorer survival with higher CRP, with worst outcomes at >15 mg/dL. At 30, 90, and 180 days, CRP demonstrated moderate discrimination (AUC 0.628, 0.653, and 0.654; all p < 0.001), with predictive cut-offs 11–15 mg/dL in the overall cohort. Subgroup analyses revealed markedly lower thresholds in vulnerable populations. Diabetic patients showed cut-offs 5–6 mg/dL with the highest AUC values (up to 0.714). Younger patients and smokers exhibited thresholds near 9–10 mg/dL, while subacute STEMI presentations demonstrated lower cut-offs compared with acute infarction. These findings indicate that the prognostic value of CRP is context-dependent rather than uniform. Conclusions: Admission CRP predicts short-term mortality after STEMI, with subgroup-specific cut-offs emerging below conventional thresholds, highlighting profiles where modest inflammatory activation carries disproportionate risk. Full article