Search Results (1,606)

Obesity is a growing global health concern with widespread impacts on physical, psychological, and social well-being. Clinically, it is a major driver of type 2 diabetes (T2D), cardiovascular disease (CVD), non-alcoholic fatty liver disease (NAFLD), and cancer, reducing life expectancy by 5–20 years and imposing a staggering economic burden of USD 2 trillion annually (2.8% of global GDP). Despite its significant health and socioeconomic impact, earlier obesity medications, such as fenfluramine, sibutramine, and orlistat, fell short of expectations due to limited effectiveness, serious side effects including valvular heart disease and gastrointestinal issues, and high rates of treatment discontinuation. The advent of glucagon-like peptide-1 (GLP-1) receptor agonists (e.g., semaglutide, tirzepatide) has revolutionized obesity management. These agents demonstrate unprecedented efficacy, achieving 15–25% mean weight loss in clinical trials, alongside reducing major adverse cardiovascular events by 20% and T2D incidence by 72%. Emerging therapies, including oral GLP-1 agonists and triple-receptor agonists (e.g., retatrutide), promise enhanced tolerability and muscle preservation, potentially bridging the efficacy gap with bariatric surgery. However, challenges persist. High costs, supply shortages, and unequal access pose significant barriers to the widespread implementation of obesity treatment, particularly in low-resource settings. Gastrointestinal side effects and long-term safety concerns require close monitoring, while weight regain after medication discontinuation emphasizes the need for ongoing adherence and lifestyle support. This review highlights the transformative potential of incretin-based therapies while advocating for policy reforms to address cost barriers, equitable access, and preventive strategies. Future research must prioritize long-term cardiovascular outcome trials and mitigate emerging risks, such as sarcopenia and joint degeneration. A multidisciplinary approach combining pharmacotherapy, behavioral interventions, and systemic policy changes is critical to curbing the obesity epidemic and its downstream consequences. Full article

Individual willingness to pay (WTP) for green energy plays a vital role in mitigating climate change. Based on social cognitive theory (SCT), which emphasizes the dynamic interaction among individual cognition, behavior and the environment, this study develops a theoretical model to identify factors influencing green energy WTP. The study is based on 585 valid questionnaire responses from urban areas in China and uses Structural Equation Modeling (SEM) to reveal the linear causal path. Meanwhile, fuzzy-set Qualitative Comparative Analysis (fsQCA) is utilized to identify the combined paths of multiple conditions leading to a high WTP, making up for the limitations of SEM in explaining complex mechanisms. The SEM analysis shows that social trust, social networks, and social norms have a significant positive impact on individual green energy WTP. And this influence is further transmitted through the mediating role of environmental self-efficacy and expectations of environmental outcomes. The FsQCA results identified three combined paths of social capital and environmental cognitive conditions, including the Network–Norm path, the Network–efficacy path and the Network–Outcome path, all of which can achieve a high level of green energy WTP. Among them, the social networks are a core condition in every path and a key element for enhancing the high green energy WTP. This study promotes the expansion of SCT, from emphasizing the linear role of individual cognition to focusing on the configuration interaction between social structure and psychological cognition, provides empirical evidence for formulating differentiated social intervention strategies and environmental education policies, and contributes to sustainable development and the green energy transition. Full article

Background and objectives: Life expectancies have increased globally, including in Romania, leading to an aging population and thus increasing the burden of chronic diseases. Over 80% of individuals over 65 have more than three chronic conditions, with many exceeding ten and often requiring multiple medications and supplements. This widespread polypharmacy raises concerns about drug interactions, side effects, and inappropriate prescribing. This review examines the impact of polypharmacy in older adult patients, focusing on the physiological changes affecting drug metabolism and the potential risks associated with excessive medication use. Special attention is given to proton pump inhibitors (PPIs), a commonly prescribed drug class with significant benefits but also risks when misused. The aging process alters drug absorption and metabolism, necessitating careful prescription evaluation. Methods: We conducted literature research on polypharmacy and PPIs usage in the older adult population and the risk associated with this practice, synthesizing 217 articles within this narrative review. Results: The overuse of medications, including PPIs, may lead to adverse effects and increased health risks. Clinical tools such as the Beers criteria, the STOPP/START Criteria, and the FORTA list offer structured guidance for optimizing pharmacological treatments while minimizing harm. Despite PPIs’ well-documented safety and efficacy, inappropriate long-term use has raised concerns in the medical community. Efforts are being made internationally to regulate their consumption and reduce the associated risks. Conclusions: Physicians across all specialties must assess the risk–benefit balance when prescribing medications to older adult patients. A personalized treatment approach, supported by evidence-based prescribing tools, is essential to ensure safe and effective pharmacotherapy. Addressing inappropriate PPI use is a priority to prevent potential health complications. Full article

Postoperative ileus is a prolonged impairment of gastrointestinal motility following surgical procedures. This often leads to increased morbidity, extended hospital stays, and high healthcare expenditures. In this review, we discuss the pathophysiology underlying postoperative ileus, its epidemiology, and perioperative management strategies. Patient characteristics, as well as expected perioperative course, could be used to stratify the risks of postoperative ileus. Preventive measures hinge upon a multimodal approach, minimally invasive surgical techniques, fluid management, early postoperative ambulation, and opioid-sparing analgesia strategies. Adjuvant interventions such as alvimopan, caffeine, and chewing gum have demonstrated efficacy in modulating the neurogenic and inflammatory components of postoperative ileus. Minimally invasive approaches, comprehensive perioperative management, and adjuvant therapies hold promise for prevention. Current management relies heavily on supportive care, underscoring the need for research into the underlying neurogenic and inflammatory mechanisms to guide the development of targeted treatments. Full article

This paper proposes an energy-efficient current control strategy for drive modules of permanent magnetic actuators (PMAs) to reduce the cost and volume of DC-link capacitors. The drive module of the PMA does not receive the input power from an external power source during operation. Instead, the externally charged DC-link capacitors are used as internal backup power sources to guarantee the reliable operation even in the case of an emergency. Therefore, it is important to use the charged energy efficiently within the limited DC-link capacitors. However, conventional control strategies using a voltage open loop have trouble reducing the energy waste. This is because the drive module with the voltage open loop uses unnecessary energy even after the PMA mover has finished its movement. To figure it out, the proposed control strategy adopts a current control loop to save energy even if the displacement of the PMA mover is unknown. In addition, the proposed strategy can ensure the successful operation of the PMA by using the driving force analysis. The efficacy of the proposed strategy is verified through the experimental test. It would be expected that the proposed strategy can reduce the cost and volume of the PMA drive system. Full article

Background: Direct oral anticoagulants (DOACs) are generally preferred over warfarin for preventing arterial and venous thromboembolism. However, the efficacy and safety of DOACs in patients with extremely low body weight (BW) are uncertain. This study investigates anti-factor Xa (anti-FXa) activity of apixaban and compares it between patients with normal BW (>50 kg) and underweight (≤50 kg). Methods: We enrolled 150 patients on branded generic apixaban (Apixan^TM) for atrial fibrillation (AF), venous thromboembolism, and intracardiac thrombus. Anti-FXa activity of apixaban was measured at peak concentration (C_peak) and trough concentration (C_trough) after at least one week of therapy. Results: Mean age was 64.0 ± 12.7 years, with 53.3% being male. Mean BW was 61.3 ± 15.3 kg. Of the 150 patients, 132 (88%) had AF, and 43 (28.7%) had low BW. Overall, 87.3% and 84.7% of patients had C_trough and C_peak within the expected range. Underweight patients had significantly higher mean C_trough and C_peak than normal BW patients. A higher proportion of low-BW patients exceeded the expected C_peak range compared to normal-BW patients (25.6% vs. 3.7%, p < 0.001). Low BW was the only independent predictor of exceeding C_peak specified range (adjusted OR 4.87, 95% CI 1.31–18.15, p = 0.018). Conclusions: Most patients maintained apixaban levels within expected ranges, but those with low BW were more likely to exceed the specified range of C_peak. Full article

In this paper, the effective bulk modulus of pump-controlled hydraulic cylinders is studied in the context of linear time-invariant modeling and control. Using an experimental test-rig, the minimum expected value of the effective bulk modulus is identified, and its impact on stability and achievable performance under feedback control is analyzed. A method for control design and analysis based on a single operating point, analogous to that of what is traditionally utilized in valve-controlled systems, is proposed and validated. It is shown that despite the drastic reduction in the minimum effective bulk modulus occurring in these systems compared to that of valve-controlled cylinders, adequate performance may be achieved under feedback control due to the presence of adequate damping. Two critical modeling aspects commonly neglected in the research literature on these systems are highlighted, and their importance is demonstrated. These results demonstrate the efficacy of linear time-invariant methods in pump-controlled cylinders, as well as the importance of making appropriate modeling decisions, and should therefore be of high relevance to both researchers and engineers working with pump-controlled cylinders. Full article

To elucidate the key material parameters governing the tribological performance of ceramic composites under dry sliding against steel, this study presents a comprehensive comparative assessment of the microstructural characteristics, mechanical performance, and tribological behavior of two alumina–zirconia (Al₂O₃–ZrO₂) ceramic composites, each reinforced with a 42 vol.% carbide phase: zirconium carbide (ZrC) and tungsten carbide (WC). Specifically, tungsten carbide (WC) was selected for its exceptional bulk mechanical properties, while zirconium carbide (ZrC) was chosen to contrast its potentially different interfacial reactivity against a steel counterface. ZrC and WC were selected as reinforcing phases due to their high hardness and distinct chemical and interfacial properties, which were expected to critically affect the wear and friction behavior of the composites under demanding conditions. Specimens were consolidated via spark plasma sintering (SPS). The investigation encompassed macro- and nanoscale hardness measurements (Vickers hardness HV₁, HV₁₀; nanoindentation hardness H), elastic modulus (E), fracture toughness (K_IC), coefficient of friction (COF), and specific wear rate (W_s) under unlubricated reciprocating sliding against 100Cr6 steel at normal loads of 10 N and 25 N. The Al₂O₃–ZrO₂–WC composite exhibited an ultrafine-grained microstructure and markedly enhanced mechanical properties (HV₁₀ ≈ 20.9 GPa; H ≈ 33.6 GPa; K_IC ≈ 4.7 MPa·m^½) relative to the coarse-grained Al₂O₃–ZrO₂–ZrC counterpart (HV₁₀ ≈ 16.6 GPa; H ≈ 27.0 GPa; K_IC ≈ 3.2 MPa·m^½). Paradoxically, the ZrC-reinforced composite demonstrated superior tribological performance, with a low and load-independent specific wear rate (W_s ≈ 1.2 × 10⁻⁹ mm³/Nm) and a stable steady-state COF of approximately 0.46. Conversely, the WC-reinforced system exhibited significantly elevated wear volumes—particularly under the 25 N regime—and a higher, more fluctuating COF. Scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy (SEM–EDX) of the wear tracks revealed the formation of a continuous, iron-enriched tribofilm on the ZrC composite, derived from counterface material transfer, whereas the WC composite surface displayed only sparse tribofilm development. These findings underscore that, in steel-paired tribological applications of Al₂O₃–ZrO₂–based composites, the efficacy of interfacial tribolayer generation can supersede intrinsic bulk mechanical attributes as the dominant factor governing wear resistance. Full article

The school climate is defined as the conditions present within a learning environment that influence the development of educational practices in the context of the school. A positive school climate is crucial for improving learning opportunities, students’ academic performance, and the overall quality of daily schoolwork, thereby promoting educational sustainability. The aim of this research was to analyse and compare the relationships among teachers and among students to understand the school climate in high-efficacy schools and low-efficacy schools. A content analysis was conducted on 50 semistructured interviews with members of the leadership teams from both types of schools. The findings showed that in highly effective schools, there are more favourable perceptions of the school climate, better relationships among teachers, and higher expectations for students than in schools with low efficacy. Improving the school climate can optimise educational performance and should be considered a key strategy to improve both the effectiveness of schools and their long-term sustainability. Full article

Narrative review synthesizes the most current literature on the SARS-CoV-2 XEC variant, focusing on its genomic evolution, immune evasion characteristics, epidemiological dynamics, and public health implications. To achieve this, we conducted a structured search of the literature of peer-reviewed articles, preprints, and official surveillance data from 2023 to early 2025, prioritizing virological, clinical, and immunological reports related to XEC and its parent lineages. Defined by the distinctive spike protein mutations, T22N and Q493E, XEC exhibits modest reductions in neutralization in vitro, although current evidence suggests that mRNA booster vaccines, including those targeting JN.1 and KP.2, retain cross-protective efficacy against symptomatic and severe disease. The XEC strain of SARS-CoV-2 has drawn particular attention due to its increasing prevalence in multiple regions and its potential to displace other Omicron subvariants, although direct evidence of enhanced replicative fitness is currently lacking. Preliminary analyses also indicated that glycosylation changes at the N-terminal domain enhance infectivity and immunological evasion, which is expected to underpin the increasing prevalence of XEC. The XEC variant, while still emerging, is marked by a unique recombination pattern and a set of spike protein mutations (T22N and Q493E) that collectively demonstrate increased immune evasion potential and epidemiological expansion across Europe and North America. Current evidence does not conclusively associate XEC with greater disease severity, although additional research is required to determine its clinical relevance. Key knowledge gaps include the precise role of recombination events in XEC evolution and the duration of cross-protective T-cell responses. New research priorities include genomic surveillance in undersampled regions, updated vaccine formulations against novel spike epitopes, and long-term longitudinal studies to monitor post-acute sequelae. These efforts can be augmented by computational modeling and the One Health approach, which combines human and veterinary sciences. Recent computational findings (GISAID, 2024) point to the potential of XEC for further mutations in under-surveilled reservoirs, enhancing containment challenges and risks. Addressing the potential risks associated with the XEC variant is expected to benefit from interdisciplinary coordination, particularly in regions where genomic surveillance indicates a measurable increase in prevalence. Full article

The Luhua chicken is an outstanding local breed in China that has been placed under conservation due to the impact of specialized breeding and the widespread adoption of commercial varieties. As such, this study analyzed reproductive traits across three consecutive generations and utilized whole-genome resequencing data from 60 Luhua chickens to assess conservation efficacy through genetic diversity, run of homozygosity (ROH) distribution, kinship, and population structure so as to better conserve the breed. The results show that, across generations, the body weight at first egg increased, the age at first egg was delayed, and the egg weight at first laying increased. No significant variations were found in the body weight at 300 d or the total egg number. The key genetic parameters of the polymorphism information content (PIC), expected heterozygosity (HE), observed heterozygosity (HO), and mean identical-by-state (IBS) distance were 0.234, 0.351, 0.277, and 0.782, respectively. The majority of ROHs ranged from 0.5 to 1 Mb, and the inbreeding coefficient based on ROHs was calculated at 0.021. The findings reveal that these traits remained unchanged across the three generations. Our research suggests that optimizing the mating plan of Luhua chickens is essential to minimize inbreeding risk. Furthermore, the methodology applied in this study provides a valuable reference for the conservation monitoring of other indigenous chicken breeds. Full article

Introduction: Chronic alcohol use is a complex condition influenced by psychological, behavioral, and socio-demographic factors. This study aimed to develop a comprehensive psychosocial profile of individuals with alcohol use disorder (AUD) by examining associations between psychometric variables and relapse risk including repeated psychiatric hospitalizations. Methodology: A cross-sectional observational analytical study was conducted on a sample of 104 patients admitted for alcohol withdrawal management at the “Prof. Dr. Al. Obregia” Psychiatric Clinical Hospital in Bucharest between March 2023 and September 2024. Participants completed a set of validated psychometric tools: the Drinker Inventory of Consequences—Lifetime Version (DrInC), Readiness to Change Questionnaire—Treatment Version (RTCQ), Drinking Expectancy Questionnaire (DEQ), and Drinking Refusal Self-Efficacy Questionnaire (DRSEQ). Additional data were collected on the socio-demographic (education level, socio-professional category), genetic (family history of alcohol use), and behavioral factors (length of abstinence, tobacco use, co-occurring substance use disorders). Results: Higher alcohol-related consequence scores (DrInC) were significantly associated with lower education (p < 0.001, η² = 0.483), disadvantaged socio-professional status (p < 0.001, η² = 0.514), and family history of alcohol use (p < 0.001, η² = 0.226). Self-efficacy (DRSEQ) was significantly lower among individuals with co-occurring substance use (p < 0.001) and nicotine dependence (p < 0.001). Logistic regression showed that the DrInC scores significantly predicted readmission within three months (OR = 1.09, p = 0.001). Conclusions: Psychometric tools are effective in identifying individuals at high risk. Personalized, evidence-based interventions tailored to both psychological and socio-professional profiles, combined with structured post-discharge support, are essential for improving long-term recovery and reducing the readmission rates. Full article

As life expectancy increases, muscle atrophy, characterized by a decline in muscle mass and strength that can impair mobility, has become a growing concern, highlighting the potential of protein supplementation as a promising intervention strategy. A horse meat hydrolysate, with a molecular weight of less than 3 kDa, derived from m. biceps femoris and produced using the food-grade enzyme Alcalase^® (A4 < 3kDa) was evaluated for its efficacy in mitigating dexamethasone-induced muscle atrophy, a widely accepted model for studying catabolic muscle loss. Administered orally to C57BL/6 mice at dosages of 200 mg/kg or 500 mg/kg body weight for 35 days, A4 < 3kDa effectively countered the weight loss induced by dexamethasone in the whole body, quadriceps, tibialis anterior, and gastrocnemius muscles. Moreover, it increased muscle fiber cross-sectional area and grip strength. These effects were attributed to increased protein synthesis via the protein kinase B (AKT)/forkhead box O3 (FoxO3a)/mammalian target of rapamycin (mTOR) signaling pathway. A4 < 3kDa augmented the phosphorylation of key components of the signaling pathways associated with muscle atrophy, resulting in reduced mRNA expression of Atrogin-1 and MuRF-1. These findings demonstrate the potential of A4 < 3kDa as a functional food ingredient for preventing muscle atrophy. Full article

The phototherapeutic applications of porphyrin-based nanoscale metal–organic frameworks (nMOFs) are limited by the poor penetration of conventional excitation light sources into biological tissues. Radiodynamic therapy (RDT), which directly excites photosensitizers using X-rays, can overcome the issue of tissue penetration. However, RDT faces the problems of low energy conversion efficiency, requiring a relatively high radiation dose, and the potential to cause damage to normal tissues. Researchers have found that by using some metals with high atomic numbers (high Z) as X-ray scintillators and coordinating them with porphyrin photosensitizers to form MOF materials, the excellent antitumor effect of radiotherapy (RT) and RDT can be achieved under low-dose X-ray irradiation, which can not only effectively avoid the penetration limitations of light excitation methods but also eliminate the defect issues associated with directly using X-rays to excite photosensitizers. This review summarizes the relevant research work in recent years, in which researchers have used metal ions with high Z, such as Hf⁴⁺, Th⁴⁺, Ta⁵⁺, and Bi³⁺, in coordination with carboxyl porphyrins to form MOF materials for combined RT and RDT toward various cancer cells. This review compares the therapeutic effects and advantages of using different high-Z metals and introduces the application of the heavy atom effect. Furthermore, it explores the introduction of a chemodynamic therapy (CDT) mechanism through iron coordination at the porphyrin center, along with optimization strategies such as oxygen delivery using hemoglobin to enhance the efficacy of these MOFs as radiosensitizers. This review also summarizes the potential of these materials in preclinical applications and highlights the current challenges they face. It is expected that the summary and prospects outlined in this review can further promote preclinical biomedical research into and the development of porphyrin-based nMOFs. Full article

Background/Objectives: The potential advantages of robotic assistance in spinal procedures are a growing area of interest, and patient perception plays a key role in its broader acceptance. However, public perception of robotic surgery in spinal operations remains unexplored. This study aims to assess the general public’s perceptions, expectations, and concerns regarding robot-assisted spine surgery. Methods: In the fall of 2024, a questionnaire was distributed to attendees at a public open day at the Neurocenter of Southern Switzerland, where the Globus ExcelsiusGPS™ spine surgery robot was demonstrated live on a mannequin. The 15-item questionnaire assessed demographic data, prior knowledge of medical robots, mental representations of surgical robots, expectations, and emotions after witnessing the demonstration. Data were analyzed using descriptive statistics, chi-square, Wilcoxon, McNemar tests, and logistic regression analysis. Results: A total of 109 questionnaires were collected. Most participants were female (64.4%) and had no direct experience with spinal pathology (79.8%). While 87.2% were aware of robotic surgery in general, only 65.1% specifically knew about its use in spine surgery. After witnessing the live demonstration, 81.9% felt reassured by the robot′s presence in surgery, compared to 61.3% before the demonstration (p = 0.007). Preference for robot-assisted surgery increased from 50.5% to 64.5% (p < 0.001). Notably, individuals with back-related issues showed greater confidence in the robot’s capabilities (p = 0.032). Conclusions: The general public perceives robotic spine surgery positively, viewing it as faster, more precise, and capable of performing tasks not readily performed by humans. The study highlights the importance of live demonstrations in enhancing trust and acceptance of robotic systems. Its findings have economic implications, as patients may be more likely to choose hospitals offering robot-assisted spine surgery. However, it is essential to also acknowledge alternative methods, such as computer-assisted navigation, which has demonstrated efficacy in spine surgery. Full article