Search Results (33,709)

Importance: Chronic liver disease requires sustained engagement with the health system, which co-occurring social and functional risks may disrupt. Whether these risks form reproducible patterns with different mortality associations is uncertain. Objective: To identify social and functional risk patterns among US adults with chronic liver disease and evaluate their associations with all-cause mortality. Design, Setting, and Participants: Nationally representative cohort study of National Health Interview Survey sample adults interviewed from 2011 through 2018 and linked to the National Death Index through 31 December 2019. Participants were aged 18 years or older, eligible for mortality linkage, reported a chronic liver condition, and had no baseline liver cancer. Exposures: Latent class membership derived from 7 binary indicators: poverty, food insecurity, uninsurance, cost-related delayed care, no usual place of care, single-adult household status, and activity limitation. A complete 0- to 7-item count was a secondary exposure. Main Outcomes and Measures: All-cause mortality. Survey-weighted Cox models estimated hazard ratios (HRs) with sequential demographic, clinical, and liver-specific adjustment. Prespecified sensitivity analyses used 20 multiple imputed data sets, sampling-weighted pseudo-likelihood latent class models, complete-case re-estimation, a fixed 5-year horizon, and class-by-age interaction testing. Results: Among 3407 adults (weighted mean age, 54.0 years; 49.4% female), 529 deaths occurred over 17,297.6 person-years (median follow-up, 5.0 years [IQR, 3.0–7.0]). Four classes were retained: low social and access burden (weighted prevalence, 63.1%); functional limitation with financial strain (13.2%); poverty, single-adult household, and functional limitation (15.0%); and uninsurance with major access barriers (8.7%). Compared with the low-burden class, the functional-limitation/financial-strain class had higher adjusted mortality (HR, 1.95; 95% CI, 1.34–2.82; p < 0.001); the other 2 classes did not differ significantly. Sampling-weighted latent class analysis after multiple imputation reproduced 97.2% of modal assignments, and the association persisted with attenuation (HR, 1.55; 95% CI, 1.08–2.22; p = 0.02). Each additional risk was associated with higher mortality (exact count: HR, 1.24 [95% CI, 1.13–1.36]; imputed count: HR, 1.19 [95% CI, 1.10–1.29]). The class-by-age interaction was not significant (p = 0.41). Conclusions and Relevance: Among US adults with self-reported chronic liver disease, social and functional adversity was both cumulative and patterned. A profile combining functional limitation, food insecurity, and cost-related delayed care had the clearest independent mortality association despite largely retained insurance coverage. These profiles are not a validated clinical score, but the findings argue against reliance on any single indicator, particularly insurance status, as a marker of vulnerability. Full article

Background: Minor phytocannabinoids engage CB₁ and CB₂ receptors, as well as broader receptors and ion-channel targets. However, fragmented evidence limits translation into central nervous system (CNS) therapeutics. This review introduces pharmacological switching, defined as a dose-, state-, or model-dependent shift in the dominant determinant of a compound’s net effect that reverses the direction, rather than merely the magnitude, of that effect on a defined functional endpoint, as a framework for compound–indication matching. Unlike biased agonism, which redistributes downstream coupling without reversing direction, switching requires directional reversal between or within receptor systems. Methods: This narrative review integrates receptor pharmacology, preclinical CNS disease-model data, early-phase clinical evidence, and pharmacokinetics identified through a structured literature search. Results: Three mechanistic axes recurred: PPARγ/CB₂/Nrf2-linked neuroinflammatory modulation; TRP/GABA_A/5-HT₁A-linked control of neuronal excitability; and low-efficacy CB₁ antagonism with 5-HT₁A potentiation. Their expression was context-dependent: tetrahydrocannabivarin is reported to shift from CB₁ antagonism toward partial agonism as receptor occupancy rises, cannabidiolic acid shows stress-conditional anxiolytic and antiemetic activity, and cannabigerolic acid displays seizure-model-dependent bidirectionality. No instance yet meets all five defining criteria; each is graded provisional or proposed pending systematic testing. Human evidence remains limited: inconclusive cannabidivarin efficacy in epilepsy and neuropathic pain, proof-of-mechanism neuroimaging in autism, and early tetrahydrocannabivarin safety data. Conclusions: Minor phytocannabinoids are pharmacologically diverse but clinically underdeveloped. A tiered, biomarker-guided framework is proposed to match compound–indication pairs to the doses, formulations, and subgroups most likely to express their therapeutic pharmacology. Full article

Processing crabs for meat generates large quantities of waste (secondary raw materials). Internal organs are typically discarded, which causes environmental problems and highlights the need for the integrated use of marine bioresources. The red king crab hepatopancreas is an excellent source of various proteins, including enzymes with different substrate specificities. In this study, an improved method was developed for producing a complex enzyme preparation from the hepatopancreas of red king crab (Paralithodes camtschaticus) harvested by a large industrial enterprise in the Barents Sea. Physicochemical analysis revealed high protein (16%) and lipid (10%) contents in the hepatopancreas. The developed method involves centrifugation to rapidly separate the fat fraction from the aqueous protein fraction and acetone washing to remove residual lipids. The use of low temperatures (0 to 5 °C) for autolysis is justified to prevent a decrease in enzymatic activity of the final preparation. Obtained enzyme preparations were analyzed for protease, collagenase, and endo- and exochitinase activity. They exhibited high proteolytic (A_prot = 252 μmol Tyr×g⁻¹×min⁻¹), exochitinolytic (A_exo = 0.94 μmol GlcNAc×g⁻¹×min⁻¹), and collagenolytic (A_col = 210 mIU·mg⁻¹) activities. It has been shown that enzymatic activities depend on seasonality (winter and summer) of the crab catch, which is due to differences in the physiological processes of crabs during seasonal cyclical temperature changes in their natural habitat. The developed process flowsheet for producing an enzyme preparation from the red king crab hepatopancreas can be used as the basis for technology by enterprises engaged in the comprehensive processing of marine bioresources. Full article

Teaching in higher education has evolved towards incentivizing approaches that involve active student participation. The use of educational games is a proven approach to enhancing motivation, making students engage with the material. A contemporary illustration of this genre is digital educational escape games (DEEGs). Due to their problem-solving approach, they are particularly suitable for STEM disciplines. Research lacks investigations on how DEEGs influence learning outcomes at different educational levels. This article explores success determinants of DEEGs in two STEM groups: senior vocational education and training students and higher education students. An intervention study was conducted with a DEEG on the subject of cryptography. Data were gathered using a pre- and post-test survey and logfile data extracted from the game backend. The data analysis is based on partial least squares structural equation modeling. The main findings show that statistically significant differences can be observed in the variance explained regarding the target construct learning outcome, as well as in two path coefficients: computer gaming affinity to learning outcome and game use to learning outcome. The differences detected lead to the conclusion that vocational education and training students have different study habits than higher education students, leading to different effects of the predictors on the target construct. Nevertheless, the differences detected in the two samples are to be examined further to verify the results of this exploratory study. Full article

This study examines teachers’ acceptance of an inquiry-oriented, Crime Scene Investigation (CSI)-based teaching sequence supported by a Virtual Scanning Electron Microscope (Virtual-SEM) using an extended Technology Acceptance Model (TAM). While TAM has been widely used to explain technology adoption, its traditional focus on cognitive perceptions may not fully capture the pedagogical complexity of educational settings. To address this, the study integrates pedagogical and affective variables, namely Inquiry Engagement (INQ), Trust (TR), and Self-Efficacy (SE), into the TAM framework. Data were collected from 30 teachers who evaluated a teaching sequence designed according to constructivist principles and the 5E Instructional Model. Descriptive statistics, reliability analysis, correlation analysis, and multiple regression analyses were employed to examine the relationships among constructs. The findings indicate high perceived usefulness, positive attitudes, and strong behavioral intention to adopt the sequence. Inquiry Engagement was significantly associated with both Perceived Usefulness and Attitude Toward Use, while Trust was significantly associated with Perceived Ease of Use and attitudes. In contrast, Perceived Usefulness showed a weak and non-significant association with attitudes, suggesting that pedagogical factors may play a particularly important role in technology acceptance. Attitude Toward Use showed the strongest association with Behavioral Intention. The findings provide preliminary support for an extended, pedagogically enriched TAM and highlight the potential importance of instructional design in technology acceptance. Full article

Existing autonomous trading systems rely on collaborative or single-agent analysis, lacking structured mechanisms for adversarial deliberation across opposing market perspectives. We propose Consensus-Gated Execution (CGX), a multi-agent architecture where specialized Bull and Bear agents engage in a three-round structured debate, with a Meta-Evaluator synthesizing their arguments to gate trade execution based on consensus strength. The system is evaluated through two complementary experiments: a 52-week aggregation study (2024) and a four-year multi-regime validation (2022–2025) across 417 biweekly sessions spanning bear, recovery, bull, and mixed market conditions. Trade signals are filtered using a tunable consensus threshold, allowing the system to balance trading frequency against signal quality. In the aggregation study, CGX achieves a Sharpe ratio of 1.90 with a maximum drawdown of 11.6%, representing a 3× improvement over trend following. In the multi-year evaluation, CGX reduces maximum drawdown by 85% and annualized volatility by 86%, with the Bear gate blocking 93% of sessions during the 2022 crash versus only 12% during the 2024 bull run. These results demonstrate that adversarial debate combined with consensus-based execution gating provides a principled framework for capital preservation across diverse market regimes. Full article

Background/Objectives: Psychological well-being is an important indicator of occupational mental health among special education teachers, as it is closely associated with work engagement, professional performance, and attitudes toward students with disabilities. Despite its importance, limited research has examined factors associated with psychological well-being among special education teachers in Arab contexts. Therefore, this study examined the level of psychological well-being among special education teachers and investigated the relative contributions of mindfulness and empathy. In addition, the study tested the mediating role of empathy in the relationship between mindfulness and psychological well-being. Methods: A cross-sectional quantitative predictive correlational design was employed with a sample of 259 special education teachers in Riyadh, Saudi Arabia. Data were collected using an Arabic-adapted version of Ryff’s Psychological Well-Being Scale, the short form of the Five-Facet Mindfulness Questionnaire, and the Empathy Scale for Teachers. Path analysis was conducted to test a partial mediation model examining the mediating role of empathy in the relationship between mindfulness and psychological well-being. Results: The findings indicated high levels of psychological well-being among special education teachers. Mindfulness and empathy accounted for significant variance in psychological well-being, and path analysis showed that empathy partially mediated the relationship between mindfulness and psychological well-being. Conclusions: These findings highlight the potential importance of mindfulness and empathy in relation to the psychological well-being of special education teachers and suggest the value of giving greater attention to these dimensions in pre-service preparation and ongoing professional support programs. The study also contributes context-specific evidence from Saudi Arabia to the literature on teacher well-being in special education. Full article

The transition toward sustainable energy systems is not only a technological and economic challenge but also a social one, with public acceptance playing a decisive role in the success of sustainability transitions. While traditional technology acceptance models primarily emphasize cognitive and utilitarian determinants, increasing attention has been directed toward underlying motivational processes. Self-Determination Theory (SDT) provides a valuable framework for understanding how autonomous and controlled motivation shape attitudes and behaviours toward sustainable energy technologies. This systematic review synthesizes empirical and theoretical research on the application of SDT in the context of social acceptance within this domain. Following PRISMA guidelines, studies published between January 2000 and April 2026 were identified through searches of Web of Science, Scopus, and Google Scholar, with 34 eligible studies included in the thematic analysis. The findings from many of the reviewed studies suggest that autonomous motivation, supported by the satisfaction of autonomy, competence, and relatedness needs, is associated with greater technology acceptance, trust, engagement, and long-term behavioural support. In contrast, controlled motivation is more often associated with resistance, weak internalisation, or short-term compliance. The review further highlights the important moderating role of contextual factors, including policy design, communication strategies, trust, and socio-cultural environments. By integrating SDT into sustainable technology acceptance research, this review advances motivation-based perspectives on sustainability transitions and provides practical implications for policymakers, technology developers, and communication practitioners seeking to foster enduring public engagement with sustainable innovations. Full article

The University Student Engagement Inventory (USEI) is a multidimensional self-report instrument designed to assess student engagement in higher education through three interrelated dimensions: behavioral, emotional, and cognitive engagement. Developed within a hierarchical framework, the USEI provides both dimension-specific scores and an overall indicator of student engagement, supporting research, institutional assessment, and educational quality evaluation across diverse cultural and educational contexts. Student engagement is widely recognized as a key determinant of academic success, persistence, and educational quality in higher education. The University Student Engagement Inventory (USEI) was developed to provide a theoretically grounded and psychometrically sound measure of engagement that captures students’ behavioral, emotional, and cognitive involvement in learning activities. This encyclopedia entry reviews the conceptual foundations, development process, factorial structure, psychometric properties, and applications of the USEI. Evidence from multiple studies indicates that the instrument exhibits satisfactory reliability, construct validity, predictive validity, and measurement invariance across different countries, languages, and educational settings. The USEI has been translated and adapted for use in diverse cultural contexts and has been employed extensively in research examining academic performance, well-being, persistence, and learning environments, including online and blended education. Its brevity, multidimensional structure, and cross-cultural validation have supported its use in educational research and institutional assessment. Overall, the USEI represents a robust and versatile instrument for evaluating student engagement and supporting evidence-based improvements in higher education. Full article

A number of studies have examined the acute effects of shinrin-yoku (forest bathing), or forest walking; however, only a limited number of epidemiological studies have examined the association between habitual forest walking and daily health. The aim of this study was to examine the association of daily happiness, the Japanese concept of ikigai, and enjoyment of daily life with the frequency of forest walking. We used data from the secondary survey of the Japan Multi-Institutional Collaborative Cohort (J-MICC) Daiko study for this cross-sectional study. A total of 3472 participants (2518 women) were included in the analysis. Logistic regression analysis showed that the aORs for frequency of feeling happy, degree of happiness, ikigai, and daily life enjoyment were 1.72 (95% confidence interval [CI]: 1.29–2.28), 1.54 (95% CI: 1.14–2.09), 1.65 (95% CI: 1.25–2.20), and 2.38 (95% CI: 1.60–3.35), respectively, for those who reported going for forest walks at least once per month when those who reported rarely engaging in this practice served as the reference. This study found that the frequency of forest walking was associated with daily happiness, ikigai, and enjoyment of daily life, suggesting that occasional forest bathing may lead to improved well-being and quality of life. Full article

Backgrond/Objectives: Human anatomy education has traditionally relied on cadaveric dissection as the reference standard for acquiring anatomical knowledge. However, decreasing availability of donated bodies, curricular changes, and rapid technological advances have encouraged the progressive integration of complementary educational resources, including historical anatomical collections, physical models, plastinated specimens, and digital technologies. At the same time, anatomical museums have evolved from repositories of scientific heritage into dynamic educational environments that promote public engagement, accessibility, and lifelong learning. Methods: This article presents the educational experience of the Human Anatomy and Histology Institute of the University of Palermo, where historical anatomical collections, cadaveric dissection, plastination, three-dimensional (3D) digitization, virtual anatomy, and interactive educational technologies have been integrated within a single multimodal teaching framework. Results: The strengths and limitations of each educational resource are discussed in relation to contemporary anatomy education and museum communication. Our experience suggests that digital technologies achieve their greatest educational value when they complement rather than replace traditional anatomy teaching. Conclusions: Integrating historical collections with cadaveric study, physical models, and immersive digital tools offers a comprehensive educational approach capable of enhancing anatomical understanding, improving accessibility, and promoting more engaging learning experiences for students and the wider public. Full article

The regular practice of physical exercise is often associated with promoting benefits for practitioners. In recent decades, street running has become popular worldwide, with most participants being recreational runners who engage in the activity primarily to promote health, well-being, leisure, and quality of life, although some also participate with competitive goals. Among the psychological aspects related to exercise, studies have shown that some individuals may become susceptible to “exercise dependence,” a condition in which exercise takes a central role in a person’s life. As a result, individuals may exhibit characteristics such as excessive training, injuries; weight control issues, withdrawal symptoms when unable to exercise and even problems in social relationships when exercise is exclusively prioritized. Background/Objectives: The aim of this study was to investigate and analyze levels of susceptibility to running dependence and its relationship with exercise volume and mood states (tension, depression, anger, vigor, fatigue, and mental confusion). Methods: This was a quantitative cross-sectional study involving 761 regular Brazilian runners (59.8% male and 40.2% female) who consented to participate and answered the Sociodemographic Questionnaire, the Escala de Dependência de Corrida (EDC), a Brazilian Portuguese adaptation of the Negative Addiction Scale (NAS), and the Brunel Mood Scale (BRUMS). The analysis plan was conducted through descriptive statistics (mean, standard deviation, median, 1st and 3rd quartiles, interquartile range, and 95% confidence intervals) and inferential statistics (Spearman’s Correlation and Kruskal–Wallis Test). In all tests, the significance level adopted was p < 0.05. Results: The sample was divided into three groups of susceptibility to exercise dependence: low (37.6%), moderate (36.4%), and high (26%). Scores indicative of greater susceptibility to exercise dependence showed positive correlations with running practice volume (years of experience, weekly training frequency, weekly training duration, and weekly mileage), as well as with vigor. Although a statistically significant correlation was also observed for tension, its magnitude was trivial (rs = 0.080). Comparisons using the Kruskal–Wallis test showed that higher susceptibility levels were associated with greater running volumes and higher raw vigor scores, whereas no significant group differences were observed for the remaining mood states. Conclusions: Higher susceptibility to exercise dependence was associated with greater running volume and higher raw vigor scores. No consistent associations were observed with negative mood states, except for a trivial correlation with tension. These findings suggest that greater susceptibility to exercise dependence among runners was primarily associated with higher raw vigor scores rather than with broader alterations in mood states. Full article

Background: This research explored how psychological capital (PsyCap) is associated with innovative work behavior (IWB) through the serial mediation of career adaptability (CA) and work engagement (WE) among Pakistani healthcare practitioners. The study was grounded in the Career Construction Model of Adaptation (CCMA). Methods: Data were collected from 355 healthcare practitioners. Model 6 of the PROCESS macro with bias-corrected bootstrapping was used to examine the proposed serial mediation model while controlling for the effects of gender, age, tenure, and professional category. Results: The total indirect effect through both serial mediators was statistically significant, suggesting that CA and WE help explain how PsyCap is associated with IWB. In line with the CCMA, the findings support a sequential pattern of associations whereby psychological resources (adaptive readiness) are associated with adaptable career functioning (adaptability resources), which in turn is linked with motivational engagement at work (adapting responses), and this state of engagement is subsequently associated with innovation-oriented actions (adaptation results). Conclusions: This study applies and extends the CCMA by examining its adaptation process in the healthcare sector, as well as conceptualizing WE as an adapting response and IWB as a behavioral adaptation outcome. The findings provide practical insights by highlighting the potential value of targeted interventions that strengthen PsyCap, CA, and WE to support IWB while also fostering the career adaptation process in healthcare organizations. Full article

Background: This study aimed to investigate whether individuals with trichotillomania (TTM) are at a higher risk of engaging in self-harm behaviors compared to those without TTM. Methods: In this matched cohort study, we analyzed electronic health records of all patients admitted to public hospitals in Hong Kong from 1 January 1993 to 31 December 2022. We identified a TTM cohort of 285 patients and a comparison cohort of 285 individuals. All participants were followed up until they received a diagnosis of self-harm, died from other causes, or until the end of 2023, whichever came first. To assess the risk of self-harm following TTM onset, Cox proportional hazards regression models were applied. Results: Throughout the 30-year study period, the number of individuals who exhibited self-harm behavior in the TTM and comparison groups was 8 (2.8%) and 8 (2.8%), respectively. The TTM and comparison groups had similar proportions of subjects who inflicted self-harm (χ² = 0.00, p = 0.977). The incidence of self-harm was 26.00 and 26.92 per 10,000 person-years in the TTM and comparison groups, respectively. Compared with the comparison group, the adjusted hazard ratio for self-harm in the TTM group was 1.44 (95% confidence interval, 0.45–4.61). Conclusions: TTM is not associated with an increased risk of self-harm. Future research is necessary to replicate our findings and more fully elucidate the potential unique risk factors for self-harm in these patients. Full article

Micro-credentials have attracted intense scholarly and policy attention, yet recent practitioner evidence, most notably the 2026 UPCEA survey of US institutions, the catalyst for this review, suggests that institutional commitment has plateaued even as individual engagement deepens. This hybrid review examines whether the peer-reviewed literature can account for that pattern. Sixty-five peer-reviewed studies (2020–2026) and eight major practitioner and policy reports were coded against an identical six-dimension framework spanning adoption, purposes, integration mechanisms, enabling conditions, barriers, and evidence of value. The two evidence streams proved strikingly complementary—and strikingly disconnected. The scholarly literature richly documents purposes, enabling conditions, and barriers, but measures adoption rarely, examines integration mostly in proposal rather than operation, and contains no direct study of the plateau; systematic adoption evidence resides almost entirely in practitioner reporting. Across both streams, recognition emerges as the binding constraint: employers, learners, and quality-assurance systems consistently condition the value of micro-credentials on the credit-bearing integration that most institutions have approached only tentatively. The review concludes that micro-credential value is conferred by institutional integration rather than intrinsic to the credentiaand proposes a research agenda centred on longitudinal adoption trajectories, verified outcomes, and integration observed in practice. Full article