Search Results (37,854)

Background: Psychosis is a common neuropsychiatric symptom associated with Parkinson’s disease (PD), with prevalence rates of up to 75% over the course of the disease. Parkinson’s disease psychosis (PDP) is associated with increased morbidity, caregiver burden, depression, poorer quality of life and progression of dementia. It has also been shown to be a strong predictive factor for long-term care placement, and results in up to 71% increase in risk of mortality compared with PD patients free from psychotic symptoms. Use of APs for PDP is common, with up to 35% of PD patients prescribed at least one AP within 7 years of PD diagnosis. Methods: Four electronic databases (Ovid MEDLINE, Embase, PsycINFO, PubMed) were systematically searched for double-blind, randomised, placebo-controlled clinical trials for the use of APs in the treatment of PDP and their effects on PD motor symptoms, according to PRISMA guidelines. Results: Eleven studies from ten publications were identified and included in this review. Four studies investigated quetiapine, three investigated olanzapine, two investigated clozapine and a further two investigated pimavanserin. Quetiapine showed no significant improvement for PDP over placebo in three of the four studies, with both olanzapine studies also showing no improvement. Olanzapine studies also showed significant motor worsening compared to placebo. Clozapine significantly improved psychosis compared with placebo in both studies, with large effect sizes in primary outcome measures; (−0.82, 95% CI −1.37 to −0.26), −0.89 (95% CI −1.42 to −0.36). Pimavanserin also showed significant improvement (−0.48, 95% CI −0.77 to −0.18). Quetiapine, clozapine and pimavanserin showed no significant worsening in motor scores compared with placebo groups. Conclusions: Data from the studies included in this review suggest that the use of quetiapine for the management of PDP may not be evidence based. Clozapine may improve PDP symptoms with low doses however significant side-effects may limit usability. The findings from this review support the use of clozapine as an alternative AP for the management of PDP when clinically appropriate. Full article

The heart’s electromagnetic field (HEMF) represents the strongest magnetic signal in the human body and has been increasingly associated with processes related to the Heart–Brain Axis (HBA). The present review summarizes its biophysical basis along with current and emerging biosensing technologies. It examines hypotheses regarding interpersonal interactions and interactions with external fields, including geomagnetic activity, and reviews evidence linking the HEMF to autonomic activity and emotional states. It provides an overview of magnetic field-based therapeutics, introduced here as our own term “BioMagnetoTherapies” (BMT), underscoring their common objective of externally inducing, stabilizing or restoring coherence across the HBA. Collectively, it positions cardiac electromagnetic signals as both a measurable marker, key to HBA dynamics and related disorders, as well as a promising target for emerging biosensor- and BioMagneto-Therapeutics. Full article

Background: This paper is a systematic review of 100 peer-reviewed articles (2015–2025) related to artificial intelligence (AI) applications in the auditing field, and includes machine learning, natural language processing, robotic process automation, and other AI methods. Purpose: The paper delves into the integration of these AI technologies into the audit workflow; empirical implications of these technologies on audit effectiveness; efficiency and quality; and technical, organizational, and regulatory obstacles that suggest more widespread adoption is still limited. Methods: Five large-scale databases and other sources were searched and selected using PRISMA; structured data were extracted, assessed in quality and narrative, and thematically analyzed. Results: The discussion indicates that machine learning-based anomaly detection and predictive analytics, document analysis through NLP, and automation through RPA are becoming part of planning, risk assessments, control tests, and substantive procedures/reporting, with improvements in detection capabilities, coverage and efficiency reported in various empirical and design science studies. The review also presents common architectural models of AI-enabled audit processes, including layered data and governance, model development and oversight, orchestration and automation, auditor-facing applications, and human-in-the-loop controls. Conclusions: The article proposes an AI-based audit workflow reference architecture and summarizes evidence on opportunities, threats, and implementation obstacles, highlighting gaps in longitudinal assessment, comparative evaluation of AI methods, and regulatory recommendations. The results have practical implications for auditors, standard-setters, and system designers seeking to revise the audit approach and regulations to enable AI-driven assurance. Full article

Background: Vitamin D has been associated with blood pressure across the life course in observational studies, although effect sizes are generally modest and findings are not fully consistent. We examined the association between serum 25-hydroxyvitamin D [25(OH)D] concentrations and multiple blood pressure indices in a community-based cohort of young adults. Methods: We conducted a cross-sectional analysis within the Young Taiwanese Adults (YOTA) cohort, restricting the sample to adults aged 18–45 years with complete serum 25(OH)D and blood pressure data. Serum 25(OH)D was modeled as a continuous variable and additionally examined using predefined concentration categories. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were assessed using standardized protocols. Multivariable linear regression models evaluated associations, with sequential adjustment for demographic, anthropometric, cardiometabolic, and lifestyle covariates. Restricted cubic spline models assessed potential nonlinearity. Results: Among 923 participants, higher serum 25(OH)D concentrations were modestly and linearly associated with lower SBP, DBP, and MAP after multivariable adjustment. Each 10 ng/mL increase in serum 25(OH)D was associated with a 1.07 mmHg lower SBP, a 1.19 mmHg lower DBP, and a 1.22 mmHg lower MAP. Associations remained consistent in sensitivity and subgroup analyses. Conclusions: In young adults, higher serum 25(OH)D concentrations were modestly associated with lower blood pressure indices. These findings confirm prior observational evidence of modest inverse associations between serum 25-hydroxyvitamin D concentrations and blood pressure and extend these observations to a relatively healthy young adult population. Prospective studies are required to clarify temporality and clinical relevance. Full article

This critical integrative review reassesses the lipid paradigm by systematically mapping 380 influential trials and cohort studies on cholesterol, saturated fats, and statins in relation to cardiovascular and cognitive outcomes. The evidence base reveals a nearly even split between studies supporting and challenging LDL-centric causality, alongside pervasive methodological flaws, including reliance on surrogate lipid markers, ecological inferences, residual confounding, and industry-related reporting biases. Trial-generation comparisons and structured risk-of-bias assessment (ROB 2, ROBINS-I) repeatedly show that substantial pharmacological LDL reductions do not consistently yield proportional reductions in myocardial infarction, stroke, or all-cause mortality. Integrating Mendelian randomization with clinical and metabolomic data, the review advances a Critical Window Hypothesis in which LDL is necessary but not sufficient for atherogenesis, exerting dominant causal influence during early and midlife plaque initiation, while inflammatory, oxidative, and hemodynamic factors become primary drivers in advanced disease. Metabolomic studies of extreme longevity and late-life cohorts demonstrate that bile acids, steroid metabolites, and low-glycemic metabolic profiles—not total cholesterol—better predict survival and cognitive preservation, and that higher LDL in the oldest-old often associates with lower mortality and dementia risk. These findings challenge universal LDL-centric policies and support lifestyle medicine strategies prioritizing systemic metabolic optimization over isolated cholesterol targets. Full article

Background/Objectives: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality worldwide. Electrolyte disturbances are common in this patient cohort, with serum chloride frequently elevated. Chloride dysregulation may be associated with poor neurological outcomes through mechanisms including paradoxical gamma amino butyric acid receptor excitation, cytotoxic edema, and ferroptosis. The aim of this review was to evaluate the relationship between serum chloride levels and outcomes in patients with TBI. Methods: A literature review was performed to identify all potential studies that reported on serum chloride levels and TBI. All study types and patient groups were included. Studies were included if they reported on serum chloride measurements as well as outcomes such as mortality, surgical intervention, intracranial pressure, and neurological/functional outcome scores in patients with TBI. References and citations were also reviewed. Results: A small number of mostly retrospective studies with modest patient numbers demonstrate an association between high chloride levels and increased mortality in patients with TBI, with this relationship persisting independent of hypernatremia. Recent large, randomized trials showed that balanced crystalloid solutions, despite lower chloride content, may be associated with worse outcomes in TBI patients compared to saline. No studies directly correlated chloride levels with intracranial pressure measurements. Chloride level rather than total chloride load appears more strongly associated with adverse outcomes, with non-hypertonic saline sources contributing substantially to chloride burden. Mechanistic evidence links chloride channel dysregulation to ferroptosis and cytotoxic edema, with sex-specific patterns of transporter expression. Conclusions: Limited available evidence suggests that hyperchloremia is independently associated with increased mortality in TBI though causality remains unestablished. The findings regarding balanced solutions challenge conventional fluid management assumptions and highlight the complexity of chloride’s role in TBI pathophysiology. The absence of studies directly correlating chloride with intracranial pressure represents a critical evidence gap. Future studies with larger patient numbers, prospective designs, and multimodal neuromonitoring should further define these relationships to inform evidence-based chloride management strategies. Full article

This article aims to analyze the impact of the energy sector on the economic security of European households over the period 2010–2023, addressing an important gap in the literature since there is no EU cross-country evidence linking energy dependence on non-EU countries to a multidimensional measure of household economic insecurity over a long-time span. To achieve our goal, the dependent variable considered was an aggregate index of economic insecurity developed in previous research and constructed based on three fundamental dimensions: basic needs of the household, household fragility, and the burden of unemployment. Subsequently, panel data regression analysis with fixed effects was performed (considering 23 EU countries and the time period 2010–2023). The results highlight how more energy dependency on third countries could lead to more economic insecurity for European households. The robustness tests confirmed the initial results and underlined structural differences between countries. The research demonstrates how the energy dependence of EU states on countries outside the EU could have serious repercussions on the long-term economic security of Europeans, but, at the same time, this can be counterbalanced by a possible shift towards domestic renewable energy sources. Based on these results, both our hypotheses were confirmed. Full article

Patients with end-stage liver disease (ESLD) and their caregivers experience extensive physical, psychological, and social burdens and needs for resources. However, empirical evidence on patients’ and caregivers’ specific reported use of resources to help manage ESLD is lacking. Understanding the type and helpfulness of resources used could strengthen clinical care to address individual needs for resources. Aim: To examine and compare resources patients and caregivers identified as being most helpful in managing ESLD in relation to resources they felt would be helpful. Methods: Patients with ESLD and their caregivers responded in writing to two open-ended questions as part of a survey: (1) What resources have you found most helpful in dealing with patient’s liver disease? and (2) What resources would be helpful in dealing with patient’s liver disease? Conventional content analysis was used to identify resource categories. Results: A total of 192 patients and 198 caregivers completed surveys. We identified two major resource domains—medical and non-medical—and five categories within each. Analysis revealed participant group- and disease severity-based differences in helpful resources. Conclusions: Proactively engaging patients and caregivers early in the course of illness to identify relevant resources that might facilitate ability to manage ESLD. An interprofessional care approach would facilitate efforts supporting financial, social, spiritual, emotional, and mental health needs. Future longitudinal research of unique resource needs along the disease trajectory may help to develop effective interventions. Full article

Protein misfolding and aggregation represent key pathological mechanisms in neurodegenerative and systemic amyloid disorders, yet disease-modifying therapeutic strategies remain limited. In recent years, plant-derived nanomaterials have attracted increasing attention as multifunctional platforms capable of interacting with misfolded proteins and modulating aggregation-related pathways. This review examines the evolution of research between 2015 and 2025 on plant-derived nanomaterials—including green-synthesized metallic nanoparticles, plant extracellular vesicles, and phytochemical-based nano-delivery systems—in the context of protein misfolding disorders. The available literature was analyzed to identify principal mechanisms of action, experimental models, and emerging therapeutic perspectives. Current evidence suggests that these nanomaterials may influence protein aggregation through direct molecular interactions, modulation of oxidative stress and neuroinflammatory responses, and enhancement of cellular protein clearance processes. However, the field remains characterized by methodological heterogeneity, limited standardization, and insufficient translational validation. By synthesizing recent developments, this review highlights key research trends, mechanistic gaps, and future directions necessary for advancing plant-derived nanomaterials toward biomedical applications targeting protein misfolding diseases. Full article

Background/Objectives: Proton therapy has emerged as an advanced radiotherapy modality due to its unique physical dose distribution and its distinct radiobiological properties. The finite range of protons in tissue enables highly conformal dose delivery with minimal exit dose, significantly reducing irradiation of surrounding normal tissues compared to photon-based radiotherapy. Beyond these physical advantages, proton beams exhibit a spatially varying linear energy transfer that increases toward the distal edge of the spread-out Bragg peak, leading to clustered and complex DNA damage that is more difficult for cancer cells to repair. Methods: This review integrates experimental, computational, and clinical evidence to examine how proton-induced DNA damage, relative biological effectiveness, oxygen effects, and non-targeted responses contribute to tumor control and normal tissue sparing. Results: Comparative analyses with photon intensity-modulated radiotherapy demonstrate consistent reductions in acute and late toxicities across multiple tumor sites, particularly in pediatric patients and in tumors located near critical organs. The review also discusses emerging technologies, including pencil beam scanning, image-guided and adaptive proton therapy, compact accelerator systems, and ultra-high dose rate FLASH proton therapy, which collectively aim to enhance treatment precision, biological effectiveness, and accessibility. Conclusions: Together, these developments support proton therapy as a rapidly evolving modality with significant potential to improve therapeutic outcomes in modern oncology. Full article

The use of appropriate learning strategies that accommodate working memory capacity is crucial for successful long-term learning. To our knowledge, there is little evidence in the literature showing which learning strategies STEM students use and their perceived effectiveness of these strategies. This paper addresses this gap by applying a mixed-methods design to gain insight into STEM students’ learning behaviour in terms of the use and perceived effectiveness of available learning strategies. Specifically, we collected quantitative scoping survey data, complemented by qualitative focus group data to gain a rich, holistic understanding of students’ perceptions and rationales for using learning strategies. Students rated content blocking and problem-solving attempts as more effective than interleaving and using worked examples, respectively. Students differentiated their use of different learning strategies, using more worked examples than problem-solving attempts and more rereading than retrieval practice. Additionally, the extent to which they used a strategy was positively correlated with their knowledge about its effectiveness. Our data also show that the use of both highly and moderately effective learning strategies positively predicted grades. The focus group findings highlighted the complexity of learning behaviour in that students used a variety of learning strategies, depending on their learning habits, the nature of their courses, their motivation and interests. Students evaluated the effectiveness of a strategy based on whether it improved their grades and by the combination of perceived and actual effort required to use it. Overall, STEM students have limited knowledge of learning strategies and ultimately need support to engage with their learning in an efficient and productive way. Full article

Cardiac telerehabilitation has become a promising alternative to traditional programmes for preventing acute coronary syndrome (ACS) in the secondary phase. However, current implementations are still reactive and standardised, lacking personalisation and flexibility in clinical settings. By integrating artificial intelligence (AI), it may be possible to overcome these limitations and provide intelligent, scalable, and patient-centred care. Methods: We conducted a structured literature review across PubMed, Scopus, the Cochrane Library, and Web of Science, targeting English-language studies published from January 2015 to May 2025. Inclusion criteria included adult populations with a history of ACS or high cardiovascular risk, assessing interventions based on AI, telerehabilitation, or their combination. Studies are needed to report clinical, functional, behavioural, or technological outcomes. A thematic narrative synthesis was utilised. Results: AI-enhanced telerehabilitation demonstrates potential advantages over conventional digital care in selected domains, including adaptive risk prediction, personalised exercise modulation, and adherence support. Several systems report real-time adjustment of exercise protocols, early dropout detection, and predictive analytics for rehospitalisation. AI integration may also contribute to personalised behavioural feedback and psychosocial monitoring. Nevertheless, the overall level of evidence remains preliminary and heterogeneous, with most AI-based interventions evaluated in pilot, feasibility, or modelling studies rather than large-scale randomized trials. Conclusions: The integration of AI into telerehabilitation represents a promising evolution in post-ACS care, shifting from predominantly reactive monitoring toward more adaptive and data-driven support models. While early-phase studies suggest feasibility and potential clinical benefit, robust multicentre randomized controlled trials and cost-effectiveness analyses are required before definitive conclusions regarding superiority or widespread implementation can be drawn. Full article

Ecotourism in protected areas creates a conservation paradox: tourism revenue funds protection, yet tourism infrastructure simultaneously degrades the wildlife it protects. We examined this paradox in white-faced capuchins (Cebus imitator) in Tortuguero National Park, comparing behaviour across a high-tourism accommodation site (2152 monthly guests) and a strictly regulated terrestrial trail. Using focal animal and sweep sampling methods, we recorded 477 behavioural units across 261 min, analysing locomotion, feeding, and agonistic behaviours through generalized linear models. Primates in accommodation areas exhibited significantly reduced high substrate use (p = 0.005), showed a trend toward increased anthropogenic food reliance (p = 0.070), and higher—but not statistically significant—rates of agonistic behaviours (p > 0.05). The negative correlation between natural foraging and active food supply (r = −0.31) is consistent with anthropogenic provisioning that may alter primate ecological functions. These findings demonstrate that effective conservation in tourism contexts requires integrated management addressing three interconnected challenges: (1) habituation to human presence, (2) food provisioning with cascading consequences, and (3) ecosystem-level degradation through altered primate functions. We recommend evidence-based interventions including secured waste management, enforcement of wildlife feeding prohibitions, and environmental education programs with community participation. Ecotourism sustainability requires managing human–wildlife interactions and integrating local stakeholder perspectives to preserve animal welfare and ecosystem functions essential for conservation. Full article

This review synthesizes recent progress in modern energy storage technologies and proposes a selection-oriented comparison for power-system stabilization. Technologies are grouped into electrochemical, mechanical, chemical, and thermal storage, and evaluated using harmonized criteria (power and energy capability, response time, round-trip efficiency, lifetime, cost proxies, and maturity level). A comparative dataset and use-case mapping are used to link technology characteristics to grid services, with emphasis on voltage support, operational durability, and waste-heat utilization. The analysis highlights pumped-storage hydropower as the most robust option for long-duration, high-capacity applications, while battery energy storage systems are best suited for fast ancillary services, provided that cycle life, safety, and system integration constraints are met. Finally, the review discusses current technology trends (e.g., LFP and sodium-ion deployment, solid-state development, and commercialization barriers for lithium-sulfur) and identifies evidence-based directions for future research and deployment. Full article

Homestay tourism is increasingly recognised as a pathway to sustainable tourism development, especially in community-based destinations. This study examines the roles of local community attitudes and environmental sustainability in shaping perceived value and tourist satisfaction within Nigerian homestay tourism. Using a cross-sectional survey design, data were collected from 386 homestay tourists across south-western Nigeria and analysed with Partial Least Squares Structural Equation Modelling (PLS-SEM). The results reveal that local community attitude significantly boosts tourists’ perceived value, while environmental sustainability positively influences both perceived value and tourist satisfaction. However, perceived value does not strongly predict tourist satisfaction, and the moderating effect of community attitude on the relationship between value and satisfaction appears weak. This study contributes to the literature by integrating and extending the Theory of Planned Behaviour (TPB) beyond behavioural intention, demonstrating its relevance to understanding the formation of value–satisfaction in community-based tourism. It also challenges dominant tourism assumptions by showing that perceived value may serve as a supporting rather than primary determinant of satisfaction in rural homestay settings. In practice, the findings suggest that homestay operators and policymakers should focus on environmental sustainability practices and on enhancing experiential service quality, rather than relying solely on value-for-money propositions. By providing context-specific evidence from sub-Saharan Africa, this study advances sustainable tourism scholarship and offers strategic insights for inclusive rural tourism development. Full article