Search Results (944)

Background/Objectives: Energy availability (EA), defined as the dietary energy remaining after exercise energy expenditure (EEE), is a central determinant of both health and performance in athletes. Chronic insufficient EA leads to low energy availability (LEA), which is an underlying mechanism of Relative Energy Deficiency in Sport (REDs). This narrative review critically explores the conceptual evolution of EA and LEA, summarizes current physiological evidence, and discusses methodological and practical challenges in their assessment and application in free-living athletes. Methods: Evidence from experimental and observational studies was reviewed to describe the hormonal, metabolic, and performance outcomes associated with LEA. Screening tools, including the Low Energy Availability in Females Questionnaire (LEAF-Q) and the Low Energy Availability in Males Questionnaire (LEAM-Q), were also evaluated for their validity and applicability in different sports contexts. Results: LEA is associated with alterations in thyroid and reproductive hormones, which, in turn, contribute to reduced resting metabolic rate, lower bone mineral density, and delayed recovery. While screening questionnaires can help identify athletes at risk, their accuracy varies by sport and individual characteristics. Incorporating hormonal and metabolic biomarkers provides a more direct and sensitive method for detecting physiological stress. Measuring dietary intake, EEE, endocrine balance and body composition in real-world settings remains a major methodological challenge. Combining hormonal, metabolic, and behavioral indicators may improve the identification of athletes experiencing LEA. Conclusions: EA plays a central role in the interaction between nutrition, exercise, and athlete health, but methodological limitations in its assessment may compromise accurate diagnosis. Improving measurement techniques and adopting integrated monitoring strategies are essential to improve early detection, guide individualized nutrition, and prevent RED-related health and performance impairments. Full article

Background: The acceptance of new vaccines under uncertainty—such as during the COVID-19 pandemic—poses a major public health challenge because efficacy and safety information is still evolving. Methods: We propose an integrative analytical framework that combines a theory-based model of vaccine acceptance—the cognitive–affective–normative (CAN) model—with machine-learning techniques (decision tree regression, random forest, and Extreme Gradient Boosting) and SHapley Additive exPlanations (SHAP) integrated into an importance–performance map (IPM) to prioritize determinants of vaccination intention. Using survey data collected in Spain in September 2020 (N = 600), when the AstraZeneca vaccine had not yet been approved, we examine the roles of perceived efficacy (EF), fear of COVID-19 (FC), fear of the vaccine (FV), and social influence (SI). Results: EF and SI consistently emerged as the most influential determinants across modelling approaches. Ensemble learners (random forest and Extreme Gradient Boosting) achieved stronger out-of-sample predictive performance than the single decision tree, while decision tree regression provided an interpretable, rule-based representation of the main decision pathways. Exploiting the local nature of SHAP values, we also constructed SHAP-based IPMs for the full sample and for the low-acceptance segment, enhancing the policy relevance of the prioritization exercise. Conclusions: By combining theory-driven structural modelling with predictive and explainable machine learning, the proposed framework offers a transparent and replicable tool to support the design of vaccination communication strategies and can be transferred to other settings involving emerging health technologies. Full article

The global shipping industry is surging ahead, and with it, a quiet revolution is taking place on the water: marine lithium-ion batteries have emerged as a crucial clean energy carrier, powering everything from ferries to container ships. When these vessels dock, they increasingly rely on shore power charging systems to refuel—essentially, plugging in instead of idling on diesel. But predicting how much power they will need is not straightforward. Think about it: different ships, varying battery sizes, mixed charging technologies, and unpredictable port stays all come into play, creating a load profile that is random, uneven, and often concentrated—a real headache for grid planners. So how do you forecast something so inherently variable? This study turned to the Monte Carlo method, a probabilistic technique that thrives on uncertainty. Instead of seeking a single fixed answer, the model embraces randomness, feeding in real-world data on supply modes, vessel types, battery capacity, and operational hours. Through repeated random sampling and load simulation, it builds up a realistic picture of potential charging demand. We ran the numbers for a simulated fleet of 400 vessels, and the results speak for themselves: load factors landed at 0.35 for conventional AC shore power, 0.39 for high-voltage DC, 0.33 for renewable-based systems, 0.64 for smart microgrids, and 0.76 when energy storage joined the mix. Notice how storage and microgrids really smooth things out? What does this mean in practice? Well, it turns out that Monte Carlo is not just academically elegant, it is practically useful. By quantifying uncertainty and delivering load factors within confidence intervals, the method offers port operators something precious: a data-backed foundation for decision-making. Whether it is sizing infrastructure, designing tariff incentives, or weighing the grid impact of different shore power setups, this approach adds clarity. In the bigger picture, that kind of insight matters. As ports worldwide strive to support cleaner shipping and align with climate goals—China’s “dual carbon” ambition being a case in point—achieving a reliable handle on charging demand is not just technical; it is strategic. Here, probabilistic modeling shifts from a simulation exercise to a tangible tool for greener, more resilient port energy management. Full article

Background: Several studies have investigated the importance of physical exercise (PE) in overweight and obese populations; however, to date, no bibliometric study has analyzed research trends in high-intensity interval training (HIIT) in overweight and obese populations across the entire life course. Objective: To analyze the scientific output of HIIT trends in overweight and obese populations. Method: Theoretical study using bibliometrics as a research technique. A total of 282 studies were identified in the Web of Science and PubMed databases for analysis with VOSViewer software 1.6.20. The equation used was (“High-intensity interval training” OR HIIT) AND (overweight OR obesity OR “risk factors” OR “obesity risk”). Results: The year 2022 was the most productive year (n = 46). Most of the documents are research articles (81%), followed by review articles (15%). Most studies do not specify the characteristics of the sample, only mentioning the application of a HIIT program in overweight or obese individuals in (65.6%) of the total articles found. There is low scientific output in research focused on women (23.4%). The most frequently occurring words were “exercise” (n = 145), “obesity” (n = 131), “high-intensity interval training” (n = 81), “overweight” (n = 78), “physical activity” (n = 73), “body composition” (n = 46), “weight loss” (n = 45), “health” (n = 42), and “cardiorespiratory fitness” (n = 40). Conclusions: Scientific research has advanced the understanding of the impact of HIIT in relation to excess weight, with total fat reduction being one of the most frequently reported variables and no differences observed between sexes. HIIT has shown benefits in populations with overweight and obesity when compared with low-intensity training programs. Full article

Background/Objectives: Birth preparedness and complication readiness (BPCR) is a cornerstone of maternal health strategies designed to minimize the “three delays” in seeking, reaching, and receiving skilled care. In Ethiopia, uptake of BPCR remains insufficient, and little evidence exists on how individual- and community-level factors interact to shape preparedness. This study assessed the determinants of BPCR among women of reproductive age in Hawela Lida district, Sidama Region. Methods: A community-based cross-sectional study was conducted among 3540 women using a multistage sampling technique. Data were analyzed with multilevel mixed-effect negative binomial regression to account for clustering at the community level. Adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs) were reported to identify determinants of BPCR. Model fitness was assessed using Akaike’s Information Criterion (AIC), the Bayesian Information Criterion (BIC), and log-likelihood statistics. Results: At the individual level, women employed in government positions had over three times higher expected BPCR scores compared with farmers (AIRR = 3.11; 95% CI: 1.89–5.77). Women with planned pregnancies demonstrated higher BPCR preparedness (AIRR = 1.66; 95% CI: 1.15–3.22), as did those who participated in model family training (AIRR = 2.53; 95% CI: 1.76–4.99) and women exercising decision-making autonomy (AIRR = 2.34; 95% CI: 1.97–5.93). At the community level, residing in urban areas (AIRR = 2.78; 95% CI: 1.81–4.77) and in communities with higher women’s literacy (AIRR = 4.92; 95% CI: 2.32–8.48) was associated with higher expected BPCR scores. These findings indicate that both personal empowerment and supportive community contexts play pivotal roles in enhancing maternal birth preparedness and readiness for potential complications. Random-effects analysis showed that 19.4% of the variance in BPCR was attributable to kebele-level clustering (ICC = 0.194). The final multilevel model demonstrated superior fit (AIC = 2915.15, BIC = 3003.33, log-likelihood = −1402.44). Conclusions: Both individual- and community-level factors strongly influence BPCR practice in southern Ethiopia. Interventions should prioritize women’s empowerment and pregnancy planning, scale-up of model family training, and address structural barriers such as rural access and community literacy gaps. Targeted, multilevel strategies are essential to accelerate progress toward improving maternal preparedness and reducing maternal morbidity and mortality. Full article

Internal Boxing (neijiaquan 內家拳) is an advanced form of the Daoist gymnastic exercise of daoyin (導引). However, how it achieves a paradigmatic shift from qi/blood regulation to deep-level transmutation of sexual energy still requires further exploration. Therefore, it is of great significance to look into how Internal Boxing inheres and integrates various techniques of “desire transmutation” (zhuanyu 轉欲) from internal alchemy (neidan 內丹), thereby transcending traditional daoyin, bringing about a significant systematic reconfiguration in the model of body cultivation practices in Daoist medicine. The traditional daoyin (i.e., “guiding and stretching”) practice emphasizes the regulation of qi/blood, but it remains limited in accounting for and producing the self-conscious transmutation of sexual energy. In contrast, Internal alchemy provides a different system of theory and techniques, which is centered on the concept of “transmutation of desires”, converting human desires into high-level life energy through a process of interaction between one’s internal spirit (xinshen 心神) and internal breathing (neixi 內息). This study thus examines the ways in which Internal Boxing integrates and reconfigures these techniques within its bodily training regimen. In the core of all these styles is the goal to refine the primordial essence (yuanjing 元精) by transitioning the method to induce the flow of vital energy from breathing to somatic movements. As a result, this study shows that the innovations of Internal Boxing reconfigure the qi/blood regulation model in the traditional daoyin practice, causing a systematic reconfiguration in the transmutation of sexual energy and, further, bridging the gap between daoyin and internal alchemy in both theory and practice. Furthermore, such innovations also develop a holistic view of the human body as marked by an emphasis on the “unity of pre-heaven (xiantian 先天) and post-heaven (houtian 後天) states”, which expands in both depth and breadth the theories of body cultivation practices in Daoist medicine. Full article

Background/Objectives: The diagnosis and risk stratification of valvular heart disease have traditionally relied on resting echocardiography. However, in a significant portion of patients, resting findings do not fully reflect the hemodynamic severity of the condition, particularly in asymptomatic individuals with severe valvular disease or those with nonspecific symptoms. In this context, stress echocardiography emerges as a vital imaging modality, providing a dynamic assessment of valvular, ventricular, and pulmonary function under hemodynamic load (from physical exercise or pharmacological agents). Methods: We conducted a comprehensive synthesis and critical evaluation of the current landscape, recent advancements, and future directions regarding the application of stress echocardiography in valvular heart disease. Results: This comprehensive review explores the incremental role of stress echocardiography in valvular heart disease, analyzing the evolution of its clinical applications, from low-flow, low-gradient aortic stenosis to the evaluation of contractile reserve and exercise-induced pulmonary hypertension in mitral stenosis and regurgitation. We discuss standardized protocols, key parameters to monitor, and the diagnostic and prognostic outcomes from major clinical trials and current guidelines. Attention is given to stress echocardiography’s ability to unmask the true severity of the disease and to identify patients at high risk for adverse events, thereby guiding crucial clinical decisions, such as the optimal timing for surgical or transcatheter intervention. Conclusions: The review evaluates the limitations of modality and outlines future research directions, including its integration with new technologies like 3D echocardiography and speckle tracking techniques, to further optimize the role of stress echocardiography as a decision-making tool in the multidisciplinary management of valvular heart disease. Full article

Background: The subacromial space, measured as the acromiohumeral distance (AHD), is a key determinant of shoulder biomechanics and injury risk. Athletes performing repetitive upper-limb resistance training are particularly exposed to cumulative tendon stress. Musculoskeletal ultrasound (US) enables dynamic, cost-effective assessment, yet its role in strength athletes remains underexplored. The aim of this study was to determine whether young adults engaged in regular upper-limb weight training present a narrower acromiohumeral distance and a higher prevalence of ultrasound-detected tendon abnormalities compared with non-weight-training individuals. Methods: We conducted a post hoc subanalysis of a cross-sectional cohort of 66 young adults (18–45 years; mean 29.6 ± 9.0 years; 27 men/39 women) evaluated with standardized shoulder US. Participants were classified as weight-training (n = 15; 36.2 ± 5.7 years; 11 men/4 women) or non-weight-training (n = 51; 27.6 ± 8.8 years; 16 men/35 women). AHD was measured in millimeters, and abnormalities of the supraspinatus, subscapularis, long head of the biceps tendon (LHBT), and subacromial–subdeltoid bursa were recorded. Between-group comparisons used Welch’s t-test or χ²/Fisher’s exact test; effect sizes were expressed as Cohen’s d or odds ratios (OR). Multiple testing was corrected with the false discovery rate (FDR). Results: Weight-training participants exhibited a significantly smaller AHD (7.13 ± 0.54 vs. 7.49 ± 0.68 mm; t (28) = −2.12, p = 0.038; mean difference −0.36 mm, 95% CI −0.70 to −0.03; Cohen’s d = −0.56). Supraspinatus tendinopathy was more prevalent in weight-training athletes (93.3% vs. 41.2%; OR 17.7, 95% CI 2.16–145.8; FDR-adjusted p = 0.003). Subscapularis tendinitis (40.0% vs. 17.6%; OR 3.58, 95% CI 1.00–12.88; FDR p = 0.14) and LHBT tenosynovitis (20.0% vs. 3.9%; OR 6.82, 95% CI 1.02–45.8; FDR p = 0.09) showed non-significant trends. Conclusions: Upper-limb weight training in young adults is associated with reduced AHD and a markedly higher prevalence of supraspinatus tendinopathy. Ultrasound proved valuable for early detection of structural and morphological alterations in shoulder soft tissues. Preventive strategies focusing on load management, exercise technique, and targeted strengthening should be prioritized. Full article

This article undertakes a cross-cultural comparative inquiry into the motif of “women’s weaving” in medieval Daoism and Christianity. Although the two traditions developed with minimal historical contact, both elevate women’s textile labor into a central metaphor for cosmogenesis, sacred order, and individual salvation. Nevertheless, their hermeneutic trajectories diverge in essential ways. Working within a tripartite analytical framework (intellectual roots, artistic images, ritual practices) to argue that Daoism interprets “women’s weaving” as a proactive technique of transformation and nurture, based on a cosmology of immanent huasheng lun. In this reading, the image is affiliated with the cosmic creativity of nüxian, the inner transformation of their body, and the autonomous pursuit of transcendence. By contrast, within Christianity’s transcendent theological horizon of creatio ex nihilo, “women’s weaving” is configured primarily as an ethical discipline of responsive obedience, closely tied to the mystery of the Incarnation, the imitatio Dei, and communal spiritual exercises and charity under monasticism. The cross-cultural resonance of this motif, I contend, is grounded in the “men’s ploughing and women’s weaving” economic formation, patriarchal gender order, and shared symbolic cognition; its decisive bifurcation arises from contrasting deep cultural structures—namely, cosmology, conceptions of the body, soteriology, and church–state arrangements. Through this micro-case, the article further argues that the sacralization of secular gender roles constitutes an agentic cultural choice, one that indexes distinct civilizational pathways in understanding creation, nature, the body, and freedom. Full article

Background/Objectives: Alzheimer’s disease (AD) has a prolonged preclinical phase and marked heterogeneity. Brain age and the Brain Age Gap (BAG), derived from neuroimaging and machine learning (ML), offer a non-invasive, system-level indicator of brain integrity, with potential relevance for early detection, risk stratification, and intervention monitoring. This review summarizes the conceptual basis, imaging characteristics, biological relevance, and explores its potential clinical utility of BAG across the AD continuum. Methods: We conducted a narrative synthesis of evidence from morphometric structural magnetic resonance imaging (sMRI), connectivity-based functional magnetic resonance imaging (fMRI), positron emission tomography (PET), and diffusion tensor imaging (DTI), alongside recent advances in deep learning architectures and multimodal fusion techniques. We further examined associations between BAG and the Amyloid/Tau/Neurodegeneration (A/T/N) framework, neuroinflammation, cognitive reserve, and lifestyle interventions. Results: BAG may reflect neurodegeneration associated with AD, showing greater deviations in individuals with mild cognitive impairment (MCI) and early AD, and is correlated with tau pathology, neuroinflammation, and metabolic or functional network dysregulation. Multimodal and deep learning approaches enhance the sensitivity of BAG to disease-related deviations. Longitudinal BAG changes outperform static BAG in forecasting cognitive decline, and lifestyle or exercise interventions can attenuate BAG acceleration. Conclusions: BAG emerges as a promising, dynamic, integrative, and modifiable complementary biomarker with the potential for assessing neurobiological resilience, disease staging, and personalized intervention monitoring in AD. While further standardization and large-scale validation are essential to support clinical translation, BAG provides a novel systems-level perspective on brain health across the AD continuum. Full article

Background: Population ageing and the growing prevalence of chronic diseases, particularly stroke, have negative repercussions on fine motor function, compromising the independence of older adults. The Specialist Nurse in Rehabilitation Nursing plays a central role in functional recovery and in improving quality of life. This study aims to describe the process of developing and validating the design of rehabilitation nursing care for older adults with impaired fine motor function. Methods: This paper is a three-phase methodological study conducted between January and July 2025: (1) initial development of the design of rehabilitation nursing care for older adults with impaired fine motor function; (2) validation of the content of the proposed design, using the modified e-Delphi technique; and (3) development of the final model of the care design. Results: The e-Delphi study, involving a panel of 15 experts, allowed the content validation of the design of rehabilitation nursing care for older adults with impaired fine motor function after two rounds. Following the suggestions, the final care design model, in relation to fine motor function, comprises five steps: (1) collection of relevant data, (2) identification of possible nursing diagnoses, (3) definition of objectives, (4) planning and implementation of interventions, and (5) evaluation of outcomes. As part of step 4, photographic records of exercises focused on the recovery of fine motor function were included. Conclusions: The final model of the design of rehabilitation nursing care for older adults with impaired fine motor function, developed and validated in this study, may serve as a guiding framework in the delivery of specialised care to this population. Full article

Balloon pulmonary angioplasty (BPA) has become an established treatment modality for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH), particularly in those with distal pulmonary artery lesions or significant comorbidities precluding pulmonary endarterectomy. BPA provides significant improvement in pulmonary hemodynamics, right ventricular function, exercise tolerance, and quality of life. Recent randomized controlled trials, including the RACE and MR-BPA trials, have demonstrated that BPA results in greater reduction in pulmonary vascular resistance and mean pulmonary arterial pressure compared to riociguat, although with a higher incidence of procedure-related complications. Ancillary follow-up data further suggest that a sequential strategy combining medical therapy and BPA may optimize outcomes and reduce adverse events. Advances in procedural techniques, imaging guidance, and patient selection have substantially improved the safety profile of BPA. International registries and expert consensus guidelines now support its incorporation into the multimodal management of CTEPH. This review synthesizes current evidence on the efficacy, safety, and practical aspects of BPA, while highlighting ongoing challenges, including long-term outcome data, standardization of treatment endpoints, and the role of combination therapy. BPA is poised to play an increasingly central role in personalized care strategies for CTEPH. Full article

Background: Abdominal wall hernias represent a significant global surgical burden, with over 20 million repairs performed annually. The convergence of rising obesity and diabetes rates with complex hernia management has necessitated innovative preoperative optimization strategies that address both metabolic dysfunction and mechanical challenges. Objectives: This comprehensive review synthesizes current evidence on emerging pharmacologic and procedural optimization strategies for patients undergoing abdominal wall hernia repair, with particular emphasis on glucagon-like peptide-1 (GLP-1) receptor agonists, botulinum toxin A (BTA) injections, progressive preoperative pneumoperitoneum (PPP) and biomechanical calculated repair. Methods: We conducted an extensive literature review incorporating recent clinical trials, observational studies, and meta-analyses, focusing on metabolic optimization with GLP-1 receptor agonists, mechanical preparation techniques, and their comparative effectiveness in reducing perioperative complications and hernia recurrence. Results: GLP-1 and GLP-1/GIP agonists demonstrate substantial metabolic benefits including weight reduction (10–20%), improved glycemic control, reduced systemic inflammation, and decreased postoperative complications in surgical populations. Recent evidence suggests reduced surgical site infection, thromboembolic events, and wound dehiscence in GLP-1 receptor agonists users. However, concerns regarding delayed gastric emptying and aspiration risk require careful perioperative management. BTA and PPP remain valuable techniques for mechanical optimization in loss-of-domain hernias, though modern biomechanically calculated repair (BCR) approaches using cyclic load analysis may reduce their necessity in many cases. The GRIP/CRIP concept demonstrates superior outcomes with 5–7% five-year recurrence rates compared to 15% with conventional approaches. Emerging evidence highlights collagen metabolism dysfunction as a fundamental determinant of hernia recurrence, prompting development of collagen-focused prehabilitation programs incorporating nutritional supplementation, aquatic exercise, and targeted physical conditioning. Conclusions: A paradigm shift toward integrated, personalized preoperative optimization is emerging, combining metabolic conditioning with mechanical preparation based on individual patient phenotypes and hernia complexity. Future research should focus on comparative effectiveness trials, optimal timing protocols, and multimodal strategies to maximize surgical outcomes while minimizing complications. Full article

Several major studies require that students understand and master the concepts and procedures of mathematics. More specifically, an area of mathematics such as algebra requires students to be able to simplify, operate with, or solve fractions. Many students entering university show numerous shortcomings and errors, especially when simplifying algebraic fractions. This is why we conducted a study using eye-tracking techniques to better understand how students process these types of exercises in attentional terms, comparing students who can handle them successfully against those who show errors in their procedures. For this purpose, we evaluated the eye movements of 64 students from different university majors to characterize the attentional–visual strategies they use to simplify four different algebraic fraction exercises. We found that each type of simplification exercise needs a specific strategy where some parts of the rational algebraic expressions are cognitively relevant. Students with correct answers tend to allocate attention to these elements. Students with incorrect answers tend to find similar expressions with the intention to cancel them out, without applying any metacognitive thinking. The rational algebraic expression needs to be taught in a more conceptual manner than procedural. Full article

Background: Foam rolling has become an increasingly popular self-myofascial release (SMR) technique among athletes to prevent injuries, improve recovery, and increase athletic performance. This study investigated how SMR improves mechanical and movement efficiency in recreational road cyclists. Methods: We conducted an exploratory randomized controlled trial (RCT) to investigate the effects of SMR using a foam roller on biomechanical and physiological performance parameters over a six-month period. A total of 32 male participants, aged 26–57 years, with a mean Body Mass Index (BMI) of 24.0 kg/m² (SD = 2.2), were randomly assigned to either an intervention group (n = 16), which incorporated a standardized SMR program into their post-exercise recovery, or a control group (n = 16), which followed the same cycling protocol without SMR. The training program included heart rate-controlled strength endurance intervals. As the primary target, the variables we investigated included torque effectiveness, leg force symmetry, and pedal smoothness. Secondary measurements included submaximal oxygen uptake (VO₂) as well as bioelectrical variables, which we analyzed using classic, repeated-measures ANOVA models and descriptive statistical methods. Results: The analysis revealed significant interaction effects in favor of the intervention group for torque effectiveness (η²_p = 0.434), leg strength symmetry (η²_p = 0.303), and pedal smoothness (η²_p = 0.993). No significant group × time interactions were found for submaximal VO₂ or bioelectrical parameters. Conclusions: Our findings indicate that foam rolling may serve as an effective adjunct to endurance training by enhancing functional neuromuscular performance in cyclists, particularly in torque control and pedal coordination. Its impact on aerobic efficiency and muscle composition appears to be minimal. The results support theoretical models that attribute SMR benefits to proprioceptive, circulatory, and neuromuscular mechanisms rather than structural tissue adaptations. Full article