Search Results (1,499)

Background: Sarcopenic obesity (SO) is a clinically relevant but often under-recognized condition in older adults. This study examined whether obesity severity and body fat distribution are associated with physical capacity, functional autonomy and health-related quality of life in a sex-specific manner. Methods: In this observational case–control study with cross-sectional assessments, 45 older obese adults (OB; 27 men and 18 women) and 40 non-obese (NOB) comparison participants (18 men and 22 women), aged 65–85 years, underwent anthropometric assessment, bioelectrical impedance analysis, geometric body shape indexing, physical performance testing, autonomy assessment, physical activity evaluation and health-related quality-of-life assessment. SO was classified using a study-specific operational application of the ESPEN/EASO framework based on excess adiposity, impaired muscle function, and BIA-derived skeletal muscle mass adjusted for body mass. Results: Using this operational framework, all participants in the OB group were classified as presenting an SO phenotype. OB men showed substantially greater visceral adipose tissue mass than OB women (+106.5%, ES: 1.27, large, p < 0.001) and a higher A body shape index-associated relative risk (+27.9%, ES: 0.82, large, p < 0.001). Conversely, OB women showed more severe mobility impairment than OB men, with lower performance in the 8-Foot Up-and-Go (−22.9%, ES: 0.66, medium, p < 0.001) and 6-Min Walk test (−23.4%, ES: 0.64, medium, p < 0.001) and slightly lower basic autonomy. Health-related quality of life was significantly reduced only in OB men (−10.8%, ES: 1.07, large, p < 0.001) than NOB. Conclusions: In this clinical sample, an operational SO phenotype was identified among older OB adults and exhibited divergent sex-specific profiles. Men showed a predominantly geometric visceral risk phenotype and poorer perceived health status, whereas women showed more pronounced impairment in mobility and basic functional autonomy. These findings support sex-differentiated, multidisciplinary rehabilitation strategies in older adults with obesity. Full article

In this study, the double-neutral (3P + 2N) configuration, considered a traditional solution for busbar systems subjected to overcurrent and thermal stresses under harmonic loads, and alternative cross-sectional expansion (from 6 mm × 55 mm to 6 mm × 65 mm) scenarios are investigated using a multidisciplinary approach. In this context, the electrical, electromagnetic, current density distributions, and magnetic flux densities (B_max) of the systems are modeled in the COMSOL Multiphysics® (AC/DC Module 6.2 version) environment; the obtained q″ (W/m³) loss maps were transferred to FLOEFD convective airflow (CFD) simulations as volumetric heat sources, and steady-state electro-thermal analyses were performed. Convergence tests were conducted with the BiCGStab solver to ensure numerical stability, solver convergence, and spatial grid independence, and high accuracy was obtained at a margin of error of 3.5222 × 10⁻⁴. The findings showed that the proximity effect, due to the close placement of the pair of neutral conductors at the 150 Hz harmonic frequency, increased the current density to 4.68 A/mm² and turned the neutral line into an additional heat source. In contrast, in the 4-conductor scheme where all conductor cross-sections were increased by 18.18%, the magnetic flux density at 150 Hz was suppressed from 27.21 mT to 23.50 mT, and the current density was distributed more homogeneously, optimizing the temperature rise limits (ΔT). Furthermore, the techno-economic cost analysis conducted revealed that, under premium scenarios for LME raw copper and processed bar copper, the application of increased cross-sectional area offered an optimization that was approximately 5.77% more economical per meter (approximately $36 USD for a standard 3 m length) compared to the double-neutral configuration. Consequently, it has been proven that in BTS designs, not only total harmonic distortion (THD) but also the triplen harmonic ratio, frequency-dependent AC resistance (R_ac) variations, and material mass–cost balance should be considered together. Full article

Tobacco use disorder (TUD) is a complex multifactorial condition resulting from the interplay between nicotine-induced neurobiological adaptations, behavioral and learning processes, environmental influences, and individual genetic susceptibility. Genetic research has progressively evolved from twin and family studies through candidate-gene approaches to large-scale genome-wide association studies (GWAS), substantially improving our understanding of the genetic architecture of tobacco use and nicotine dependence. This review summarizes the current evidence on the genetic basis of TUD, with particular emphasis on major biological pathways. We also discuss the limitations of early candidate-gene studies and the paradigm shift introduced by large GWAS and meta-analyses, and polygenic risk scores, which indicate that tobacco use and nicotine dependence have a highly polygenic and pleiotropic architecture. Finally, we review the potential clinical applications of genetic information in smoking-cessation treatment, while highlighting current limitations in clinical translation. In the future, it is clear that a multidisciplinary approach—combining genetics, clinical practice, and social sciences—will be necessary to transform tobacco use management into a precision-based model and reduce its impact on public health. Full article

Pancreatic neuroendocrine neoplasms (PanNENs) are a heterogeneous group of tumors characterized by variable biological behavior and frequent overexpression of somatostatin receptors, making them ideal candidates for theranostic approaches. Over the past two decades, advances in molecular imaging and peptide receptor radionuclide therapy (PRRT) have fundamentally transformed the diagnosis and management of advanced PanNENs, establishing nuclear medicine as a central component of precision oncology. This review provides a comprehensive overview of the evolving role of theranostics in PanNENs, with particular emphasis on recent developments in nuclear medicine and radiation-based precision medicine. We discuss the biological foundation of molecular imaging, current clinical evidence supporting PRRT, and emerging strategies for personalized radionuclide therapy based on quantitative imaging, patient selection, and individualized dosimetry. Furthermore, we highlight next-generation radiopharmaceuticals, including somatostatin receptor antagonists and α-emitting radionuclides, as well as novel diagnostic tracers that are expanding the scope of theranostic applications. The review also examines the growing impact of artificial intelligence, radiomics, and computational modeling in image analysis, treatment planning, and adaptive radionuclide therapy. Finally, we discuss future perspectives toward adaptive precision theranostics, in which molecular imaging, multi-omics integration, advanced dosimetry, and artificial intelligence converge to support dynamic, patient-specific treatment strategies. Continued technological innovation and multidisciplinary collaboration are expected to further establish theranostics as a cornerstone of personalized management for patients with PanNENs. Full article

Private-university new-campus construction involves complex interactions among owner decision-making, multidisciplinary design, construction coordination, regulatory requirements, and economic constraints, yet systematic frameworks for prioritizing design-management factors in this context remain limited. This study develops a case-informed hierarchical evaluation framework for design management in private-university campus construction using University A as an information-rich case. A structured literature search, an open-ended expert questionnaire survey, case evidence, and the Analytic Hierarchy Process (AHP) were integrated to identify, refine, and prioritize relevant design-management factors. Following literature-based factor identification and expert- and case-based refinement, the empirically evaluated framework comprised three first-level dimensions, seven second-level criteria, and eighteen third-level indicators. A panel of 20 construction-industry professionals participated in the expert assessment and AHP weighting. Stakeholder and Organizational Factors received the largest first-level weight (0.6482), followed by Technical and Economic Factors (0.2249) and External and Project-Context Factors (0.1269). The five highest-ranked indicators were Owner design-management capability (0.1681), Designers’ professional competence (0.1625), Owner-initiated design adjustments (0.1537), Changes in applicable technical standards (0.1124), and BIM/3D model-assisted coordination (0.0612), together accounting for 65.79% of the total global weight. Sensitivity analyses based on alternative expert weighting and leave-one-expert-out assessment indicated that the upper portion of the ranking was generally stable. Case evidence from University A further demonstrated the practical relevance of the highest-priority indicators to owner governance, multidisciplinary coordination, design changes, technical compliance, and detailed-design interfaces. The expanded literature review additionally identified life-cycle cost considerations as an important dimension for extending the framework; because this factor was not included in the original expert assessment, it was not assigned an AHP weight in the present study. The proposed framework therefore provides an exploratory and case-informed basis for prioritizing design-management attention and allocating management resources, while its broader applicability and effects on project performance require validation across additional projects and independent expert panels. Full article

Background: Neurocognitive functioning in transgender adults remains understudied and is predominantly derived from Western samples, often treated as universally applicable. Evidence from non-Western contexts is limited, despite the potential influence of structural stigma and minority stress on cognition and research participation. Türkiye represents a sociopolitical setting where transgender individuals face significant barriers to healthcare and research. To date, no study has systematically examined the neuropsychological profile of transgender adults in Türkiye using a four-group design. Methods: This retrospective, cross-sectional study was conducted at a multidisciplinary university-based gender identity clinic. Eighty-one adults were included: transgender women (n = 14), transgender men (n = 39), cisgender women (n = 13), and cisgender men (n = 15), with cisgender groups matched for age and education. Participants completed a standardized neuropsychological battery assessing visuospatial abilities, executive functions/processing speed, working memory, and verbal fluency. Group differences were analyzed using nonparametric methods, with additional aggregated transgender–cisgender comparisons. Results: Group differences were observed in visuospatial functioning (Judgment of Line Orientation, Rey–Osterrieth Complex Figure; all p ≤ 0.05) and executive control (Trail Making Test Part B, p = 0.048; B–A difference, p = 0.014). Group-level differences were domain-specific: both transgender groups scored below both cisgender groups on the visuospatial measures, whereas the ordering on executive-control measures differed, and distributions overlapped substantially throughout. Processing speed, working memory, and verbal fluency did not differ significantly (p > 0.05). No clear association between hormone therapy status and performance was detected in this small sample. Conclusions: The observed distributions were domain-specific and substantially overlapping, and should not be interpreted as indicating correspondence between cognitive performance and either gender identity or sex assigned at birth. Differences were domain-specific, with substantial overlap across groups. Findings support a context-sensitive, non-pathologizing interpretation emphasizing sociocultural factors rather than inherent deficits. Longitudinal and cross-cultural studies incorporating psychosocial variables are needed. Full article

Background/Objectives: Veterinary vaccine manufacturing is essential for controlling transboundary animal diseases, strengthening animal health systems, and supporting livestock development, particularly in Southeast Asia where livestock production continues to expand. However, modernization toward Pharmaceutical Inspection Co-operation Scheme (PIC/S) Good Manufacturing Practice (GMP) compliance remains challenging because it requires coordinated development across regulatory, technical, organizational, financial, and governance domains. This study aimed to develop an evidence-informed strategic framework for veterinary vaccine manufacturing modernization through a structured and systematically documented framework development methodology integrating multidisciplinary evidence and practice-informed implementation experience. Methods: An evidence-informed framework development study was conducted through the multidisciplinary integration of multiple evidence sources, including international regulatory guidance, peer-reviewed scientific literature, multidisciplinary feasibility assessment, and practice-informed implementation experience derived from a government-commissioned consultancy project. Framework development followed a structured methodology comprising evidence collection, evidence categorization, multidisciplinary evidence synthesis, framework development, iterative refinement, and expert-informed validation. Only generalized methodological principles and potentially transferable implementation knowledge were incorporated to ensure confidentiality of project-specific information. Results: Multidisciplinary evidence synthesis identified ten evidence domains encompassing regulatory, technical, organizational, economic, legal, environmental, governance, workforce, infrastructure, and implementation considerations. These domains were translated through a structured process into an evidence-informed strategic framework organized around four sequential modernization phases—Design, Construction, Validation, and Continuous Improvement—supported by cross-cutting strategic enablers. Iterative refinement through expert review, technical consultation, and implementation verification strengthened the framework’s scientific consistency, regulatory alignment, and practical applicability. Conclusions: Veterinary vaccine manufacturing modernization should be regarded as a multidisciplinary organizational transformation rather than solely as an infrastructure or engineering project. Beyond proposing a strategic framework, this study provides a transparent, systematically documented and traceable methodology for translating multidisciplinary evidence into strategic decision-support tools. The proposed framework may assist governments, regulatory authorities, vaccine manufacturers, and researchers in developing evidence-informed modernization strategies for veterinary biological manufacturing systems, particularly in low- and middle-income countries, subject to adaptation to specific regulatory, technical, institutional, and resource contexts. Full article

Background/Objectives: Enhanced Recovery After Surgery (ERAS) has substantially advanced perioperative care across multiple surgical disciplines. Research in colorectal surgery has clearly demonstrated the effectiveness of ERAS programs; however, evidence regarding the application of these protocols in elderly patients undergoing upper gastrointestinal (GI) surgery remains limited. This population has a high prevalence of multimorbidity, frailty, and diminished physiological reserve, factors that collectively increase vulnerability to postoperative complications and may influence adherence to ERAS pathways. Methods: This narrative review is based on a structured literature search of PubMed, Scopus, and Web of Science for studies published between 2000 and 2025. The search identified randomized controlled trials (RCTs), observational studies, meta-analyses, and clinical guidelines evaluating ERAS protocols in elderly patients undergoing upper GI surgery. Results: Available evidence indicates that ERAS protocols are feasible and safe in elderly patients undergoing upper GI surgery, including gastrectomy and esophagectomy. Studies consistently associate their implementation with shorter hospital stays, faster gastrointestinal recovery, and no significant increase in postoperative complications or readmission rates. However, heterogeneity in study designs, ERAS components, and definitions of ‘elderly’ limits comparability across studies. Conclusions: ERAS protocols represent a promising perioperative strategy for elderly patients undergoing upper GI surgery. When implemented within a multidisciplinary framework and tailored to patients’ frailty and comorbidities, these protocols may improve postoperative recovery while maintaining safety. Future research should prioritize multicenter RCTs to identify the most effective ERAS components and evaluate long-term clinical and functional outcomes in this population. Full article

Chronic pain continues to be a major global health burden and is frequently refractory to conventional pharmacologic and conservative therapies. Spinal cord stimulation (SCS) has emerged as an important neuromodulatory treatment for selected patients with chronic neuropathic and mixed pain syndromes. Since its introduction in the 1960s, SCS has evolved from paresthesia-based tonic stimulation into more adaptive and personalized neuromodulation. This review summarizes the current evidence regarding the mechanisms, clinical applications, technological advances, and future directions of SCS therapy. Mechanistically, SCS modulates nociceptive transmission through dorsal column and dorsal horn pathways, inhibitory neurotransmitter systems, wide-dynamic-range neuronal activity, and supraspinal pain-processing networks. Technological advances have expanded available stimulation paradigms, including burst stimulation, high-frequency stimulation, closed-loop evoked compound action potential-controlled systems, and differential target multiplexed stimulation. These approaches aim to improve analgesic durability, reduce the burden of paresthesia, and address mechanisms such as neuroinflammation and neural habituation. Clinically, SCS is used for conditions including failed back surgery syndrome, complex regional pain syndrome, painful diabetic neuropathy, ischemic limb pain, and emerging non-traditional pain states. However, outcomes remain variable and are influenced by psychological readiness, pain phenotype, anatomic factors, trial response, neurophysiologic markers, and patient engagement. Complications such as lead migration, infection, implantable pulse generator malfunction, and loss of efficacy remain important considerations. Future progress in SCS will likely depend on artificial intelligence, remote monitoring, biomarker-guided programming, and integration with multidisciplinary chronic pain care. Full article

Against the backdrop of rapid development in marine engineering, the construction industry faces practical challenges, such as water scarcity, limited availability of natural river sand, and high raw material transportation costs. This has led to an increasing demand for resource-efficient concrete production technologies and improved construction economic efficiency. Seawater–sea-sand concrete (SWSSC) offers a locally sourced solution that effectively reduces the construction sector’s overreliance on freshwater and river sand, lowers material transportation costs for coastal infrastructure projects, and supports marine engineering and infrastructure development along the Belt and Road Initiative. However, existing research lacks systematic organization and visualized quantitative analysis. Utilizing the CiteSpace 7.0.R0 knowledge graph analysis software, this study selects 982 relevant papers published in the Web of Science (WOS) Core Collection between 2016 and 2025 as the sample. By employing analytical methods—including annual publication volume statistics, collaboration networks among researchers, keyword co-occurrence patterns, and temporal evolution charts—we systematically delineate the overall research landscape, distribution of key research institutions, trends in research hotspots, and future frontier directions in this field. The analysis results indicate that: (1) The total number of publications in the global seawater–sand concrete field has been increasing year by year. From 2016 to 2018, it was the basic exploration period, with an average annual publication volume of less than 10. From 2019 to 2021, it was the deepening and expansion period, with research expanding from the performance of a single material to material modification and structural application. From 2022 to 2025, it was the rapid prosperity period, with the publication volume reaching its peak in 2024–2025 (208 articles and 203 articles), and the publication volume continued to rise. (2) China ranks first globally with 798 publications, but its centrality in international cooperation networks is only 0.24, reflecting low overall collaboration density and loose partnerships between institutions and authors, without the formation of cross-institutional core research teams with global leadership. (3) Research hotspots in this field primarily focus on material properties, durability characteristics, and mechanical strength, among which FRP reinforcement systems serve as a bridge for interdisciplinary research bridging material fundamentals and engineering applications, representing a key research branch. (4) From the perspective of evolutionary trends, the field exhibits three major developmental shifts from macroscopic mechanical performance characterization to in-depth investigation of microscopic damage mechanisms, from single-material studies to composite structural systems, and from short-term laboratory accelerated testing to full life-cycle performance evaluation, with the low-carbon potential of seawater–sand concrete increasingly becoming a prominent research focus. Therefore, this paper advocates strengthening international and inter-institutional academic collaboration, fostering multidisciplinary innovation, and prioritizing breakthroughs in key areas, such as large-scale intelligent performance prediction, long-term performance database development, and digital-twin-based operation and maintenance management, to facilitate the transition of seawater–sand concrete technology toward efficient, low-carbon, safe, and intelligent engineering applications. Full article

The Island of Montecristo, part of the Tuscan Archipelago, was subjected to an “invasive species” eradication effort co-financed by the European Union under the Life+ “Montecristo 2010” project in 2012. Biocidal agents were utilized in abundance, with the objective of targeting select species of flora and fauna. This included the aerial broadcast of pellets containing brodifacoum to attempt to eradicate the rat population. Brodifacoum’s environmental persistence has led to concerns regarding its potential for secondary, tertiary, and subsequent poisoning of numerous species. This article presents an analysis of probabilistic body mechanics simulations indicating that 4.12 tons of pellets containing brodifacoum would have likely reached the sea following the aerial distribution on Montecristo; a comprehensive literature review of the adverse effects and environmental persistence of second-generation anticoagulant rodenticides (SGARS); as well as a theoretical application of the European Industrial Accident Scale (EIAS) to assess environmental contamination. The question of whether the practice of distributing substantial amounts of pesticides to eradicate a selected species constitutes a conservation initiative or could lead to environmental damage is a salient one, and this article aims to provide a multidisciplinary approach to address this question. Full article

Artificial intelligence (AI) has generated considerable excitement in radiology, with claims of transformative improvements in diagnostic accuracy, workflow efficiency, and clinical decision support. However, a critical gap persists between AI’s theoretical promise and its real-world performance, particularly in complex, high-stakes scenarios such as cancer-associated thromboembolism (CAT). CAT is a leading cause of morbidity and mortality in oncology patients, yet it remains underdiagnosed on routine imaging. This paper provides a general radiology critique of current AI applications, then narrows focus to CAT management. This review additionally evaluates AI’s role in incidental pulmonary embolism detection, risk stratification, and treatment decision support. While AI demonstrates sensitivity gains, it faces substantial limitations: data heterogeneity, lack of prospective validation, poor generalizability across cancer subtypes, and integration challenges with clinical workflows. Therefore, AI is not yet a reliable standalone tool for CAT management, but may serve as an adjunct if clinically validated, explainable, and embedded within multidisciplinary frameworks. Full article

(1) Background: Preconception care (PCC) is an important component of preventive reproductive healthcare and public health because modifiable risk factors affecting maternal, neonatal, and longer-term health may be present before conception. Despite broad recognition of its potential value, substantial uncertainty remains regarding how PCC should be organised, financed, and implemented across different healthcare systems. (2) Methods: This structured narrative review synthesised evidence on healthcare- provider models, financing, affordability, willingness to pay (WTP), and barriers and facilitators affecting PCC implementation. A structured search of PubMed, Scopus, and Web of Science Core Collection covered publications from January 2010 to March 2026 and was updated on 14 July 2026. Original research studies, systematic and scoping reviews, narrative reviews, clinical guidelines, policy reports, and relevant methodological or health-economic publications were considered. A structured qualitative appraisal was used to interpret evidence according to study design or evidence type, directness to PCC, healthcare-system context, methodological limitations, and consistency across sources. A total of 61 publications were retained in the structured evidence synthesis. (3) Results: No single PCC delivery model was consistently supported as universally applicable. Across heterogeneous settings, the evidence more consistently supported broad principles including accessibility, continuity of care, multidisciplinary coordination, clear professional roles, financial accessibility, and integration with existing healthcare pathways. Implementation was constrained by insufficient training, consultation-time limitations, unclear professional responsibilities, fragmented service organisation, inadequate reimbursement, and socioeconomic inequalities. Evidence on WTP, specific financing arrangements, and digital delivery models was more limited and context-dependent. (4) Conclusions: The available evidence supports PCC as an important preventive reproductive-health strategy, but the optimal organisational and financing models remain uncertain and are likely to depend on healthcare-system context. Integrated and multidisciplinary approaches appear promising, although specific provider configurations, financing mechanisms, and digital interventions require further comparative and longitudinal evaluation. The author-developed hypothetical conceptual model proposed in this review should therefore be interpreted as a hypothesis-generating synthesis of the available evidence rather than as an empirically validated clinical pathway or causal model. Full article

An integrated model is presented to estimate the energy consumption of a Formula SAE–type electric vehicle by combining MATLAB/Simulink simulations with real operational data from the Cotopaxi kart circuit. The implemented subsystem incorporates vehicle dynamics, speed, and grade profiles, and it enables the calculation of tractive energy across different competition scenarios. The L3 cycle (maximum speed 90.91 km/h, distance 16.67 km) proved the most demanding, with a tractive energy consumption of 1389.10 Wh, mechanical losses of 630.89 Wh, and a useful net energy of 758.21 Wh. Rolling resistance and inertia accounted for 21.33% and 56.29% of the consumption, respectively, highlighting the influence of acceleration/deceleration dynamics. All cycles were dominated by active phases, with 0% stops and cruising time < 0.21%, validating the model for high-demand conditions. The technical feasibility of second-life Lithium Iron Phosphate (LFP) cells for the battery pack was also confirmed: a 30s2p configuration using 100 Ah cells meets the peak energy demand of 18.30 kWh while maintaining adequate operational margin and a safe discharge C-rate. Structural simulation in ANSYS enabled optimization of mass and stiffness, reducing overall energy demand. This multidisciplinary approach provides a quantitative basis for battery sizing and energy management strategies in competitive electric vehicle applications. Full article

Background/Objectives: Hospital performance is a multidimensional construct that cannot be adequately assessed using isolated financial, clinical, organizational, or patient-reported indicators. This study aimed to develop and evaluate an Integrated Multidimensional Hospital Performance Assessment Framework combining organizational management, healthcare quality, patient satisfaction, and cost efficiency. Methods: An observational, descriptive, comparative study was conducted using data collected during 2018–2019 from two Romanian public hospitals with different organizational profiles: a multidisciplinary general hospital and a monospecialty hospital. Organizational, operational, financial, and clinical indicators were analyzed comparatively. Patient satisfaction was assessed in 184 hospitalized patients, including 130 from the general hospital and 54 from the monospecialty hospital, using a structured questionnaire with excellent internal consistency (Cronbach’s α = 0.92). Cost efficiency was estimated using Stochastic Frontier Analysis based on hospital expenditure, activity, resource utilization, case complexity, and quality-related variables. Results: Significant differences were identified between the hospitals in staff composition, bed occupancy, outpatient activity, case-mix complexity, surgical activity, healthcare quality, and financial performance. Patient satisfaction was generally high in both institutions, although several dimensions differed significantly, particularly overall satisfaction, waiting time, physician consultation, treatment received, and adherence to the prescribed medication schedule. The general hospital had a lower mean cost-inefficiency score than the monospecialty hospital (0.253 vs. 0.395), corresponding to higher estimated cost efficiency (0.747 vs. 0.605; p < 0.001). Conclusions: The proposed framework offers a comprehensive and practical approach to hospital performance assessment, and its application in two public hospitals provides a proof-of-concept demonstration of feasibility. Further multicenter studies are required for external validation and assessment of its generalizability across different hospital settings. Full article