Search Results (27,193)

Ocean turbulence, a fundamental process influencing marine hydrodynamics, holds significant guiding implications for the development of multiple disciplines and has emerged as a research hotspot in ocean science in recent years. However, constrained by traditional oceanographic instruments limited to single-point measurements, current observations and analyses of oceanic turbulence still experience considerable shortcomings. To advance oceanic turbulence observations beyond single-point measurements toward comprehensive three-dimensional (3D) field characterization, this study introduces an innovative Holographic Astigmatic Particle Tracking Velocimetry (HAPTV) technology combined with an integrated in situ underwater measurement and processing system. For the first time, this system has successfully acquired 3D two-component (u, v components) ocean flow fields in natural environments. The measured flow velocities reach up to 15 cm/s, with turbulence dissipation rates on the order of 10⁻⁴ m²/s³, which is consistent with the hydrodynamic conditions in coastal marine environments. These results demonstrate the feasibility of using HAPTV for field-scale turbulence observations, offering a novel volumetric alternative to conventional single-point techniques. Nevertheless, due to factors such as excessively high concentrations of suspended matter in nearshore waters and z-axis positioning limitations, the accuracy of the flow field results obtained from the initial sea trials still needs to be improved. Full article

Variations in terrestrial carbon flux influence atmospheric CO₂ exchange and related climate feedback, with Net ecosystem productivity (NEP) serving as a key metric for assessing ecosystem carbon source–sink dynamics. Given the vital ecological barrier function of the Tibetan Plateau (TP), understanding the spatiotemporal variability of NEP and its climatic controls is essential for elucidating carbon sink and climate interactions under ongoing climate change. The spatiotemporal dynamics of NEP across the TP from 1979 to 2018 are investigated using the process-based Community Land Model version 5.0 (CLM5.0). And climate sensitivity experiments are conducted to quantify the relative contributions of different climate factors to NEP variability. Furthermore, future changes in NEP for the period 2025–2100 under multiple Shared Socioeconomic Pathway (SSP) scenarios are projected. The results indicate that the TP functioned predominantly as a net carbon sink during the historical period, with a multi-year mean NEP of 23.96 g C m² yr⁻¹. Spatially, NEP showed a significantly increasing gradient from the northwest to the southeast. During 1979–2018, NEP exhibited an overall decreasing trend across most regions of the TP. Air temperature was identified as the dominant controlling factor, accounting for approximately 68% of the interannual NEP variability, followed by solar radiation (21%) and precipitation (11%). The dominant climatic drivers of NEP variation differ among regions: air temperature predominates in the southwestern and southeastern regions, radiation dominates in the northwestern and central areas, and precipitation exerts a controlling effect in the northern and western regions. Future projections suggest that NEP remains positive under all SSP scenarios, indicating that the TP is likely to persist as a carbon sink throughout the 21st century. This study provides important reference for the development of ecological protection, restoration planning, and regional carbon neutrality strategies. Full article

TCP transcription factors constitute a key regulatory family in plants, playing crucial roles in plant growth and development. Although this gene family has been extensively studied across diverse plant species, research in Gypsophila paniculata remains limited. Through genome-wide identification and analysis, this study identified 17 GpTCP in G. paniculata. Our analysis revealed that all GpTCP proteins contain a conserved TCP domain, with subcellular localization predictions indicating nuclear localization. Promoter analysis identified multiple cis-regulatory elements associated with plant organ development and growth regulation. Chromosomal synteny studies showed that gene expansion within the G. paniculata TCP gene family occurred after subfamily differentiation. Over-expression of GpTCP10 in Arabidopsis thaliana caused root development inhibition, leaf curling, smaller flowers, and yellowing of flowers. Further studies showed that in two normally growing G. paniculata varieties with different flower sizes, GpTCP10 was specifically expressed in leaf and floral tissues, with significantly higher expression levels in the smaller-flowered G. paniculata. These findings reveal the evolutionary characteristics of the TCP family in G. paniculata, and highlight the role of GpTCP10 in regulating organ growth and development in transgenic Arabidopsis thaliana and floral organ size in G. paniculata. Full article

Background/Objectives Approximately 1 in 10 community-dwelling older adults are affected by or at risk of malnutrition, and this prevalence increases to nearly 1 in 3 among those receiving home care or recently hospitalized, contributing to higher rates of frailty, falls, hospitalization, functional decline, and mortality. Many of these individuals depend on informal or family caregivers for nutritional care, including assistance with grocery shopping meal preparation, feeding, and monitoring dietary intake. Thus, informal caregivers play an increasingly central role in supporting dietary intake and maintaining nutritional status. This narrative review aims at assessing the relationship between informal caregiver involvement and malnutrition in community-dwelling older adults who are dependent for nutritional-related needs, summarizing evidence on caregiver’s role and caregiver-associated determinants of malnutrition, as well as on interventions that incorporate caregivers into nutrition care. We discuss factors associated with malnutrition in later life, with particular emphasis on caregiver knowledge, burden, interventions and outcomes. In addition, caregiver-inclusive models of care and tools, including nutrition education and guidelines/recommendations, medical nutrition therapy, and multidisciplinary care models will be addressed. Methods: A structured review of the literature was conducted (date of last search December 2025), searching multiple databases for pertinent articles. Following identification of eligible articles for inclusion, a narrative synthesis of evidence was completed. Results and Conclusions: Despite the high degree of heterogeneity in methodology, observational studies demonstrate that several caregiver attributes influence the nutritional status of care recipients, including caregiver’s own nutritional status, burden, knowledge and literacy, psychosocial, environmental and economic factors. Intervention studies show that caregiver-focused, -inclusive and -delivered interventions have a positive impact on several outcomes, including improved older care recipient dietary intakes, nutritional status and quality of life without impacting on caregiver burden. Thus, strengthening caregiver support and integrating caregivers into nutrition screening and intervention frameworks may represent a critical opportunity to reduce malnutrition risk and improve health outcomes among older adults. Still, significant gaps remain in caregiver-focused intervention research, particularly in diverse cultural and social contexts. Full article

The modeling and control of photovoltaic and other engineering systems highly depend on the accuracy of parameter identification. However, parameter extraction for photovoltaic equivalent models typically presents a high-dimensional, strongly nonlinear, and multimodal global optimization problem. Traditional analytical or gradient-based methods are sensitive to initial values and easily fall into local optima. To address this issue, this paper proposes a multi-strategy improvement teaching–learning-based optimization algorithm (SNTLBO). A social learning network structure with symmetric interaction topology is introduced into the classical TLBO framework to characterize the knowledge propagation relationships among individuals. Through this symmetric and balanced information exchange mechanism, learners can be guided not only by the teacher but also by multiple neighbors within the network, enabling more diverse and symmetric exploration of the search space and enhancing population diversity and global search capability. Furthermore, a teacher reputation mechanism is constructed, where historical performance is used to weight teacher influence, strengthening the guidance of high-quality solutions and accelerating convergence. Meanwhile, an adaptive teaching factor is designed to dynamically adjust the teaching intensity based on the distance between the teacher and students in the solution space, maintaining a dynamic balance (symmetry) between exploration and exploitation. To evaluate the performance of the proposed algorithm, SNTLBO is systematically compared with 11 advanced optimization algorithms on two benchmark test suites, CEC2017 (30D, 50D) and CEC2022 (10D, 20D). Non-parametric statistical tests are conducted to assess significance. The results demonstrate that SNTLBO shows competitive advantages in terms of convergence speed, solution accuracy, and stability. Finally, SNTLBO is applied to the parameter estimation of single-diode, double-diode, triple-diode, quadruple-diode, and photovoltaic module models. Experimental results show that the proposed algorithm achieves higher identification accuracy and robustness in terms of RMSE, IAE, and I–V/P–V curve fitting, verifying its effectiveness and practical value for complex global optimization and practical engineering applications. Full article

Type 2 diabetes (T2D) exhibits substantial phenotypic heterogeneity, resulting in diverse cardiovascular (CV) outcomes driven by multiple pathophysiological mechanisms beyond hyperglycemia alone. T2D should be recognized as a systemic cardiometabolic condition in which insulin resistance, chronic inflammation, oxidative stress, and endothelial and microvascular dysfunction promote a broad spectrum of cardiovascular diseases. The traditional “one-size-fits-all” approach to cardiovascular risk management has been proven insufficient, as individuals with T2D display marked variability in clinical presentation, disease trajectory, treatment response, and cardiovascular phenotype. In this context, personalized medicine strategies integrating clinical phenotyping, individualized risk stratification, and tailored therapeutic interventions offer the potential to optimize cardiometabolic outcomes while minimizing treatment burden and adverse effects. This narrative review examines the rationale and current evidence supporting personalized cardiovascular risk management in T2D. We discuss the heterogeneity of diabetes-related CV phenotypes, encompassing both atherosclerotic and non-atherosclerotic complications. We further examine the major cardiometabolic risk factors closely linked to diabetes, including dyslipidemia, hypertension, obesity, chronic kidney disease, and metabolic liver disease, which act synergistically to accelerate vascular damage and end-organ injury, and are essential for defining personalized prognostic and therapeutic programs. Finally, we present structured approaches to cardiovascular assessment and highlight contemporary management strategies that prioritize integrated, phenotype-driven risk reduction using cardioprotective glucose-lowering therapies together with optimized lipid-lowering, antihypertensive, antithrombotic, and weight-modifying interventions. The transition from population-based guidelines to individualized, patient-centered care represents a paradigm shift in diabetes management, with the potential to substantially reduce the excess CV burden associated with this condition. Full article

Background/Objectives: Mexicans are disproportionately affected by dyslipidemia, specifically low high-density lipoprotein (HDL-C) and high triglyceride (TG) concentrations. Research on the genetic contributions to dyslipidemia, conducted primarily among European populations, has identified numerous single-nucleotide polymorphisms (SNPs) with small effect sizes and low replication rates. A genetic risk score (GRS) can examine the cumulative effects of multiple SNPs and potentially explain greater phenotypic variability than individual SNPs. GRS in Mexican populations and those without diagnosed dyslipidemia are limited. This study aims to construct a GRS from lipid metabolism-related SNPs and determine its associations with blood lipid concentrations in young Mexican college students. Methods: Adults (ages 18–25 years, n = 580) provided a fasting blood sample to determine TG and HDL-C concentrations. DNA was genotyped for 14 SNPs in lipid metabolism pathways (reverse cholesterol transport [RCT], cellular lipid uptake, and lipoprotein formation and transport). Additive (number of risk alleles) and weighted (regression-derived β coefficients) GRS were calculated for individual pathways, and their sum (total GRS) was explored. Associations among individual SNPs, GRS, and blood lipids were determined through general linear models in SAS. Results: The additive RCT and total GRS were associated with TG (both p < 0.05). The RCT pathway explained 3.4% of the variability in TG concentrations, and the total GRS explained 6.1%. The weighted RCT GRS was associated with HDL-C (p = 0.007). The ATP-binding cassette protein (ABCA1) rs9282541 variant was most strongly associated with HDL-C (p = 0.016). When this SNP was removed from the GRS, the association became non-significant. Conclusions: SNPs in lipoprotein metabolism pathways cumulatively associate with blood lipid concentrations in young Mexican adults. The ABCA1-rs9282541 variant, previously shown to be positively associated with low HDL-C concentrations in Amerindian populations, had the strongest association with HDL-C. Further work is needed to elucidate the roles of genetic admixture and lifestyle risk factors in dyslipidemia in this population. Full article

Fine particulate matter (PM2.5) and ozone (O₃) are the key factors restricting the continuous improvement of air quality in the Changsha–Zhuzhou–Xiangtan urban agglomeration (CZT). Due to the potential correlation between variations in urban PM2.5–O₃ concentration, the analysis of its composite pollution characteristics is helpful in formulating accurate and thorough air control policies. Based on the long-term concentration change in PM2.5 and O₃, this study analyzed the features and synergistic factors of PM2.5–O₃ pollution in the CZT by using spatial autocorrelation and a linear driving model of PM2.5–O₃. The results showed that from 2017 to 2023, under the current Chinese atmospheric environment standard, the CZT saw four combined pollution days. However, if the daily limit values were viewed in line with Grade II of the WHO transition period (O₃: 120 μg/m³, PM2.5: 50 μg/m³), the combined pollution days would reach 111. The concentration of O₃ in Zhuzhou and Xiangtan was about 10 μg/m³ lower than that in Changsha. Lower SO₂ levels in Changsha might influence the partitioning of OH radicals and reactive nitrogen species, potentially affecting local O₃ formation efficiency. NO₂ and meteorological conditions jointly influence the co-variation in PM2.5 and O₃, with NO₂ playing a more significant role in PM2.5 formation. The long-term time series and daily concentrations of PM2.5 and O₃ in the CZT showed opposing values, but there were short-term synergistic events on the scale of daily concentrations, and the time period was typically 3–10 days. Low humidity and strong sunlight may cause antagonistic events in which the concentration of O₃ rises rapidly. Under static and stable weather conditions with low wind speed, no rainfall and moderate humidity, the concentration of PM2.5 and O₃ rose alternately on sunny and cloudy days, demonstrating synergistic growth. Full article

Background: Traumatic spinal injuries (TSI) are often associated with substantial physical burden and potential psychological consequences. Early detection of depressive symptoms may be important for improving quality of life during recovery. Despite the high prevalence of injury, unique sociocultural factors affecting mental health, and the need to optimize long-term rehabilitation outcomes, there is a lack of longitudinal assessments of depression in TSI patients in this region of the MENA (Middle East and North Africa). This study aimed to examine the occurrence of depressive symptoms following TSI over a 3-month period. Methods: A prospective cohort study was conducted to assess the occurrence of depression in TSI patients admitted between 2019 and 2022 at the Hamad Trauma Center. Conscious patients aged 18–65 years diagnosed with TSI were included. Perceived social support was assessed using the RAND Social Support Survey (Medical Outcomes Study Social Support Survey), a validated instrument measuring multiple dimensions of social support. Patient Health Questionnaire-9 (PHQ-9), a widely validated self-administered screening tool for depressive symptoms, was utilized twice: at 2 weeks and at 3 months post-trauma to evaluate early-onset depressive symptoms and their persistence or resolution over time. Results: A total of 189 TSI were included. The cohort was predominantly young individuals. The most common mechanisms of injury included falls (42.1%) and motor vehicle crashes (31.1%). The mean Injury Severity Score was 16.5 ± 8.2 and the spine Abbreviated Injury Scale score was 2.4 ± 0.7. Injuries involved cervical (32.8%), thoracic (38.1%), and lumbo-sacral (6.9%) regions. A total of 32.6% underwent spinal surgery, and 9.0% experienced neurological deficits. Most patients reported emotional and informational support (69%), and 62% reported caregiving support. At 2 weeks post-trauma, patients demonstrated mild depressive symptoms, with a mean PHQ-9 score of 4.6 ± 5.1, which decreased to 2.5 ± 4.2 at 3 months. The proportion of patients screening positive for depressive symptoms (PHQ-9 ≥ 5) decreased from 39.1% (52/133) at 2 weeks to 19.5% (26/133) at 3 months, corresponding to a 19.6% absolute reduction over the follow-up period. A subset of patients reported increased feelings of depression or hopelessness and sleep disturbances at three months compared with two weeks post-trauma. Conclusions: Patients with TSIs experience psychological distress in the early post-injury period, with a subset screening positive for depressive symptoms. Although depressive symptom scores declined over 3 months, continued psychological screening and follow-up care remain important components of comprehensive TSI management during recovery and rehabilitation. Our results should be considered cautiously because of gender-biased findings, single center data and potential attrition bias. Full article

Background: Focal segmental glomerulosclerosis (FSGS) is a leading cause of renal disease presenting with steroid-resistant nephrotic syndrome (SNRS) and variable stages of chronic kidney disease (CKD). Monogenic etiologies for FSGS are increasingly recognized, particularly in pediatric and familial cases. Missense variants in the MAF BZIP Transcription Factor B (MAFB) gene cause a dominantly inherited condition with variable phenotype, ranging from isolated ocular or renal manifestations to syndromic FSGS. Methods: Detailed clinical and genetic investigations were conducted in an extended family presenting with a spectrum of renal and extra-renal manifestations. Results: Using Exome Sequencing (ES), a heterozygous variant, c.797T>C; p.(Leu266Pro) in the MAFB gene was identified in multiple affected family members. Variant segregation confirmed its presence in additional family members. The proband exhibited CKD accompanied by congenital auricular anomalies, hearing loss, and neurodevelopmental delay. An affected sibling presented with nephrotic-range proteinuria, Duane retraction syndrome (DRS) and neurodevelopmental involvement, while another family member had an isolated renal phenotype. Several of these features have not been previously associated with MAFB. Tools for structural modeling and stability predictions supported the functional impact of this variant. Conclusions: Our findings expand the phenotypic spectrum of MAFB-associated disease and further emphasize its variability. Full article

Oxidative stress is a hallmark of carcinogenesis, yet the epigenetic mechanisms linking the lifestyle-based Oxidative Balance Score (OBS) to cancer risk remain poorly understood. This study investigated the epigenetic bridge between OBS and pan-cancer susceptibility using a multi-cohort approach integrating population-based and cancer genomic data. We calculated OBS based on 16 dietary and lifestyle factors (including dietary fiber, vitamins, minerals, physical activity, smoking, alcohol, and BMI) for 2749 participants from the Korean Genome and Epidemiology Study (KoGES) and identified OBS-associated CpG sites via epigenome-wide association analysis. These markers were validated against The Cancer Genome Atlas (TCGA) pan-cancer dataset using a novel Hybrid Pi-score (HyPi) to quantify the directional consistency between OBS-driven methylation in healthy individuals and cancer-specific epigenetic alterations across three clinical comparisons: normal vs. tumor, survival outcomes, and tumor stage. We observed profound sex-specific epigenetic signatures, with zero overlap in the top 200 OBS-associated CpG sites between males and females, underscoring fundamental sexual dimorphism in oxidative stress-epigenome interactions. Notably, the top 20 OBS-associated CpGs demonstrated strong directional consistency with multiple cancer types in TCGA, particularly in kidney renal clear cell carcinoma and lung adenocarcinoma, exhibiting methylation patterns inversely correlated with tumorigenesis. Mechanistically, these findings support the role of one-carbon metabolism and vitamin C-dependent DNA demethylation pathways in mediating OBS effects. Our study provides the first evidence of an epigenetic link between lifestyle-based oxidative balance and pan-cancer risk, highlighting the utility of the HyPi score as a novel sex-specific predictive biomarker for cancer prevention. These results suggest that optimizing oxidative balance through precision nutrition may epigenetically modulate cancer susceptibility, opening new avenues for personalized prevention strategies. Full article

Ion-adsorption rare earth element (REE) deposits represent strategic critical resources in China, which were traditionally considered to be predominantly hosted in granite weathering crusts. However, the recent discovery of new deposit types within the weathering crusts of shallow metamorphic rocks in South China has opened up novel exploration frontiers, while research on their metallogenic mechanisms remains insufficient. To elucidate the REE enrichment mechanisms in shallow metamorphic rock weathering crusts, this study focuses on the Getengzui ion-adsorption REE deposit in southern Jiangxi Province. Twenty-four samples were collected from the weathering crust profiles of the Qingbaikouan Shenshan and Kuli Formations. Multiple analytical approaches were employed, including major and trace element analysis, Chemical Index of Alteration (CIA), Base Leaching Index (BA), and quantitative evaluation of element mass transfer coefficients (τ). Trace element spider diagrams, REE distribution patterns, and A-CN-K diagram analysis were also utilized. The results reveal that the weathering crusts have progressed to the middle–late stage of chemical weathering. The average CIA value is 83 for the middle-upper part of the completely weathered horizon in the Kuli Formation. In contrast, for the completely weathered horizon in the Shenshan Formation, the value is 86. Intense chemical weathering has resulted in the near-complete decomposition of primary silicate minerals and extensive leaching of base cations. This progress has created an acidic pore water environment, which is critical for REE mobilization. REEs exhibit characteristics of in situ secondary enrichment, with significant enrichment of ΣREE in the middle-upper part of the completely weathered horizon. The peak τ(ΣREE) values reach 0.78 and 2.43 for the Kuli and Shenshan Formations, respectively. Apatite dissolution is identified as the primary source of REE ions. Differences exist in the geochemical mobility sequences of elements between the two formations. REE enrichment is controlled by multi-stage geochemical barriers, including an oxidation barrier and a clay adsorption barrier. The oxidation barrier preferentially fixes Ce⁴⁺, whereas the clay adsorption barrier serves as the dominant mechanism for large-scale REE enrichment. Parent rock lithology is the primary factor governing the efficiency, scale, and fractionation characteristics of REE enrichment. The Kuli Formation is favorable for forming the thick, large-scale orebodies enriched in light rare earth elements (LREEs). In the contrast, the Shenshan Formation tends to host higher-grade orebodies, characterized by a relatively balanced ratio of LREEs and heavy rare earth elements (HREEs). This study clarifies the main controlling factors for ion-adsorption REE mineralization in two shallow metamorphic rocks. It thereby provides a theoretical basis for future exploration. This framework is applicable to analogous REE resources within shallow metamorphic rock distributions across South China and nationwide. Full article

Ménière’s disease is an idiopathic disorder of the inner ear whose causes and pathogenetic mechanisms remain insufficiently elucidated. Advances in genetic analysis technologies have shifted attention toward the role of hereditary components in Ménière’s disease, generating a considerable number of studies investigating the relationship between human genetic variations and disease onset. The results of these investigations highlight the complex and heterogeneous nature of pathogenesis, involving both genetic and epigenetic alterations. Studies have identified multiple candidate genes involved in the regulation of endolymphatic fluid homeostasis, immune response, control of oxidative stress, and maintenance of the structural integrity of the inner ear. However, the reproducibility of these associations varies substantially across populations, reflecting the impact of ethnic heterogeneity, HLA haplotypes, and phenotypic diversity among patients. Moreover, non-genetic factors may act as triggers or modulators of the disease in genetically predisposed individuals. Taken together, the evidence supports a polygenic and context-dependent model of the disorder, in which genes influence susceptibility but do not directly determine disease development. Integrating genomic information with clinical data, analyzing immunological profiles, and investigating exposure to environmental factors are essential steps for patient classification and for the development of individualized treatment strategies. Full article

Chronic wound healing is a complex pathological process driven by multiple factors, presenting a significant global healthcare challenge. It not only severely compromises patients’ quality of life but also imposes a substantial socioeconomic burden. In recent years, with deepening insights into the wound microenvironment, composite therapeutic strategies combining natural herbal medicines and their active components with modern biomaterials have offered novel approaches to overcoming refractory wounds caused by diabetic ulcers, vascular lesions, burns, and infections. This paper first outlines the biological foundations of normal wound healing, emphasizing the core mechanisms underlying chronic wound persistence—including persistent inflammatory responses, impaired tissue repair, and cellular dysfunction. Building upon this foundation, the article systematically reviews the existing therapeutic approaches (such as conventional debridement) before focusing on the classification and application of novel biomaterials. It further analyzes the synergistic therapeutic advantages of using materials as delivery systems for natural bioactive compounds. This combined approach enables targeted regulation of the chronic wound microenvironment, synergistically promoting cell proliferation and migration to accelerate healing. Deepening our understanding of the biological mechanisms underlying chronic wounds, coupled with advanced biomaterial technologies, will propel clinical treatment toward more precise and efficient outcomes. Full article

Background and Objectives: It is crucial to determine physical findings and outcome measures that affect functional status of the patients, and the impact levels of these parameters on patients. Therefore, the aim of this study was to investigate the determinant and predictive effect of pain levels, shoulder range of motion (ROM) values, disability and health-related quality of life factors on functional status in individuals with partial-thickness rotator cuff tears (PRCT). Materials and Methods: Firstly, the functional status of 45 patients (mean age: 50.78 ± 5.28 years; 29 female) with PRCT, then activity and night pain levels with Numeric Pain Rating Scale, active flexion, abduction and external rotation of the shoulder ROM values with goniometer, disability level with Quick Disabilities of Arm, Shoulder & Hand Questionnaire, and health-related quality of life levels with Short Form-12 were evaluated and recorded. Results: It was detected that all determinants whose effect on functionality was evaluated with a multiple regression model explained 76% of the variance, and this effect level was statistically significant (R square = 0.760, adjusted R square = 0.707, F = 14.272, p < 0.001). Detailed evaluation showed that flexion and external rotation ROM values (respectively; β = 0.54, p < 0.001; β = 0.38, p = 0.001) and disability level (β = 0.44, p < 0.001) had statistically significant determinant effects on functional status. No statistically significant results which could be correlated with functional status were found for activity and night pain, abduction ROM value, and health-related quality of life domains (p > 0.05). Conclusions: Shoulder flexion and external rotation ROMs and disability level were found to have a predictive effect on the functional status in individuals with PRCT. It is noteworthy that more subjective and patient-reported findings and outcome measures such as pain and health-related quality of life had no predictive effect on functionality. By determining the level of these effects, results were reached that can shed light on the literature by guiding the development of reliable assessment algorithms. Full article