Search Results (488)

Background: Amyloidosis is an infiltrative cardiomyopathy caused by amyloid deposition into the myocardium. In recent years, recognition of this treatable cause of heart failure has increased. There are striking sex differences in the diagnosis, clinical course and outcome of the disease. Notably, women have a worse prognosis than men with similar amounts of cardiac involvement. Methods: This review provides an overview of the current state of knowledge regarding the epidemiology, clinical features, diagnosis and treatment of amyloid heart disease. The differences observed between men and women are discussed, and recent advances in the field are highlighted. Results: Compared to men, women are generally older at diagnosis, appear to have less severe cardiac disease at the time of impairment and are more frequently diagnosed late. The less apparent disease manifestations in women may be responsible for the delay in diagnosis. Moreover, women may be underdiagnosed when sex-neutral diagnostic criteria are used. Conclusions: Addressing diagnostic disparities may require the use of sex-specific diagnostic thresholds, as well as a more expansive use of multimodality imaging. Future clinical trials should aim to enroll a greater number of female participants to inform optimal therapeutic approaches and to define the sex-specific disease phenotype for this increasingly treatable disease. Full article

Corporate balance sheets report aggregate equity and liability totals but conceal the internal allocation of financing sources across asset categories—an identification problem that conventional econometric methods cannot resolve without additional parametric assumptions. This paper develops a maximum entropy (ME) panel estimator to recover two latent scalar parameters: x ∈ (0,1), the share of equity capital directed toward long-term asset financing, and y ∈ (0,1), the corresponding debt allocation share. Grounded in maximum entropy principle, the estimator selects the unique parameter vector that satisfies the mean-level balance-sheet constraint while maximising joint Shannon entropy—the least-biassed solution consistent with observable data. The closed-form logistic representation yields a scalar Lagrange multiplier λ*, interpreted as a financing pressure index, recoverable via bisection in at most 21 iterations at tolerance ε = 10⁻⁵. Building on the ME estimates, we introduce a continuous matching alignment index M* = x* − y* that measures the degree of compliance with the financial matching principle along a continuous spectrum rather than as a binary categorisation. Applied to a ten-firm, cross-sectoral panel spanning Technology, Finance, Energy, and Automotive sectors over an observation window spanning 2001 to 2025 (with firm-specific subperiods reflecting differences in IPO dates and data availability), the framework reveals substantial heterogeneity in latent financing flows: equity allocation shares range from 30.1% (NVIDIA) to 75.1% (ExxonMobil), while debt allocation shares span 37.1% to 77.5%. Across the panel, only Meta exhibits substantial positive matching alignment, while Microsoft, ExxonMobil, Apple, and Tesla show only very slight differences that fall within the neutral band, and the remaining firms show varying degrees of structural departure from the matching benchmark; the thresholds used to summarise these descriptive labels are interpretive aids rather than re-imposed binary criteria, and the substantive ranking of firms along M* does not depend on the specific threshold values adopted. The ME solution’s entropy H(x*, y*) and the normalised diversification index D(x*, y*) describe allocation balance under the estimator’s information–theoretic criterion rather than independently observed firm complexity; in the present sample, the cross-firm ordering of these values is not recovered by firm size, leverage, or sector classification alone. These findings, based on a ten-firm case-study panel with time-invariant allocation parameters, should be interpreted as descriptive patterns of the present sample rather than statistically validated regularities. They provide a theoretically rigorous and computationally tractable identification of unobservable corporate financing flows, with potential implications for capital structure theory, financial risk assessment, and balance sheet analysis that would benefit from validation on larger and more representative samples in future work. Full article

Background/Objectives: The aim of the study was to assess the metabolic response of women to a six-week consumption of full-fat sheep milk yogurt, with a focus on cardiovascular risk markers, lipid profile, and subfractions of low-density (LDL) and high-density (HDL) lipoproteins of both atherogenic and non-atherogenic nature. Methods: A total of 55 women were enrolled in the nutritional intervention after the application of inclusion criteria. Blood samples were collected at baseline and after the six-week intervention period. Lipoprotein subfractions were determined in serum using the Lipoprint System LDL/HDL Subfractions Kit in combination with the Lipoprint^® analyzer. Results: In the group of women over 40 years of age with overweight or obesity, without adjustment for total cholesterol, a significant increase was observed in selected HDL subfractions (intermediate HDL-6, HDL-7 and small HDL-8, HDL-9; p < 0.05), while the small/large HDL ratio, LDL subfractions, and mean LDL particle size remained unchanged (p > 0.05). A decrease in triglycerides, LDL/HDL ratio, TG/HDL ratio, and cardiovascular risk index was recorded, alongside a slight increase in LDL-C and HDL-C levels. After adjustment for total cholesterol (T-C), no significant deterioration in the lipid profile was observed in either the group with normal or elevated T-C levels; in the group with elevated T-C, only the intermediate HDL-7 subfraction increased significantly (p < 0.05). Despite the presence of risk-level values in some parameters already at baseline (VLDL, IDL-A, IDL-B, small HDL), no worsening was observed. Conclusions: Six-week consumption of full-fat sheep milk yogurt did not lead to deterioration of the lipid profile or lipoprotein subfractions. The results suggest a neutral to mildly beneficial effect on selected cardiovascular risk markers. Full article

We develop a collection of nontrivial examples that illustrate and test recent stability results for linear control systems ($LCS$) on Lie groups. We treat the main structural classes: Abelian (${\mathbb{R}}^n$), nilpotent (Heisenberg), solvable non-nilpotent (rigid motions of the plane $SE\left(2\right)$), compact semisimple ($SO\left(3\right)$), noncompact semisimple ($SL(2,\mathbb{R})$ via Iwasawa decomposition) and mixed/Levi-type groups. The examples are designed to (i) show the sharpness of geometric boundedness criteria, (ii) exhibit typical failure modes (exponential escape, polynomial central drift, noncompact neutrals), and (iii) demonstrate how the canonical quotient and suitable outputs recover $BIBO$ stability. The executive framework ($ICS$ existence/uniqueness, canonical quotient $G/\Gamma$, $BIBO$ characterization, robustness and ISS-type bounds) is briefly recalled; the main part of the paper consists of detailed worked examples implementing the practical checklist for applying these theorems. Full article

Background: Regional periarticular bone mineral density may influence fixation and survivorship in total knee arthroplasty, but its relationship to coronal alignment remains unclear. This study assessed the association between coronal knee alignment and osteoporosis using CT Hounsfield Unit (HU)-based thresholds. Methods: Patients aged ≥ 50 years with standing long-leg radiographs and phantomless knee-CT (2008–2025) were retrospectively identified. Exclusion criteria included >12 months between studies, incomplete CT, non-120 kV acquisition, prior fracture or surgery, or metabolic bone disease other than osteopenia or osteoporosis. Mean trabecular attenuation was measured over 15 mm of epiphyseal bone in the distal femur and proximal tibia. Osteoporosis was defined using CT-HU thresholds. Coronal alignment was measured using hip–knee–ankle angle (HKAA) and categorized as varus (<178°), neutral (178–182°), or valgus (>182°). Measurements were performed by a reviewer blinded to osteoporosis classification. Multivariable logistic regression adjusted for age, sex, body mass index, and Kellgren–Lawrence grade. Results: Among 306 patients (mean age 66.9 ± 9.0 years; 51.3% female), 99.3% underwent CT for arthroplasty planning. Osteoporosis prevalence was 34.3% of varus, 58.2% of neutral, and 68.6% of valgus knees. Increasing valgus alignment was associated with higher osteoporosis odds, whereas varus alignment showed lower odds. Female sex (OR 3.06; p < 0.001), age (OR 1.06/year; p < 0.001), and HKAA (OR 1.05/degree; p = 0.042) remained independently associated with osteoporosis, whereas Kellgren–Lawrence grade was nonsignificant. Conclusions: Coronal alignment was associated with CT-defined regional knee osteoporosis. Valgus alignment showed increased odds of osteoporosis, whereas varus alignment showed lower prevalence. Full article

Selecting the right energy storage system (ESS) for grid integration is a high-stakes decision involving conflicting technical, economic, environmental, and risk criteria under deep uncertainty. The existing fuzzy multi-criteria decision-making (MCDM) methods either fail to capture neutral or abstaining expert judgments or treat evaluation criteria as independent, which is an unrealistic assumption in complex engineering decisions. To address both limitations simultaneously, this study develops four new aggregation operators by extending the Bonferroni mean (BM) into the q-rung picture fuzzy sets (q-RPFSs) framework: the q-RPFBM-based, q-RPFWBM-based, q-RPFGBM-based, and q-RPFWGBM-based operators. Unlike the existing q-RPFS operator families (Dombi, Frank, Fermatean, Yager, Maclaurin), which aggregate criteria independently, BM-based operators explicitly model pairwise interactions among criteria with a structurally distinct aggregation logic that is especially critical when criteria such as cost, risk, reliability, and environmental impact are mutually correlated. The theoretical validity of the operators is confirmed through proofs of idempotency, monotonicity, and boundedness. Applied to a comprehensive ESS selection problem for Türkiye (covering nine alternatives across nineteen sub-criteria and five main criteria, including an explicit risk dimension), the framework consistently identifies pumped hydro storage as the optimal choice. Sensitivity analyses under varying q, s, and t parameters, as well as perturbed criterion weights, confirm the robustness of this ranking. The proposed framework offers energy planners and decision-makers a principled and transparent tool for evaluating ESS under high uncertainty and criterion interdependence. Full article

One of the most critical challenges in maritime transport decarbonization, as part of the EU greenhouse gas (GHG) neutrality strategy, is the reduction in GHG and harmful emissions from the energy systems of existing vessels. Furthermore, the potential for implementing decarbonization technologies in operating vessels remains significantly more limited compared to newly constructed ships. Selecting appropriate decarbonization measures requires a comprehensive evaluation of technological feasibility, economic viability, and environmental performance, in accordance with the regulatory frameworks established by the IMO and the EU. A major limitation in such decision-making processes is ensuring the representativeness and reliability of expert judgments. In order to improve the reliability of results by expanding and structuring the information base, this study proposes and implements a method based on the integration of SWOT analysis with multi-criteria decision-making (MCDM) methods. The objective of this study was to examine the methodological aspects of testing the integrated application of comprehensive analysis and ranking methods for decarbonization technologies as applied to a prototype oil tanker. Based on the SWOT analysis method, technological solutions that are available for practical application were identified for the medium-term decarbonization period considered in the study, up to 2030–2035. Subsequent rating based on several applied multi-criteria (MCDM) analysis methods (TOPSIS, COPRAS, SAW) allowed us to examine the range, stability and sensitivity of the obtained solutions in relation to the methods themselves and scenarios with variations in the weighting factors of the evaluation criteria. The complete match of the ratings obtained using the TOPSIS and COPRAS methods confirms the stability of the multi-criteria decision-making process (priority-compromise order): CCS, kite, air lubrication, Flettner rotor. The performed sensitivity analysis showed that the technology rankings remain relatively stable when the weighting factor for the CO₂ reduction criterion varies within a range of approximately ±10%, while larger deviations result in an increasing difference between all three MCDM methods. For the TOPSIS method, the change limits for the critical values of the threshold indicators were ±20%, the COPRAS method showed intermediate results, and changing the weighting coefficients within a ±20% range did not alter the selection of the best technology. The results obtained allow for a positive assessment of the effectiveness of the proposed integrated methodology when applied as an alternative in the initial stage of ranking decarbonization methods for in-service ships. Full article

Background/Objectives: Disorders of consciousness (DOC), including vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious state (MCS), present significant diagnostic challenges. Misdiagnosis rates approach 40%, often due to limitations in detecting subtle behavioural responses through clinical observation alone. Eye-tracking technology offers objective, quantitative assessment of visual behaviours that may reveal covert signs of consciousness. This systematic review aimed to evaluate the diagnostic accuracy of eye-tracking technology compared to the Coma Recovery Scale-Revised (CRS-R) for detecting visual responses and consciousness signs in patients with DOC; to examine stimulus effects; and to assess prognostic value. Methods: A systematic literature search was conducted across SciSpace, Google Scholar, PubMed, and institutional libraries following PRISMA 2020 guidelines. Eligibility criteria specified studies involving patients with prolonged DOC assessed using eye-tracking technology. Data extraction, risk of bias assessment, and GRADE certainty evaluation were conducted systematically. Results: Fifteen studies (n = 4–123 patients; published 2012–2025) were included. Eye-tracking detected visual responses in significantly more patients than clinical observation alone (46.2% vs. 18.1% in one study). Mirror stimuli demonstrated the highest detection sensitivity (97% vs. 69% for person and 57% for object). Affectively salient stimuli elicited stronger tracking responses in patients with MCS (37.3% vs. 29.9–30.6% neutral). Advanced VR-based systems achieved high diagnostic accuracy (sensitivity 100%, specificity 88.9%) with prognostic value (overt tracking predicting 62.5% command-following at one year). GRADE certainty was Low for detection rates and diagnostic discrimination, and Very Low for sensitivity, specificity, and prognostic outcomes. Conclusions: Eye-tracking provides objective, sensitive assessment of visual behaviours in patients with DOC and may reduce misdiagnosis rates, supporting a conditional recommendation for its use as a supplementary assessment tool alongside CRS-R. Methodological heterogeneity, small sample sizes, and absence of blinding limit certainty. Adequately powered, multicentre prospective studies are urgently needed. Full article

Metabolic disorders such as obesity, type 2 diabetes, and lipid disorders are major health challenges worldwide. There is increasing interest in the role of food-derived antioxidants in the context of metabolic disorders due to their documented antioxidant activity. Antioxidants such as flavonoids and polyphenols neutralize reactive oxygen species and reduce oxidative stress, which can affect cell function and metabolic processes. Anthocyanins, curcumin, and resveratrol exhibit physiological and pharmacological properties such as antioxidant, anti-inflammatory, anti-cancer, anti-obesity, and anti-diabetic effects. The main aim of this systematic review is to comprehensively evaluate and synthesize the current scientific evidence on the role of anthocyanins, curcumin, and resveratrol in the prevention and management of metabolic disorders, with a focus on obesity, type 2 diabetes, and dyslipidemia. Databases such as PubMed and Embase were searched, and the final selection included 105 studies that met the inclusion criteria. The analyzed studies demonstrated that anthocyanin supplementation (up to 320 mg/day) was associated with reductions in inflammatory markers such as IL-6 and TNF-α, improvements in HDL cholesterol, and modest reductions in HbA1c (~0.3–0.5%). Curcumin supplementation was associated with decreases in body weight (up to 0.82 kg), BMI (up to 0.30 kg/m²), triglycerides, total cholesterol, and fasting glucose levels. Resveratrol showed mixed but potentially beneficial effects on insulin sensitivity, oxidative stress markers, and lipid metabolism, although the clinical outcomes remained inconsistent across studies. These findings suggest that the antioxidant effects of anthocyanins, curcumin, and resveratrol may be related to their ability to suppress oxidative stress and inflammatory processes, thereby contributing to improvements in glucose and lipid metabolism. The conclusions from this analysis may contribute to a better understanding of the role of antioxidants in the management of metabolic health and indicate directions for future research in this area. Full article

This paper examines the trustworthiness of generative AI as a tourism recommender system by analyzing how ChatGPT5.2 responds to an open-ended, zero-shot prompt: “Recommend me a list of 10 German Christmas Markets.” Using German Christmas markets as a case study, outputs, texts in reasoning panels, and cited sources of fifteen replicates (carried out over five consecutive days) were systematically documented and analyzed. The results show a consistent and patterned selection which is dominated by a small canon of markets (Nürnberg, Dresden, Köln, München, and Stuttgart). The generative AI model does not neutrally sample from the entire pool of approximately 2000 German markets but instead reproduces a narrow canon of “iconic” destinations. Analysis of reasoning traces and follow-up conversations demonstrates that ChatGPT5.2 applies hidden selection criteria, including canonical status, landmark setting, branding strength, and perceived trip-planning usefulness, while also introducing undisclosed filters such as geographic spread across Germany and stylistic diversity. Although the model claims to use source triangulation and quality checks, the evidence shows substantial reliance on tourism marketing pages, travel media, blogs, and social media, especially for descriptive commentary. The study concludes that generative AI tourism recommendations are useful but non-neutral and should be interpreted as “curated,” bias-bearing constructs rather than transparent information retrieval. The implications of this on tourism management and the marketing of Christmas markets are discussed. Full article

This study proposes a theological-orthodox reinterpretation of contemporary management concepts—particularly “value innovation,” the “blue ocean strategy,” and the E.R.S.C. matrix—within the framework of church administration. Starting from the premise that such concepts cannot be directly imported into the ecclesial context without distortion, the paper argues for their “theological translation,” whereby their underlying logic is reoriented toward the service of the person, communion, and oikonomia. The analysis demonstrates that church administration cannot be understood as a neutral technical system, but as a form of diakonia, intrinsically linked to the ecclesial nature of the Church as the Body of Christ. Consequently, “value” is redefined not in utilitarian or economic terms, but as concrete good: the protection of human dignity, the strengthening of communion, the accessibility of liturgical and pastoral life, and the responsible use of resources. Within this framework, innovation is understood as a Christ-centered renewal of administrative practices, while differentiation (“blue ocean”) becomes a form of service rather than competition. The E.R.S.C. matrix is reinterpreted as an ascetical discipline of discernment, guiding administrative decisions through criteria rooted in theological anthropology and ecclesial ethics. Furthermore, the study addresses the ethical meaning of surplus, the role of transparency, the integration of virtue and competence in organizational culture, and the transformation of communication from image management into truthful witness. Ultimately, the paper argues that authentic church administration is not defined by procedural efficiency alone, but by its capacity to manifest, through structures and decisions, the love of Christ in concrete institutional life. Full article

This paper investigates the oscillation properties of solutions to a second-order nonlinear difference equation in noncanonical form with bounded and unbounded neutral terms. By employing the monotonicity of the neutral term together with a linearization technique, we establish new conditions that guarantee all solutions of the equation oscillate. Our results are applicable to various nonlinear forms of the equation, and, notably, the oscillation of all solutions is ensured through a single condition. Consequently, the proposed oscillation criteria are straightforward to apply and distinct from existing results on nonlinear difference equations. Four examples are presented to demonstrate the novelty and significance of the main findings. Full article

Conventional multi-criteria decision-making approaches for battery energy storage system (BESS) dispatch evaluation treat regulatory and policy conditions as compensable criteria within a single aggregate score. This becomes problematic when institutional admissibility functions as a prerequisite for deployment rather than a tradeable attribute. This study aims to develop and test a sequential gate framework. The methodological contribution lies in the evaluation architecture itself: the framework distinguishes sequential admissibility gating from conventional compensatory Multi-Criteria Decision-Making (MCDM). Deployment feasibility is conceptualized as a layered construct in which regulatory admissibility defines the feasible solution space and technical performance differentiates among admissible options. The framework integrates systematic literature screening, quantitative policy and regulatory assessment, and technical ranking using a hybrid Best-Worst Method, Entropy weighting, and TOPSIS approach. A Danish case study covering twelve dispatch strategies compares the proposed sequential design with two flat alternatives. The results show that the evaluation architecture materially affects outcomes: sequential gating excludes an institutionally incomplete strategy and reorders the upper tier by removing compensatory policy effects. Coordinated multi-BESS control at Electric Vehicle charging parks achieves the highest combined feasibility (closeness coefficient 0.891, ranked 1st), while mobile BESS is excluded by the admissibility gate. The sequential design reorders the upper tier relative to flat MCDM, with S4 and S6 rising and S2 and S10 falling once policy compensation is neutralized after the gate. The top-ranked strategy remains robust across sensitivity analysis, Monte Carlo simulation, score perturbation, and VIKOR cross-validation. The framework is presented as an analytical pre-simulation screening tool rather than a validated implementation instrument; external validation against real deployment outcomes is identified as a priority for future research. The framework provides a structured, decision-consistent approach for evaluating deployment feasibility in regulated energy systems. Full article

This paper addresses the existence of mild solutions and the approximate controllability of a class of higher-order Hilfer fractional semi-linear neutral stochastic differential equations with non-instantaneous impulses in Hilbert spaces. The system is driven by both fractional Brownian motion and Poisson jumps, thereby capturing long-range dependence as well as random discontinuities. By combining techniques from fractional calculus, stochastic analysis, and operator theory, we establish sufficient conditions for the existence of mild solutions. The analysis is carried out through the construction of suitable solution operator families and the application of Sadovskii’s fixed point theorem in an appropriate phase space framework. In addition, we investigate the controllability properties of the system and derive criteria ensuring approximate controllability of the underlying fractional neutral dynamics. The proposed approach relies on the structural properties of the higher-order Hilfer fractional derivative, estimates for stochastic integrals with respect to fractional Brownian motion, and compactness arguments adapted to non-instantaneous impulsive effects. The inclusion of Poisson jumps and neutral terms introduces significant analytical difficulties, which are overcome using refined resolvent operator techniques and fractional power estimates. An illustrative example is presented to demonstrate the applicability of the theoretical results. The results obtained generalize and unify several recent developments in the theory of fractional stochastic systems and provide a flexible framework for analyzing controlled dynamical models with memory, randomness, and impulsive behavior. Full article

Understanding the molecular mechanisms underlying host immune responses to SARS-CoV-2 vaccination remains essential, particularly in populations with a high prevalence of obesity. In this cross-sectional study, we evaluated whether body mass index (BMI) is associated with vaccine-induced humoral immunity in a cohort from northeastern Mexico and discuss the findings within a structural immunology framework of spike antigenicity and antibody–epitope interactions. A total of 138 adults were recruited in Reynosa and Matamoros (June 2021–June 2022) and categorized as healthy weight, overweight, or obese according to BMI criteria. Serum anti-SARS-CoV-2 IgG was assessed using an ELISA-based assay, and differences across BMI groups were tested using the Kruskal–Wallis approach. Among all participants, 33.3% were classified as obese and 99.3% (137/138) were seropositive for anti-SARS-CoV-2 IgG. No significant differences in IgG levels were detected between BMI categories (p = 0.20). These results indicate that, in this Mexican cohort—sampled during a period of heterogeneous and often incomplete vaccination schedules—obesity was not associated with reduced detectable anti-SARS-CoV-2 IgG responses. Our findings support the need to integrate population-level serology with mechanistic studies that interrogate antibody quality (e.g., neutralization potency and epitope specificity) to better connect clinical determinants such as obesity with molecular correlates of protection. Full article