Search Results (490)

This study investigates the effectiveness of passive design in low-rise residential buildings located in arid desert climates, using the Dubai Solar Decathlon Middle East (SDME) competition as a case study. This full-scale experiment offers a unique opportunity to evaluate design solutions under controlled, realistic conditions; prescriptive, modeled performance; and monitored performance assessments. The prescriptive assessment reviews geometry, orientation, envelope thermal properties, and shading. Most houses adopt compact forms, with envelope-to-volume and envelope-to-floor area ratios averaging 1 and 3.7, respectively, and window-to-wall ratios of approximately 17%, favoring north-facing openings to optimize daylight while reducing heat gain. Shading is strategically applied, horizontal on south façades and vertical on east and west. The thermal properties significantly exceed the local code requirements, with wall performance up to 80% better than that mandated. The modeled assessment uses Building Energy Models (BEMs) to simulate the impact of prescriptive measures on energy performance. Three variations are applied: assigning minimum local code requirements to all the houses to isolate the geometry (baseline); removing shading; and applying actual envelope properties. Geometry alone accounts for up to 60% of the variation in cooling intensity; shading reduces loads by 6.5%, and enhanced envelopes lower demand by 14%. The monitored assessment uses contest-period data. Indoor temperatures remain stable (22–25 °C) despite outdoor fluctuations. Energy use confirms that houses with good designs and airtightness have lower cooling loads. Airtightness varies widely (avg. 14.5 m³/h/m²), with some well-designed houses underperforming due to construction flaws. These findings highlight the critical role of passive design as the first layer for improving the energy performance of the built environment and advancing toward net-zero targets, specifically in arid desert climates. Full article

Background: Pain is a complex phenomenon characterized by unpleasant experiences with profound heterogeneity influenced by biological, psychological, and social factors. According to the National Health Interview Survey, 50.2 million U.S. adults (20.5%) experience pain on most days, with the annual cost of prescription medication for pain reaching approximately USD 17.8 billion. Theranostic pain nanomedicine therefore emerges as an attractive analgesic strategy with the potential for increased efficacy, reduced side-effects, and treatment personalization. Theranostic nanomedicine combines drug delivery and diagnostic features, allowing for real-time monitoring of analgesic efficacy in vivo using molecular imaging. However, clinical translation of these nanomedicines are challenging due to complex manufacturing methodologies, lack of standardized quality control, and potentially high costs. Quality by Design (QbD) can navigate these challenges and lead to the development of an optimal pain nanomedicine. Our lab previously reported a macrophage-targeted perfluorocarbon nanoemulsion (PFC NE) that demonstrated analgesic efficacy across multiple rodent pain models in both sexes. Here, we report PFC-free, biphasic nanoemulsions formulated with a biocompatible and non-immunogenic plant-based coconut oil loaded with a COX-2 inhibitor and a clinical-grade, indocyanine green (ICG) near-infrared fluorescent (NIRF) dye for parenteral theranostic analgesic nanomedicine. Methods: Critical process parameters and material attributes were identified through the FMECA (Failure, Modes, Effects, and Criticality Analysis) method and optimized using a 3 × 2 full-factorial design of experiments. We investigated the impact of the oil-to-surfactant ratio (w/w) with three different surfactant systems on the colloidal properties of NE. Small-scale (100 mL) batches were manufactured using sonication and microfluidization, and the final formulation was scaled up to 500 mL with microfluidization. The colloidal stability of NE was assessed using dynamic light scattering (DLS) and drug quantification was conducted through reverse-phase HPLC. An in vitro drug release study was conducted using the dialysis bag method, accompanied by HPLC quantification. The formulation was further evaluated for cell viability, cellular uptake, and COX-2 inhibition in the RAW 264.7 macrophage cell line. Results: Nanoemulsion droplet size increased with a higher oil-to-surfactant ratio (w/w) but was no significant impact by the type of surfactant system used. Thermal cycling and serum stability studies confirmed NE colloidal stability upon exposure to high and low temperatures and biological fluids. We also demonstrated the necessity of a solubilizer for long-term fluorescence stability of ICG. The nanoemulsion showed no cellular toxicity and effectively inhibited PGE2 in activated macrophages. Conclusions: To our knowledge, this is the first instance of a celecoxib-loaded theranostic platform developed using a plant-derived hydrocarbon oil, applying the QbD approach that demonstrated COX-2 inhibition. Full article

Prescriptive Maintenance (PsM) transforms industrial asset management by enabling autonomous decisions through simultaneous failure anticipation and optimal maintenance recommendations. Yet, despite increasing research interest, the conceptual clarity, technological maturity, and practical deployment of PsM remains fragmented. Here, we conduct a comprehensive and application-oriented Systematic Literature Review of studies published between 2013–2024. We identify key enablers—artificial intelligence and machine learning, horizontal and vertical integration, and deep reinforcement learning—that map the functional space of PsM across industrial sectors. The results from our multivariate meta-synthesis uncover three main thematic research clusters, ranging from decision-automation of technical (multi)component-level systems to strategic and organisational-support strategies. Notably, while predictive models are widely adopted, the translation of these capabilities to PsM remains limited. Primary reasons include semantic interoperability, real-time optimisation, and deployment scalability. As a response, a structured research agenda is proposed to emphasise hybrid architectures, context-aware prescription mechanisms, and alignment with Industry 5.0 principles of human-centricity, resilience, and sustainability. The review establishes a critical foundation for future advances in intelligent, explainable, and action-oriented maintenance systems. Full article

Hemorrhoidal disease remains a prevalent yet often overlooked condition, affecting millions worldwide and imposing a substantial healthcare burden. Despite the availability of multiple treatment options, gaps persist in patient education, early symptom recognition, and optimal treatment selection. Recent advancements are evolving the pharmacist’s role in hemorrhoid management beyond traditional over-the-counter (OTC) and prescription approaches. The 2024 American Society of Colon and Rectal Surgeons (ASCRS) guidelines introduce updates on the use of phlebotonics, a class of venoactive drugs gaining recognition for their role in symptom management, yet largely underutilized in U.S. clinical practice. In parallel, novel clinical tools are reshaping how pharmacists engage in assessment and care. The integration of digital decision-support platforms and structured evaluation algorithms now empowers them to systematically evaluate symptoms, identify red flag signs, and optimize patient triage. These tools reduce diagnostic variability and improve decision-making accuracy. Given their accessibility and trusted role in frontline healthcare, pharmacists are well-positioned to bridge these critical gaps by adopting emerging treatment recommendations, leveraging algorithm-driven assessments, and reinforcing best practices in patient education and referral. This narrative review aims to equip pharmacists with updated insights into evidence-based hemorrhoid management strategies and provide them with structured assessment algorithms to standardize symptom evaluation and treatment pathways. By integrating these innovations, pharmacists can enhance treatment outcomes, promote patient safety, and contribute to improved quality of life (QoL) for individuals suffering from hemorrhoidal disease. Full article

High-intensity interval training (HIIT) has emerged as a promising non-pharmacological intervention for improving cardiometabolic health. In populations with diabetes, cardiovascular disease, obesity, or metabolic dysfunction, redox imbalance—characterized by elevated oxidative stress and impaired antioxidant defense—is a key contributor to disease progression. This narrative review synthesizes current evidence on the effects of HIIT on oxidative stress and antioxidant capacity across diverse cardiometabolic disease cohorts. While findings are heterogeneous, the majority of studies demonstrate that HIIT intervention can reduce levels of oxidative stress markers and enhance antioxidant enzyme expression. These redox adaptations may underpin improvements in vascular endothelial function, inflammation, and metabolic regulation. Importantly, variations in intensity, duration, and health status influence these responses, highlighting the need for individualized exercise prescriptions. Safety considerations are emphasized, including the necessity for medical clearance, gradual progression, and individualized training prescriptions in higher-risk individuals. In conclusion, HIIT shows potential as a targeted strategy to restore redox homeostasis and improve cardiometabolic outcomes, although further research is needed to clarify optimal protocols and the underlying mechanisms. Full article

Background/Objectives: Early experiences can significantly influence brain development, particularly when they occur during specific time windows known as sensitive or critical periods. Therefore, the early promotion of neurodevelopmental functions is crucial in children at risk for neurodevelopmental disabilities, such as those with cerebral palsy. This article introduces AMIRA (A Multidimensional and Integrated Rehabilitation Approach), a rehabilitative framework designed for infants at risk of neurodevelopmental disabilities. Methods: AMIRA is intended to guide clinical–rehabilitation reasoning rather than prescribe a rigid sequence of predetermined activities for the child. The theoretical foundation and structure of AMIRA are presented by formalizing its criteria, objectives, tools, and intervention procedures. The framework comprises four distinct sections, each supported by adaptive strategies to facilitate access to materials and to promote play-based interactions among the child, their environment, and communication partners. Particular attention is given to optimizing both micro- and macro-environments for children with, or at risk of, co-occurring visual impairment. Each rehabilitative section includes three progressive phases: an initial observation phase, a facilitation phase to support the child’s engagement, and an active experimentation phase that gradually introduces more challenging tasks. Results: The intervention pathways in AMIRA are organized according to six core developmental domains: behavioral–emotional self-regulation, visual function, postural–motor skills, praxis, interaction and communication, and cognitive function. These are outlined in structured charts that serve as flexible guidelines rather than prescriptive protocols. Each chart presents activities of increasing complexity aligned with typical developmental milestones up to 24 months of age. For each specific ability, the corresponding habilitation goals, contextual recommendations (including environmental setup, objects, and tools), and suggested activities are provided. Conclusions: This study presents a detailed intervention approach, offering both a practical framework and a structured set of activities for use in rehabilitative settings. Further studies will explore the efficacy of the proposed standardized approach. Full article

Background and objectives: Life expectancies have increased globally, including in Romania, leading to an aging population and thus increasing the burden of chronic diseases. Over 80% of individuals over 65 have more than three chronic conditions, with many exceeding ten and often requiring multiple medications and supplements. This widespread polypharmacy raises concerns about drug interactions, side effects, and inappropriate prescribing. This review examines the impact of polypharmacy in older adult patients, focusing on the physiological changes affecting drug metabolism and the potential risks associated with excessive medication use. Special attention is given to proton pump inhibitors (PPIs), a commonly prescribed drug class with significant benefits but also risks when misused. The aging process alters drug absorption and metabolism, necessitating careful prescription evaluation. Methods: We conducted literature research on polypharmacy and PPIs usage in the older adult population and the risk associated with this practice, synthesizing 217 articles within this narrative review. Results: The overuse of medications, including PPIs, may lead to adverse effects and increased health risks. Clinical tools such as the Beers criteria, the STOPP/START Criteria, and the FORTA list offer structured guidance for optimizing pharmacological treatments while minimizing harm. Despite PPIs’ well-documented safety and efficacy, inappropriate long-term use has raised concerns in the medical community. Efforts are being made internationally to regulate their consumption and reduce the associated risks. Conclusions: Physicians across all specialties must assess the risk–benefit balance when prescribing medications to older adult patients. A personalized treatment approach, supported by evidence-based prescribing tools, is essential to ensure safe and effective pharmacotherapy. Addressing inappropriate PPI use is a priority to prevent potential health complications. Full article

Burn injuries result in complex physiological and psychological sequelae, including hypermetabolism, muscle wasting, mobility impairment, scarring, and disrupted body image. While advances in acute care have improved survival, comprehensive rehabilitation strategies are critical for restoring function, appearance, and psychosocial well-being. Structured physical activity, including resistance and aerobic training, plays a central role in counteracting muscle atrophy, improving cardiovascular function, enhancing scar quality, and promoting psychological resilience and body image restoration. This narrative review synthesizes the current evidence on the effects of exercise-based interventions on post-burn recovery, highlighting their therapeutic mechanisms, clinical applications, and implementation challenges. In addition to physical training, emerging technologies such as virtual reality, aquatic therapy, and compression garments offer promising adjunctive benefits. Notably, artificial intelligence (AI) is gaining traction in burn rehabilitation through its integration into wearable biosensors and telehealth platforms that enable real-time monitoring, individualized feedback, and predictive modeling of recovery outcomes. These AI-driven tools have the potential to personalize exercise regimens, support remote care, and enhance scar assessment and wound tracking. Overall, the integration of exercise-based interventions with digital technologies represents a promising, multimodal approach to burn recovery. Future research should focus on optimizing exercise prescriptions, improving access to personalized rehabilitation tools, and advancing AI-enabled systems to support long-term recovery, functional independence, and positive self-perception among burn survivors. Full article

Objectives: The objective of this study was to assess the effect of aerobic exercise on depressive symptoms and to determine the optimal exercise prescription for Parkinson’s disease (PD) patients. Methods: A comprehensive search was conducted across PubMed, Web of Science, Cochrane, Scopus, and Embase databases. A meta-analysis was conducted to determine the standardized mean difference (SMD) and 95% confidence interval. Results: Aerobic exercise significantly alleviated depressive symptoms in PD patients (SMD, −0.68, p = 0.002). Subgroup analyses revealed that moderate intensity aerobic exercise (SMD, −0.72, p = 0.0006), interventions conducted for ≥12 weeks (SMD, −0.85, p = 0.04), ≥3 times per week (SMD, −0.68, p = 0.002), ≥60 min per session (SMD, −0.57, p < 0.0001), and ≥180 min per week (SMD, −0.87, p = 0.0002) were more effective in improving depressive symptoms in PD patients, especially in PD patients with a disease duration of ≤6 years (SMD, −1.00, p = 0.04). Conclusions: Integrating the available data, it is clear that aerobic exercise is a proven method for alleviating depressive symptoms in PD patients. This meta-analysis provides empirical support for clinicians to recommend that PD patients engage in aerobic exercise regimens of no less than 12 weeks’ duration, performed at a minimum frequency of three sessions per week, with each session lasting in excess of 60 min and a cumulative weekly duration of at least 180 min, to effectively attenuate depressive symptomatology. Earlier implementation of aerobic exercise interventions is recommended, as PD patients in the early stages of the disease (up to 6 years post-diagnosis) may derive the greatest benefit in terms of depression symptom improvement from such programs. Full article

Background: Resistance training (RT) promotes muscle hypertrophy and strength gains in both men and women. However, sex differences in neuromuscular performance, muscle fiber composition, and the hormonal environment influence strength and power adaptations. While men generally exhibit greater absolute and relative strength, it remains unclear to what extent these differences persist across various load intensities. A better understanding of sex-specific strength and power profiles may help optimize training strategies. The aim of this study was to compare strength and power performance during the bench press exercise in physically active males and females, relative to body mass and fat-free mass (FFM). Methods: Twenty-nine physically active individuals (16 men: 21.3 ± 4.1 years, 13 women: 22.6 ± 4.9 years) performed a one-repetition maximum (1RM) test and an incremental velocity-based assessment at 45%, 55%, 65%, 75%, and 85% of the 1RM using a Smith machine. The barbell velocity was measured via a linear transducer, with the mean propulsive velocity (MPV) recorded for each load. Power-related variables (e.g., peak force [F0], maximal velocity [V0], and maximal power [Pmax]) were analyzed. To account for differences in body composition, data were adjusted for body mass and FFM. Results: Men exhibited significantly greater strength and power than women across most loads when adjusted for both body mass and fat-free mass (FFM) (p < 0.05). These differences were particularly pronounced when normalized to FFM (45–75%1RM; p = 0.001–0.031), with large effect sizes observed (ηp² = 0.185–0.383). Notably, sex differences in mean propulsive velocity (MPV) disappeared at 85%1RM (p = 0.208; ηp² = 0.06), suggesting that maximal neuromuscular recruitment may minimize sex-related disparities at higher intensities. Furthermore, men demonstrated significantly higher values in six of the seven power-related variables, with no significant differences in the %1RM required to achieve an optimal power output. Conclusions: These findings confirm that men exhibit greater strength and power than women, even after adjusting for body composition. However, at high relative loads (≥85%1RM), sex differences in movement velocity appear to diminish, likely due to similar recruitment patterns of high-threshold motor units. These results highlight the importance of sex-specific resistance training programs, particularly in relation to load prescription and the application of velocity-based training methods. Full article

Digital Twins (DTs) are transforming manufacturing by bridging the physical and digital worlds, enabling real-time insights, predictive analytics, and enhanced decision making. In Industry 4.0, DTs facilitate automation and data integration, while Industry 5.0 emphasizes human-centric, resilient, and sustainable production. However, implementing DTs in robotic metal additive manufacturing (AM) remains challenging because of the complexity of the wire-based laser metal deposition (LMD) process, the need for real-time monitoring, and the demand for advanced defect detection to ensure high-quality prints. This work proposes a structured DT architecture for a robotic wire-based LMD cell, following a standard framework. Three DT implementations were developed. First, a real-time 3D simulation in RoboDK, integrated with a 2D Node-RED dashboard, enabled motion validation and live process monitoring via MQTT (message queuing telemetry transport) telemetry, minimizing toolpath errors and collisions. Second, an Industrial IoT-based system using KUKA iiQoT (Industrial Internet of Things Quality of Things) facilitated predictive maintenance by analyzing motor loads, joint temperatures, and energy consumption, allowing early anomaly detection and reducing unplanned downtime. Third, the Meltio dashboard provided real-time insights into the laser temperature, wire tension, and deposition accuracy, ensuring adaptive control based on live telemetry. Additionally, a prescriptive analytics layer leveraging historical data in FireStore was integrated to optimize the process performance, enabling data-driven decision making. Full article

Despite recent advances in the treatment of obesity, lifestyle medicine remains foundational to the treatment of individuals with obesity, regardless of the modality chosen by the patient with the guidance of the clinician they are working with, including in conjunction with, as appropriate, anti-obesity medications and metabolic surgery. Lifestyle medicine involves the use of diet, exercise, sleep, stress, and other lifestyle modalities in the treatment of disease. Clinicians and health systems should, after a patient-centered discussion with the patient, do their best to ensure access to lifestyle treatments. Gold standard guidelines recommend intensive, multicomponent lifestyle change programs for obesity treatments with evidence-based diet and exercise counseling and established, theoretically driven behavior change components. Clinicians treating obesity should be aware of their own biases, make efforts to reduce stigmatizing experiences in their practice, and address weight stigma in their treatment plans as needed. A variety of dietary patterns can be used to support patients with obesity, and clinicians should make evidence-based but patient-centered recommendations that aim to maximize adherence. Diet and exercise can play an important role in reducing the side effects of treatment and optimizing outcomes in weight loss, attenuating the effects of metabolic adaptation, and weight maintenance. Exercise should be increased gradually to reduce injury with a goal of 200–300 min (approximately 3.3–5 h) of moderate to vigorous intensity exercise per week to maximize weight maintenance effects with exercise prescriptions customized to patients risks. A variety of practice models can be leveraged along with the use of an interdisciplinary team to provide lifestyle medicine care for those with obesity. Full article

Background/Objectives: Proton therapy delivers highly conformal doses to the target area without producing an exit dose, minimizing cumulative doses to healthy liver tissue. This study aims to evaluate current practices, challenges, and variations in the implementation of proton stereotactic body radiation therapy (SBRT) and hypofractionated therapy for liver malignancies, with the goal of providing a technical assessment to promote broader adoption and support future clinical trials. Methods and Materials: An extensive survey was conducted by NRG Oncology across North American proton treatment centers to assess the current practices of proton liver SBRT and hypofractionated therapy. The survey focused on key aspects, including patient selection, prescription and normal tissue constraints, simulation and motion management, treatment planning, quality assurance (QA), treatment delivery, and the use of image-guided radiation therapy (IGRT). Results: This survey captures the current practice patterns and status of proton SBRT and hypofractionated therapy in liver cancer treatment.  Proton therapy is increasingly preferred for treating inoperable liver malignancies due to its ability to minimize healthy tissue exposure. However, the precision required for proton therapy presents challenges, particularly in managing uncertainties and target motion during high-dose fractions and short treatment courses. Survey findings revealed significant variability in clinical practices across centers, highlighting differences in motion management, dose fractionation schedules, and QA protocols. Conclusion: Proton SBRT and hypofractionated therapy offer significant potential for treating liver malignancies. A comprehensive approach involving precise patient selection, treatment planning, and QA is essential for ensuring safety and effectiveness. This survey provides valuable insights into current practices and challenges, offering a foundation for technical recommendations to optimize the use of proton therapy and guide future clinical trials. Full article

Variable-rate nitrogen (VR-N) application allows farmers to optimize nitrogen (N) input site-specifically within field boundaries, enhancing both economic efficiency and environmental sustainability. In this study, VR-N technology was applied to durum wheat in two small-scale commercial fields (3–4 ha each) located in distinct agro-climatic zones of Thessaly, central Greece. A real-time VR-N application algorithm was used to calculate N rates based on easily obtainable near-real-time data from unmanned aerial vehicle (UAV) imagery, tailored to the crop’s actual needs. VR-N implementation was carried out using conventional fertilizer spreaders equipped to read prescription maps. Results showed that VR-N reduced N input by up to 49.6% compared to the conventional uniform-rate N (UR-N) application, with no significant impact on wheat yield or grain quality. In one of the fields, the improved gain of VR-N when compared to UR-N was 7.2%, corresponding to an economic gain of EUR 163.8 ha⁻¹, while in the second field—where growing conditions were less favorable—no considerable VR-N economic gain was observed. Environmental benefits were also notable. The carbon footprint (CF) of the wheat crop was reduced by 6.4% to 22.0%, and residual soil nitrate (NO₃⁻) levels at harvest were 13.6% to 36.1% lower in VR-N zones compared to UR-N zones. These findings suggest a decreased risk of NO₃⁻ leaching and ground water contamination. Overall, the study supports the viability of VR-N as a practical and scalable approach to improve N use efficiency (NUE) and reduce the environmental impact of wheat cultivation which could be readily adopted by farmers. Full article

Background: Pneumococcal vaccination rates in the United States (US) remain suboptimal, especially for adults aged 19 to 64 with high-risk medical conditions. Community-pharmacy-based immunization services increase vaccine access, particularly in rural areas. This study describes the provision of pneumococcal immunization services, assesses the processes used to identify and confirm patient eligibility, and determines barriers to immunization services in rural community pharmacies. Methods: A cross-sectional survey was emailed to members of the Rural Research Alliance of Community Pharmacies, located in the southeastern US. The survey assessed which pneumococcal vaccines were offered, age groups, prescription requirements, and how patient eligibility was determined. In addition, participants were asked to rate a series of patient-related and organizational barriers to pneumococcal vaccination. Results: Ninety-four pharmacies completed the survey, with most (96.8%) offering pneumococcal vaccines, most commonly PCV20 (95.6%). Most pharmacies vaccinated patients upon request (98.9%) or when patients presented with a prescription (82.4%), but few proactively contacted patients to schedule the vaccination (17.6%). Pharmacists most often administered pneumococcal vaccines to patients aged 65 and older and used patient age and immunization information systems to identify eligible patients. The most common patient-related barrier was the patient’s belief that they do not need the vaccine. The most common organizational barriers were inadequate reimbursements for vaccine administration and vaccine products. Conclusions: Pneumococcal vaccinations are commonly offered in rural community pharmacies, which play an important role in immunization access. With recent guideline changes to the age-based recommendation, there is an opportunity to optimize strategies to increase vaccine uptake. Full article