Search Results (12,901)

Background/Objectives: Obesity care requires nutritional prescriptions that are individualized, nutritionally coherent, understandable, and feasible within high-volume clinical services. We describe the NUTRI-OBEDIGITHUM pathway, which integrates multidimensional digital phenotyping, clinician-supervised exchange-based nutritional prescription, patient-oriented materials, and structured education, and we report preliminary descriptive outcomes from a retrospective real-world cohort. Methods: This descriptive methodological and operational study included a retrospective observational analysis of anonymized routine-care data. NUTRI-OBEDIGITHUM integrates OBEDIGITHUM, a digitally enabled obesity-care pathway, with Dietcamb^®, a software-supported method that translates individualized energy and macronutrient targets into food exchanges, meal distributions, household measures, food lists, and example menus. The source database comprised 3928 unique patients. Among patients with a plausible baseline weight and an observable 6-month window, the eligible outcome was the measurement closest to day 183 within ±60 days, after prespecified plausibility checks. Baseline characteristics were compared descriptively according to outcome availability. Baseline medication exposure was assessed using free-text mentions only. Results: By the data cutoff, the 6-month window had opened for 3215 patients; 929 (28.9%) had an eligible 6-month weight and 2286 (71.1%) did not. In the analyzed cohort, mean age was 53.7 ± 14.0 years, 70.5% were women, and mean body mass index was 35.9 ± 6.3 kg/m². Mean weight changed from 98.5 ± 20.7 kg at baseline to 94.2 ± 20.3 kg at follow-up, corresponding to a descriptive paired change of −4.3 kg (95% CI −4.7 to −3.9); median total body-weight loss was 3.4%. Losses of at least 5%, 10%, and 15% were observed in 39.6%, 17.8%, and 6.4% of patients, respectively. A baseline GLP-1 receptor-agonist mention was present in 151/929 patients (16.3%); medication timing, dose, duration, dispensing, persistence, and adherence were unavailable. Conclusions: NUTRI-OBEDIGITHUM provides an operational framework for converting multidimensional obesity phenotyping into a structured, flexible, clinician-supervised, and patient-oriented nutritional prescription. The observed weight trajectories are descriptive complete-case findings from a selected, uncontrolled cohort and cannot establish the independent effectiveness of the pathway, Dietcamb^®, or pharmacotherapy. Prospective studies should evaluate reach, adoption, fidelity, usability, adherence, nutritional adequacy, safety, NUTRI-specific workload and cost, and metabolic outcomes. Full article

South Korea faces a severe demographic crisis characterized by an unprecedented decline in its total fertility rate, transforming labor migration governance from routine administration into a contested policy arena. Focusing on the Employment Permit System (EPS) and Vietnamese labor flows—one of the largest sending-country cohorts—this study examines how competing policy beliefs shape migration governance and contribute to periodic policy shifts. Employing an integrated framework combining the Advocacy Coalition Framework (ACF) and Punctuated Equilibrium Theory (PET), the analysis traces policy dynamics using documentary evidence, including official statistics, bilateral memoranda of understanding (MOUs), parliamentary records, and policy white papers. The findings identify competing instrumentalist growth and nativist closure orientations that structure policy debate while varying across specific dimensions of migration governance. Policy stability has been periodically disrupted by shifts in policy image and political attention, most notably the 2012 restrictions associated with escalating non-return concerns and the post-2020 expansion of EPS admissions linked to demographic-emergency reframing. The study concludes that continued reliance on temporary migration creates an instrumentalization trap: expanding labor recruitment without corresponding changes in opportunities for long-term residence and social incorporation limits migration’s capacity to address structural demographic decline. Full article

Recent studies on users of urban parks call for the need for more insight into the importance of green spaces as catalysts of more inclusive spaces. This paper contributes to the ongoing debate by examining urban parks as age-inclusive infrastructures in a post-socialist context. Three parks in the City of Timișoara, Romania, are selected as a comparative case study. Our analysis combines systematic field observations and GIS-based mapping of park accessibility and facilities with 42 semi-structured interviews with young, mid-aged and older visitors to the three contrasting parks: a renovated historic central park, a peripheral forest-like park and a small neighbourhood park embedded in a communist-era housing estate. The findings suggest that inclusiveness for all generational categories, as well as attachment for neighbourhood parks, are important drivers for urban parks users. Inclusiveness is driven not only by amenities, but also by park-specific attachment, as well as the quality of maintenance and lighting. These factors shape perceived equity and convenience. We advocate for a differentiated management model tailored to each park, balancing conservation-oriented quiet zones with flexible, event-capable areas. This model prioritises lighting, seating ergonomics and safety measures as core components of age-inclusive planning. Our findings support the need for different management of urban green spaces that capitalises on the social and spatial specificities of each park. The comparison further shows that the smallest and least equipped park generates the strongest attachment and the most regular use across all generations: proximity and continuity of maintenance matter more than surface area or scale of investment. Full article

Newborn screening (NBS) in Pakistan remains limited by fragmented service delivery, uneven provincial capacity, and the absence of an implementation pathway that links policy intent to operational planning. This study aimed to co-design a provincial NBS implementation framework for Punjab. To do so, we used a sequential blended workshop model supported by visual planning methods. We conducted a qualitative, three-phase co-design process with 19 participants from laboratory medicine, pediatrics, obstetrics, public health, academia, and policy. Phase I consisted of pre-work and an online workshop to establish a shared knowledge base and identify implementation barriers and enablers. Phase II used an in-person, visually facilitated planning workshop to translate these findings into a provincial NBS implementation framework. Phase III involved a asynchronous email-based review to refine the framework and reach consensus. Content analysis from Phase I identified five implementation domains: physical and technical infrastructure, operational systems, clinical integration, workforce and engagement, and governance and policy. In Phase II, these domains were translated into a visual implementation framework that specified priorities, stakeholders, risks, enablers, and action areas for phased rollout. Congenital hypothyroidism was identified as the most feasible entry-point condition. The final framework positioned NBS not as a stand-alone pilot, but as a coordinated provincial system requiring governance, financing, referral pathways, quality assurance, and workforce development. This study contributes an implementation-oriented model for moving from fragmented NBS initiatives to a provincial implementation framework in a low- and middle-income setting. It also offers a practical foundation for broader national scale-up. Full article

Basalt-fiber textile-reinforced engineered cementitious composite (BTR-ECC) combines favorable durability, cost-effectiveness, and mechanics, making it a viable option for structural retrofitting. Although axial behavior is well-documented, off-axis loading zones often constitute structural weak points. To address this gap, this study experimentally and theoretically examines the mechanical responses and failure mechanisms of BTR-ECC at off-axis tensile angles of 0°, 15°, 30°, and 45°. The results demonstrate that: (1) The tensile stress–strain curves exhibit a distinct trilinear characteristic (linear elastic, strain-hardening, and fracture), featuring densely distributed microcracks confined to 30–50 μm. Dominant failure modes include textile rupture, interfacial debonding and pull-out, and PVA fiber bridging. (2) With increasing angles, tensile strength at 0°, 15°, 30°, and 45° surpasses plain ECC by 84.8%, 73.6%, 52.9%, and 54.0%, respectively, confirming effective synergistic load transfer between the basalt-fiber textile and the matrix. Despite progressive strength degradation, the strain energy density remains relatively stable across all orientations, indicating robust energy dissipation capacity. (3) A phenomenological constitutive model based on the tangent modulus approach is established to describe the off-axis tensile response. The model shows good agreement with the experimental data and may serve as a reference for the analysis of BTR-ECC structures within the calibrated range of the four tested angles. Full article

This study investigates how environmentally sustainable and socially responsible entrepreneurship is perceived and prioritized within the Albanian business community and explores the factors that may further support it. Based on 200 structured surveys of business representatives (each responding on behalf of a different Albanian company), this study examines how IT support and sustainability orientation affect the perceived importance and current implementation of sustainability practices. These practices include environmental practices such as waste and water management, economic aspects such as responsible growth and stakeholder collaboration, and social responsibility initiatives related to employee development, inclusion, and community engagement. The study also investigates how perceived reporting limitations affect perceived economic and circular-economy opportunities in Albanian firms. To examine the underlying structure of these dimensions, a Principal Component Analysis (PCA) was first conducted on the listwise-complete subset of the sample (n = 152), followed by a Confirmatory Factor Analysis (CFA) and Structural Equation Modeling (SEM) on the full sample (n = 200). The analysis identified six latent factors, including Ecological, Social, and Economic Sustainability, Ecological, Social, and Economic Sustainability, IT Support for Sustainability, Limitations in Sustainability Reporting, Circular Economy Activities and Opportunities, Economic Opportunities and Benefits of Sustainability Reporting (KMO = 0.903; Bartlett’s χ²(1378) = 6746.19, p < 0.001) with excellent internal consistency (Cronbach’s α = 0.813–0.946). SEM revealed that IT support for Sustainability (β = 0.42) and Ecological–Social–Economic Sustainability Orientation (β = 0.47) together account for 56% of the variance in the perceived importance of sustainability implementation drivers, while perceived reporting limitations are negatively associated with both perceived economic opportunities and circular economy activities. Overall, the findings suggest that Albanian businesses are increasingly aware of the importance of sustainable entrepreneurship and recognize the potential of the circular economy and sustainability reporting. However, realizing this potential may depend on enhancing internal capabilities, particularly IT support and strategic orientation, while simultaneously improving the institutional environment so that sustainability can become a mainstream notion. Full article

In recent years, education for sustainable development has assumed an increasingly important role in shaping the key competences needed to understand and adopt responsible consumption behaviors. In such a context, this article proposes an analysis of the way in which an elective course on Sustainable Consumption Behaviors, introduced recently into a university educational program at a higher education institution in Romania, can create opportunities for engaging students with knowledge and values related to sustainability. The article is built around a case study on the curricular design of the course, examined in relation to the conceptual framework of education for sustainable development and to the UNESCO competences. The analysis maps the teaching assessment activities onto the framework of key sustainability competencies proposed by UNESCO. It presents both the content and architecture of the course, as well as the thematic distribution of the choices made by students for the assessment tasks. The results indicate that students’ assessment choices were predominantly oriented toward applied topics closer to their everyday experiences: food waste, recycling, reuse, organizational practices for promoting sustainable consumption, and others. Overall, these results suggest that pedagogical approaches centered on practical relevance, critical reflection, and creativity may create favorable conditions for engaging with values associated with sustainability. Therefore, through this article, we highlight the real potential that such thematic elective courses could have in strengthening education for sustainable development and sustainable consumption in higher education. Full article

The Mediterranean Basin ranks among the region’s most vulnerable to climate change, yet little evidence exists as to whether the scientific literature emphasises strategic planning or operational implementation. This study measures the thematic distribution of adaptation strategies in the Mediterranean adaptation literature and identifies which categories of measures remain comparatively under-researched. A systematic review following PRISMA 2020 was conducted on peer-reviewed articles indexed in the Web of Science Core Collection and published between 2015 and 2024, retrieved through a thematic query built on regional and landscape planning vocabulary. Of 89 articles retained in the qualitative synthesis, 64 reported at least one codable adaptation measure and entered the quantitative analysis, yielding 123 coded occurrences across twelve thematic categories; the remaining 25 returned a null coding vector. Chi-square goodness-of-fit testing against a maximum-entropy benchmark, with residuals corrected for article-level dependence by cluster bootstrap and for multiplicity by the Benjamini–Hochberg procedure, shows an uneven distribution (χ² (11, N = 123) = 56.02, p < 0.001; Cramér’s V = 0.20; Pielou’s evenness J = 0.90). Sustainable development and adaptation policy are over-represented; green spaces, cultivation and hydrological interventions are under-represented. An article-level analysis of register co-occurrence finds no segregation between policy-oriented and technical categories: 34.4% of coded articles engage both registers, and the two are statistically independent across the corpus (odds ratio 2.02, p = 0.17). The imbalance is therefore one of volume rather than of community structure. Because the unit of observation is the published article rather than the implemented intervention, and because the corpus is restricted to planning-oriented, English-language, indexed literature dominated by northern-rim EU member states, these findings characterise the orientation of a defined body of literature and cannot establish a gap in adaptation practice. The study provides a reproducible method for measuring thematic emphasis and an empirical basis for identifying under-researched categories of operational adaptation measures. Full article

Background/Objectives: Eating-related difficulties in people with multiple sclerosis (MS) may reflect different behavioural and psychological processes, including emotional responses to illness-related stress, habitual overeating, attempts to control food intake, and broader self-management routines. Variable-centred analyses may obscure this heterogeneity by examining eating-related tendencies separately. This study aimed to examine whether habitual overeating, emotional overeating, and dietary restraint in adults with MS are better represented as one general continuum of eating-related difficulty or as distinct person-centred profiles that differ in coping styles, health locus of control, and MS self-management. Methods: This cross-sectional secondary analysis included 382 adults with definite MS. Latent class analysis used 30 binary My Eating Habits Questionnaire items. One-step latent class regression models examined coping and health locus of control. Linear regression compared self-management scores. The models were adjusted for sex, age, disease duration, and Expanded Disability Status Scale score. Results: A five-class solution was retained (BIC = 11,067.60; entropy = 0.920), comprising low difficulties, moderate mixed tendencies, two emotional eating/restraint profiles, and dysregulated overeating. Emotional eating with moderate restraint was associated with lower task-oriented coping and internal health control, and with higher emotion-oriented and avoidance-oriented coping and external health-control beliefs. Dysregulated overeating was associated with lower task-oriented coping, higher avoidance-oriented coping, and stronger powerful-others health beliefs. Self-management was higher for emotional eating with moderate restraint (B = 5.3, 95% CI 1.8 to 8.9; p = 0.003) and high emotional eating and restraint (B = 6.0, 95% CI 1.8 to 10.3; p = 0.005), versus low difficulties. Sensitivity analyses gave similar findings. Conclusions: Eating-related tendencies in MS formed distinct profiles rather than a single continuum. These profiles differed in coping and health-control patterns, suggesting that similar eating-related difficulties may occur in different psychological and self-management contexts. The higher self-management scores observed in restraint-related profiles should be interpreted cautiously and should not be taken to indicate that restrictive eating is adaptive. This study does not establish clinical classification or treatment recommendations. Instead, it provides a descriptive empirical basis for future studies testing whether these profiles are stable and whether they predict dietary, nutritional, psychological, and clinical outcomes. Full article

Self-leadership is increasingly important in service and knowledge-intensive work, yet sustained self-regulation may also create hidden psychological costs. This study introduces self-leadership overload (SLO) as a distinct self-regulatory strain state and examines whether it emerges nonlinearly, whether the self-leadership–SLO association is stronger under high work pressure, and whether SLO shows indirect associations with employee outcomes through work rumination. A two-wave survey of 408 full-time employees across seven service and knowledge-intensive sectors was analyzed using scale-development procedures, iterative PLS-SEM, two-stage nonlinear and moderation models, bootstrapped indirect-effect analysis, incremental-validity tests, and supplementary robustness checks. Self-leadership was positively associated with work happiness and sustainable performance, while its quadratic terms for these outcomes were nonsignificant. By contrast, the quadratic self-leadership–SLO term was positive and significant, indicating a progressively stronger association with overload at higher levels of self-leadership, and work pressure strengthened this association. SLO was associated with lower work happiness and sustainable performance and higher burnout and turnover intention; significant indirect associations through work rumination were observed for all four outcomes. SLO also explained additional variance beyond demographic and employment controls, conventional self-leadership, work pressure, and organizational and personal resources (ΔR² = 0.049–0.123). General organizational resources did not show the hypothesized buffering pattern, whereas health-oriented self-care was negatively associated with overload. The findings refine the self-leadership paradox by showing that a beneficial self-regulatory capability can coexist with an escalating internal burden without a corresponding direct curvilinear downturn in positive outcomes. The study contributes a theoretically bounded and empirically differentiated SLO construct and highlights workload boundaries, recovery, and health-oriented self-care as important conditions for sustainable self-leadership. Full article

Surface-enhanced Raman scattering-based lateral flow immunoassays (SERS-LFIAs) have emerged as a promising platform for rapid food safety analysis. However, their quantitative reliability is often compromised by matrix-dependent variations during lateral flow, and the influence of probe size on analytical performance remains insufficiently understood. In this work, Au@DTNB immunoprobes with diameters of 15, 30, and 50 nm were prepared to systematically investigate the effect of nanoparticle size on the quantitative performance of SERS-LFIA for aflatoxin B1 (AFB1) detection. All three probe sizes exhibited excellent concentration-dependent responses and generated four-parameter logistic calibration curves with correlation coefficients (R2) of 0.997, 0.994, and 0.992, respectively. Although the 50 nm probes produced the strongest Raman signals, recovery experiments in rice and soybean samples revealed that the 15 nm probes provided the highest quantitative accuracy, with recoveries of 90.1–109.2% and 100.4–108.9%, respectively, and relative standard deviations below 7.2%. In contrast, larger probes exhibited progressively greater deviations from the spiked concentrations despite their stronger SERS responses. These results demonstrate that maximizing Raman signal intensity alone does not necessarily improve quantitative performance in complex food matrices. Instead, probe size should be optimized according to matrix characteristics to achieve reliable quantitative analysis. This work establishes a matrix-oriented strategy for probe size selection and provides practical guidance for the rational design of quantitative SERS-LFIA platforms for food safety analysis. Full article

Background: Determining the appropriate magnitude of lumbar lordosis (LL) correction in adult spinal deformity (ASD) remains controversial. The fused spinopelvic angle (FSPA), a posture-independent parameter, may provide a geometric measure of fused-construct orientation associated with proximal junctional kyphosis (PJK) risk. Methods: This retrospective single-center study included 258 patients aged ≥65 years with ASD and pure sagittal malalignment associated with lumbar degenerative kyphosis/drop body syndrome who underwent long-segment fixation from T10 to the sacrum with sacropelvic fixation. Patients were divided into non-PJK (n = 135) and PJK (n = 123) groups. Adjusted nested logistic regression models, receiver operating characteristic (ROC) analysis, and DeLong comparison were used to evaluate the association of FSPA with PJK and its incremental value beyond postoperative pelvic incidence–lumbar lordosis (PI-LL). Results: Postoperative FSPA was lower in the PJK group (p < 0.001) and remained independently associated with PJK in the fully adjusted model including postoperative PI-LL (adjusted OR = 0.910 per degree; 95% CI, 0.866–0.957; p < 0.001). FSPA showed greater discriminatory ability than postoperative PI-LL (AUC, 0.694 vs. 0.596; difference, 0.099; 95% CI, 0.035–0.162; DeLong p = 0.002). Adding FSPA to the clinical model containing postoperative PI-LL significantly improved model fit (likelihood-ratio p < 0.001). The cohort-derived FSPA threshold of 2.38° yielded 64.2% sensitivity and 63.7% specificity. Conclusions: Higher postoperative FSPA was independently associated with lower odds of radiographic PJK and provided additional predictive information beyond postoperative PI-LL. The identified threshold of 2.38° may serve as a preliminary reference for postoperative alignment in this selected cohort. Full article

The coffee berry borer (CBB), Hypothenemus hampei (Ferrari) (Coleoptera: Curculionidae: Scolytinae), is one of the most destructive pests of coffee, causing significant losses in yield, bean quality, and overall crop profitability. Current integrated pest management strategies reduce damage but cannot prevent insects from locating and infesting coffee fruit. Because host selection by CBB relies on olfactory cues, modifying the emission of key volatile compounds represents a potential strategy to reduce pest attraction. This study aimed to decrease CBB attraction by editing genes involved in the biosynthesis of the monoterpenes limonene and pinene, which participate in host recognition. Agrobacterium-mediated transformation was performed in Coffea arabica seedlings, and gene editing used a binary vector carrying sgRNAs targeting terpene synthase genes, the cas9 gene, and the bar selection marker. Nine cas9-positive plants were obtained, including six of them also positive for bar, with seven plants exhibiting non-synonymous mutations at the target site for limonene synthase. Quantitative PCR (qPCR) analysis revealed a significant reduction in transcript levels in edited fruit, ranging from 95.5% to 99.2% compared to wild-type controls. Furthermore, GC-MS analysis confirmed a reduction of approximately 55% in limonene emission in variants exhibiting low-frequency mutations. Olfactometry bioassays revealed significantly reduced attraction, with only 17–36% of H. hampei females orienting toward edited fruit compared with 64–83% for wild-type controls (p < 0.05). These results suggest that targeted editing of limonene synthase can modulate volatile emissions and alter host-seeking behavior in H. hampei, providing a proof-of-concept for engineering crop plants with reduced pest attraction and offering a complementary, sustainable strategy for pest management in coffee production systems. Full article

Dryland reforestation and afforestation have expanded rapidly worldwide. Their success depends not only on tree establishment, but also on long-term persistence and goal attainment. Yet how well these dimensions are addressed across the full restoration trajectory remains unclear. Here, we developed a full restoration trajectory assessment framework and used LLM-assisted literature analysis to systematically evaluate 2362 empirical studies of dryland tree-based restoration. Our results showed substantial imbalances across the restoration trajectory. Research attention was uneven across restoration stages, with greater emphasis on degradation drivers and water constraints before restoration, and on early establishment rather than post-establishment management and long-term persistence during restoration. Goal–outcome alignment was high for major ecological objectives but substantially lower for socioeconomic goals, and cross-boundary effects were rarely considered. Together, these findings reveal that current research remains biased toward establishment and within-site outcomes, while ecological appropriateness, persistence, socioeconomic goal attainment, and broader spatial consequences receive comparatively limited attention. By quantitatively evaluating dryland tree-based restoration across the full restoration trajectory, our study identifies key evidence gaps and provides a framework for guiding restoration toward greater ecological appropriateness, long-term persistence, and goal-oriented evaluation. Full article

A chalazion is an inflammatory lesion of the eyelid caused by a blockage in the sebaceous glands. To identify subtle biochemical differences in chalazion secretions and patient serum, we apply a graph-theory-based visibility-graph approach to Raman spectra, focusing on its exploratory potential for detecting band-specific spectral differences. As a classical baseline, we also employ Principal Component Analysis (PCA); however, the visibility-graph approach provides complementary, band-localized information that may support interpretation of subtle spectral differences. The study included samples from chalazion patients and control subjects, comprising healthy individuals and patients with lipid disorders. Raman spectra were analyzed by transforming the data into visibility graphs, enabling identification of hidden correlations and signal dynamics. Within the VG representation, group differences were concentrated mainly in the 1100–1300 cm⁻¹ range, with localized extrema near 1177, 1184, and 1260 cm⁻¹ in chalazion secretions and near 1172, 1174, 1219, and 1257 cm⁻¹ in serum. The identified positions overlap regions with possible lipid- and protein-related contributions, including C–C, =CH, and amide III vibrations, and are treated as candidate spectral positions rather than markers of individual molecular compounds. From the perspective of complex-network-based signal analysis, the visibility-graph transformation provides an alternative way of representing Raman spectra and extracting structural information that is not readily apparent in the original spectral domain. This information-oriented approach is consistent with entropy-related studies of complex signals, where nonlinear structure, local organization, and hidden dependencies in data are of central interest. These findings suggest that visibility-graph analysis may be useful as an exploratory tool for identifying candidate lipid-related spectral features, although further validation using larger sample sets is required. Full-range PCA was also examined over 200–2000 cm⁻¹. It revealed global covariance patterns distributed across several spectral regions, whereas VG localized the pairwise differences within the 1100–1300 cm⁻¹ range at specific Raman-shift positions. Full article