Search Results (3,784)

Menopause marks a complex biopsychosocial transition defined by the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. South Asian women tend to experience menopause earlier (45–47 years) than North American women, yet limited culturally appropriate interventions exist to address their symptoms. While hormone replacement therapy can reduce discomfort, its associated risks and limited cultural feasibility restrict its use in this population. There is a growing need to explore non-pharmacological and culturally relevant alternatives. Physical activity has been associated with potential well-being benefits during menopause. This study examined the prospective acceptability of a pedometer-based walking intervention, encouraging 10,000 steps daily, among South Asian immigrant women. The study was conducted in 2024 and completed within approximately seven months. A cross-sectional survey was conducted with 64 South Asian women aged 40–70+ years, who completed a questionnaire assessing the prospective acceptability and perceived barriers to participation. Overall, participants reported moderate to high levels of acceptability of the proposed walking intervention. Some participants perceived potential benefits for well-being; however, given the study design, effectiveness and symptom management outcomes were not assessed. Sociocultural factors—such as family responsibilities, modesty concerns, and limited access to supportive environments—were identified as potential barriers to participation. These findings suggest that a pedometer-based walking intervention may be acceptable to some South Asian immigrant women, though acceptability was not uniform and may be influenced by contextual factors, including opportunity costs. Further research using longitudinal or interventional designs is needed to evaluate feasibility, uptake, and effectiveness. Full article

Insufficient physical activity (IPA) among university students remains an important public health concern associated with adverse health outcomes. Although barriers to physical activity (PA) are widely documented, less is known about how these barriers cluster within different university contexts and student subgroups. This study examined hierarchical configurations of perceived barriers associated with IPA in a multicountry university sample. A cross-sectional analytical study was conducted with 686 undergraduate students (60.8% women; mean age = 22.4 ± 5.1 years) from Chile, Mexico, Spain, and Italy. Perceived barriers were assessed using the BBAQ-21 and self-reported PA using the IPAQ–Short Form. CART and Exhaustive CHAID decision-tree models were applied to identify subgroup configurations based on cumulative barrier burden. Country-based subsamples and self-reported post-pandemic PA emerged as the principal segmentation variables. The Mexican subsample showed the highest barrier burden. Students reporting increased PA generally clustered within lower-barrier configurations, whereas stable or reduced PA tended to coincide with greater perceived barrier burden. Perceived barriers formed differentiated and context-dependent configurations associated with PA patterns. These findings provide exploratory insight into how barriers cluster within university populations and support more context-aware interpretation of PA-related constraints within higher education settings. Full article

Efficient management of soil–water resources is critical for global food security under intensifying climatic and demographic pressures. This review provides a comprehensive synthesis of artificial intelligence (AI) and distributed deep learning methodologies applied to soil–water interactions in precision agriculture. The physical and hydraulic foundations of soil–water systems—including water retention, unsaturated flow governed by the Richards equation, and soil degradation processes—are examined and situated within a unified framework of AI-based modeling and decision support. Classical machine learning (ML) algorithms (Random Forests, Support Vector Machines, gradient boosting) and deep learning architectures (convolutional neural networks, long short-term memory networks, transformers) are evaluated with respect to their capacity to predict soil moisture dynamics, estimate hydraulic properties, support smart irrigation scheduling, and generate digital soil maps at field-to-regional scales. Distributed training paradigms, federated learning for privacy-preserving multi-farm analytics, and edge AI deployment on low-power IoT hardware are assessed as enabling infrastructures for scalable agricultural intelligence. This review further addresses explainability, uncertainty quantification, and ethical dimensions inherent to AI-driven agricultural systems. Key challenges—including training data scarcity in data-poor regions, model interpretability, integration with physics-based hydrological models, and real-time deployment constraints—are critically discussed. Prospective research directions encompass physics-informed neural networks, foundation models for earth observation, autonomous digital twins of soil–water systems, and federated learning architectures aligned with data sovereignty frameworks. The synthesis underscores AI’s transformative potential for sustainable agricultural water management while delineating the technical and sociotechnical barriers that must be resolved to realize this potential at a global scale. Full article

Aim: Self-stigma represents a major barrier to recovery among individuals with severe mental illness (SMI). This review aimed to identify and synthesize the available evidence on the effectiveness of non-pharmacological interventions for reducing self-stigma in adults with SMI, while also exploring physical appearance care as a potentially relevant but under-researched area. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and the Cochrane Handbook recommendations. The review protocol was registered in PROSPERO (CRD420251013333). Data Sources: A comprehensive search was conducted across multiple databases, including the Virtual Health Library, PubMed, Web of Science, the Cochrane Library, and EBSCOhost databases. A snowball search of reference lists was also performed. Studies published in English or Spanish within the past ten years were included. Review Methods: Two independent reviewers screened titles, abstracts, and full texts according to predefined criteria. Methodological quality was assessed using the Critical Appraisal Skills Programme España (CASPe). A qualitative synthesis was conducted for all included studies, and a random-effects meta-analysis was performed for studies providing sufficient quantitative data. Standardized mean differences and heterogeneity statistics were calculated. Results: Twenty-eight studies were included in the qualitative synthesis, and twelve were eligible for meta-analysis. Multicomponent interventions integrating psychoeducation, cognitive restructuring, narrative approaches, and social support showed the most consistent effects across the evaluated outcome domains. Meta-analytic findings indicated small-to-moderate reductions in self-stigma and improvements in hope, with low levels of statistical heterogeneity across outcomes. Effects on self-esteem, quality of life, self-efficacy, and psychiatric symptomatology were limited or inconsistent across studies. No studies specifically evaluated interventions focused on physical appearance care. Conclusions: Non-pharmacological interventions appear to produce modest but potentially meaningful reductions in self-stigma among individuals with SMI, particularly when delivered through multicomponent psychosocial approaches that integrate psychoeducation, cognitive restructuring, narrative techniques, and social support. Full article

Clear cell renal cell carcinoma (ccRCC) accounts for approximately 75% of renal cell carcinomas and is defined by near-universal VHL inactivation, leading to constitutive HIF stabilisation, metabolic reprogramming, and an immunologically distinct tumour microenvironment (TME). Although ccRCC is characterised by abundant immune infiltration, this paradoxically correlates with poor prognosis, reflecting a TME that imposes interconnected physical, immunological, and metabolic barriers to effective immunotherapy. Chimeric antigen receptor (CAR)-based therapies have revolutionised the treatment of haematological malignancies, but their translation to ccRCC has encountered substantial hurdles. The first-in-human trial targeting carbonic anhydrase IX (CAIX) was limited by on-target off-tumour toxicity and CAR immunogenicity—lessons that fundamentally reshaped the field. CD70 has since emerged as the dominant clinical target, expressed in over 80% of ccRCCs with a highly restricted normal tissue distribution. The phase I COBALT-RCC trial of CTX130, an allogeneic CRISPR-Cas9-edited CD70-directed CAR-T cell product, provided formal proof of concept, achieving disease control in 81.3% of heavily pretreated patients and a durable complete response now exceeding three years—the first such sustained remission reported for any CAR-T cell product in a solid malignancy. Nevertheless, the low frequency of durable responses and universal loss of CAR-T cell persistence by day 28 underscore that major barriers remain. Beyond CD70, the field has diversified across multiple platforms, including CAR–natural killer (NK) cells, CAR–natural killer T (NKT) cells, and CAR–macrophages, each offering distinct biological advantages. This review synthesises current knowledge of the ccRCC TME, the preclinical landscape of CAR-based therapies, and emerging clinical evidence from more than 30 registered trials. We discuss target antigens; engineering strategies to overcome TME barriers, including cytokine armouring, chemokine receptor co-expression, switch receptors, and metabolic reprogramming; and rational combination approaches. We argue that the convergence of optimised target selection, cellular engineering, combination strategies, and biomarker-driven trial design may ultimately improve outcomes for patients with ccRCC. However, achieving a cure remains an aspirational goal, and significant barriers must first be overcome. Full article

Pancreatic ductal adenocarcinoma (PDAC) remains among the most therapeutically intractable malignancies, with a 5-year survival rate of approximately 10% and near-universal resistance to immune checkpoint inhibitor (ICI) therapy. This refractoriness arises from the convergence of pronounced intratumoral heterogeneity (ITH) and a profoundly immunosuppressive tumor microenvironment (TME), which together configure PDAC as a prototypical immune-excluded tumor. Beyond low tumor mutational burden, PDAC exhibits layered genetic, epigenetic, transcriptional, and metabolic heterogeneity that enables rapid adaptation and immune evasion under selective pressure, while dense desmoplastic stroma, cancer-associated fibroblasts (CAFs), and immunosuppressive immune populations collectively impose formidable physical and immunologic barriers to antitumor immunity. In this review, we synthesize multi-omics, spatial transcriptomic, and immunologic evidence to elucidate how ITH and the TME dynamically interact to reinforce immune resistance. We examine reciprocal crosstalk mechanisms—including immune-driven clonal selection, interclonal cooperation, metabolic niche specialization, and metabolic–epigenetic coupling—and discuss emerging platforms such as single-cell spatial omics, patient-derived organoid immune co-culture systems, and longitudinal circulating tumor DNA monitoring that enable high-resolution mapping of ITH–TME dynamics. Finally, we evaluate ITH–TME-guided combination therapeutic strategies targeting oncogenic drivers, stromal architecture, myeloid suppression, and metabolic checkpoints, and propose a prioritized framework for near-term and speculative clinical translation in PDAC. Full article

Background: Sedentary behavior is a major modifiable risk factor for chronic metabolic disorders, particularly type 2 diabetes mellitus (T2DM). Despite recommendations promoting regular physical activity (PA), adherence remains low. DIA/01 is a multidisciplinary study designed to promote healthy lifestyles for the prevention and management of T2DM, supporting healthcare systems. Methods: A total of 123 adults with T2DM diagnosed will be enrolled at the Diabetes Center of the University Hospital of Perugia throughout 2025. Inclusion criteria are age 25–80 years, ability to walk independently, being inactive, and BMI 18.5–40 kg/m². Exclusion criteria include severe cardiovascular, central nervous system, or musculoskeletal diseases contraindicating PA. Participants will be randomized into three groups: (1) standard care (SC); (2) SC plus theoretical PA counseling (TCPA); and (3) SC plus TCPA plus a 3-month supervised mixed exercise program. The assessment, conducted at baseline and at 6 and 12 months, includes total weekly PA (WPA) time, using IPAQ-SF and actigraphy. Moreover, glycated hemoglobin, sedentary time (ST), functional capacity, body composition, cardiometabolic risk factors, dietary adherence, perceived barriers and willingness to initiate PA, readiness to change, health-related quality of life, and sleep quality will be studied. This study is registered in the Clinical Trials Registry on 13 May 2026, with the identifier NCT07583355. Conclusions: Participants in groups (2) and (3) are expected to show greater improvements in WPA, reductions in ST, and favorable changes in metabolic and functional outcomes compared with SC. This approach may support long-term engagement in regular PA and contribute to improving the clinical management of T2DM. Full article

Background/Objectives: Wheelchair users with multiple sclerosis (MS) often face barriers that restrict participation in physical activity and exercise training. This manuscript reports on participant feedback to guide evaluating and refining a novel exercise training program, Seated Physical activity INtervention (SPIN). SPIN was adapted from the Guidelines for Exercise in MS (GEMS) approach using a three-step community-engaged research framework based on meeting the needs of wheelchair users with MS. Methods: Semi-structured interviews were conducted with 9 participants who completed the 16-week SPIN intervention. The key SPIN intervention components were the exercise prescription, exercise equipment, and behavioral coaching grounded in Social Cognitive Theory. Formative interview domains included overall experience, enjoyable and missing components, delivery modifications, barriers, lessons learned, and additional research topics of interest. Data were analyzed and reported using a rapid qualitative analysis approach. Results: Interviews averaged 16 ± 10 min. Participants reported enjoying SPIN, noting program strengths as being flexible and appropriate for individuals with MS, receiving coaching calls by knowledgeable staff that offered support and accountability, and receiving exercise equipment and video demonstrations. Participants also identified strategies for enhancing the program such as including peer support, offering real-time feedback during exercise, and adding other wellness behavior topics (e.g., diet). Conclusions: The results offer helpful ideas to consider when developing exercise training programs for wheelchair users with MS and other disabilities that may improve health and well-being. Full article

FDM-printed polylactic acid (PLA) composites containing 5 and 10 wt% obsidian powder sourced from the Kars region of Eastern Anatolia (Turkey) were produced via twin-screw masterbatch extrusion and subsequent single-screw filament dilution. Mechanical (tensile, three-point flexure, notched Charpy impact, Shore D), physical (density), thermal (simultaneous TGA/DSC) and microstructural (macroscopic fractography and SEM at 100×–1000×) characterizations were performed on FDM-printed specimens. Young’s modulus rose monotonically by +9.0% at 5 wt% and +18.2% at 10 wt%, while ultimate tensile strength decreased by 12.4% and 17.3%, respectively. The flexural modulus increased by +15.2% at 5 wt% and plateaued at 10 wt% (+16.7%), whereas the flexural strength decreased by only 3.5% at 10 wt%, indicating that flexure-mode loading is markedly more tolerant of obsidian filler than axial tension. Shore D hardness rose by +2.11 points from 0 to 5 wt% with saturation thereafter. TGA showed a dual thermal effect: T₅ and T₁₀ dropped by 5–6 °C from 5 to 10 wt%, while the main decomposition rate decreased by ~46% and the decomposition interval widened from 9.7 to 23.5 °C, indicating a barrier/heat-shielding effect of dispersed silicate particles. SEM revealed a continuous ductile → transitional → brittle progression with increasing obsidian content; extended interfacial debonding lines at 10 wt% identified weak unmodified filler/matrix coupling as the principal performance-ceiling factor. Density measurements indicated a ~3–6% residual void fraction consistent with the inter-bead voids observed by SEM. To the authors’ knowledge, this is the first systematic study of obsidian as a reinforcing filler in PLA; the 5 wt% composition is identified as a strong candidate for esthetic, flexure-dominant, and low-load structural applications. Full article

Over the past decade, educators and administrators in higher education have taken steps toward improving accessibility in teaching and learning. Yet research on supporting students with disabilities in experiential pedagogies, such as community-engaged learning, remains limited, particularly regarding best practices for inclusive instruction. The present study addresses this gap by exploring the perceptions and experiences of students with disabilities in community-engaged learning opportunities, as well as the support mechanisms that may contribute to their meaningful participation in these experiences. Forty-three students with disabilities participated in this qualitative study. Drawing on focus groups, individual interviews, and written responses, the study identifies themes for more inclusive design and delivery, including clearly outlining the physical and digital demands of engagement activities well in advance, designing courses with flexibility in mind, protecting students’ privacy, and including an accessibility statement in the syllabus. While the thematic analysis offers practical recommendations for educators and administrators, aimed at reducing barriers and fostering meaningful participation, the study also advocates for greater theoretical engagement with the personal and relational dimensions of experiential education. Full article

Background/Objectives: Parkinson’s disease (PD) is increasingly recognized as a multisystem disorder affecting perceptual, emotional, and reward-related processes. While arts-based interventions in PD have primarily focused on active creative arts engagement, it remains unclear whether receptive arts engagement with visual art—how artworks are perceived and evaluated—is altered. Our objective is to determine whether aesthetic evaluation of visual artworks differs in individuals with PD compared to age-matched healthy controls. We further examine whether emotional interpretation, color-emotion associations, and experiential responses to art viewing are altered. Methods: In a cross-sectional case–control study, individuals with PD (n = 87) and age-matched healthy controls (n = 49) completed two online assessments. Participants evaluated 36 artworks from the Vienna Art Picture System in terms of liking, beauty, and subjective art attributes. Objective image-derived features were computed for each artwork. Interpretable machine learning models were used to test whether evaluation patterns predicted diagnostic group and to identify determinants of aesthetic judgments. Participants further completed a color-emotion association task using ambiguous expressive portraits and reported perceived changes in cognitive, emotional, motivational, and physical states following art viewing. Results: Aesthetic evaluation patterns did not support reliable classification of PD status, indicating no systematic group differences in liking, beauty, or attribute-based judgments between PD and controls. Instead, aesthetic judgments were robustly predicted by individual differences and objective artwork properties, including art-historical style, symmetry, complexity, and color-related features, whereas diagnostic group, gender, and age did not contribute to predictions. Emotional interpretation and color-emotion associations were largely comparable between groups, with a single specific deviation in color-emotion mapping. Positive emotions were less frequently associated with pink in people with PD. Self-reported experiential responses to art viewing did not differ significantly between groups. Conclusions: Aesthetic evaluation of visual artworks appears largely preserved in people with PD. These findings suggest that, in digital viewing contexts, substantial adaptation of visual content to make it accessible for people with PD may not be necessary, although subtle perceptual and emotional differences may still be relevant. Efforts may instead be better directed toward addressing practical barriers to visual art engagement. Full article

To achieve precise trajectory tracking for surface vessels subject to unknown dynamics, strict physical limitations, and external disturbances, this paper proposes an Adaptive Fixed-Time Control Framework that ensures a deterministic response under full constraints. First, navigation safety is guaranteed by employing a Barrier Lyapunov Function (BLF) to strictly confine vessel position states, enabling constrained position tracking without requiring prior knowledge of the desired trajectory. Second, addressing the input constraint aspect of the “full constraints” problem, a fixed-time auxiliary system is introduced to compensate for nonlinearities induced by actuator saturation, thereby maintaining control feasibility. Central to this framework is the realization of a deterministic response; by incorporating fixed-time convergence theory, the controller guarantees that velocity tracking errors converge within a predefined time bound independent of initial conditions. Furthermore, an RBF neural network combined with adaptive techniques is utilized to estimate unknown dynamics and external disturbance bounds online, enhancing robustness and safety in realistic marine environments. Full article

Aphis craccivora is a major piercing–sucking insect pest in faba bean (Vicia faba L.) production and severely restricts yield and quality. To identify aphid-resistant genetic resources and clarify the key physiological and biochemical mechanisms underlying resistance and susceptibility, 937 faba bean germplasm accessions were evaluated using a stepwise strategy comprising natural field screening, precise net-house re-screening, laboratory validation based on aphid life-table parameters, and physiological and biochemical characterization of representative resistant and susceptible accessions. After final laboratory validation, three resistant and three susceptible accessions were selected and subjected to aphid feeding for 0 h (CK), 36 h, and 72 h. Eleven physiological and biochemical traits were dynamically analyzed, including the activities of superoxide dismutase (SOD), peroxidase (POD), catalase (CAT), and phenylalanine ammonia-lyase (PAL), as well as the contents of soluble protein, soluble sugar, free amino acids, tannins, total phenolics, flavonoids, and lignin. Three stable aphid-resistant accessions were ultimately identified. Laboratory life-table analysis showed that the net reproductive rate of aphids on resistant accessions was significantly lower than that on susceptible accessions, with R₀ decreasing from 53.63 to 25.08, representing a reduction of 53.2%. The intrinsic rate of increase decreased by 26.7%, whereas the mean generation time increased by 10.7%, confirming the reliability of the screening results. Physiological and biochemical analyses showed that aphid feeding induced significant and time-dependent increases in SOD, POD, CAT, and PAL activities and in tannin, total phenolic, flavonoid, and lignin contents in resistant accessions, whereas these defense responses were weak in susceptible accessions. In contrast, susceptible accessions showed abnormal accumulation of soluble sugars and free amino acids, whereas resistant accessions maintained these nutrients at low levels. Lignin exhibited both constitutive and inducible defense characteristics in resistant accessions and emerged as a prominent candidate indicator for aphid resistance in faba bean. This study establishes an effective technical pipeline for screening aphid-resistant faba bean germplasm and reveals a coordinated defense network involving antioxidant enzymes, phenylpropanoid metabolism, secondary metabolites, and physical barriers. These findings provide elite parental germplasm and theoretical support for aphid-resistance breeding in faba bean. Full article

The integration of online Digital Twin (DT) technologies with industrial control systems represents an important step toward real-time monitoring and synchronization of manufacturing processes within Industry 4.0 environments. However, reproducible approaches for connecting simulation environments with real industrial control hardware using standardized communication protocols remain insufficiently described in the existing literature. This study presents the development of an online Digital Twin for real-time monitoring of manufacturing processes using OPC UA communication and programmable logic controller (PLC) data exchange. The proposed approach combines discrete-event simulation with real-time industrial data acquisition to enable synchronization between a physical manufacturing system and its virtual representation. The implementation was experimentally validated in a laboratory-scale cyber–physical production system using Tecnomatix Plant Simulation, Siemens S7-1200 PLC, and KEPServerEX middleware. The developed architecture enables real-time process state monitoring, event-driven synchronization, and verification of selected control and safety functions within the simulation environment. The results demonstrate stable synchronization between the physical and digital systems with response times ranging from 50 to 200 ms, confirming the feasibility of near-real-time integration. The implemented light barrier scenario further demonstrated the capability of the online DT to reflect safety-related events occurring in the physical system. The main contribution of this study lies in the implementation and experimental verification of an OPC UA-based online Digital Twin architecture for manufacturing process monitoring in a laboratory environment. The presented approach provides a foundation for future extensions toward predictive analytics, scenario-based simulation, and advanced manufacturing optimization applications. Full article

Background: Cervical cancer remains a significant health issue in Indonesia, where structural barriers, fragmented information, and sociocultural norms continue to hinder timely diagnosis and treatment. Families play a central role throughout the illness journey, yet their perspectives are often overlooked in the development of digital patient navigation systems. This study explored family experiences, caregiving challenges, and expectations for a family-centered digital navigation model, DIVA.ID, by integrating Digital Health frameworks and Family Systems Theory. Methods: A qualitative descriptive approach was employed through semi-structured, in-depth interviews with 18 purposively selected family caregivers of women with cervical cancer at a major referral hospital in West Java. Participants were selected because they were directly involved in daily care, treatment decisions, logistical support, or emotional assistance. Interviews were conducted between August and October 2025 and continued until thematic saturation was reached, as indicated by repetition of categories and the absence of new major codes in the final interviews. Data were analyzed using inductive–deductive content analysis guided by Elo and Kyngäs, with five researchers conducting independent coding, iterative code comparison, consensus meetings, and theoretical mapping. Results: Four main themes emerged: (1) family involvement in decision-making, including collective discussion, shifting authority roles, and patient autonomy; (2) caregiver burden, involving physical exhaustion, psychological distress, social restriction, stigma, financial pressure, and employment disruption; (3) psycho-spiritual coping mechanisms, including emotional sharing, prayer, crying, patience, and surrender to God; and (4) digital healthcare needs, covering BPJS guidance, treatment information, scheduling, communication pathways, shelter support, and mental–spiritual support. Mapping these themes to Digital Health frameworks and Family Systems Theory clarified how DIVA.ID could translate family experiences into practical navigation functions. Conclusions: This study provides empirical foundations for a culturally sensitive, family-centered digital navigation model in Indonesia. Rather than demonstrating effectiveness, the findings identify design requirements for DIVA.ID that should be tested in subsequent feasibility, usability, and intervention studies. Full article