Search Results (13,362)

Background/Objectives: 23-valent pneumococcal polysaccharide vaccine (PPV23) effectiveness against community-acquired pneumonia (CAP) remains controversial, with critical gaps in low-coverage settings and beyond 5 years post-vaccination. We estimated real-world PPV23 effectiveness against CAP hospitalization and characterized its duration among elderly adults in a low-coverage region. Methods: A multicenter matched case–control study was conducted across 14 hospitals in Eastern China (2018–2022). Cases were patients aged ≥ 60 years hospitalized with clinically diagnosed CAP. Up to three controls per case were matched on sex, age (±3 years), admission date (±5 days), hospital, and residential community. Conditional logistic regression estimated vaccine effectiveness (VE), adjusting for chronic comorbidities and healthcare utilization. Results: Among 6645 cases and 15,806 controls, 5-year PPV23 coverage was 2.14% (cases) and 2.76% (controls). PPV23 was associated with a 22.5% reduction in CAP hospitalization (adjusted VE = 22.5%, 95% CI: 4.1% to 37.3%). Protection was concentrated in non-severe CAP (adjusted VE = 25.7%, 95% CI: 7.0% to 40.7%), with no significant effect in severe CAP (adjusted VE = −11.7%, 95% CI: −115.1% to 42.0%). Extending the exposure window to 6 years yielded no significant VE (adjusted VE = 17.3%, 95% CI: −1.8% to 32.8%). Conclusions: PPV23 provides meaningful protection against CAP hospitalization in elderly adults in low-coverage settings, only for non-severe disease. Waning efficacy beyond 5 years supports revaccination at that interval. Full article

The development of deep oil and gas reservoirs has become a key focus in the exploration and exploitation of hydrocarbon resources. To elucidate the mechanisms governing the flow evolution of reservoir sandstone under deep, high-triaxial stress conditions, this study takes the deep reservoir sandstone of a specific block as its subject. Using a true triaxial rock mechanics–seepage coupled testing system to simulate the in situ high-triaxial stress environment. Synchronous testing of the sandstone’s mechanical and seepage properties was conducted, and a staged permeability model for the elastic and damaged zones of the sandstone was developed and experimentally validated. The results indicate that, under deep, high-triaxial stress conditions, the total stress–strain behaviour of sandstone is divided into compaction, elastic deformation, yield and post-failure stages. The mechanical behaviour exhibits a ‘compression–unloading–failure’ pattern, whilst permeability follows a U-shaped evolution characterised by an ‘exponential decline–sudden increase–stabilisation’ trend; furthermore, the influence of damage on flow properties is irreversible. The intermediate principal stress exerts a significant strengthening effect on the mechanical properties of sandstone; as it increases, the peak strength and residual strength of the sandstone rise, whilst post-peak brittleness decreases and ductility increases. The intermediate principal stress is a key factor regulating the evolution of permeability. During the elastic stage, the initial permeability of the sandstone decreases as the stress increases, and the rate of exponential decay accelerates; during the damage stage, the post-peak permeability decreases as the stress increases, and the irreversible closure of pores caused by true triaxial stress makes it difficult for the post-peak permeability to recover to its initial value. The coefficient of determination for the permeability model fitted to the elastic stage is greater than 0.9, whilst that for the damage stage ranges from 0.76 to 0.85. These models effectively characterise the quantitative relationship between permeability and strain under different stress conditions, demonstrating good reliability and applicability. The research findings provide experimental evidence for elucidating the coupled relationship between mechanics and flow in sandstone under deep, high-triaxial stress conditions, as well as for predicting flow behaviour in deep reservoirs and designing development schemes. Full article

Anxiety disorders affect more than 301 million people worldwide and remain the most prevalent class of mental health conditions. Detection methods have traditionally relied on subjective self-reports, which fail to capture the dynamic physiological signatures of anxiety in daily life. In this longitudinal study, continuous wearable monitoring was conducted with 67 working professionals over nine months, yielding 44,443 h of multimodal data segmented into 890,494 five-minute windows. An unsupervised approach was applied, and ten distinct autonomic states were identified through spectral clustering without the use of emotion labels during clustering. Among these, a rare dysregulated state was discovered, characterized by extreme peripheral cooling ($d=-6.77$), tachycardia ($d=+4.41$), and heightened electrodermal activity, showing a 31-fold enrichment for self-reported anxiety ($p=0.0022$). Beyond this extreme signature, anxiety was expressed heterogeneously across four physiological phenotypes ranging from acute dysregulation to mild perturbation. External validation with the WESAD dataset confirmed generalizability, while the absence of the rare state in laboratory stress paradigms highlighted its specificity to ecological anxiety. By integrating unsupervised discovery with post hoc self-report validation, this work advances our theoretical understanding of autonomic affect and provides a methodological foundation for scalable workplace mental health monitoring. Full article

Systematic field data on adjuvant-amended microbial-derived pesticides against L. pratensis in arid, high-ultraviolet cotton regions remain scarce. This study systematically evaluated the laboratory toxicity and field efficacy of four kinds of microbial-derived pesticides (abamectin, emamectin benzoate, B. bassiana, and M. anisopliae) and their combinations with adjuvants against L. pratensis in Xinjiang cotton fields. As a comprehensive regional study, this work elucidates the differential enhancement patterns of d-limonene and mineral oil on antibiotic insecticides and entomopathogenic fungi, providing targeted field data for pesticide reduction strategies. The laboratory toxicity of seven microbial-derived pesticides was determined using the leaf-tube residual film method. Four effective agents were selected and combined with d-limonene or mineral oil for field efficacy trials. Abamectin and emamectin benzoate exhibited rapid and high insecticidal activity, with 48 h LC₅₀ values of 1.198 mg/L and 3.424 mg/L, respectively. The two entomopathogenic fungi exhibited slower insecticidal activity than the chemical insecticides but maintained relatively stable control effects throughout the observation period. In field trials, when abamectin or emamectin benzoate was applied at a 30% reduced rate in combination with mineral oil or d-limonene, the control efficacy was equivalent to or higher than that of the full-rate application of the pesticide alone. The treatment of abamectin (4.20 g a.i./hm²) plus mineral oil achieved the highest control efficacy (89.24%) at 3 days post-treatment. For B. bassiana and M. anisopliae, reduced-rate adjuvant-amended treatments showed numerically higher initial and residual efficacy than the full-rate single-agent fungal treatments. The treatment of M. anisopliae (7.35 × 10¹² spores/hm²) plus d-limonene reached 70.50% efficacy at 7 days post-treatment, which was significantly higher than that of the full-rate fungal treatment alone. No phytotoxicity symptoms were observed on cotton plants. Under the tested conditions, the rational combination of microbial-derived pesticides with appropriate adjuvants demonstrates the potential for a 30% reduction in pesticide dosage while maintaining or improving field efficacy, providing region-specific reference for the sustainable management of L. pratensis in Xinjiang cotton fields. Full article

Background: Arthur Schopenhauer’s On the Fourfold Root of the Principle of Sufficient Reason (in its revised 1847 edition) has been variously interpreted as an epistemological prelude to his metaphysics of will, as a continuation of Kantian transcendental philosophy, or as an early expression of Schopenhauer’s broader soteriological concerns. These readings often differ in emphasis but converge in treating the text primarily as subordinate to Schopenhauer’s later system or early intellectual development. Methods: This article offers a systematic textual reconstruction of the 1847 edition within the Kantian tradition of transcendental critique. It proceeds through close reading and conceptual analysis of Schopenhauer’s articulation of the principle of sufficient reason, situating individual argumentative steps within both Kantian and post-Kantian debates. The aim is not to deny the relevance of systematic or developmental readings, but to clarify the internal philosophical function of the text’s argumentative structure. Results: The analysis shows that Schopenhauer’s account of the principle of sufficient reason consistently operates as a critical and immanent framework for structuring possible explanation rather than as a metaphysical grounding principle. Across its four domains, the principle is differentiated into irreducible forms governing distinct types of object-relation, thereby constraining illegitimate transitions between epistemic justification and ontological explanation. This reading highlights (i) the internal differentiation of explanatory forms, (ii) the restriction of causal claims to intra-phenomenal relations, and (iii) the systematic limitation of metaphysical grounding strategies. Conclusions: On this reading, the Fourfold Root does not function primarily as a foundational doctrine for Schopenhauer’s metaphysics of will, but as a critical investigation into the limits of metaphysical explanation within experience. It thereby reconfigures metaphysical inquiry as a reflective clarification of the conditions under which explanation is possible, rather than as a doctrine of ultimate ontological grounds. Full article

Traditional wet markets are critical components of Indonesia’s urban food system, yet remain largely unexamined from an occupational health and safety (OHS) perspective. This study identified and prioritized OHS risks among vendors and visitors at Nanggalo Market, a high-density traditional market in Padang, West Sumatra. This was an exclusively qualitative, descriptive, non-probability (purposive) study; no actual occupational accidents, injuries, or exposure incidents were evaluated, and risk levels reflect participants’ perceptions together with researchers’ triangulated observations rather than objective incident records. An observational qualitative design combined elicitation surveys with 45 participants (20 vendors, 20 visitors, 5 market managers), direct observation, and in-depth interviews with 7 key informants. Risk assessment followed the AS/NZS 4360:2004 matrix, classifying risks by likelihood and consequence severity based on participant- and researcher-perceived evidence rather than recorded incident data. Ten potential hazards were identified across six activity zones: traffic and parking; buying and selling; culinary activities; building structures and floor conditions; security and stray animals; and emergency access. Seven risks were classified as high-level, including slipping on wet floors, lack of evacuation routes, lack of fire extinguishers, narrow circulation paths, poor toilet conditions, crowding, and traffic injuries, while three were moderate. All high-level risks lacked adequate controls. Recommended interventions span the full hierarchy of controls, prioritizing engineering and administrative measures, and propose community-based occupational health posts as a sustainable mechanism. These findings provide an evidence base for strengthening OHS governance in traditional wet markets across Indonesia and comparable low- and middle-income country settings. Full article

Maceration is one of the most important tools available to winemakers for shaping the chemical composition, sensory profile, and overall style of red wines. However, understanding the consequences of different maceration choices remains challenging due to the diversity of available techniques, the complexity of extraction phenomena, and the fragmented nature of the available literature, which spans a wide range of technological strategies, cultivars, vintages, winemaking conditions, and analytical approaches. This review thus provides a comprehensive overview of traditional, advanced and emerging maceration techniques used in red winemaking. Conventional approaches, including pre-fermentative cold maceration, fermentative maceration, extended post-fermentative maceration, whole-bunch fermentation, and carbonic maceration, are discussed alongside technological modifications such as cryoextraction, thermovinification, flesh-release and Accentuated Cut Edges, as well as emerging and non-thermal technologies including pulsed electric fields, ultrasound, high-pressure processing, microwaves and ohmic heating. Particular attention is given to the mechanisms governing extraction, with emphasis on how processing conditions and tissue-disruption phenomena influence grape cell wall integrity, membrane permeability, and the release of targeted constituents from different grape tissues. Finally, the advantages, limitations, and practical implications of each technique are highlighted for researchers and winemakers, indicating the need for an integrated consideration of chemical, microbiological, sensory, technological, and economic factors when optimizing red wine production. Full article

Background and Objectives: Persistent COVID-19 sequelae, often referred to as “long COVID”, still constitute a major global medical challenge. In particular, general fatigue is the most widely reported, serious symptom. In the framework of Japanese traditional (Kampo) medicine (JTM), post-infection fatigue is frequently considered a “Qi deficiency”, a significant loss of vital energy. In JTM, accurately diagnosing Qi deficiency is essential for determining the appropriate treatment. However, one challenge in JTM diagnosis is that mastering traditional diagnostic techniques takes time. We sought to validate the “Qi deficiency score”, a quantitative patient-reported outcome measure designed to assess Qi deficiency in patients suffering from long COVID. Materials and Methods: This was a methodological study. We conducted a cross-sectional study of 237 patients who sought treatment at the post-COVID-19 clinic (COVID-19 Aftercare Clinic) at Okayama University Hospital. The patient population was randomly split into two cohorts: one for Exploratory Factor Analysis (EFA, n = 122) and another for Confirmatory Factor Analysis (CFA, n = 115). The simple Qi-deficiency score comprises eight items derived from Terasawa’s diagnostic criteria, with a total range of 0–56. We evaluated internal consistency using Cronbach’s α/McDonald’s ω and examined structural validity. Convergent validity was established by examining correlations between the simple Qi deficiency score and the Fatigue Assessment Scale (FAS), the Self-rating Depression Scale (SDS), and Quality of Life (QOL) metric. Results: The score’s internal consistency (α = 0.64 and ω = 0.63) was considered modest for screening traditional clinical syndromes. EFA showed major factors representing Qi deficiency symptoms. CFA supported a one-factor model with modest fit indices (CFI = 0.87; RMSEA = 0.079; SRMR = 0.077; TLI = 0.82). Factor loadings revealed that “Body feels tired (now)” (0.98) and “Tires easily (tendency)” (0.73) were the most significant symptoms. Convergent validity showed a strong positive correlation with the FAS (r = 0.61, ρ = 0.60) and a moderate correlation with the SDS (r = 0.55, ρ = 0.55). A significant negative correlation was found with QOL scores (r = −0.42, ρ = −0.43). Conclusions: The simple Qi deficiency score may be useful for evaluating Qi deficiency in patients with post-COVID-19 condition. Full article

Background/Objectives: Early handwriting and motor skills underpin later academic success, yet robust evidence for psychomotor programs in preschoolers is limited. This study examined whether participation in a six-week psychomotor intervention was associated with changes in graphomotor performance, writing proficiency, and motor competence in preschool children. Methods: This non-randomized quasi-experimental study included pre- and post-intervention assessments and a control group. Thirty-four preschoolers were assigned by class to an intervention group (n = 19) or a control group (n = 15). For six weeks, the intervention group completed three 50 min psychomotor sessions per week targeting fine- and gross-motor abilities, whereas the control group continued its usual school routine. Graphomotor performance (Pascual Graphomotor Test), writing proficiency (seven-item teacher scale) and motor competence (Movement Assessment Battery for Children-2) were assessed one week before and after the program. Results: The intervention group showed significant improvements in graphomotor performance and all motor-skill tasks assessed. Between-group comparisons of pre–post change favored the intervention group for the total graphomotor score (mean difference = −3.14 points, 95% CI [−4.59, −1.68]; p < 0.001; Hedges’ g = −1.48) and for all four motor-skill tasks (p ≤ 0.019). At post-intervention, pencil grip was the only writing proficiency item showing a significant between-group difference (p = 0.002; Cramér’s V = 0.617), whereas no significant differences were observed for the remaining items. Conclusions: A psychomotor intervention was associated with greater improvements in motor competence and graphomotor performance compared with the control condition. However, evidence for broader improvements in writing proficiency, including handwriting legibility, was limited. Although pencil grip differed between groups at post-intervention, this finding should be interpreted cautiously because the groups already differed at baseline. Full article

High-intensity interval training (HIIT) is an effective exercise strategy for improving cardiorespiratory fitness (CRF) and cardiometabolic health in laboratory settings, yet its effectiveness in real-world conditions remains less clear. This systematic review and meta-analysis examined the effects of real-world HIIT on CRF and cardiometabolic outcomes in adults. We searched five major databases (inception to December 2025) for controlled and non-controlled reports of ≥1 cardiorespiratory or cardiometabolic outcome. Random-effects models were used to calculate weighted mean differences (WMD), with subgroup and meta-regression analyses to explore moderators. Thirty-one studies (n = 1119) were included. In the pooled pre–post analyses, HIIT was associated with significant within-group improvements in VO_2max/peak (3.9 mL/kg/min), systolic (−4 mmHg) and diastolic blood pressure (−3 mmHg), triglycerides (−8 mg/dL), total cholesterol (−9 mg/dL), LDL (−10 mg/dL), and waist circumference (−1.7 cm) across interventions. In controlled comparisons, HIIT was superior to passive controls for VO_2max/peak (6.9 mL/kg/min) and waist circumference (−2.9 cm), while superiority over active controls was limited to VO_2max/peak (1.1 mL/kg/min). Moderator analyses revealed larger cardiometabolic benefits in overweight and clinical populations, and greater improvements in fasting glucose and blood pressure with higher exercise volume and longer intervention duration. In conclusion, real-world HIIT can effectively improve CRF and selected cardiometabolic outcomes across diverse adult populations. Specific cardiometabolic benefits appear to be pronounced in overweight, clinical, and previously untrained individuals. Notably, substantial heterogeneity and moderate methodological quality warrant cautious interpretation. Full article

Empirical evidence for AI formative assessment combined with gamification remains scarce in subjective aesthetic disciplines. This study examined whether such integration enhances metacognitive regulation in undergraduate color education and whether the effect is conditional on learners’ prior AI credibility belief. A four-arm, four-wave cluster-randomized controlled trial (N = 540, 24 classes, eight cross-allocated teachers) compared gamification with AI feedback, gamification with dose-matched human feedback, gamification only, and traditional instruction; the primary outcome was metacognitive regulation measured 4 weeks post-intervention. Gamification produced a small-to-medium effect over traditional instruction (d = 0.34, p_Holm = 0.015). AI and human feedback did not differ on average (d = 0.07; underpowered). Autoregressive mediation confirmed metacognitive regulation as a longitudinal mediator of intervention effects on motivation and achievement. On an exploratory basis, prior AI credibility belief moderated the AI-versus-human indirect effect on motivation (p_Holm = 0.034) but not achievement (p_Holm = 0.054), with higher-belief learners benefiting; given the limited power of the AI-versus-human comparison, this conditional pattern is reported as a tentative finding rather than as confirmatory evidence. These findings extend self-determination theory and the self-regulated learning framework to aesthetic education and provide preliminary support for the deployment of prior-trust-aware AI feedback, pending replication. Full article

Background/Objectives: Exogenous ketone supplementation has been proposed to enhance endurance performance by altering substrate metabolism and sparing muscle glycogen. Prolonged carbohydrate restriction may upregulate ketolytic capacity and could therefore modulate the response to exogenous ketone ingestion. This study investigated the impact of increasing circulating ketone bodies through exogenous ketone supplementation on endurance performance in athletes chronically adapted to a ketogenic diet. Methods: Participants (n = 9 recreationally active males, with ≥1 year of ketogenic adherence) visited the lab four times. The first visit determined their $\stackrel{.}{\mathrm{V}}$O₂max. The second visit accustomed them to test procedures. In a counterbalanced design, visits three and four tested the consumption of a 60 g carbohydrate beverage (CHO), or a beverage comprising 60 g carbohydrate and 0.5 g/kg 1,3-butanediol (CHO + BD). This was followed by a 60 min set-intensity exercise bout, followed by a 16.1 km time trial. Results: βHB significantly increased in the CHO + BD group (rest: 0.72 ± 0.33 mmol/L; post-exercise: 1.69 ± 0.30 mmol/L) compared to CHO (rest: 0.80 ± 0.53; post-exercise: 0.55 ± 0.30) (p < 0.001). There was no significant difference in time trial performance between groups (1606 ± 138 s; 1620 ± 134 s; p > 0.05). During set intensity exercise, there was no significant main effect of supplementation on lactate concentration, substrate oxidation, oxygen consumption at a fixed workload, RPE or heart rate (p > 0.05). However, glucose was significantly lower at minutes 40 and 60 of set intensity exercise in CHO + BD compared to CHO. Conclusions: No significant effect of 1,3-butanediol ingestion on endurance performance was detected in this sample of nine chronically ketogenic male athletes. βHB significantly increased from resting levels; however, time trial performance did not differ between conditions. Given the small sample and limited statistical power, these preliminary findings indicate no detectable ergogenic effect under the present conditions rather than evidence of no effect, and larger studies are warranted. Full article

Background: Post-COVID-19 Condition (PCC) causes persistent multisystem symptoms, reduced quality of life, and high healthcare needs. Data on patient experiences in Switzerland are scarce. Objective: To assess healthcare access, treatment pathways, waiting times, and insurance-related burden among individuals with PCC in Switzerland. Methods: We conducted a nationwide anonymous online survey between July and October 2025. Adults living in Switzerland with symptoms persisting ≥12 weeks after SARS-CoV-2 infection were eligible. Recruitment was conducted through support groups, social media, and specialized PCC consultations at several Swiss hospitals. The multilingual questionnaire covered demographics, symptoms, healthcare utilization, treatment experiences, and insurance issues. Results: A total of 333 individuals participated (81.7% women; mean age 45.8 years). The most frequent symptoms were fatigue (98.5%), brain fog (92.5%), post-exertional malaise (91.0%), sleep disturbances (82.3%), and musculoskeletal pain (80.8%). Only 12.6% reported early and adequate medical support, whereas 45.0% had to actively seek care themselves and 24.6% had received no support. General practitioners were the most frequently consulted providers (77.5%), followed by specialized PCC clinics (39.0%). Waiting times were prolonged: 32.1% waited 4–6 months, 32.4% >6 months and 10.8% reported no available consultation service. Satisfaction with care was modest (3.02/5). Difficulties with social insurance were reported by 42.6%, including missing benefits, lack of recognition, and prolonged procedures. Conclusions: Individuals with PCC in Switzerland face major barriers to timely and coordinated care. Strengthening primary care competencies, expanding multidisciplinary services, and implementing structured patient-centered pathways are urgently needed to improve outcomes and reduce long-term disability. Full article

Background and Clinical Significance: Gallstone ileus (GI) is a rare but serious complication of gallstone disease. This condition is characterized by migration of gallstones through a cholecystoenteric fistula, resulting in mechanical bowel obstruction. GI primarily affects older patients with multiple comorbidities. Case Presentation: Herein, we describe a case of 68-year-old Saudi woman with a history of end-stage renal disease, pulmonary hypertension, diabetes mellitus, bronchial asthma, and atrial fibrillation. She presented with acute calculous cholecystitis. Due to her condition, she was managed conservatively initially. The patient was recommended laparoscopic cholecystectomy but she declined due to fear of anesthesia-related complications. She re-presented after two months with abdominal pain, vomiting, distension, and constipation. Computed tomography (CT) scan showed a 3.2 cm ectopic gallstone impacted in the distal ileum with proximal bowel dilatation and segmental ischemia, confirming GI. Laparotomy showed bowel ischemia and localized perforation. The patient was managed with enterolithotomy, resection of 25 cm of distal ileum, and primary anastomosis. Post-surgery, the patient had favorable recovery. Conclusions: This case highlights need for early diagnosis and appropriate management of GI in patients with multiple comorbidities. Full article

Panax genus, a perennial medicinal herb belonging to the family Araliaceae, has been revered for millennia as a cornerstone of traditional Asian medicine and is increasingly recognized globally for its diverse pharmacological properties. The therapeutic efficacy of this genus is primarily attributed to its unique family of triterpene saponins known as ginsenosides or panaxosides, along with other bioactive constituents including polysaccharides, polyacetylenes, phenolic compounds, and various secondary metabolites. However, the phytochemical composition and subsequent pharmacological profile of this genus are profoundly influenced by multiple factors throughout its lifecycle, from cultivation through post-harvest processing. This comprehensive review systematically examines how growing conditions, harvest timing, storage parameters, and processing methodologies shape the chemical diversity and medicinal potency of Panax genus, providing critical insights for optimizing quality, standardization, and therapeutic applications. Wild and wild-simulated ginseng cultivated for extended periods demonstrate superior ginsenoside diversity and concentration. Optimal harvest ages of 4 years for garden ginseng and 7 years for wild-simulated varieties ensure chemical stability and therapeutic efficacy. Controlled storage at 70–90% relative humidity preserves bioactivity, while strategic processing through steaming, aging, or fermentation, transforms major ginsenosides into pharmacologically potent minor compounds with enhanced therapeutic properties. Understanding these multifactorial influences is essential for quality control, standardization, harvest optimization, and the development of ginseng-based pharmaceuticals and nutraceuticals. Full article