Search Results (6,281)

Background/Objectives: To evaluate and compare the characteristics of clinical trials (CTs) involving patients with primary Sjögren’s syndrome (pSS), using biologics, and focusing on the features of the patients recruited. Methods: This systematic review assessed pSS CTs evaluating biologic drugs published from 2010 to 2024 according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The literature search of the electronic databases was performed individually by the authors. The extracted variables regarding the baseline characteristics of participants and trial-related information were defined a priori, collected, and compared. Results: A total of 16 CTs were included in this review in line with the inclusion criteria. The trials were predominantly multicenter (75%) randomized controlled trials with a placebo arm (93.8%), with only five trials recruiting participants across multiple (≥3) continents. The search included a total of 1607 patients (mean age 51 years, 94% female) with a mean disease duration of 6.47 years. Race and ethnicity were underrepresented variables, found in 37.5% and 12.5% of the trials, respectively, with White patients comprising the majority (77.8%). The EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI) was reported in 93.8% of the CTs. However, only recent studies have emphasized it as the primary outcome. Conclusions: Recent trials on biologics in pSS patients show better methodological quality, with a more standardized assessment of disease activity using ESSDAI, and an increased focus on patient-reported outcomes. Global participation is increasing, but limited racial and ethnic diversity, endpoint variability, and inconsistent biomarker reporting remain critical issues. Full article

Background: “Healthy Life Longevity” (a latent variable) is defined as the number of survival days, along with recommended subjective health and long-term care needs. This study aimed to clarify the structural relationships among several related factors. Methods: In September 2001, a postal survey using a self-administered questionnaire was conducted among 16,462 elderly residents of Tokyo. In a cohort study, 8162 individuals with confirmed survival after six years were examined. We analyzed data to evaluate the need for long-term care three years after the initial survey. Additionally, the number of days survived was calculated from the third year after the initial survey. Covariance structure analysis was used to explore the structural relationships. Results: The direct effects of lifestyle habits, including a healthy diet, dental care rather than physician care, and socioeconomic factors, were minimal in improving “Healthy Life Longevity.” However, a structural relationship was established: desirable lifestyles, including diet and dental care, were selected based on socioeconomic status, thereby influencing mental, physical, and social health and reducing disease incidence. This relationship ultimately enhanced “Healthy Life Longevity.” Socioeconomic factors were identified as confounders in the association between preferred lifestyle choices, including diet, and Healthy Life Longevity. The determination coefficient of “Healthy Life Longevity” is 83%. Conclusions: Although healthy longevity can be achieved by improving mental, physical, and social health, and reducing disease burden, the relevant structure is shaped by socioeconomic status. Additionally, socioeconomic status is associated with healthy longevity by facilitating the choice of a preferred lifestyle, including diet, and the selection of a dentist. Future randomized intervention studies focused on socioeconomic status should explore ways to promote healthy longevity. Full article

The Occupational Health and Safety Act 1993 and its attendant regulations in South Africa require industries to implement occupational health programmes informed by corresponding occupational health (OH) hazards. The programmes are only inferred and, in certain instances, non-prescriptive, leaving employers with the discretionary latitude to adopt and adapt preferred model programmes. On the other hand, the cited act and the health regulations are enforced using a combination of both prescriptive and performance-based regulatory approaches. Amidst implemented OH programmes and regulatory inspection and enforcement, occupational disease prevalence in the South African industry persists. This study identified the regulatory organisation, enforcement, and reporting practices of occupational health programmes in South Africa. This qualitative study analysed seven health-related regulations of the Occupational Health and Safety Act 1993 in South Africa, and 114 company reports (51 sustainability and 63 integrated reports). The frequency of conducting OH programme aspects was clearly prescribed and enforced through the prescriptive regulatory framework. Training, personnel, and risk assessment methods were the most ambiguously regulated programme aspects, and their enforcement varies between prescriptive and performance-based regulatory frameworks. Ninety-nine companies reported implementation of generic occupational health and safety programmes, with twenty-one reporting specific OH programme implementation. The current state of affairs complicates both employer compliance obligations and regulator enforcement efforts. The situation is compounded by an absence of model programmes in some instances and requires policy reforms. Full article

Cleisthenes herzensteini is a commercially important demersal fish in the Northwest Pacific. However, the resource stock of this species has undergone a drastic decline due to overfishing and habitat degradation. As a representative taxon for benthic adaptation in the order Pleuronectiformes, the molecular mechanisms underlying its specialized phenotypic traits remain poorly elucidated. Furthermore, population-level studies focusing on the mitochondrial genome of Cleisthenes herzensteini are currently scarce. Given that the mitochondrial genome serves as an ideal genetic tool for deciphering species evolution and population genetics, sequencing of its mitogenome will help fill critical gaps in genetic resources and provide essential support for species conservation and phylogenetic research. In this study, we sequenced, assembled, and annotated its complete mitochondrial genome. The circular mitogenome is 17,171 bp in length and exhibits a typical A + T bias (54.04%). Repeat sequence analysis identified 35 dispersed repeats. Codon usage analysis revealed that leucine was the most frequently encoded amino acid, with CUU being the preferred codon. Several protein-coding genes possessed incomplete stop codons (T--/TA-), and a nucleotide preference for A and C was observed at the third codon position. Phylogenetic reconstruction based on mitogenomes from 23 species supported the monophyly of the order Pleuronectiformes. C. herzensteini showed the closest relationship with Dexistes rikuzenius, forming a distinct clade alongside Hippoglossoides dubius and Limanda aspera. These results provide essential genetic resources for understanding the evolution and population genetics of C. herzensteini and related flatfishes. According to the investigation, this study represents the first report on the sequencing and analysis of the complete mitochondrial genome of the Cleisthenes herzensteini. This not only fills the gap in mitochondrial genetic information for this species but also provides a reference for subsequent investigations into the phylogenetic relationships and evolutionary processes within the family Pleuronectidae. Full article

(1) Background: Drug–drug interactions (DDIs) are a frequent cause of medication-related harm, particularly in ambulatory care. Community pharmacists are uniquely positioned to identify and manage these risks. This study assessed DDI knowledge, practices, and barriers among community pharmacists in the Jazan Region, Saudi Arabia. (2) Methods: A structured, self-administered questionnaire was distributed to community pharmacists. The survey assessed DDI knowledge using 26 clinically relevant drug pairings and included questions on professional behavior, training exposure, software use, and educational needs. Descriptive and inferential statistics were applied to identify associations between knowledge scores and demographic or practice-related variables. (3) Results: A total of 219 pharmacists participated in the study. The mean knowledge score was (9.63 ± 4.58) out of 26, reflecting suboptimal to moderate awareness. Female pharmacists demonstrated significantly higher DDI knowledge scores than males (10.74 ± 5.4 vs. 9.08 ± 4.2; p = 0.016). Knowledge scores also differed significantly by academic qualification (p < 0.001), with PharmD holders scoring higher than B. Pharm and postgraduate degree holders. Pharmacists with less than 10 years of experience had significantly higher scores compared with those with longer practice duration (p = 0.002). Additionally, pharmacists who graduated from Saudi institutions scored higher than those trained outside Saudi Arabia (10.22 ± 4.7 vs. 8.44 ± 4.2; p = 0.005). Pharmacists who had received professional development training and those who attended workshops regularly also scored significantly higher. Familiarity with guidelines showed a positive trend. Reported barriers to effective DDI counseling included time constraints, limited patient understanding, and poor collaboration with prescribers. Self-rated awareness of DDIs was positively associated with actual knowledge scores. Pharmacists expressed strong preferences for workshops, online courses, and webinars as future training formats. (4) Conclusions: Pharmacists in the Jazan Region demonstrate moderate awareness of DDIs, with variation influenced by training, experience, and qualifications. Enhancing access to structured professional development and integrating clinical decision support tools could strengthen pharmacists’ role in preventing DDIs in community practice. Full article

Background: Food insecurity among college students is a multidimensional challenge shaped by individual, interpersonal, institutional, community, and policy factors. Although many campuses require or provide meal plans, students may experience food insecurity when barriers related to agency (choice and autonomy), utilization (nutrition security), and availability persist. This study explored how undergraduate students at a private, urban U.S. university experience and navigate the multiple dimensions of food insecurity. Methods: We conducted in-depth, semi-structured interviews via Zoom between December 2024 and January 2025 with n = 22 undergraduate students recruited based on food security status, determined by a Fall 2024 longitudinal survey using the USDA Six-Item Short Form. Transcripts were double-coded by trained research assistants in ATLAS.ti using an inductive codebook. Thematic analyses followed a phronetic, iterative approach, organizing findings within a socio-ecological determinants framework and comparing themes by food security status. Results: We identified nine themes across four domains (individual, interpersonal, institutional and community, and political). At the individual level, constrained personal resources for groceries and cooking, time scarcity leading to skipped meals, and health impacts that detracted from academics emerged as key themes. Interpersonally, reliable family financial support was protective and informal support from peers/coaches filled gaps sporadically for some. At the institutional and community level, dining hall hours misaligned with student schedules, perceived limited variety and nutrition quality reduced food agency and utilization, and transportation impeded use of the sole grocery partner accepting university meal plan benefits. Notably, meal plans including unlimited meal swipes provided stable access but did not guarantee food security when food agency and utilization barriers persisted. Many students relied on campus events for free food; formal assistance (e.g., food pantry) was largely underused. At the policy level, Supplemental Nutrition Assistance Program (SNAP) awareness and enrollment was limited among our sample. Conclusions: Meal plan access alone is insufficient to ensure food security. Campus strategies should extend beyond access to prioritize flexibility, variety, and alignment with students’ schedules and preferences, while strengthening communication and eligibility support for external benefits. Future work should design and evaluate interventions that integrate all dimensions of food security and address institutional policies affecting students’ basic needs. Full article

In the current context of the energy transition, the reuse of offshore oil and gas (O&G) structures that have reached the end of their operational life presents new engineering challenges. Many projects aim to adapt existing facilities for a range of alternative uses. This paper outlines guidelines for identifying the most suitable conversion options aligned with the goals of the ongoing energy transition, focusing on the Italian offshore area. The study promotes the reuse—instead of partial or full removal—of existing offshore platforms originally built for the exploitation of hydrocarbon reservoirs. From an engineering perspective, the project describes the development of guidelines based on an innovative methodology to identify new uses for both offshore oil and gas platforms and the depleted reservoirs, with a focus on safety and environmental impact. The guidelines identify the most suitable and effective conversion option for the platform–reservoir system under consideration. To ensure a realistic approach, the developed methodology allows one to identify the preferable conversion option even when some piece of information is missing or incomplete, as often happens in the early stages of a feasibility study. The screening process provides an associated level of uncertainty related to the degree of data incompleteness. The outcome is a complete evaluation procedure divided into five phases: definition of criteria; assignment of an importance scale to determine how critical each criterion is; connection of indices and weights to each criterion; and analysis of the relationships between them. The guidelines are implemented in a software tool that supports and simplifies the decision-making process. The results are very promising. The developed methodology and the related guidelines applied to a case study have proven to be an effective decision-support for analysts. The study shows that it is possible to identify the most suitable conversion option from a technical, engineering, and operational point of view while also considering its environmental impact and safety implications. Full article

Background: Electronic Health Records (EHRs) are a rich source of clinical information used for patient monitoring, disease progression analysis, and treatment outcome assessment. However, their large-scale, heterogeneity, and temporal characteristics make them difficult to analyze. Topic modeling has emerged as an effective method to extract latent structures, detect disease characteristics, and trace patient trajectories in EHRs. Recent neural and transformer-based approaches such as BERTopic has significantly improved coherence, scalability, and domain adaptability compared to earlier probabilistic models. Methods: This Systematic Literature Review (SLR) examines topic modeling and its variants applied to EHR data over the past decade. We follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework to identify, screen, and select relevant studies. The reviewed techniques span traditional probabilistic models, neural embedding-based methods, and temporal extensions designed for pathway and sequence modeling in clinical data. Results: The synthesis covers trends in publication patterns, dataset usage, application domains, and methodological contributions. The reviewed literature demonstrates strengths across different modeling families, while also highlighting challenges related to scalability, interpretability, temporal complexity, and privacy when analyzing large-scale EHRs. Conclusions: Topic modeling continues to play a central role in understanding temporal patterns and latent structures in EHRs. This review also outlines future possibilities for integrating topic modeling with Agentic AI and large language models to enhance clinical decision-making. Overall, this SLR provides researchers and practitioners with a consolidated foundation on temporal topic modeling in EHRs and its potential to advance data-driven healthcare. Full article

Pedestrian safety in developing countries faces critical challenges from rapid urbanization and infrastructure deficiencies. This study investigates how visual context influences pedestrian crossing preferences through a controlled stated preference experiment in multiple Ecuadorian cities. A sample of 875 participants was randomly assigned to view either non-compliant (mid-block crossing) or compliant (signalized crosswalk) imagery before evaluating six hypothetical scenarios involving three crossing alternatives. Multinomial logit models reveal that waiting time, traveling with a minor, and walking distance are primary determinants of choice. Visual context showed systematic associations with choice patterns: compliant imagery was associated with increased preference for safer alternatives (50.5% versus 43.8% prediction accuracy) and larger safety-related parameter magnitudes. Principal Component Analysis identified two latent perception constructs, safety/security and bridge-specific convenience, providing behavioral interpretation of choice patterns. Substantial spatial heterogeneity emerged across cities (χ² = 124.10 and 84.74, p < 0.001), with larger urban centers showing stronger responsiveness to formal infrastructure cues. The findings demonstrate that visual stimuli systematically alter choice distributions and attribute sensitivities through normative activation and perceptual recalibration. This research contributes methodologically by establishing visual framing effects in stated preference frameworks and provides actionable insights for pedestrian infrastructure design, emphasizing alignment of objective safety improvements with perceived risk and contextual behavioral cues. Full article

Background/Objectives: Recent public and scientific discussions have raised concerns about a possible link between prenatal paracetamol exposure and autism spectrum disorder (ASD). However, pharmacovigilance-based evidence remains scarce, and the role of reporting bias has not been systematically assessed. This study aimed to characterize ASD-related adverse event reports involving paracetamol in the U.S. Food and Drug Administration’s Adverse Event Reporting System (FAERS) and to evaluate potential disproportionality signals, considering demographic, temporal, and geographic patterns. Methods: FAERS data from January 2010 to September 2025 were screened for reports listing paracetamol as the suspect drug and ASD-related Preferred Terms. After excluding duplicates and concomitant drugs, 1776 unique cases were analyzed. Patient demographics, reporter type, and country of origin were summarized descriptively. Disproportionality was calculated using four algorithms: Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Information Component (IC), and Empirical Bayes Geometric Mean (EBGM). Results: Among 172,129 paracetamol-associated reports, 1776 (1.03%) included ASD-related terms. All were classified as serious and mostly submitted by consumers (98.6%). Gender was available in 47.7% of cases, showing male predominance (68.8%). Most reports referred to fetal exposure during pregnancy. Nearly all originated from the United States (98.4%). A marked rise was observed after 2022, with 562 reports in 2023 and 1051 in 2025. Disproportionality analyses revealed consistently elevated signals (ROR = 69.8, PRR = 69.2, IC025 = 5.60, EB05 = 48.3). Conclusions: The strong disproportionality signal likely reflects increased public attention and reporting dynamics rather than a causal association. Further integration of pharmacovigilance and epidemiologic data is warranted to clarify the clinical significance of these findings. Full article

Wood supply chains are complex, involving many stakeholders, intricate processes, and logistical challenges to ensure the timely and accurate delivery of wood products to customers. Weather-related variations in forest road accessibility further complicate operations. This paper explores the challenges faced by forest managers in targeting many delivery requirements—four or more. To address this, simulation-based optimization, using NSGA-III, a many-objective optimization algorithm, is proposed to simultaneously optimize often conflicting objectives primarily by minimizing delivery lead time, delivery deviations in backlogs, and delivery variation. NSGA-III enables the exploration of a diverse set of Pareto-optimal solutions that show trade-offs across a flexible set of four, or more, delivery objectives. A Discrete Event Simulation model is integrated to evaluate objectives in a complex wood supply chain. The implementation of NSGA-III within the framework allows forestry decision-makers to navigate between different harvest schedules and evaluate how they target a set of preference-based delivery objectives. The simulation can also provide detailed insights into how a specific harvest schedule affects the supply chain when post-processing possible solutions, facilitating decision making. This study shows that NSGA-III could substitute NSGA-II to optimize the wood supply chain for more than three objective functions. Full article

Background: Care homes are complex care environments where supporting residents’ identity, wellbeing, and sense of personhood is central to person-centred care. Reminiscence is widely recognised as a psychosocial approach that can support these outcomes. However, existing evidence has largely focused on group-based interventions, with comparatively limited attention given to how individual reminiscence is implemented and sustained within care home practice. Methods: This study was an implementation-focused qualitative exploration of staff experiences of introducing and embedding individualised reminiscence in care home practice. Care home staff participated in four monthly workshops that introduced principles of individualised reminiscence and supported them to plan and implement reminiscence with at least one resident. Participants used either the InspireD digital reminiscence app (n = 19) or non-digital approaches such as life story books (n = 2), depending on local preferences and perceived suitability. Three focus groups were conducted with 21 care home staff to explore experiences of implementing individualised reminiscence and perceptions of its impact on residents, staff, and families. Data were analysed using reflexive thematic analysis. Results: Four interrelated themes were identified: (1) reminiscence within pressured systems; (2) resident experience and identity; (3) adapting and sustaining practice; and (4) families as partners in reminiscence. Participants described challenges associated with workload pressures, role expectations, and variability in family involvement, which influenced how reminiscence was adopted in practice. Despite these constraints, participants described perceived benefits for residents, including perceived improvements in mood, engagement, and expressions of identity. Participants also discussed perceived increased staff confidence, strengthened staff–resident relationships, and enhanced awareness of person-centred care practices. Conclusions: Findings highlight the perceived potential of individualised reminiscence to support person-centred and relational care in care homes, while identifying key contextual influences on implementation. Further research is needed to examine sustainability and effectiveness using comparative and mixed-method designs. Full article

AI Recommender Systems (RecSys) function as personalised forecasting engines, predicting user preferences to reduce information overload. However, the efficacy of these systems is often bottlenecked by the “Last Mile” of forecasting: the end-user’s willingness to adopt and rely on the prediction. While the existing literature often assumes that algorithmic accuracy (e.g., low RMSE) automatically drives utilisation, empirical evidence suggests that users frequently reject accurate forecasts due to a lack of trust or cognitive friction. This study challenges the utilitarian view that users adopt systems simply because they are useful, instead proposing that sustainable adoption requires a state of Cognitive Absorption—a psychological flow state enabled by the Cognitive Economy of trust. Grounded in the Motivation–Opportunity–Ability (MOA) framework, we developed the Trust–Absorption–Intention (TAI) model. We analysed data from 366 users of a major predictive platform using Partial Least Squares Structural Equation Modelling (PLS-SEM). The Disjoint Two-Stage Approach was employed to model the reflective–formative Higher-Order Constructs. The results demonstrate that Cognitive Trust (specifically the relational dimensions of Benevolence and Integrity) operates via a dual pathway. It drives adoption directly, serving as a mechanism of Cognitive Economy where users suspend vigilance to rely on the AI as a heuristic, while simultaneously freeing mental resources to enter a state of Cognitive Absorption. Affective Trust further drives this immersion by fostering curiosity. Crucially, Cognitive Absorption partially mediates the relationship between Cognitive Trust and adoption intention, whereas it fully mediates the impact of Affective Trust. This indicates that while Cognitive Trust can drive reliance directly as a rational shortcut, Affective Trust translates to adoption only when it successfully triggers a flow state. This study bridges the gap between algorithmic forecasting and behavioural adoption. It introduces the Cognitive Economy perspective: Trust reduces the cognitive cost of verifying predictions, allowing users to outsource decision-making to the AI and enter a state of effortless immersion. For designers of AI forecasting agents, the findings suggest that maximising accuracy may be less effective than minimising cognitive friction for sustaining long-term adoption. To solve the cold start problem, platforms should be designed for flow by building emotional rapport and explainability, thereby converting sporadic users into continuous data contributors. Full article

Background: Pre-exposure prophylaxis (PrEP) offers over 99% protection against HIV when used consistently, but stigma continues to undermine persistence in care. While much research has described the external manifestations of PrEP-related stigma, less is known about how individuals cope with these stigmas and how such coping processes influence persistence. Guided by Social Cognitive Theory, this study examined the psychosocial strategies men who have sex with men (MSM) in Tanzania use to cope with PrEP-related stigma and sustain persistence in care. Methods: Thirty-two in-depth interviews were conducted with purposefully selected MSM aged 18–38 years at Ngamiani Health Centre in Tanga region. The sampling included both persistent and non-persistent PrEP users with variation in age and sexual position preferences. Participants were sampled for variation in persistence status (persistent and non-persistent), age, and sexual position preference to capture heterogeneity in stigma experiences and coping processes. Interviews were conducted in Kiswahili, audio-recorded, transcribed, translated, and analyzed using reflexive thematic analysis. Results: Participants described PrEP-related stigma as socially constructed through narratives that equated PrEP with HIV treatment, labeled it a “gay pill,” associated it with promiscuity, or linked it to bodily harm or increased HIV risk. These stigmas impact persistence in care through discouraging clinic visits and daily pill taking. However, some participants remained persistent in care despite stigma by using protective mental strategies such as personal agency, mental time travel, and affirmation from supportive social connections, which buffered emotional impacts and sustained persistence. Conclusions: Persistence in PrEP care is shaped not only by stigma in the social environment but also by how individuals interpret and respond to it. Interventions should therefore combine structural stigma-reduction efforts with mental health-informed strategies that strengthen agency and supportive social relationships to sustain PrEP engagement among MSM. Full article

A group of experts of different specialties involved in the care of prostate cancer (PCa) patients participated in the ENFOCA2 project, promoted by the Spanish Oncology Genitourinary Group (SOGUG), with the aim to review, discuss, and summarize current relevant aspects related to screening, diagnosis, imaging, risk-based approach, and molecular characterization of PCa. A multidisciplinary team (MDT) approach is essential to ensure that patients receive evidence-based care, promoting shared decision-making, and tailoring treatment to the patient’s unique values and preferences. Population-based screening based on risk-stratified algorithms is needed to overcome the limitations of opportunistic screening for detecting clinically significant PCa. Next-generation imaging (NGI) methods, such as prostate-specific membrane antigen (PSMA) PET/CT alone or combined with multiparametric MRI (mpMRI), have a promising role in different scenarios of the diagnostic process due to their high sensitivity. The diagnostic yield of mpMRI should be improved, especially for assessing extraprostatic extension. The use of specific molecular probes as imaging markers for MRI could improve the staging of metastatic disease. Protocols for germline testing developed by international societies, such as the European Association of Urology (EAU) and the National Comprehensive Cancer Network (NCCN), should be adapted at local levels, with BRCA1/2, ATM, PALB2, CHEK2, MLH1, MSH2, MSH6, PMS2, EPCAM, and HOXB13 as the genes to be investigated. Genomic classifier tools help identifying aggressiveness of cancers and aid in personalized treatment decision-making. Joint efforts of multidisciplinary physicians are crucial to improve health outcomes for patients with PCa across the spectrum of this disease. Full article