Search Results (5,896)

Background/Objectives: Urinary incontinence (UI) and impaired balance are common geriatric syndromes that negatively affect health and quality of life in older women. However, the combined effects of power-based multicomponent training (PMT), pelvic floor muscle (PFM) activation instructions, and psychoeducational (PSY) support remain unclear. This study aims to evaluate the effects of a PMT, alone or progressively combined with PFM activation instructions and PSY support, on PFM function, UI symptoms, balance, fear of falling, and physical function in community-dwelling older women. Methods: This study describes the protocol for an 18-week, four-arm additive, parallel-group, assessor- and analyst-blinded randomized controlled trial with a 6-month follow-up. A total of 120 women aged 60–80 years with UI will be randomly assigned to four groups: (1) PMT only (EX), (2) PMT plus verbal PFM activation instructions (EXVERB), (3) PMT combined with PFM activation instructions and psychoeducational sessions (EXVERBPSY), or (4) a control group receiving educational sessions on geriatric syndrome prevention. Sessions will be conducted twice weekly for 18 weeks. The single primary endpoint is maximal PFM strength assessed by the manometric perineometry. Pre-specified secondary outcomes include additional PFM function measures, upper- and lower-limb (LL) strength and power, balance performance, fear of falling, quality of life, psychological well-being, and anthropometric variables. Assessments will be conducted at baseline, post-intervention, and 6-month follow-up. The trial is registered at ClinicalTrials.gov (NCT06839040). Expected results: This trial is expected to provide evidence on the effectiveness of a multidisciplinary intervention combining exercise, PFM activation strategies, and PSY support for reducing UI severity and improving balance performance and fear of falling in older women. Conclusions: This protocol describes a four-arm additive randomized controlled trial evaluating a multidisciplinary intervention targeting two highly prevalent and interrelated geriatric syndromes. The study may contribute to the development of more comprehensive exercise-based and PSY interventions for older women and may inform healthcare strategies aimed at promoting healthy ageing and improving the management of UI and fear of falling. Full article

The replacement of synthetic dyes with natural food colorants has become a priority for the food industry, as emerging evidence from in vitro and animal studies on the potential neurotoxic and pro-inflammatory effects of certified dyes converges with consumer pressure for clean-label formulations. Yet despite this, the industrial uptake of natural pigments remains uneven, held back by stability limitations that differ considerably from one pigment class to the next and from one food matrix to another. This review covers the chemistry, industrial applications, and stabilization approaches of the main natural colorant groups: carotenoids, anthocyanins, betalains, chlorophylls, curcuminoids, phycocyanin, and genipin-derived pigments, with particular attention to the physicochemical reasons behind their instability and the practical tools available to address it. Among stabilization strategies, spray-drying microencapsulation with composite protein–polysaccharide wall materials is often the most scalable and cost-effective option, whereas freeze drying may be preferable for high-value pigments or applications in which maximum pigment retention is the priority. Whether the encapsulating matrix remains in a glassy or rubbery state stands out as a key factor governing oxidative degradation across all pigment categories, which makes water activity management a non-negotiable element of any serious formulation effort. Anthocyanins require more than physical encapsulation alone: copigmentation and structural approaches such as acylation and pyranoanthocyanin formation hold degradation routes that no shell material can prevent on its own. For hydrophobic pigments like carotenoids and curcuminoids, lipid-based delivery systems consistently deliver higher bioaccessibility than aqueous or dried formats. pH control, antioxidant incorporation, and modified atmosphere packaging add a useful but ultimately incomplete third line of defense. One development worth attention is the use of pH-responsive pigments in biopolymer packaging films, where color instability, long treated as a drawback, becomes a real-time indicator of food freshness. Bridging the remaining performance gap with synthetic dyes will call for stabilization platforms that tackle the molecular, physical, and environmental dimensions of degradation together, built around the particular chemistry of each pigment and the demands of each application. Full article

Background: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are increasingly reported among gay, bisexual, and other men who have sex with men (GBMSM) engaging in chemsex, yet data remain limited. This ambispective cohort study conducted at Hospital Clínic of Barcelona (2018–2024) aimed to characterize CA-MRSA infections among GBMSM living with HIV. Methods: Epidemiological, behavioral, and clinical data were collected from medical records and standardized questionnaires. MRSA isolates from clinically indicated samples were identified by mass spectrometry and underwent antimicrobial susceptibility testing. Results: Among 446 participants, 62 (14%) were diagnosed with CA-MRSA, accounting for 109 infection episodes over a median follow-up of 3.21 years (IQR 1.39–5.05). All episodes involved skin and soft-tissue infections; 17% required hospitalization, 35% surgery, and 51% received non-active empirical antibiotics. Recurrent infections occurred in 32% of participants, and detectable HIV viral load was present in 28% of episodes. High levels of polydrug use were reported. Resistance to clindamycin (33%), cotrimoxazole (23%), and mupirocin (96%) was observed. Decolonization was attempted in 65% of participants. Conclusions: CA-MRSA infections were frequent, with substantial recurrence and antimicrobial resistance. These findings highlight challenges for infection control and antimicrobial stewardship and support further evaluation of preventive and decolonization strategies in this population. Full article

Healthcare-associated infections remain a major public health challenge, and primary health care (PHC) plays a critical role in preventing and interrupting transmission within communities. This study assessed knowledge and self-reported adherence to Standard Precautions and Transmission-Based Precautions among nursing professionals working in PHC. The findings were subsequently interpreted through the conceptual perspective of Infection Containment Readiness (ICR). A cross-sectional census study was conducted in 16 PHC units in Mato Grosso do Sul, Brazil, including 75 eligible nursing professionals. Knowledge was assessed using a validated instrument comprising 47 items distributed across five domains, while adherence was evaluated through 12 self-reported practice indicators. Overall knowledge was satisfactory, with a mean accuracy rate of 78.9%. Higher performance was observed in medication safety and sharps disposal (92.0%), glove use (81.8%), and hand hygiene (77.0%), whereas lower scores were identified in risk recognition (75.6%) and respiratory precautions and cough etiquette (68.2%). Important misconceptions were identified regarding tuberculosis transmission and respiratory infection control. Self-reported adherence was heterogeneous, particularly for respiratory protection measures, tuberculosis-related practices, glove use during capillary blood glucose testing, and participation in continuing education activities. Based on the observed findings and current infection prevention literature, we propose a hypothesis-generating conceptual framework for interpreting ICR in PHC. These findings suggest that strengthening infection prevention in PHC requires strategies that address not only knowledge acquisition but also risk recognition, contextual decision-making, and organizational support for preventive practices. Full article

Background: In primary care settings, cervical cancer screening and prevention are highly dependent on healthcare provider initiatives, particularly in countries like Türkiye where the HPV vaccine is not yet integrated into the national routine immunization schedule. Since HPV vaccines provide over 90% protection against cervical cancer, the proactive guidance of primary care providers is critical. This study evaluated family physicians’ knowledge levels and awareness of HPV infection and human papillomavirus (HPV) vaccines in primary care settings in Türkiye. Methods: A total of 238 family physicians working in Türkiye participated in this descriptive cross-sectional study using a convenience sampling method. Data were collected through an online questionnaire administered via Google Forms. The survey included a sociodemographic information form and a 33-item HPV knowledge scale. Data were analyzed using descriptive statistics, normality assessment, chi-square test, Mann–Whitney U test, Kruskal–Wallis test, and hierarchical logistic regression analysis. Results: Overall, 81.1% of participants recommended the HPV vaccine, and 83.6% believed it should be included in the national schedule. Notably, only 15.1% of the participating physicians had received the HPV vaccine themselves, whereas 40.6% of the unvaccinated subgroup (82/202) stated they were considering personal vaccination. HPV knowledge levels were generally high, but lower when regarding the current national program. Vaccine recommenders and female participants had significantly higher knowledge scores, while out-of-pocket vaccine cost emerged as a major barrier to clinical recommendation. In multivariable hierarchical logistic regression, individual knowledge domains did not emerge as independent standalone predictors after controlling for demographics, with only knowledge of the current national program showing a borderline trend (p = 0.066), although the inclusion of the knowledge variables as a collective block significantly improved the overall model explanatory power (p = 0.003). Conclusions: Family physicians in Türkiye showed generally high HPV-related knowledge and a high rate of HPV vaccine recommendation. This study clarifies that primary care advocacy is shaped by the combined influence of professional knowledge and overriding structural factors, rather than individual knowledge domains acting as independent standalone predictors. While future strategies must focus on developing targeted continuous medical education to bridge specific knowledge gaps and optimize opportunistic counseling, achieving optimal immunization coverage ultimately relies on integrating the vaccine into national programs to mitigate out-of-pocket cost barriers. Full article

Cancer prevention through dietary intervention utilizing bioactive natural compounds has garnered significant attention due to the therapeutic limitations of conventional cancer treatments. These plant-derived active compounds, including polyphenols, terpenoids, organosulfur compounds, bioactive peptides, and alkaloids, possess potent anticancer properties. This systemic review addresses a critical gap in the scientific literature by elucidating the precise multitargeted oncogenic regulatory mechanisms of these molecules. A comprehensive methodology was employed, involving a systematic literature search across major electronic databases (including PubMed, Web of Science, Embase, and SCOPUS) to identify relevant original peer-reviewed studies. The evidence gathered demonstrates that these active compounds deliver significant health benefits and protect cells by modulating crucial molecular targets involved in cell cycle regulation, apoptosis, oncogenic signaling, epigenetic control, angiogenesis, oxidative stress, and inflammation. Specifically, they operate via multi-targeted cascades, such as inhibiting the PI3K/Akt, NF-κB, and STAT3 pathways. To provide a clear structural overview, these active compounds are categorized comprehensively based on their botanical and structural origins, including spices, fruits, and rhizomes. However, despite their promising bioactivities, these compounds have not yet been fully translated into clinical therapy due to challenges such as low bioavailability, rapid metabolism, limited systematic exposure, and a lack of convincing evidence from large-scale clinical trials. Although most current evidence remains rooted in in vitro and experimental animal models, clinical validation through high-quality trials is still required. Ultimately, this review underscores the potential of these active compounds and highlights how advances in formulation and nano delivery strategies offer promising solutions for effective cancer prevention. Full article

Background: Chikungunya virus (CHIKV) infection is an emerging disease of growing concern to international travelers due to the expanding geographic distribution of competent vectors, climate change, and frequent outbreaks in endemic and previously unaffected regions. Until recently, prevention relied exclusively on vector control and bite prevention; however, the recent approval of chikungunya vaccines has introduced a new preventive strategy. Methods: We conducted a narrative review of currently licensed chikungunya vaccines and candidates in clinical development, focusing on immunogenicity, safety, regulatory status, and implications for travel medicine practice. Results: Two vaccines have recently received regulatory approval: the live-attenuated vaccine IXCHIQ^® and the virus-like particle vaccine Vimkunya^®. Both demonstrated high immunogenicity based on neutralizing antibody thresholds accepted as surrogate markers of protection. Post-marketing safety signals associated with IXCHIQ^®, particularly in older adults, have led to divergent regulatory decisions between authorities. The indication of vaccination in national recommendations varies somewhat depending on age, duration of travel, and individual risk factors. Several additional vaccine platforms remain under investigation, although some candidates have been discontinued. Conclusions: The recent approval of chikungunya vaccines marks a significant milestone in the field of travel medicine. However, uncertainties regarding long-term protection, safety in specific populations, and optimal targeting of travelers remain. Individualized risk–benefit assessment is essential, and further data are needed to refine vaccination strategies for travelers and populations at risk. Full article

The African esophageal squamous cell carcinoma (ESCC) corridor extends from Ethiopia to the Eastern Cape and contains some of the highest age-standardized ESCC incidence rates reported anywhere, with five-year survival below 5%. The corridor’s heterogeneous incidence (sex ratios from 1:1 to 7:1; tenfold variation between adjacent populations) has resisted single-factor explanation through more than half a century of investigation. We synthesize the multicenter evidence accumulated since the IARC 2018 Group 2A classification of very hot beverages (>65 °C), with particular attention to the African Esophageal Cancer Consortium (ESCCAPE) outputs and to whole-genome sequencing. We argue, on the convergent evidence of animal toxicology, human in vitro mucosa, and population genomics, that thermal exposure acts as a tumor promoter rather than an initiator. On this reading, the corridor’s heterogeneous burden reflects heterogeneous chemical co-exposure profiles operating against a shared thermal-promoter substrate. Extending the comparative margin-of-exposure (MOE) methodology to esophageal squamous carcinogenesis, we present an MOE framework distinguishing genotoxic compounds (within-mode-of-action additive) from thermal exposure (separate companion figure) and apply it to two corridor scenarios. The framework supports a four-lever prevention strategy combining tobacco control, alcoholic-strength reduction in unrecorded spirits, clean-cookstove deployment, and graduated thermal-exposure reduction. Full article

Neurorehabilitation units (NRUs) are long-term care settings associated with multiple risk factors for carriage and infection by multidrug-resistant organisms (MDROs), including prolonged hospitalization, the use of invasive medical devices, high antibiotic exposure, and multiple comorbidities. We report the case of a patient admitted to an NRU for rehabilitation after cerebral hemorrhage who developed complex co-colonization by several MDROs, including Pseudomonas aeruginosa producing either FIM or VIM metallo-β-lactamases, Acinetobacter baumannii producing OXA-23 serine-carbapenemase, Klebsiella pneumoniae producing either KPC or OXA-48 serine-carbapenemases or both, Proteus mirabilis producing VEB extended-spectrum β-lactamase, and vancomycin-resistant Enterococcus faecium of the VanA type. During the 22-month hospitalization, the patient experienced several infection episodes, some of which were apparently related with colonizing MDROs. This case highlights that co-colonization by multiple MDROs may occur in patients admitted to NRUs in endemic settings, and emphasizes the importance of implementing targeted infection prevention and control strategies in these healthcare environments. Full article

With the integration of renewable energy and power-electronic devices, grid-forming modular multilevel converters (GFM-MMCs) play a critical role in active grid support. An AC grid voltage sag can trigger a large support current, which may cause large voltage fluctuations in submodule capacitors and arm overmodulation, thereby threatening system safety. This paper proposes a multidimensional collaborative method to improve the support capability of grid-forming MMCs under severe grid voltage sags. The multidimensional physical constraints of internal energy fluctuation during fault transients are clarified. The corresponding safe operating boundaries are then established, after which a coordinated optimization strategy is developed. This approach integrates second-harmonic circulating current and zero-sequence voltage injections. Offline optimization utilizes a particle swarm optimization (PSO) algorithm across the full operating range. Expanding the safe P–Q operating region requires no extra hardware costs. A neural network enables a millisecond-level direct mapping control architecture. This architecture addresses the long online computation time of traditional heuristic algorithms by embedding offline optimization data into the network weights. The trained network performs rapid forward computation to generate optimized commands, which is verified by a hardware-in-the-loop (HIL) experiment. The experimental results verify the effectiveness of the proposed method, with clear performance improvements being observed. The strategy suppresses capacitor-voltage peak and prevents overmodulation. This directly improves the MMC support capability during severe faults. Full article

With the vigorous development of offshore energy and mining, offshore fracturing and deep-sea mining necessitate the ship-to-ship and platform-to-ship transfer of solid particles via floating hoses. However, traditional floating hoses designed for oil transportation are inadequate for the long-term and stable conveyance of granular materials, as solid particles are prone to deposition and blockage under excessive bending. Additionally, in large-scale offshore fracturing operations, tension fluctuations in high-pressure hoses accelerate hose wear and compromise structural integrity. To address these challenges, this study proposes a systematic framework integrating neural network prediction with a feedforward–feedback composite control strategy. Spatial Attention–Convolutional Neural Network (SA-CNN) achieves the highest prediction accuracy and the strongest generalization capability across all operating conditions. Then, a feedforward–feedback composite control strategy is formulated, where the feedforward component is derived from SA-CNN predictions and the feedback component is provided by a PID controller, with an adaptive weighting mechanism adjusting their contributions based on prediction confidence. A curvature safety constraint is also incorporated to prevent excessive bending. The results show that the composite control strategy achieves the highest peak tension reduction, while achieving the lowest RMSE. Unlike pure PID, which introduces severe oscillations, the composite control strategy converges smoothly, confirming that feedforward prediction effectively suppresses feedback-induced oscillations. This study provides a theoretical foundation and a practical solution for the safety assurance of floating hoses in high-pressure fracturing fluid delivery applications and offshore solid particle transshipment. Full article

The inappropriate utilization of traditional antimicrobials has expedited the development of multidrug-resistant bacterial strains, thereby generating an urgent demand for innovative, safe, and efficacious alternatives. Graphene oxide (GO), characterized by its distinctive physicochemical properties, holds significant potential for a wide range of biomedical applications, such as the prevention of oral diseases, periodontal therapy, control of gastrointestinal infections, wound healing, antibacterial therapy for the respiratory tract, and management of urogenital infections. The antimicrobial mechanisms of GO include physical disruption of microbial membranes, induction of reactive oxygen species (ROS), and its role as a photosensitizer. Moreover, improving the dispersion, stability, release behavior, and reusability of GO-based composites can markedly enhance their effectiveness. The antimicrobial activity of GO is further modulated by its physicochemical properties, synthesis methods, bacterial characteristics, and environmental conditions, while potential synergistic or antagonistic interactions remain to be elucidated. This review synthesizes recent advancements in GO-based antimicrobial strategies, elucidates key mechanisms and influencing factors, and addresses major challenges and future research directions, with the objective of facilitating the clinical translation of GO as a next-generation antimicrobial material. Full article

Reliable obstacle avoidance is essential for bionic robotic fish operating in complex underwater environments. However, when a robotic fish performs depth-keeping cruising near U-shaped obstacles, the traditional artificial potential field (APF) method is prone to local minima, which can cause the vehicle to become trapped and lead to obstacle avoidance failure. To address this problem, this paper proposes a virtual sentinel obstacle strategy based on the APF method. Virtual sentinel obstacles are deployed near the entrance of U-shaped obstacles, and corresponding deployment rules are formulated to prevent the robotic fish from entering the local minimum region. To further improve path planning performance, a two-stage fuzzy controller is developed to adjust heading rotation and cruising step size. The proposed method is evaluated through numerical simulations and physical experiments using a self-developed bionic robotic fish prototype. The results show that the virtual sentinel obstacle strategy prevents entrapment around the tested U-shaped obstacles, while fuzzy control shortens the path and improves smoothness. The physical experiments further verify the feasibility of the proposed strategy in a two-dimensional underwater obstacle avoidance scenario. These results indicate that combining virtual sentinel obstacles with APF-based planning provides a feasible approach for U-shaped obstacle avoidance by bionic robotic fish. Full article

Energy-storage-integrated renewable energy stations contain both grid-following and grid-forming converters, which makes their wideband impedance behaviour difficult to predict. This paper studies a field-oriented harmonic impedance measurement method for such stations. A three-phase cascaded H-bridge converter is used to develop a harmonic impedance measurement device connected to the 35 kV bus. For the measured system, a generalized Norton equivalent model is established for the grid-following part, while a generalized Thevenin equivalent model is derived for the grid-forming energy-storage part. A frequency-domain multi-objective target-oriented decoupled control strategy is then designed for the measurement device. The strategy assigns fundamental power synchronisation, harmonic disturbance injection, and submodule capacitor voltage balancing to different frequency components. This design prevents the fundamental current loop from suppressing the injected harmonic current. Simulation studies are carried out under four conditions, including no harmonic injection and 5th-, 25th-, and 99th-order harmonic injections. The baseline case shows no clear commanded-frequency current component. Under harmonic commands, the device injects the corresponding current components while maintaining stable multilevel bridge-port voltage. The device also demonstrates robust impedance-identification performance under grid background harmonics, measurement noise, and equivalent-impedance variations. The results indicate that the proposed device has application capability for wideband impedance measurement and stability analysis in energy-storage-integrated grid-connected systems. Full article

Background: The global shift to sustainable diets has raised interest in plant-based protein sources, particularly pulses, due to their nutritional value, health benefits, and low environmental impact. Pulses are rich in protein, dietary fiber, and a variety of bioactive compounds that may influence gut microbiota and metabolic health. Objective: This narrative review aims to evaluate the role of pulse consumption in modulating gut microbiota, improving metabolic health, and contributing to the prevention of non-communicable diseases (NCDs), while considering the impact of processing techniques such as fermentation and sustainability aspects. Methods: A comprehensive literature search was conducted using major scientific databases to identify relevant studies published during the last 10 years. Evidence from in vitro, in vivo experimental and human studies was included, focusing on pulse composition, bioactive compounds, gut microbiota modulation, metabolic outcomes, and the effects of processing methods such as fermentation. Results: Pulses demonstrate promising potential to improve gut health by promoting beneficial microbiota, increasing short-chain fatty acid production, and enhancing intestinal barrier function. Evidence also suggests favorable effects on lipid metabolism, glycemic control, and inflammation. Processing techniques, particularly fermentation, improve nutrient bioavailability, digestibility, and bioactive profiles. Beyond health outcomes, this review places pulses in the larger context, emphasizing their contribution to healthy, sustainable diets. Conclusions: Pulses are key components for achieving sustainable, health-promoting diets with promising effects on gut and metabolic health. However, current evidence is largely derived from preclinical studies, highlighting the need for long-term human interventions and scalable processing strategies to fully realize their potential. Full article