Search Results (216)

Background/Objectives: Iron deficiency without anemia (IDWA) is common among female patients with chronic kidney disease (CKD), yet the clinical implications of iron therapy in this population remain uncertain. While iron supplementation is frequently used in anemic CKD patients, evidence regarding its outcomes in non-anemic, iron-deficient individuals is limited and conflicting. Methods: This retrospective cohort study utilized the multi-institutional TriNetX database to examine the 5-year outcomes of iron therapy in adult women with stage 3 CKD, normal hemoglobin (≥12 g/dL), normal mean corpuscular volume (MCV), and low serum ferritin (<100 ng/mL). Primary outcomes included all-cause mortality, major adverse cardiovascular events (MACE), acute kidney injury (AKI), pneumonia, progression to advanced CKD (estimated glomerular filtration rate ≤30 mL/min/1.73 m²), and gastrointestinal (GI) bleeding. Results: We identified 53,769 eligible non-anemic patients with stage 3 CKD, low serum ferritin levels, and normal MCV. Propensity score matching (1:1) was conducted on demographic variables to compare iron-treated (n = 6638) and untreated (n = 6638) cohorts. Over the 5-year follow-up, iron therapy in non-anemic females with stage 3 CKD, low ferritin levels, and iron supplementation was significantly associated with increased risks of MACE, AKI, pneumonia, CKD progression, and GI bleeding (log-rank p < 0.0001). No significant difference in all-cause mortality was observed. Data on transferrin saturation and the dosage of iron supplementation were unavailable. Conclusions: In non-anemic women with stage 3 CKD and low ferritin levels, iron supplementation was linked to increased MACE, renal, and pneumonia risks without evident survival benefits. These findings suggest that iron therapy in this group of patients may not confer cardiovascular benefit and may pose risks. Full article

The ongoing secular changes in human movement development means that an assessment of primitive reflexes is now required not only in disabled but also in neurotypical children. This study had three aims: (1) presenting the TASHUN test battery as suitable for the assessment of primitive reflex activity in normal children and child athletes; (2) analyzing reflex characteristics of neurotypical children; (3) verifying validity and reliability of tests. Spearman’s rank correlation and ROC analysis were used for validation. Intraclass Correlation Coefficient and RM ANOVA analyzed reliability. The test on 242 schoolgirls has demonstrated that retained primitive reflexes are present in almost every individual (84.7–95.7%). Correlations showed strong positive association, with all values exceeding 0.8, and ROC analysis demonstrated excellent predictive strength (AUC values over 0.9). Interobserver reliability showed excellent agreement (ICC values above 0.9). No significant offset was present among the scoring by evaluators. Therefore, testing for primitive reflexes is necessary in neurotypical children in order to obtain a realistic image about the physiology of reflexes and their role in motor development. Our screening could be useful for practicing sport professionals, researchers and academics, to identify deficiencies, to further explore reflexes and to train future PE teachers and trainers. Full article

Currently, most studies evaluating storm surges are conducted at the provincial level, and there is a lack of detailed research focusing on cities. This paper focuses on the urban scale, using some fine-scale data of coastal areas obtained through remote sensing images. This research is based on the Hazard–Exposure–Vulnerability (H-E-V) framework and PPRR (Prevention, Preparedness, Response, and Recovery) crisis management theory. It focuses on 52 Chinese coastal cities as the research subject. The evaluation system for the disaster response capabilities of Chinese coastal cities was constructed based on three aspects: the stability of the disaster-incubating environment (S), the risk of disaster-causing factors (R), and the vulnerability of disaster-bearing bodies (V). The significance of this study is that the storm surge capability of China’s coastal cities can be analyzed based on the results of the evaluation, and the evaluation model can be used to identify its deficiencies. In this paper, these storm surge disaster response capabilities of coastal cities were scored using the entropy weighted TOPSIS method and the weight rank sum ratio (WRSR), and the results were also analyzed. The results indicate that Wenzhou has the best comprehensive disaster response capability, while Yancheng has the worst. Moreover, Tianjin, Ningde, and Shenzhen performed well in the three aspects of vulnerability of disaster-bearing bodies, risk of disaster-causing factors, and stability of disaster-incubating environment separately. On the contrary, Dandong (tied with Qinzhou), Jiaxing, and Chaozhou performed poorly in the above three areas. Full article

Superb Fairy-wren Optimization Algorithm (SFOA) is an animal-based meta-heuristic algorithm derived from Fairy-wren’s behavior of growing, feeding, and avoiding natural enemies. The SFOA has some shortcomings when facing complex environments. Its switching mechanism is not enough to adapt to complex optimization problems, and it faces a weakening of population diversity in the late stage of optimization, leading to a higher possibility of falling into local optima. In addition, its global search ability needs to be improved. To address the above deficiencies, this paper proposes an Adaptive Superb Fairy-wren Optimization Algorithm (ASFOA). To assess the ability of the proposed ASFOA, three groups of experiments are conducted in this paper. Firstly, the effectiveness of the proposed improved strategies is checked on the CEC2018 test set. Second, the ASFOA is compared with eight classical/highly cited/newly proposed metaheuristics on the CEC2018 test set, in which the ASFOA performed the best overall, with average rankings of 1.621, 1.138, 1.483, and 1.966 in the four-dimensional cases, respectively. Then the convergence and robustness of ASFOA is verified on the CEC2022 test set. The experimental results indicate that the proposed ASFOA is a competitive metaheuristic algorithm variant with excellent performance in terms of convergence and distribution of solutions. In addition, we further validate the ability of ASFOA to solve real optimization problems. The average ranking of the proposed ASFOA on 10 engineering constrained optimization problems is 1.500. In summary, ASFOA is a promising variant of metaheuristic algorithms. Full article

Urban mobility resilience plays a central role in sustainable urban planning discussions, especially considering the challenges of extreme events, climate change, and the increasing scarcity of fossil fuels. This study evaluates urban mobility resilience in Petrópolis (RJ), incorporating socio-spatial heterogeneity and energy vulnerability. This research fills methodological gaps in the literature by proposing a composite resilience index that integrates technical, socioeconomic, and fossil fuel dependency variables within a robust multicriteria framework. We selected eleven variables relevant to urban mobility and organized them into inference blocks. We normalized the variables using Gaussian functions, respecting their maximization or minimization characteristics. We applied the Analytic Hierarchy Process (AHP) to assign weights to the criteria and then aggregated and ranked the results using multicriteria analysis. The final index represents the adaptive capacity of urban territories facing the energy crisis, and we applied it spatially to the neighborhoods of Petrópolis. The analysis identified a significant concentration of neighborhoods with low resilience, particularly in quadrants, combining deficiencies in public transportation, high dependence on fossil fuels, and socioeconomic constraints. Factors such as limited pedestrian access, insufficient motorized public transport coverage, and a high proportion of elderly residents emerged as significant constraints on urban resilience. Intervention strategies that promote active mobility, improve accessibility, and diversify transportation modes proved essential for strengthening local resilience. The results emphasize the urgent need for public policies to reduce energy vulnerability, foster active mobility, and promote equity in access to transportation infrastructure. Full article

The Catostemma clade comprises three genera: Aguiaria, Catostemma, and Scleronema. These genera are representatives of the tribe Adansonieae, and are part of the subfamily Bombacoideae of the Malvaceae family. Taxonomic studies of these genera are scarce and limited to isolated publications of new species or regional floras. We reviewed their taxonomy, morphology, and geography, and assessed gaps in our knowledge of this group. We carried out a bibliographic survey, an analysis of herbarium collections, and collected new material in Brazilian forests. Here, we provide an identification key, nomenclatural revisions, morphological descriptions, taxonomic comments, geographic distribution maps, illustrations, and analyses of the conservation status for all species. We also discuss probable synapomorphies of the clade, to advance our understanding of phylogenetic relationships within the Adansonieae tribe of Bombacoideae. In total, we recognize 16 species: 1 Aguiaria, 12 Catostemma, and 3 Scleronema, of which 7 are endemic to Brazil, 1 to Colombia, and 1 to Venezuela. Two species are ranked as Critically Endangered (CR), and four as Data Deficient (DD). Full article

As urbanization has accelerated, rail transit has evolved from being a mere means of transportation to a public area that houses the city’s cultural memory and serves as a crucial portal for the public to understand the culture of the city. As an urban public space with huge passenger flow, the metro (or subway) cultural space has also become a public cultural space, serving communal welfare and representing the image of the city. It is currently attracting more and more attention from the academic community. Wuhan, located in central China, has many subway lines and its engineering construction has set several national firsts, which is a typical sample of urban subway development in China. In this study, we use Python 3.13.0 crawler technology to capture the public’s comments on cultural space of Wuhan metro in social media and adopt SnowNLP sentiment score and LDA thematic clustering analysis to explore the overall quality, distinct characteristics, and deficiencies of Wuhan metro cultural space construction, and propose targeted design optimization strategies based on this study. The main findings are as follows: (1) The metro cultural space is an important window for the public to perceive the city culture, and the public in general shows positive perception of emotions: among the 16,316 data samples, 47.7% are positive comments, 17.8% are neutral comments, and 34.5% are negative comments. (2) Based on the frequency of content in the sample data for metro station exit and entrance space, metro train space, metro concourse and platform space, they are ranked as weak cultural spaces (18%), medium cultural spaces (33%), and strong cultural spaces (49%) in terms of the public’s perception of urban culture. (3) At present, there are certain deficiencies in Wuhan metro cultural space: the circulation paths in concourses and platforms are overly dominant, leaving little space for rest or interaction; the cultural symbols of metro train space are fragmented; the way of articulation between cultural and functional space in the metro station exit and entrance space is weak, and the space is single in form. (4) Wuhan metro cultural space needs to be based on locality landscape expression, functional zoning reorganization, innovative scene creation to optimize the visual symbol system and behavioral symbol system in the space, to establish a good image of the space, and to strengthen the public’s cultural identity and emotional resonance. Full article

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular disorder caused by pathogenic variants in ENG (HHT1) and ACVRL1 (HHT2), with distinct phenotypic expressions. Background/Objectives: This study investigates the genotype–phenotype correlations, including comparing the quality of life by phenotype, conducting a cardiovascular risk assessment, and evaluating the impact of mutation type on its clinical manifestations and prognosis. Methods: A cross-sectional study was conducted on 85 HHT patients, stratified into HHT1 (ENG, n = 43) and HHT2 (ACVRL1, n = 42). Their clinical and biochemical parameters, arteriovenous malformations (AVMs), epistaxis severity, quality of life, and cardiovascular risk were assessed. Genetic variants were classified as truncating or non-truncating. The statistical analyses included logistic regression and survival analysis. Results: The onset of epistaxis occurred earlier in HHT1 (log-rank p = 0.011), whereas its severity (p = 0.006) and iron deficiency were greater in HHT2 (p = 0.043). Pulmonary AVMs were significantly more frequent in HHT1 (58.1% vs. 9.5%, p < 0.01), contributing to a potential decrease in survival, despite the greater hemorrhagic burden in HHT2. Truncating mutations were independently associated with anemia (p < 0.05). Cardiovascular risk (measured using the SCORE2 scale) was low to moderate, and quality of life (measured using the EQ-5D-5L scale) was most impaired in patients with severe epistaxis (p = 0.031) or anemia (p = 0.026). Truncating mutations influence the severity of anemia independently of genotype. Limitations: The principal limitations include the small sample size and the bias generated by this being a paper based on another prospective study with a methodology designed for different objectives. Conclusions: These findings underscore the need for personalized management strategies based on genotype and mutation type. Further prospective studies are warranted to validate these associations and optimize the risk stratification in HHT. Full article

Driven by the global energy transition and the pursuit of “dual carbon” goals, sustainability risks within the coal supply chain have emerged as a central obstacle impeding the low-carbon transformation of high-carbon industries. To address the critical gap in systematic and multidimensional risk assessments for coal supply chains, this study proposes a hybrid framework that integrates the analytic hierarchy process (AHP) with the fuzzy comprehensive evaluation (FCE) method. Utilizing the Delphi method and the coefficient of variation technique, this study develops a risk assessment system encompassing eight primary criteria and forty sub-criteria. These indicators cover economic, operational safety, ecological and environmental, management policy, demand, sustainable supply, information technology, and social risks. An empirical analysis is conducted, using a prominent Chinese coal enterprise as a case study. The findings demonstrate that the overall risk level of the enterprise is “moderate”, with demand risk, information technology risk, and social risk ranking as the top three concerns. This underscores the substantial impact of accelerated energy substitution, digital system vulnerabilities, and stakeholder conflicts on supply chain resilience. Further analysis elucidates the transmission mechanisms of critical risk nodes, including financing constraints, equipment modernization delays, and deficiencies in end-of-pipe governance. Targeted strategies are proposed, such as constructing a diversified financing matrix, developing a blockchain-based data-sharing platform, and establishing a community co-governance mechanism. These measures offer scientific decision-making support for the coal industry’s efforts to balance “ensuring supply” with “reducing carbon emissions”, and provide a replicable risk assessment paradigm for the sustainable transformation of global high-carbon supply chains. Full article

Background: Newborns are referred primary carnitine deficiency (PCD) when a low free carnitine (C0) concentration (<10 μmol/L) is detected, leading to high false-positive referrals. To improve the follow-up protocol for PCD, various acylcarnitines and the summations were comprehensively evaluated in the present study. Methods: A retrospective study was performed using samples due to low C0 concentration. Data were available for 72 patients with genetically confirmed PCD, whereafter C0 with the selected sum of (butyrylcarnitine (C4) + isovalerylcarnitine (C5)) was validated in an additional cohort study including about 80,000 samples. Results: In the discovery study, C4, acetylcarnitine (C2) and C5 exhibited significant discriminant power in distinguishing PCDs from NoPCDs. The area under the ROC curve (AUC) was 99.792% (C4), 98.715% (C2) and 98.620% (C5). The excellent performances in sensitivity, specificity, negative predictive value, positive predictive value (PPV) and accuracy indexes suggested that C4, C2 and C5 would be ideal auxiliary indicators in improving the diagnostic performance of C0 for PCD. Multivariate ROC curve-based exploratory analysis showed that C5, C4 and C2 were the most top-ranked features in differentiating PCDs from NoPCDs. AUC for C4 + C5 was the highest with a cutoff required for 100% sensitivity at 0.181 μmol/L. In the validation cohort, adding C4 + C5 in the NBS program could elevate PPV from 0.75% to 1.54%. Conclusions: Our work revealed that C4 + C5 summation should be used as the auxiliary quantization indicator to reduce false-positive results for PCD. Full article

The number of hologram points in near-field acoustical holography (NAH) for a vibro-acoustic system plays a vital role in conditioning the transfer function between the source and measuring points. The requirement for many overdetermined hologram points for extended sources to obtain high accuracy poses a problem for the practical applications of NAH. Furthermore, overdetermination does not generally ensure enhanced accuracy, stability, and convergence, owing to the problem of rank deficiency. To achieve satisfactory reconstruction accuracy with underdetermined hologram data, the best practice for choosing hologram points and regularization methods is determined by comparing cross-linked sets of data-sorting and regularization methods. Three typical data selection and treatment methods are compared: iterative discarding of the most dependent data, monitoring singular value changes during the data reduction process, and zero padding in the patch holography technique. To test the regularization method for inverse conditioning, which is used together with the data selection method, the Tikhonov method, Bayesian regularization, and the data compression method are compared. The inverse equivalent source method is chosen as the holography method, and a numerical test is conducted with a point-excited thin plate. The simulation results show that selecting hologram points using the effective independence method, combined with regularization via compressed sensing, significantly reduces the reconstruction error and enhances the modal assurance criterion value. The experimental results also support the proposed best practice for inverting underdetermined hologram data by integrating the NAH data selection and regularization techniques. Full article

Background: Nursing students’ readiness for clinical practicums is critical to nursing education. Concerns about students’ preparedness for clinical courses have emerged due to increased student-to-educator ratios and limited hands-on practice time. Moreover, feedback from clinical instructors reveals that many student nurses lack the necessary knowledge and skills for patient care, thereby raising questions about their readiness for clinical practicum. Purpose: This study investigates undergraduate nursing students’ readiness for clinical practicum in the UAE by examining their perspectives, the variation in clinical study plans across different contexts, and the evidence gathered from clinical evaluations. Methodology: A case study design was adopted, utilizing semi-structured interviews with 13 nursing students from a UAE nursing college. Additionally, two types of document analysis were conducted. First, 11 nursing curricula from high-ranking universities were analyzed to compare whether students received adequate laboratory courses for their clinical practicum. Second, 217 clinical evaluation reports from third- and fourth-year nursing students across 4 campuses of the UAE nursing college were reviewed. Findings: The study identified two key themes from the interviews: incomplete readiness for clinical practicum and the factors contributing to this incomplete readiness. Document analysis revealed that, unlike many American and Australian institutions, most universities lacked co-requisite laboratory courses. Clinical evaluation reports highlighted that some students, particularly in their fourth year, were inadequately prepared for clinical practice due to deficiencies in both clinical skills and theoretical knowledge. Conclusions: The findings indicate that many nursing students felt only partially prepared for their practicum, negatively impacting their confidence and competency. Moreover, adopting the American and Australian approach of pairing practicum courses with laboratory courses may better prepare students for clinical practicum. Recommendations for future research have been outlined. Full article

Tuberculosis is an infectious condition caused by Mycobacterium tuberculosis, primarily targeting the pulmonary system, with the potential to disseminate to various other organs via the haematogenous pathway, ranking among the top ten causes of global mortality. Tuberculosis remains a serious public health problem worldwide. This narrative review aims to emphasise the clinical importance of the inter-relationships between nutrition, pharmacotherapy, and the most common drug–nutrient interactions in the context of tuberculosis and multi-drug-resistant tuberculosis management. Nowadays, pharmacologic approaches utilise polytherapeutic regimens that, although showing increased efficacy, prominently affect the nutritional status of patients and modify multiple metabolic pathways, thus influencing both the effectiveness of therapy and the patient outcomes. There is much evidence that antituberculosis drugs are associated with deficiencies in essential vitamins and various micronutrients, leading to serious adverse consequences. Moreover, poor nutrition exacerbates TB outcomes, and TB further exacerbates nutritional status, a vicious cycle that is particularly prevalent in low-resource environments. Nutritional support is necessary, and clinicians ought to evaluate it on a patient-by-patient basis, as empirical evidence has shown that it can improve immune recovery, decrease tuberculosis-associated morbidity, and increase adherence to therapy. However, drug–food interactions are increasingly prevalent, and patients with tuberculosis require personalised dietary and pharmacological regimens. In this context, antituberculosis treatment requires a holistic approach, based on the collaboration of the prescribing physician, pharmacist, and nutritionist, to assess the patient’s needs from a nutritional and pharmacological perspective, with the ultimate goal of decreasing mortality and improving the prognosis of patients through personalised therapies. Full article

Generative tools often lack the guidance of scientific design methods in the design of non-heritage products. This study proposes a new Stingray model, which collects perceptual vocabularies of modeling and other aspects by integrating the perceptual engineering method to clarify the design direction and establishes the design objectives by ranking the importance of the vocabularies using the Analytic Hierarchy Process (AHP) hierarchical analysis method. Taking the Joon County clay sculpture as an example, this study uses generative tools to achieve the innovation of packaging patterns, selects sustainable materials such as straw to complete the sustainable non-heritage packaging design, and verifies its feasibility using the TOPSIS method. The results show that the new Stingray model effectively integrates multiple design methods and solves the subjectivity and feasibility deficiencies of a single model. Meanwhile, the system-guided generative tool significantly improved design efficiency and simplified program adjustment. This study provides theoretical support for generative tools and opens a new path for the sustainable development of non-heritage packaging. Full article

The Yangtze River Delta (YRD) region, located inside the Yangtze River Basin, functions as a vital ecological and economic area in China, with its natural environment directly impacting human existence. This study seeks to elucidate the spatial and temporal evolution of rural resilience in the Yangtze River Delta region and its underlying mechanisms by establishing a comprehensive assessment framework for rural resilience, thereby offering a scientific foundation and policy guidance for the region’s sustainable development. The research first established the DPSIR (driving force–pressure–state–impact–response) assessment index system. Subsequently, the entropy weighting method and TOPSIS were utilized to assess and rank the rural resilience levels in the Yangtze River Delta region (Shanghai, Jiangsu, Zhejiang, and Anhui) from 2012 to 2022. Ultimately, partial least squares structural equation modeling (PLS-SEM) was employed to examine the intrinsic logical relationships among the five dimensions of the DPSIR framework and to extract conclusions. The study effectively met the goals of SDG 7 (clean water and sanitation), SDG 8 (decent work and economic growth), and SDG 11 (sustainable cities and communities). The research indicated that (1) the resilience level in the Yangtze River Delta region initially declined, then increased, and eventually attained a condition of stabilization. Changes in the “driving force”, influenced by the “response level” and environmental “pressure”, have affected the resilience level of rural areas. There is heterogeneity in the assessment values and ranges of change among provinces, with the “impact” component exhibiting the most substantial evaluation value. The findings yield policy recommendations for the implementation of diverse regional governance, the establishment of connectivity mechanisms, the customization of strategies to address the specific deficiencies of each province, and the systematic enhancement of rural resilience. Full article