Search Results (109)

Heart failure (HF), a prevalent global health issue characterized by the heart’s impaired ability to pump or fill blood, affects millions worldwide and continues to pose significant challenges despite advancements in treatment. This review delves into the critical and increasingly recognized role of inflammation in the development and progression of this complex syndrome. While the incidence of HF has seen a decline in some regions due to improved cardiac care, its overall prevalence is rising, particularly among younger adults and those with heart failure with a preserved ejection fraction (HFpEF). Given the persistently high rates of hospitalization and mortality associated with HF, understanding the underlying mechanisms, including the contribution of inflammation, is crucial for identifying novel therapeutic strategies. Inflammation in heart failure is a multifaceted process involving the activation of the immune system, both innate and adaptive, and encompasses various mechanisms such as the release of pro-inflammatory mediators, endothelial dysfunction, and neurohormonal activation. Myocardial damage triggers the innate immune response, while humoral immunity and chronic systemic inflammation, often linked to cardiovascular risk factors and autoimmune diseases, also play significant roles. Notably, heart failure and inflammation have a reciprocal relationship, with HF itself contributing to inflammatory processes within the cardiac tissue and systemically. Understanding these intricate pathways, including the involvement of specific immune cells and molecular mediators, is essential for comprehending the pathogenesis of heart failure and exploring potential therapeutic interventions. The review further examines various inflammatory biomarkers that have been implicated in heart failure, such as cytokines (including TNF-α and IL-1) and C-reactive protein (CRP). While these markers often correlate with the severity and prognosis of HF, clinical trials targeting specific inflammatory mediators have largely yielded disappointing results, highlighting the complexity of the inflammatory response in this context. The exploration of these biomarkers and the challenges encountered in translating anti-inflammatory strategies into effective treatments underscore the need for continued research to unravel the precise role of inflammation across different HF subtypes and to develop more targeted and effective anti-inflammatory therapies. Full article

Background: Childhood hearing loss is a public health problem of critical importance associated with speech development, academic achievement, and quality of life. Parents’ awareness and knowledge about risk factors contribute to early detection and timely intervention.  Objective: This study aims to examine Jordanian mothers’ knowledge of childhood hearing loss risk factors and investigate the impact of education level and socioeconomic status (SES) on the accuracy and comprehensiveness of this knowledge with the moderating effect of health literacy. Material and Methods: The approach employed an embedded mixed-methods design with a dominant quantitative strand supported by qualitative data, utilizing quantitative surveys (n = 250), analyzed using structural equation modeling (SEM) in SmartPLS, and qualitative interviews (n = 10), analyzed thematically to expand upon the quantitative findings by exploring barriers to awareness and healthcare-seeking behaviors. Results: The accuracy and comprehensiveness of knowledge of hearing loss risk factors were also positively influenced by maternal knowledge of hearing loss risk factors. Maternal knowledge was significantly associated with both education level and socioeconomic status (SES). Furthermore, maternal knowledge and accuracy were significantly moderated by health literacy, such that mothers with higher health literacy exhibited a stronger relationship between knowledge and accuracy. Qualitative findings revealed that individuals encountered barriers to accessing reliable information and comprehending medical advice and faced financial difficulties due to limited options for healthcare services. Conclusions: These results underscore the need for maternal education programs that address specific issues, provide simplified healthcare communication, and enhance access to pediatric audiology services. Future research should explore longitudinal assessments and intervention-based strategies to enhance mothers’ awareness and detect early childhood hearing loss. Full article

Previously, we reported that microplastic volatile organic compounds are present within the Chrysaora chesapeakei of Chesapeake Bay, MD. In this study, we report the presence of contaminants of emerging concern (CECs) on the hydrophobic surface of microplastic (MP) particles extracted from the C. chesapeakei, detected by Raman spectroscopy and identified by Wiley’s KnowItAll Software with IR & Raman Spectral Libraries. C. chesapeakei encounters various microplastics and emerging contaminants as it floats through the depths of the Patuxent River water column. This study identifies subsuming CECs found directly on microplastics from within C. chesapeakei in the wild using Raman spectroscopy. Among the extracted microplastics, some of the emerging contaminants found on the different microplastics were pesticides, pharmaceuticals, minerals, food derivatives, wastewater treatment chemicals, hormones, and recreational drugs. Our results represent the first of such findings in C. chesapeakei, obtained directly from the field, and indicate C. chesapeakei’s relationship with microplastics, with this species serving as a vector of emerging contaminants through the marine food web. This paper further illustrates a relationship between different types of plastics that attract dissimilar types of emerging pollutants in the same surrounding environmental conditions, underscoring the urgent need for further research to fully understand and mitigate the risks that MPs coexist with contaminants. Full article

In the current clinical psychiatric practice in most of the world, treatment decisions are based on a person’s capacity to make these decisions. When a person lacks the capacity to understand and appreciate treatment decisions, in many jurisdictions a third-party substitute decision maker (SDM) is appointed on his or her behalf in order to promote safety and optimal clinical outcome. In Ontario, Canada, for example, family members (typically) or public guardians are appointed as SDMs, and they form an integral part of the medical–legal system in psychiatric care. Clinicians working with both patients and their SDMs in these circumstances encounter unique challenges and deliver care in specialized ways, though little research has focused on their experiences and reflections. Based on focus group data, this qualitative study uses a descriptive and interpretative phenomenological approach through thematic analysis to examine these aspects from clinicians working in both inpatient and outpatient settings of an urban teaching hospital’s psychiatric services in Toronto, Canada. Seven key themes emerged: Clinicians (1) appreciate hardships and challenges in lives of SDMs and patients—including the challenging emotions and experiences on both sides, and the risks and relational changes from being an SDM; (2) have an understanding of the patient’s situation and respect for patient autonomy and wishes—they are promoter of autonomy and mindful of patients’ prior wishes amidst patients’ fluctuating capacity, facilitating communication, keeping patients informed and promoting transitioning from SDM to self-determination; (3) have a special working relationship with family SDMs—including supporting SDMs, avoiding harm from delayed or denied treatment, and educating and collaborating with SDMs while maintaining professional boundaries; (4) at times find it difficult working with SDMs—stemming from working with over-involved or uninterested family SDMs, coping with perceived poor SDM decisions, and they sometimes ponder if SDMs are necessary; (5) delineate differences between family and Public Guardian and Trustee (PGT) SDMs—they see PGT as closely aligned with medical decision makers, while family SDMs are more intimately involved and more likely to disagree with a physician’s recommendation; (6) recognize the importance of the SDM role in various contexts—through seeing social values in having SDMs, and acknowledging that having SDMS help them to feel better about their actions as they work to protect the patients; and (7) express ideas on how to improve the current system—at public, societal, and family SDM levels. We conclude that clinicians have unique mediating roles, with privilege and responsibility in understanding the different roles and challenges patients and SDMs face, and have opportunities to improve patient and SDM experiences, clinical outcomes, carry out education, and advocate for ethically just decisions. These clinical roles also come with frustration, discomfort, moral distress and at times vicarious trauma. Clinicians’ unique understanding of this complex and nuanced intersection of patient care provides insight into the core issues of autonomy, duty to care and protect, advocacy, and emotional dynamics involved in this sector as a larger philosophical and social movement to abolish SDMs, as advocated by the Convention on the Rights of Persons with Disability (CRPD), is taking place. We briefly discuss the role of supported decision making as an alternative as. Full article

Background: Heart rate turbulence (HRT) is a non-invasive technique that can be used to evaluate autonomic nervous system (ANS) function and cardiac arrhythmia. The objective of this study is to investigate whether COVID-19 can lead to long-term blunted HRT following recovery. Methods: This retrospective cohort study included 253 individuals with a confirmed history of COVID-19, referred to as the recovered COVID-19 group, along with 315 healthy participants who had no history of the virus. The recovered COVID-19 group was categorized into three subgroups based on their chest CT severity scores. The HRT analyses were obtained from a 24-h electrocardiography-Holter recording. Results: This study revealed that the HRT onset value was elevated in the recovered COVID-19 group, while the HRT slope value showed a significant decrease when compared to the control group. Correlation analyses indicated a positive relationship between the chest CT severity score and HRT onset, whereas a negative correlation was observed between the chest CT severity score and HRT slope. Regression analyses identified recovery from severe COVID-19, chest CT severity score, hypertension (HT), and smoking as independent predictors of both abnormal HRT onset and the existence of an abnormal HRT slope. Conclusions: Individuals who have recovered from severe COVID-19 are expected to encounter a permanent blunting of HRT, which is regarded as a significant indicator of an increased risk of ventricular arrhythmias and impaired autonomic nervous system (ANS) function. Recovered severe COVID-19 individuals should be carefully evaluated for HRT with 24-h ECG-Holter. Full article

When a line-commutated converter–high-voltage direct current (LCC-HVDC) transmission system with large-scale integration of renewable energy encounters HVDC-blocking events, the sending-end power system is prone to transient overvoltage (TOV) risks. Renewable energy units that are connected via power electronic devices are susceptible to large-scale cascading disconnections due to electrical endurance and insulation limitations when subjected to an excessively high TOV, which poses a serious threat to the safe and stable operation of the system. Therefore, the prediction of TOV at renewable energy stations (RES) under DC blocking (DCB) scenarios is crucial for developing strategies for the high-voltage ride-through of renewable energy sources and ensuring system stability. In this paper, an approximate analytical expression for the TOV at RES under DCB fault conditions is firstly derived, based on a simplified equivalent circuit of the sending-end system that includes multiple DC transmission lines and RES, which can take into consideration the multiple renewable station short-circuit ratio (MRSCR). Building on this, a knowledge-embedded enhanced deep neural network (KEDNN) approach is proposed for predicting the RES’s TOV for complex power systems. By incorporating theoretical calculation values of the TOV into the input features, the task of the deep neural network (DNN) shifts from mining relationships within large datasets to revealing the correlation patterns between theoretical calculations and real values, thereby improving the robustness of the prediction model in cases of insufficient training data and irrational feature construction. Finally, the proposed method is tested on a real-world regional power system in China, and the results validate the effectiveness of the proposed method. The approximate analytical expression for the TOV at RES and the KEDNN-based TOV prediction method proposed in this paper can provide valuable references for scholars and engineers working in the field of power system operation and control, particularly in the areas of overvoltage theoretical calculation and mitigation. Full article

The global construction industry has encountered record growth, especially following the COVID-19 pandemic period, during which the construction industry almost entirely ceased. However, the prices of building materials used by the construction sector have increased rapidly since the COVID-19 pandemic due to interruptions in the supply chain, causing increases in interest rates, inflation rates, and wage rates, as well as changes in tax rates. This has resulted in a contraction of construction activities in the euro area that warrants investigation. The purpose of this study was to empirically evaluate the impacts of political, economic, and financial risks on the cost of construction materials, which have caused a recession in the European economy. In this study, an empirical examination of the long-term equilibrium relationship between the construction cost index and various risk indices associated with politics, economics, and finance across Europe was conducted. This study also explored the construction-led growth hypothesis in the eurozone. Fully Modified Ordinary Least Squares (FMOLSs) and Dynamic Ordinary Least Squares (DOLSs) panel estimation techniques were employed here. The panel regression results were obtained using the FMOLS technique and provided statistically significant elasticity coefficients. The results revealed that the economic risk index was statistically significant at 1% with an elasticity coefficient of 0.242, whereas both the political risk index and the financial risk index had elasticity coefficients of 0.231 and 0.228 at the 10% significance level, respectively. The results of this study are robust and provide strong empirical evidence that these risk factors have negative impacts on the construction cost index within the EU area, which is in agreement with the related literature. The results of the DOLS estimation methodology were significant only at the 10% significance interval for financial and economic risk parameters, with elasticity values of 0.244 and 0.183, respectively. Moreover, the results of the Dumitrescu–Hurlin Panel Causality Test determined a significant bidirectional causal relationship between the construction cost index and the financial, economic, and political risk indices in Europe. This study ultimately validates the construction-led growth hypothesis for European nations. Full article

Debris flows propagating in natural environments often encounter irregular terrain features, such as bottom roughness and man-made structures like groundsills, which significantly influence their behavior and dynamics. In practice, groundsills are commonly used as debris flow mitigation structures. This study examines the effects of a beam-type groundsill array on the flow behavior of sediment mixtures in an inclined channel using numerical simulations. The sediment mixtures, modeled as Bingham fluids, were tested as they flowed over groundsill arrays with varying densities, characterized by the spacing-to-height ratio ($d/h$) ranging from 2 to 10. The findings indicate that interaction with the groundsills produces a hydraulic jump-like flow, reaching a height approximately 2.2 times the approach flow depth across different array densities. High-density arrays ($d/h\le 4$) substantially hindered flow propagation, reducing front velocities but leading to sediment buildup upstream of the groundsills. Conversely, low-density arrays ($d/h>4$) facilitated smoother flow with higher velocities. These insights into the relationship between array density, flow behavior, and sediment trapping provide valuable guidance for optimizing groundsill array designs to effectively reduce the mobility of gravity-driven flows of non-Newtonian fluids (such as snow avalanches, debris, lava, or mudflows) and mitigate the associated risks. Full article

The challenge of high energy consumption and carbon emissions within China’s construction industry has become increasingly urgent, as over 40% of buildings are still non-energy efficient. The multifaceted nature of systems involved in building retrofits results in a complex project, with barriers in both retrofit design and construction becoming increasingly evident. This research comprehensively assesses the common barriers in building retrofits and investigates the potential for integrating energy-efficient retrofits with information flow modeling from an interdisciplinary perspective. In order to pinpoint the main barriers hindering building retrofits, this study employs the bibliometric software VOSviewer. The analysis uncovers that the primary obstacles to energy-saving renovations are categorized into technical, economic, environmental, and other barriers. These barriers are characterized by a high degree of specialization, the inadequate integration of information, and limited collaboration among stakeholders. Subsequently, a qualitative literature review was conducted following the PRISMA methodology, which screened 40 key sources. The following conclusions were drawn: (1) The design of energy-saving renovation processes is impeded by the limited professional perspectives within the construction industry, which restricts the practical applicability; (2) Decision making for energy-saving renovations encounters notable professional barriers and suffers from inadequate information integration; (3) There is a lack of clarity regarding information needs during the implementation phase, and no effective platform exists for information coordination; (4) Risk analyses in complex energy-saving renovations largely depend on expert interviews, lacking robust scientific tools. These findings highlight that knowledge gaps and information asymmetry are the central challenges. To tackle these issues, this paper suggests the implementation of an information flow model that integrates the IDEF0 and DSM for building energy-saving retrofit projects. The IDEF0 model can clearly describe the interaction relationship of all expert information through functional decomposition, while the DSM can show the dependency relationship and information flow path among specialties through the matrix structure. This model is anticipated to enhance professional information integration and collaboration. It is proposed that improved information integration and collaboration under this framework will significantly promote the advancement of professional generative AI. Full article

Background: Obesity represents a global epidemic associated with significant health risks, including diabetes, cardiovascular disease, and certain cancers. Management strategies have evolved from focusing solely on weight reduction to emphasizing overall health improvements and mitigating associated risks. Methods: This narrative review analyzed the existing peer-reviewed literature across databases such as PubMed, Scopus, EMBASE, the Cochrane Library, and Google Scholar to examine the outcomes of bariatric surgery and its interplay with weight stigma. The review incorporated data from clinical studies, systematic reviews, and meta-analyses, focusing on bariatric surgery and its psychological impact, as well as approaches to mitigate stigma in bariatric care. Results: Bariatric surgery has emerged as the most effective intervention for sustained weight loss and the resolution of obesity-related comorbidities. However, individuals undergoing surgery frequently encounter weight stigma, both pre- and postoperatively, which manifests through discriminatory healthcare interactions, societal biases, and internalized self-criticism. These factors contribute to anxiety, depression, diminished healthcare engagement, and weight regain, ultimately affecting the long-term surgical outcomes. Conclusions: Addressing weight stigma in bariatric care is critical to optimizing outcomes. Interventions such as preoperative counseling, postoperative psychological support, and multidisciplinary care can mitigate the psychological and societal burdens of stigma. This review explores the intricate relationships between obesity, bariatric surgery outcomes, weight stigma, and the health-related quality of life (HRQOL). Full article

The exploration of ship collision avoidance behavior characteristics can provide a theoretical basis for ship collision risk assessment and collision avoidance decision-making, which is significant for ensuring maritime navigation safety and the development of intelligent ships. In order to scientifically and effectively analyze the characteristics of ship collision-avoidance behavior and to seek the intrinsic connections among ship collision-avoidance behavior feature parameters(CABFPS), this study proposes a method that combines the Apriori algorithm and complex network theory to mine ship collision-avoidance behavior characteristics from massive AIS spatiotemporal data. Based on obtaining ship encounter samples and CABFPS from AIS data, the Apriori algorithm is used to mine the association rules of motion parameters, and the maximum mutual information coefficient is employed to represent the correlation between parameters. Complex networks of CABFPS for different encounter situations are constructed, and network topological indicators are analyzed. Mutual information theory is applied to identify key parameters affecting ship collision- avoidance behavior under different situations. The analysis using actual AIS data indicates that during navigation, the relationships among various parameters are closely linked and prone to mutual influence. The impact of CABFPS on ship collision-avoidance actions varies under different encounter scenarios, with relative distance and DCPA having the greatest influence on ship collision-avoidance actions. This method can comprehensively and accurately mine the correlations between CABFPS and the influence mechanism of parameters on collision-avoidance actions, providing a reference for intelligent ship navigation and the formulation of collision-avoidance decisions. Full article

Background and Objectives: Considering the increasing prevalence of chronic heart failure (CHF) and cognitive decline (CD) observed in recent decades and the complex interrelation between these two pathologies often encountered in the same patient, in this study, we aimed to highlight the connection between CHF, defined as recommended by the European Society of Cardiology guidelines, and CD, evaluated by employing five neuropsychological scales. Materials and Methods: Our study was conducted on 190 patients with very high cardiovascular risk profiles admitted between 5 September 2021 and 15 November 2023 in the Municipal Emergency Hospital Timisoara. Of these, 103 had CHF (group A) and 87 did not (group B). Results: Although similar concerning age, sex distribution, and risk factors (excepting lipid profile), patients from group A had lower Mini Mental State Evaluation (MMSE) and Montreal Cognitive Assessment (MoCA levels (p = 0.003, respectively, p = 0.017) scores, more reduced daily activity (p = 0.021), and more severe depression (p = 0.015) compared to group B. We documented statistically significant correlations between left-ventricular ejection fraction (LVEF) and the levels of N-terminal pro–B-type natriuretic peptide (NT-pro-BNP), as well as with the results of MMSE (r = 0.226, p = 0.002 and r = −0.275, p = 0.005, respectively), daily activity, and depression (p ˂ 0.001). Multi-logistic regression models indicated age, blood pressure values, decreased daily activity, and depression as risk factors for CD in patients with CHF. Conclusions: In patients with CHF, there is an increased propensity of CD, with a direct relationship between MMSE and LVEF levels and an indirect one between MMSE and NT-pro-BNP levels. The concomitance of depression and reduced activity levels are aggravating CD in these patients. Full article

Introduction: Women with late-stage metastatic breast cancer are at an increased risk of pain and distress from symptoms and often struggle with associated emotional and financial burden of their disease. Palliative care is known to alleviate symptom burden in patients with end-stage, terminal diseases but is often underutilized in both inpatient and outpatient settings. The current study aims to investigate the prevalence of palliative care consultation on inpatients with metastatic breast cancer and examine the association between palliative care consultation and length of hospital stay and total hospital charges. Methods: Patients diagnosed with metastatic breast cancer between 1998–2017 were abstracted from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Database (NIS). The primary outcome was the presence of a palliative care consultation (PCC) during the inpatient stay. Secondary outcomes were hospital length of stay and total hospital charges. Multivariable logistic regression was used to examine factors associated with the presence of a PCC. The relationship between PCC and hospital length of stay and total hospital charges were investigated using linear regression. Results: 513,509 cases of metastatic breast cancer were identified, 5.7% had a documented in-hospital palliative care encounter. Of those who received PCC, total hospital charges were about USD 5452 less than those who did not receive consultation. Women who received PCC had higher odds of a longer hospital stay. Predictors of PCC were older age, non-White race, and residing in a lower-income ZIP code. Conclusions: Palliative care remains to be an underutilized resource among patients with end-stage metastatic breast cancer. Full article

This research aims to inspect the application of Artificial Intelligence (AI) in product and service innovation from the perspective of the Hainan Free Trade Port (HFTP) and its relationship with corporate transformation, legal compliance, and regulatory oversight. Being critical to the fourth industrial revolution, digital business and international cooperation, technology propels enterprises across various industries to transition from traditional models to intelligent and service-oriented ones. It also elucidates the theoretical foundations of AI products, the digital economy, and service innovation. It can be used to analyzes the challenges enterprises face in the HFTP while implementing AI technology, including funding, technology, management, operations, corporate culture, and innovative concepts. Based on the proposed research methodology, three hypotheses can be formulated. Hypothesis 1 states that the HFTP could facilitate enterprise transformation by applying supportive policies. Hypothesis 2 state that domestic laws and international agreements are urgently needed due to the legal risks arising from artificial intelligence. Hypothesis 3 state that HFTP enterprises comply with these laws while systemically assuring, in theory, and practice, the legal risks of artificial intelligence and its implications for legal regulation, which is a significant aspect of research, addressing legal risks related to data privacy, security, and algorithmic bias with many strategies being proposed. This shows how AI technology can change businesses in the HFTP, demonstrating the application of AI technology in the transformation of enterprises in the HFTP and the various risks they may encounter, providing valuable references for other enterprises regarding the practical significance of AI product and service innovation in the HFTP, and emphasizing the importance of international cooperation and legal instruction. Full article

Risk is an inherent part of our lives and every action we take. It accompanies us in various areas of our lives. Each of us encounters risk in everyday life by undertaking and performing specific activities or actions. Risk is not always perceived by us; there are situations when we do not notice it in our actions. The main objective of this article is to identify and assess the factors influencing the level of risk in consumer purchasing decisions in the organic products market. Additionally, it aims to indicate the desired directions of actions taken by producers and suppliers of organic food to reduce the risk associated with the purchasing process perceived by consumers. The research process took into account existing scientific achievements and the survey method, chosen due to the subject and nature of the research. The survey was addressed to consumers from the Lubuskie Voivodeship and was anonymous. The conducted research shows that the greatest risk perceived by consumers is in the case of online purchases, and the way to reduce this risk is through buyer loyalty to the place of purchase. The empirical research also provides grounds to assume that there is a relationship between individual types of risk. The research shows that respondents are most afraid of safety and social risk, and the least afraid of the risk of losing too much time. Consumers who want to reduce the risk use their own experiences or positive opinions about the product. The results provide valuable information for producers and suppliers of organic food who want to build lasting relationships with consumers based on trust and loyalty. The higher the trust, the greater the customer loyalty, and the lower the perceived risk. Full article