Search Results (468)

This study examines the adoption of a low-cost model to support digital transformation in small- and medium-sized industrial enterprises (SMEs) within the context of Industry 4.0. In light of the need to increase operational efficiency while simultaneously reducing expenditure, it becomes a priority to employ innovative and cost-effective solutions. To evaluate this impact, the research applies the PICO (Population, Intervention, Comparison, Outcome) methodology, systematically assessing how the proposed model influences digital transformation and operational efficiency. Drawing on a case study, the findings demonstrate that implementing the low-cost model leads to significant cost reductions, gains in operational efficiency, and an acceleration of digital transformation in industrial organizations. The results indicate that the approach not only optimizes internal processes but also contributes to lowering the organization’s overall costs. The conclusions confirm the hypotheses, showing that the model achieves a balance between technological advancement and economic efficiency. The study provides relevant insights into the potential of technologies to simultaneously drive operational efficiency and digital transformation within the framework of Industry 4.0, offering an innovative pathway for companies seeking to digitalize while controlling costs. This research strengthens the existing body of knowledge on the synergy between digital transformation, cost efficiency, and operational performance in industrial settings. Full article

The concept of sustainability in the supermarket sector has emerged as a strategic priority, as companies are required to reduce their environmental footprint and enhance their social and economic performance. The aim of this literature review is to identify, document, and analyze the key performance indicators (KPIs) applied in the sector, with emphasis on environmental, social, and economic dimensions, and to investigate the extent to which technical energy interventions are linked to business and consumer benefits. The methodology was inspired by the general logic of organized search and selection procedures, and for this reason, elements of the PRISMA framework were used, with a search conducted across multiple international scientific databases and selection criteria ensuring the validity and relevance of the sources. The analysis classified the indicators into the following three categories: environmental (e.g., CO₂ emissions, energy consumption), social (e.g., customer satisfaction, corporate image), and economic (e.g., ESG score, return on investment). The study revealed substantial progress made by supermarket chains globally in adopting energy-efficiency technologies, such as LED lighting and renewable energy with proven benefits in reducing consumption and consequently, improving environmental performance. However, a lack of holistic integration between technical interventions and social-economic indicators was identified, limiting the use of KPIs as a strategic tool for guiding specific sustainability strategies. This research concludes that there is a need to develop unified, sector-specific measurement frameworks that integrate environmental, social, and economic parameters, as well as empirical research that quantitatively connects energy strategies with business and consumer performance through comparable indicators in the context of supermarket operations, thereby opening ground for further exploration of the field. Full article

The gastrointestinal microbiota of ruminants constitutes a complex invisible organ, which converts plant fibers into volatile fatty acids (VFAs) and microbial protein through fermentation, serving as the primary energy and protein sources for the host. While substantial progress has been made in characterizing this system, critical gaps remain in understanding causal mechanisms and translating knowledge into scalable interventions. This review systematically synthesizes current knowledge on the composition, function, and metabolite profiles of gastrointestinal microbial communities in ruminants, with emphasis on interaction mechanisms, methodological advances, and intervention strategies. We highlight persistent challenges, including the uncultured majority of microbes, causal inference limitations, and translational bottlenecks. The review further evaluates strategies for targeted microbiome modulation aimed at improving production performance and reducing environmental emissions. Finally, we propose integrated research priorities for developing efficient, low-carbon, and sustainable ruminant production systems. Full article

Refugees often face significant barriers to healthcare access and integration, contributing to poor health outcomes. Although perceptions of health are known predictors of self-reported health status, little is known about how refugees themselves conceptualize health. This study employed a community-engaged, transformative mixed-methods design to explore refugee health perceptions in the Denver-metro area. Data collection included 149 surveys and 27 interviews with refugees and asylum seekers conducted between November 2018 and March 2019. Hierarchical linear regression was used to assess associations between social determinants of health (SDoH) and self-reported health, while qualitative data were analyzed using a constant comparative approach. The final regression model explained 75.8% of the variance in self-reported health (R² = 0.758, p < 0.001). Significant predictors included country of origin (Burma: −3.419, p = 0.030; Somalia: −9.155, p < 0.001), age (1.901, p < 0.001), sex (male: −3.252, p < 0.001), and education level (−0.999, p < 0.001). Qualitative findings revealed themes such as health as the ability to live life and health as happiness, each shaped by cultural context, community connectedness, and perceptions of safety. Integrating these findings highlights how structural conditions and culturally rooted understandings of well-being intersect to shape refugee health after resettlement. This study underscores the need for public health and clinical interventions that center refugee-defined priorities and suggests future research should incorporate constructs, such as happiness and culturally grounded notions of safety, that emerged as central to health in this study. Full article

Recent scientific advances point towards an important role for oral and gastrointestinal health in people with chronic pain. Poor oral health (e.g., periodontitis, tooth loss) is observed in subgroups of the chronic pain population, including abdominal pain, low back pain, fibromyalgia, and rheumatoid arthritis. In addition to poor oral health, studies have also revealed altered intestinal microbiota compositions in various types of chronic pain, including people with chronic low back pain, knee osteoarthritis, visceral pain, fibromyalgia, tinnitus, and migraine. While overweight/obesity contributes to the likelihood of gut dysbiosis, normal-weight individuals with chronic pain also more often present with poor gut health. Both gastrointestinal and oral health problems (e.g., periodontitis, tooth loss) are increasingly recognized across multiple chronic pain conditions, including abdominal pain, low back pain, fibromyalgia, and rheumatoid arthritis. This perspective paper provides an overview of the requirements for integrating oral and gastrointestinal health in chronic pain management. First and foremost, oral and gastrointestinal health issues need to be recognized as common chronic pain comorbidities that require tailored treatment. Next to recognition of the issue, individuals seeking care for chronic pain need to be screened routinely for these oral and gastrointestinal comorbidities. In terms of management, the following options are suggested: (1) providing oral and gastrointestinal health science education; (2) considering the possible interplay between the gut microbiome and drug treatment (including polypharmacy); (3) expanding the importance of dietary interventions; and (4) considering the potential interplay with other lifestyle factors (e.g., chronic insomnia, overweight/obesity, depression and anxiety). To inform the implementation of these suggestions, longitudinal cohort studies investigating the role of oral and gastrointestinal health in people with chronic pain, as well as studies exploring possible (modifiable) factors that affect the oral and/or gut microbiome, are needed. This includes the bidirectional interplay between the gut microbiome and drugs commonly prescribed to patients with chronic pain. Likewise, adequately powered and controlled clinical trials evaluating the effectiveness of possible treatments for oral and/or gastrointestinal comorbidities in people with chronic pain represent another research priority. Such randomized clinical trials can not only examine the possible causal link between poor oral/gut health and treatment outcomes, but also inform the development of new, innovative ways to improve care for people with chronic pain. Full article

This exploratory study examines how discursive design—using provocative, speculative artifacts to spark reflection and discussion—might expand public health experts’ problematization of approaches to tailoring and targeting interventions. Cultural tailoring and targeting (CTT) refers to adapting interventions for specific sociocultural populations. Because LGBTQ+ communities experience disproportionately high rates of tobacco use, this study applies discursive intervention concepts within this context to explore how they might help experts critically engage with CTT strategies for reaching LGBTQ+ populations more effectively. To investigate this, two pairs of discursive intervention concepts were designed and presented to three focus groups of public health experts. Each pair juxtaposed a conventional intervention approach with a more provocative, unfamiliar one—for example, deepfake-driven behavior disruption. The goal was to document the type of conversation discursive design could stimulate around CTT considerations and generate insights relevant to the value of design methodologies to foster new ways to problematize public health matters. Findings indicate that the concepts prompted critical conversations about CTT, although the depth and focus of engagement varied. Those with greater expertise in LGBTQ+ issues engaged more with CTT mechanisms and implications, while others focused on implementation and feasibility concerns—essential to intervention development but outside the study’s focus. These patterns highlight who should be included in such efforts and how they should be engaged from a facilitation perspective, raising important considerations for methodological refinements and future research. Overall, this initial exploration aims to uncover the potential of discursive design to deepen understanding of CTT interventions and inform more responsive, innovative approaches to addressing tobacco use among priority populations. Full article

The urban heat island (UHI) effect is one of the most pressing challenges associated with rapid urbanization. It arises primarily from the replacement of natural vegetation with impervious surfaces, alterations in surface energy balance, and heat emissions from human activity. Mitigating these drivers has become a global priority, particularly in fast-growing cities. Pavements play a central role in UHI intensification due to their large surface coverage, low albedo, and capacity to retain heat. This study adopts a bibliometric approach to systematically map the knowledge structure and research trends in pavement-related UHI studies. A dataset of 834 publications from Web of Science was analyzed using VOSviewer to identify leading countries and journals, central publications, the temporal evolution of research themes, and the thematic structure of the field. The analysis revealed three dominant themes: (1) pavement materials and their properties, (2) mitigation strategies that prevent UHI, and (3) cooling interventions to mitigate UHI. This study attempts to provide a comprehensive overview of the field and to clarify its interdisciplinary connections with climate adaptation and sustainability discourse. Full article

Background: The Canadian HIV Cure Enterprise (CanCURE) is a pan-Canadian research collaboratory, investigating approaches for achieving sustainable HIV remission. In preparation for the next research cycle, CanCURE researchers and the Community Advisory Board (CAB) co-designed a web-based survey to identify HIV research priorities from the perspective of people with HIV (PWH) in Canada. The current study examined gender-based differences in these priorities. Methods: From August to December 2024, we recruited PWH across Canada through community organizations and community members. We collected data using REDCap electronic data capture tools hosted at The Research Institute of the McGill University Health Centre. The survey included 36 demographic questions, 16 questions related to general knowledge about HIV and HIV cure-related concepts, and 21 questions ranking research priorities. Knowledge questions were multiple choice, while priorities could be ranked on a scale. We summarized participant characteristics via descriptive statistics, and the research priorities were further stratified according to gender. Results: Of 109 participants, 48.6% self-identified as men, 46.8% as women, and 4.6% as two-spirit, non-binary, agender, or other. The median age was 53 years old. Approximately one-third of participants had lived with HIV for ≤14 years, one-third for 15–24 years, and one-third for ≥25 years. Overall, the median knowledge score of respondents was 79%. Among the 78 participants with prior HIV research experience, three times as many men (61.1%) as women (19.0%) participated in interventional studies involving medication or medical procedures. Men ranked preventing HIV transmission to partners as a priority, studying where the virus hides as the second, and avoiding high comorbidity risks as the third. In contrast, women ranked not having to take pills daily as a priority and avoiding higher risks for comorbidities as the second priority. Both genders equally valued expanding community involvement in HIV cure research. However, men focused more on integrating social and behavioural research, while women emphasized the need for diverse ethnic representation in research. Conclusions: Although both men and women share some common priorities regarding HIV cure research, there are notable gender differences in their specific concerns. Furthermore, a significant gender gap in participation in interventional studies, essential for advancing HIV cure research, highlights the importance of aligning research priorities with concerns of both genders. Full article

Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndromes in younger women without typical atherosclerotic risk factors. Its distinct pathophysiology and vessel fragility create unique challenges for revascularization. Conservative management is preferred when hemodynamics and coronary flow permit, but selected cases necessitate intervention, primarily percutaneous coronary intervention (PCI). Despite growing insights into SCAD pathomechanics—the “outside-in” and “inside-out” hypotheses—and the central role of intracoronary imaging (OCT/IVUS), optimal device strategies remain under-researched. The present review covers contemporary SCAD-PCI pitfalls and limitations, expanding to the mechanistic underpinnings and procedural applications of drug-coated balloons (DCB) and bioresorbable scaffolds (BRS) as “leave-nothing-behind” alternatives. Both approaches have advantages and drawbacks but are attractive in selected scenarios: DCB delivers antiproliferative therapy without permanent caging, and BRS provides temporary scaffolding (amenable to overlap when required) with the potential to restore biomechanics/vasomotion after resorption. Acknowledging that definitive evidence is lacking and current data are largely observational, the review finally sets future research priorities including head-to-head trials of different DCB types and evaluation of next-generation, thinner-strut, predictably resorbing BRS. The overarching question is whether—and how—these modalities can be integrated into standardized, imaging-guided interventional algorithms for SCAD. Full article

Domestic cats are valued companions for many people, but when they free-roam, they can pose risks to biodiversity, communities, and their own welfare. Increasing cat containment has become a priority in Australia, yet shifting owner practices requires overcoming behavioural and structural barriers. The Keeping Cats Safe at Home (KCSAH) project was a four-year, AUD 2.5 million initiative delivered by the Royal Society for the Prevention of Cruelty to Animals New South Wales (RSPCA NSW) from 2021 to 2024, trialling human behaviour change strategies to reduce the impacts of roaming cats in 11 NSW local government areas. Grounded in social science research, the project combined social marketing campaigns, educational resources, school programmes, and community events with subsidised desexing. The project achieved substantial reach, engaging more than 3.5 million people via social media, 42,000 through blogs, 87,000 via the website, and 36,000 through community events. Over 2700 cats were desexed and 1700 microchipped. Ecological monitoring showed reductions in free-roaming cat densities in three council areas, with many also recording declines in nuisance complaints and impoundments. Caregivers exposed to campaign messaging reported greater capability, opportunity, and motivation to contain cats; however, methodological constraints limited the ability to assess actual behaviour change. KCSAH demonstrates the opportunities and challenges of large-scale cat management, highlighting the importance of tailored interventions, veterinary desexing capacity, and nationally consistent monitoring frameworks. Full article

Background and Objective: Lennox–Gastaut syndrome (LGS) is a severe developmental and epileptic encephalopathy characterized by multiple seizure types, distinctive electroencephalography (EEG) abnormalities, and cognitive impairment. Sleep disturbances are highly prevalent in LGS and contribute substantially to reduced quality of life. However, no comprehensive analysis has yet been conducted to systematically examine key aspects of sleep—including architecture, microstructure, sleep-disordered breathing, and circadian regulation—leaving critical knowledge gaps. To address this, we conducted a scoping review to map the current evidence on sleep abnormalities in LGS and to identify priorities for future research. Method: A scoping review was conducted following PRISMA-ScR guidelines. PubMed, Embase, Ovid, and ClinicalTrials.gov from inception to October 2025 for studies evaluating sleep parameters in individuals with LGS or mixed epilepsy cohorts with ≥50% LGS cases. Eligible designs included observational and interventional studies using polysomnography, video-EEG, actigraphy, or sleep questionnaires. Data were synthesized narratively due to heterogeneity, and methodological quality was assessed using relevant Joanna Briggs Institute (JBI) checklists. Results: After screening 1242 articles, eleven studies met inclusion criteria, spanning 1986–2025 and conducted across four continents. Most were small single-center observational studies (5–16 LGS participants) using polysomnography as the primary assessment, with others employing wearable monitoring, surface and intracranial EEG, or circadian biomarker analyses. Across studies, individuals with LGS demonstrated markedly disrupted sleep architecture—notably reduced or absent rapid eye movement (REM) sleep, fragmented non-rapid eye movement (NREM) sleep, and attenuated spindles. Microstructural analysis showed elevated cyclic alternating pattern (CAP) rates, with epileptiform discharges clustering in CAP phase A. Sleep-disordered breathing (SDB) was common, particularly in adults, and associated with tonic seizures and central apneas. Circadian rhythm dysregulation, including altered melatonin and cortisol profiles, was also reported. A feasibility study demonstrated that home-based wearable devices and sleep apnea monitors were both acceptable and practical for use in children with LGS. No interventional studies have evaluated whether addressing sleep abnormalities modifies seizure or cognitive outcomes. Interpretation: Sleep in LGS is profoundly disrupted at both macrostructural and microstructural levels. These abnormalities may exacerbate seizure burden, cognitive impairment, and SUDEP risk, representing a potentially modifiable contributor to disease severity. Larger, prospective studies integrating polysomnography, wearable monitoring, and interventional approaches are needed to clarify causal mechanisms and therapeutic potential. Full article

The global opioid crisis necessitates innovative non-pharmacological interventions for pain management and addiction recovery. This comprehensive narrative review synthesizes evidence from approximately 75 studies supporting manual therapy’s modulation of endogenous opioid systems and explores potential applications in addiction treatment. Manual therapy interventions, including massage and joint manipulation, demonstrate significant neurochemical effects, with controlled studies showing 16% increases in plasma β-endorphin levels (p = 0.025) persisting approximately one hour following treatment. These effects appear mediated through periaqueductal gray-rostral ventromedial medulla descending pathways, with naloxone reversibility studies confirming opioid-mediated mechanisms. The endogenous opioid system undergoes profound dysregulation during addiction, creating therapeutic opportunities for interventions capable of stimulating natural opioid release without exogenous substances. Clinical applications in addiction recovery may include withdrawal symptom management, craving reduction, and restoration of dysregulated reward pathways. Manual therapy’s demonstrated safety profile, accessibility, and compatibility with existing treatment modalities position it as an ideal complementary intervention for comprehensive addiction programs. However, significant methodological limitations in existing studies necessitate cautious interpretation. Rigorous randomized controlled trials specifically examining manual therapy’s effects in addiction recovery populations represent the highest research priority. Manual therapy as an endogenous opioid modulator represents a promising frontier in addiction medicine but warrants rigorous scientific investigation before potential clinical integration into evidence-based treatment protocols. Full article

Cancer remains a major global health burden driven by genetic, metabolic, and microenvironmental alterations. Although reactive oxygen species (ROS) and oxidative stress have long been implicated in cancer biology, current understanding remains fragmented and, in several areas, conceptually disputed considering how ROS and oxidative stress thresholds determine the switch between tumor-promoting signaling and cytotoxic outcomes, and whether redox-based therapies can be safely and selectively applied across different cancer types. Moreover, existing studies often examine isolated pathways or single ROS, leaving unanswered the question of how spatial and temporal ROS dynamics and oxidative stress responses shape carcinogenesis, metastasis, and therapeutic resistance. This review moves beyond descriptive summarization by critically examining unresolved mechanistic gaps, including (i) how ROS and oxidative stress interact with epigenetic and metabolic reprogramming, (ii) the context-dependent role of ROS-driven oxidative stress within the tumor microenvironment and immune evasion, and (iii) why ROS-targeting and oxidative stress-modulating therapies have shown inconsistent clinical translation despite promising preclinical data. We highlight areas of consensus as well as conflicting evidence, synthesizing recent advances across multiple cancer types to clarify where ROS and oxidative stress function as drivers, modulators, or vulnerabilities. Finally, we outline emerging research priorities, such as real-time redox profiling, subtype-specific targeting strategies, and combination approaches, to guide the development of more precise and effective ROS- and oxidative-stress-based interventions. Full article

Background/Objectives: In rural communities, caregivers of people living with dementia face limited access to support services. Digital interventions offer potential solutions for support. This paper reports on the evaluation of Verily Connect, a web-based multicomponent intervention developed to support caregivers. The aim of this qualitative study was to critically evaluate the implementation of Verily Connect to better understand its barriers and enablers. Methods: Using the Consolidated Framework for Implementation Research (CFIR), qualitative data were collected through semi-structured interviews with 24 health service professionals across 12 rural Australian communities. Thematic analysis was conducted to identify barriers and facilitators to implementation. Results: Key barriers included limited digital literacy, resistance to technology and privacy concerns, as well as competing organisational priorities, and inadequate technological infrastructure. Facilitators included organisational alignment and supportive management. Conclusions: The perceived relevance and usability of Verily Connect were enhanced by its co-design with caregivers and integration into health service models. Addressing digital literacy for caregivers, infrastructure limitations, and organisational readiness is essential for future technology-based health interventions in rural dementia care. Full article

Background: Adolescence is marked by heightened reward sensitivity and incomplete maturation of cognitive control, creating conditions that favor engagement in risky behaviors. Traditional self-report methods often overlook the fast, automatic processes—such as attentional biases, approach–avoidance tendencies, and associative schemas—that shape adolescent decision-making in real time. Aims: This Perspective aims to synthesize recent (2018–2025) advances in the study of implicit measures relevant to adolescent risk behaviors, evaluate their predictive value beyond explicit measures, and identify translational pathways for prevention and early intervention. Methods: A narrative synthesis was conducted, integrating evidence from eye-tracking, drift-diffusion modeling, approach–avoidance tasks, single-category implicit association tests, ecological momentary assessment (EMA), and passive digital phenotyping. Emphasis was placed on multi-method phenotyping pipelines and on studies validating these tools in adolescent populations. Results: Implicit indices demonstrated incremental predictive validity for risky behaviors such as substance use, hazardous driving, and problematic digital engagement, outperforming self-reports in detecting context-dependent and state-specific risk patterns. Integrative protocols combining laboratory-based measures with EMA and passive sensing captured the influence of peer presence, affective state, and opportunity structures on decision-making. Mobile-based interventions, including approach bias modification and attention bias training, proved feasible, scalable, and sensitive to change in implicit outcomes. Acoustic biomarkers further enhanced low-burden state monitoring. Conclusions: Implicit measures provide a mechanistic, intervention-sensitive complement to explicit screening, enabling targeted, context-aware prevention strategies in adolescents. Future priorities include multi-site validations, school-based implementation trials, and the use of implicit parameter change as a primary endpoint in prevention research. Full article