Search Results (17,190)

Background/Objectives: Cognitive impairment is one of the most common and debilitating clinical features of Multiple Sclerosis (MS). Neuropsychological assessment, however, is time-consuming and requires personal resources, so, due to limited resources in daily clinical practice, information on cognitive profiles is often lacking, despite its high prognostic relevance. Time-saving and effective tools are required to bridge this gap. This study evaluates the sensitivity and specificity of a revised version of TRACK-MS (TRACK-MS-R), a recently published screening tool to identify cognitive impairment in MS in a fast and reliable way, offering a balance between efficiency and diagnostic yield for the individual patient. Methods: In this prospective cross-sectional study, 102 MS patients and 94 age-, sex-, and education-matched healthy controls (HC) completed an extensive neuropsychological assessment, including TRACK-MS-R, to test for cognitive processing speed (Symbol Digit Modalities Test, SDMT) and verbal fluency (Regensburger Word Fluency Test, RWT). Sensitivity of TRACK-MS-R was assessed by using the BICAMS-M battery as a reference, and specificity was determined by comparing MS patients to HC. Results: TRACK-MS-R demonstrated high sensitivity (97.44%) when compared to the gold standard as represented by BICAMS-M for early and accurately detecting cognitive impairment in MS patients. Additionally, as a potential cognitive marker, TRACK-MS-R showed a specificity of 82.98% in distinguishing MS patients from healthy controls. Conclusions: TRACK-MS-R proves to be a highly sensitive and time-efficient screening tool for detecting cognitive impairment in patients with MS, while demonstrating good specificity compared to HC. Whereas high sensitivity is a prerequisite for a valid screening tool, its relatively modest specificity compared to BICAMS-M (62.9%) calls for caution in interpreting standalone results but instead indicates more extensive neuropsychological testing. Its briefness and diagnostic accuracy support its implementation in routine clinical practice, particularly in time-constrained settings. Full article

The global spread of Mpox virus (MPXV) underscores the urgent need for rapid, field-deployable diagnostic tools, especially in low-resource settings. We evaluated a loop-mediated isothermal amplification (LAMP) assay, termed LAMPOX, developed by Coris BioConcept. The assay was tested in three formats—two liquid versions and a dried, ready-to-use version—targeting only the ORF F3L (Liquid V1) or both the ORF F3L and N4R (Liquid V2 and dried) genomic regions. Analytical sensitivity and specificity were assessed using 60 clinical samples from confirmed MPXV-positive patients. Sensitivity on clinical samples was 81.7% for Liquid V1 and 88.3% for Liquid V2. The dried LAMPOX assay demonstrated a sensitivity of 88.3% and a specificity of 100% in a panel of 112 negative controls, with most positive samples detected in under 7 min. Additionally, a simplified sample lysis protocol was developed to facilitate point-of-care use. While this method showed slightly reduced sensitivity compared to standard DNA extraction, it proved effective for samples with higher viral loads. The dried format offers key advantages, including ambient-temperature stability and minimal equipment needs, making it suitable for point-of-care testing. These findings support LAMPOX as a promising tool for rapid MPXV detection during outbreaks, especially in resource-limited settings where traditional PCR is impractical. Full article

The ten-year fishing ban on the Yangtze River aims to restore aquatic biodiversity and rebuild fishery resources. Megalobrama skolkovii, a key species in the basin, was investigated using 2024 data to provide a preliminary assessment of its population structure, stock dynamics, and early recovery. Age analysis (n = 243) showed that 1–6-year-olds were dominated by fish aged 3 (35%), with few older than 4, indicating moderate structural truncation. Growth parameters modeled by the von Bertalanffy Growth Function yielded L_∞ = 61.89 cm and k = 0.25 year⁻¹, with a weight–growth inflection age of 4.4 years. Natural mortality (M = 0.48 year⁻¹) was estimated using Pauly’s empirical formula, and total mortality (Z = 0.55 year⁻¹) was estimated from the catch curve analysis. While fishing mortality (F) was statistically indistinguishable from zero, a plausible low-intensity fishing scenario was explored to assess potential impacts of residual activities. Length-based indicators (LBIs) showed P_mat = 46.05%, P_opt = 9.51%, and P_mega = 6.88%, suggesting reproductive recovery but incomplete structural restoration. These preliminary findings reveal an asymmetrical recovery trajectory, whereby physiological improvements and enhanced recruitment have occurred, yet full structural restoration remains incomplete. This underscores the need for continued, long-term conservation and monitoring to support population resilience. Full article

Job stress and burnout are major challenges in today’s workplaces. While most interventions adopt a clinical or deficit-based approach, this meta-analysis takes a positive perspective by examining the effectiveness of Positive Psychological Interventions (PPIs). A total of 24 studies conducted in workplace settings were analyzed to assess the impact of PPIs on psychological well-being, subjective well-being, and job performance. The results showed significant and sustained improvements across all three outcomes, with moderate effect sizes: subjective well-being (g = 0.50, 95% CI [0.18, 0.81]), psychological well-being (g = 0.46, 95% CI [0.15, 0.78]), and performance (g = 0.42, 95% CI [0.21, 0.62]). Higher effects were found for in-person interventions and those conducted in Western contexts. No significant moderation was observed for structural factors (e.g., implementation level: Individual, Group, Leader, or Organization [IGLO]) or sample characteristics (e.g., gender), among other variables examined. These findings highlight the relevance of PPIs for promoting well-being and sustaining performance, which may reflect the preservation of personal resources in the face of occupational stressors. Regardless of type, well-designed interventions may be key to fostering healthier workplace environments—especially when delivered face-to-face. Full article

Efficient planning of train crew rosters is a key factor in ensuring operational reliability and promoting long-term sustainability in railway transport, both economically and socially. This article presents a systematic approach to developing a crew rostering model in passenger rail transport, with a focus on the operational setting of the train crew depot in Česká Třebová, a city in the Czech Republic. The seven-step methodology includes identifying available train shifts, defining scheduling constraints, creating roster variants, and calculating personnel and time requirements for each option. The proposed roster reduced staffing needs by two employees, increased the average shift duration to 9 h and 42 min, and decreased non-productive time by 384 h annually. These improvements enhance sustainability by optimizing human resource use, lowering unnecessary energy consumption, and improving employees’ work–life balance. The model also provides a quantitative assessment of operational feasibility and economic efficiency. Compared to existing rosters, the proposed model offers clear advantages and remains applicable even in settings with limited technological support. The findings show that a well-designed rostering system can contribute not only to cost savings and personnel stabilization, but also to broader objectives in sustainable public transport, supporting resilient and resource-efficient rail operations. Full article

Cardiovascular disease (CVD) remains Europe’s leading cause of mortality, responsible for >45% of deaths. Beyond established risk factors (hypertension, diabetes, dyslipidaemia, smoking, obesity), psychosocial elements—depression, anxiety, financial stress, personality traits, and trauma—significantly influence CVD development and progression. Behavioural Cardiology addresses this connection by systematically incorporating psychosocial factors into prevention and rehabilitation protocols. This review examines the HEARTBEAT model, developed by Greece’s first Behavioural Cardiology Unit, which aligns with current European guidelines. The model serves dual purposes: primary prevention (targeting at-risk individuals) and secondary prevention (treating established CVD patients). It is a personalised medicine approach that integrates psychosocial profiling with traditional risk assessment, utilising tailored evaluation tools, caregiver input, and multidisciplinary collaboration to address personality traits, emotional states, socioeconomic circumstances, and cultural contexts. The model emphasises three critical implementation aspects: (1) digital health integration, (2) cost-effectiveness analysis, and (3) healthcare system adaptability. Compared to international approaches, it highlights research gaps in psychosocial interventions and advocates for culturally sensitive adaptations, particularly in resource-limited settings. Special consideration is given to older populations requiring tailored care strategies. Ultimately, Behavioural Cardiology represents a transformative systems-based approach bridging psychology, lifestyle medicine, and cardiovascular treatment. This integration may prove pivotal for optimising chronic disease management through personalised interventions that address both biological and psychosocial determinants of cardiovascular health. Full article

As a typical grain base with a dense population and high-level urbanization, the North China Plain (NCP) faces a serious threat to its sustainable development due to water shortage. Surface water area (SWA) is a key indicator for continuously measuring the trends of regional water resources and assessing their current status. Therefore, a deep understanding of its changing patterns and driving forces is essential for achieving the sustainable management of water resources. In this study, we examined the interannual variability and trends of SWA in the NCP from 1990 to 2023 using annual 30 m water body maps generated from all available Landsat imagery, a robust water mapping algorithm, and the cloud computing platform Google Earth Engine (GEE). The results showed that the SWA in the NCP has significantly increased over the past three decades. The continuous emergence of artificial reservoirs and urban lakes, along with the booming aquaculture industry, are the main factors driving the growth of SWA. Consequently, the expansion of artificial water bodies resulted in a significant increase in water evaporation (0.16 km³/yr). Moreover, the proportion of water evaporation to regional evapotranspiration (ET) gradually increased (0–0.7%/yr), indicating that the contribution of water evaporation from artificial water bodies to ET is becoming increasingly prominent. Therefore, it can be concluded that the ever-expanding artificial water bodies have become a new hidden danger affecting the water security of the NCP through evaporative loss and deserve close attention. This study not only provides us with a new perspective for deeply understanding the current status of water resources security in the NCP but also provides a typical case with great reference value for the analysis of water resources changes in other similar regions. Full article

In the context of global climate governance and the green transition, digital infrastructure serves as a critical enabler of resource allocation in the digital economy, offering strategic value in tackling synergistic pollution and carbon reduction challenges. Using panel data from 280 prefecture-level cities, this study employs a multiperiod difference-in-differences (DID) approach, leveraging smart city pilot policies as a quasinatural experiment, to assess how digital infrastructure affects urban synergistic pollution-carbon mitigation (SPCM). The empirical results show that digital infrastructure increases the urban SPCM index by 1.5%, indicating statistically significant effects. Compared with energy and income effects, digital infrastructure can influence this synergistic effect through indirect channels such as the energy effect, economic agglomeration effect, and income effect, with the economic agglomeration effect accounting for a larger share of the total effect. Additionally, fixed-asset investment has a nonlinear moderating effect on this relationship, with diminishing marginal returns on emission reduction when investment exceeds a threshold. Heterogeneity tests reveal greater impacts in eastern, nonresource-based, and environmentally regulated cities. This study expands the theory of collaborative environmental governance from the perspective of new infrastructure, providing a theoretical foundation for establishing a long-term digital technology-driven mechanism for SPCM. Full article

Background/Objectives: There is a growing need for autism spectrum disorder (ASD) assessment tools that are diagnostically aligned, clinically usable, and accessible across diverse service contexts. The Diagnostic Autism Spectrum Interview—Version 2 (DASI-2) is a freely available, semi-structured clinical interview mapped directly to DSM-5 and ICD-11 criteria. This pilot study aimed to adapt DASI-2 into Hungarian and explore the (1) acceptability of DASI-2 administration, (2) agreement with prior clinical ASD diagnoses, and (3) relationship between DASI-2 observational ratings and ADOS-2 classifications. Methods: Following a multistep translation procedure, DASI-2 was administered to seven children previously assessed for ASD in a multidisciplinary Hungarian clinical setting. The assessment included a parent interview, direct assessment with the child or young person, and completion of the DASI observational record (OR1–OR4). DASI diagnostic outcomes were compared with prior clinical decisions, and OR scores were analyzed in relation to ADOS-2 classifications. Results: All participants completed the DASI-2 interview in full. Agreement with prior clinical diagnosis was found in six of seven cases (κ = 0.70, indicating substantial agreement). When exploring the one non-aligned case, the divergence in diagnostic outcome was due to broader contextual information considered by the initial clinical team which influenced clinical opinion. The five participants diagnosed with ASD showed substantially higher DASI observational scores (mean = 15.26) than the two who were not diagnosed (mean = 1.57), mirroring ADOS-2 severity classifications. Conclusions: These findings support the acceptability and preliminary validity of DASI-2. Its inclusive structured observational record may provide a practical complement to resource-intensive tools such as the ADOS-2; however, further validation in larger and more diverse samples is needed. Full article

Background/Objectives: Phase II oncology trials often rely on single-arm designs to test $H_0:\pi ={\pi }_0$ versus $H_a:\pi >{\pi }_0$, especially when randomized trials are infeasible due to cost or disease rarity. Traditional approaches, such as the exact binomial test and Simon’s two-stage design, tend to be conservative, with actual Type I error rates falling below the nominal $\alpha$ due to the discreteness of the underlying binomial distribution. This study aims to develop a more efficient and flexible method that maintains accurate Type I error control in such settings. Methods: We propose a convolution-based method that combines the binomial distribution with a simulated normal variable to construct an unbiased estimator of $\pi$. This method is designed to precisely control the Type I error rate while enabling more efficient trial designs. We derive its theoretical properties and assess its performance against traditional exact tests in both one-stage and two-stage trial designs. Results: The proposed method results in more efficient designs with reduced sample sizes compared to standard approaches, without compromising the control of Type I error rates. We introduce a new two-stage design incorporating interim futility analysis and compare it with Simon’s design. Simulations and real-world examples demonstrate that the proposed approach can significantly lower trial cost and duration. Conclusions: This convolution-based approach offers a flexible and efficient alternative to traditional methods for early-phase oncology trial design. It addresses the conservativeness of existing designs and provides practical benefits in terms of resource use and study timelines. Full article

With the acceleration of the pace of life, increased stress levels, and changes in lifestyle factors such as diet and exercise, the incidence of diseases such as cancer and immunodeficiency has been on the rise, which is closely associated with the impaired antioxidant capacity of the body. Polypeptides and polysaccharides derived from edible fungi demonstrate significant strong antioxidant activity and immunomodulatory effects. Auricularia auricula, the second most cultivated mushroom in China, is not only nutritionally rich but also offers considerable health benefits. In particular, its polysaccharides have been widely recognized for their immunomodulatory activities, while its abundant protein content holds great promise as a raw material for developing immunomodulatory peptides. To meet the demand for high-value utilization of Auricularia auricula resources, this study developed a key technology for the stepwise extraction of polypeptides (AAPP1) and polysaccharides (AAPS3) using a composite enzymatic hydrolysis process. Their antioxidant and immunomodulatory effects were assessed using cyclophosphamide (CTX)-induced immune-suppressed mice. The results showed that both AAPP1 and AAPS3 significantly reversed CTX-induced decreases in thymus and spleen indices (p < 0.05); upregulated serum levels of cytokines (e.g., IL-4, TNF-α) and immunoglobulins (e.g., IgA, IgG); enhanced the activities of hepatic antioxidant enzymes SOD and CAT (p < 0.05); and reduced the content of MDA, a marker of oxidative damage. Intestinal microbiota analysis revealed that these compounds restored CTX-induced reductions in microbial α-diversity, increased the abundance of beneficial bacteria (Paramuribaculum, Prevotella; p < 0.05), decreased the proportion of pro-inflammatory Duncaniella, and reshaped the balance of the Bacteroidota/Firmicutes phyla. This study represents the first instance of synergistic extraction of polypeptides and polysaccharides from Auricularia auricula using a single process. It demonstrates their immune-enhancing effects through multiple mechanisms, including “antioxidation-immune organ repair-intestinal microbiota regulation.” The findings offer a theoretical and technical foundation for the deep processing of Auricularia auricula and the development of functional foods. Full article

Asphalt plant reclaimed powder is a common solid waste in road engineering. Reusing reclaimed powder as filler holds significant importance for environmental protection and resource conservation. The key factors affecting the feasibility of reclaimed powder reuse are its acidity/alkalinity and cleanliness. Traditional evaluation methods, such as the methylene blue test and plasticity index, can assess reclaimed powder properties to guide its recycling. However, these methods suffer from inefficiency, strong empirical dependence, and high variability. To address these limitations, this study proposes a rapid and precise evaluation method for reclaimed powder properties based on Fourier transform infrared spectroscopy (FTIR). To do so, five field-collected reclaimed powder samples and four artificial samples were evaluated. Scanning electron microscopy (SEM), X-ray fluorescence spectroscopy (XRF), and X-ray diffraction (XRD) were employed to characterize their microphase morphology, chemical composition, and crystal structure, respectively. Subsequently, FTIR was used to establish correlations between key acidity/alkalinity, cleanliness, and multiple characteristic peak intensities. Representative infrared characteristic peaks were selected, and a quantitative functional group index (Is) was proposed to simultaneously evaluate acidity/alkalinity and cleanliness. The results indicate that reclaimed powder primarily consists of tiny, crushed stone particles and dust, with significant variations in crystal structure and chemical composition, including calcium carbonate, silicon oxide, iron oxide, and aluminum oxide. Some samples also contained clay, which critically influenced the reclaimed powder properties. Since both filler acidity/alkalinity and cleanliness are affected by clay (silicon/carbon ratio determining acidity/alkalinity and aluminosilicate content affecting cleanliness), this study calculated four functional group indices based on FTIR absorption peaks, namely the Si-O-Si stretching vibration (1000 cm⁻¹) and the CO₃²⁻ asymmetric stretching vibration (1400 cm⁻¹). These indices were correlated with conventional testing results (XRF for acidity/alkalinity, methylene blue value, and pull-off strength for cleanliness). The results show that the Is index exhibited strong correlations (R² = 0.89 with XRF, R² = 0.80 with methylene blue value, and R² = 0.96 with pull-off strength), demonstrating its effectiveness in predicting both acidity/alkalinity and cleanliness. The developed method enhances reclaimed powder detection efficiency and facilitates high-value recycling in road engineering applications. Full article

This study quantitatively assesses the risk of water shortage (WSR) in the Baiyangdian area due to the Inter-Basin Water Transfer (IBWT) project, focusing on the impact of water transfer on regional water security. The actual evapotranspiration (ETa) is calculated, and the correlation simulation using Archimedes’ Copula function is implemented in Python 3.7.1, with optimization using the sum of squares of deviations (OLS) and the AIC criterion. The joint distribution model between ETa and three water supply scenarios is constructed. Key findings include (1) ETa increased by 27.3% after water transfer, far exceeding the slight increase in water supply before the transfer; (2) various Archimedean Copulas effectively capture the dependence and joint probability distribution between water supply and ETa; (3) water shortage risk increased after water transfer, with rainfall and upstream water unable to alleviate the problem in Baiyangdian; and (4) cross-basin water transfer reduced risk, with a reduction of 8.90% in the total probability of three key water resource scheduling combinations. This study establishes a Copula-based framework for water shortage risk assessment, providing a scientific basis for water allocation strategies in ecologically sensitive areas affected by human activities. Full article

Introduction and Objectives: Risk-sharing agreements (RSAs) have emerged as a key strategy for financing high-cost medical technologies while ensuring financial sustainability. These payment mechanisms mitigate clinical and financial uncertainties, optimizing pricing and reimbursement decisions. Despite their widespread adoption globally, Latin America has reported limited implementation, particularly for high-cost medical devices. This study aims to share insights from designing RSAs in the form of Outcome Protection Programs (OPPs) for medical devices in Latin America from the perspective of a medical devices company. Methods: The report follows a structured approach, defining key OPP dimensions: payment base, access criteria, pricing schemes, risk assessment, and performance incentives. Risks were categorized as financial, clinical, and operational. The framework applied principles from prior models, emphasizing negotiation, program design, implementation, and evaluation. A multidisciplinary task force analyzed patient needs, provider motivations, and payer constraints to ensure alignment with health system priorities. Results: Over two semesters, a panel of seven experts from the manufacturer designed n = 105 innovative payment programs implemented in Argentina (n = 7), Brazil (n = 7), Colombia (n = 75), Mexico (n = 9), Panama (n = 4), and Puerto Rico (n = 3). The programs targeted eight high-burden conditions, including Coronary Artery Disease, atrial fibrillation, Heart Failure, and post-implantation arrhythmias, among others. Private providers accounted for 80% of experiences. Challenges include clinical inertia and operational complexities, necessitating structured training and monitoring mechanisms. Conclusions: Outcome Protection Programs offer a viable and practical risk-sharing approach to financing high-cost medical devices in Latin America. Their implementation requires careful stakeholder alignment, clear eligibility criteria and endpoints, and robust monitoring frameworks. These findings contribute to the ongoing dialogue on sustainable healthcare financing, emphasizing the need for tailored approaches in resource-constrained settings. Full article

The highway and bridge industry is facing persistent challenges related to the high turnover of technical personnel, which poses risks to the continuity and sustainability of infrastructure development. Although Geographic Information System (GIS) training has increasingly been advocated as a strategy to stabilize the workforce, its practical application remains relatively limited across China. Drawing on the Conservation of Resources (COR) theory, this study examines whether GIS training is associated with lower turnover intention among technical staff, potentially through enhanced perceptions of career growth and reduced work-related anxiety. Based on 412 valid responses—primarily from technical personnel employed by major infrastructure enterprises such as regional subsidiaries of the China Communications Construction Group (CCCG) and China State Construction Engineering Corporation (CSCEC)—the study employs Partial Least Squares Structural Equation Modeling (PLS-SEM) to assess the proposed relationships. The findings indicate that GIS training is negatively associated with turnover intention, with career growth partially mediating this association. Additionally, work anxiety moderates the relationship, such that the link between GIS training and turnover intention appears weaker under higher levels of anxiety. This research contributes to bridging the gap between training practices and theoretical understanding, offering insights to inform workforce retention strategies in technology-intensive industries. Full article