Search Results (3,028)

Oculomics uses ocular images, ocular biofluids and functional ocular tests to extract diagnostic information on local or systemic biological states. Most current evidence is cross-sectional: one retinal photograph, OCT scan, OCTA examination or tear sample is compared with a reference population, or converted into a diagnostic or prognostic score. This approach is useful for screening and risk enrichment, but it does not show whether the same patient is changing over time. In this review, dynamic oculomics, or oculomic kinetics, is presented as a diagnostic-monitoring approach based on repeated ocular measurements within the same individual. Its object is the personal trajectory: baseline level, short-term variability, long-term drift, response to stimulus, recovery and modification by treatment. We discuss the biological basis of ocular trajectories, the limits imposed by local ocular regulation and disease, and the technical constraints of fundus photography, structural OCT, OCTA, functional challenge tests, tear analysis, aqueous humour analysis, continuous intraocular pressure monitoring and home-based imaging. We also examine artificial intelligence, validation, governance, health-economic considerations and practical implementation. The available evidence does not support a universal ocular surrogate for systemic disease. More realistic applications include detection of unexpectedly rapid tissue change, individualised risk stratification, treatment-response assessment and recognition of discordance between systemic markers and ocular tissue behaviour. Full article

The massive integration of variable renewable energy sources (vRES) in Central Europe is fundamentally transforming electricity price formation and straining transmission grids. However, existing academic metrics, such as the RES Capture Price, offer only a static view of investor revenues and fail to capture dynamic market rigidity and systemic risks during periods of high instantaneous vRES penetration. This study addresses this literature gap by introducing two novel and transparent methodological parameters: Market Exposure to Green Overproduction (MEGO) and the Price Divergence Coefficient (PDC). Formulated as conditional non-parametric indicators, the MEGO index quantifies the conditional probability of price collapse and the loss of market elasticity during hours when vRES penetration exceeds critical thresholds (α = 0.50 to 0.80) of systemic load. Conversely, the PDC index measures the frequency of substantial price non-convergence across neighbouring bidding zones (CZ, PL, FR) relative to the German reference market (DE). Based on an extensive dataset spanning from 2015 to mid-2026—capturing the transition to 15 min market time units— the empirical results reveal a distinct change in market behaviour. While the frequency of price collapse during high-vRES periods was lower in earlier years and temporarily reduced during the 2022 energy crisis, the post-crisis period (2024–2026) exhibits substantially higher MEGO values, with periods in which wind and solar generation exceeded 80% of instantaneous system load being associated with prices at or below 0 EUR/MWh in up to 60% of the evaluated intervals. Concurrently, the PDC analysis reveals persistent spatial price non-convergence, particularly in France and Poland. These patterns coincided with major changes in European electricity-market conditions, including the implementation of Core Flow-Based Market Coupling, variations in nuclear availability and evolving cross-border network conditions; however, the PDC indicator alone does not permit causal attribution to any individual factor. The proposed MEGO and PDC parameters provide policymakers, transmission system operators (TSOs), and investors with an intuitive diagnostic framework for dimensioning grid flexibility, energy storage, and cross-border infrastructure in the decarbonization era. Full article

The digital transformation of work has increasingly blurred the temporal, spatial, and psychological boundaries between professional and personal life. As a result, structural conditions have emerged that are associated with an elevated risk of burnout. This narrative review draws on literature identified through searches of Web of Science, Scopus and PubMed covering publications from 2004 to early 2026, which yielded 36 included studies, supplemented by further sources identified outside that search. It integrates key theoretical perspectives, including boundary theory, the Areas of Worklife model, the Job Demands-Resources framework and Conservation of Resources theory. Across diverse occupational contexts, three pathways recur: rising work-family conflict, reduced ability to psychologically detach from work during non-work time and the gradual depletion of personal resources. Structural drivers, comprising organisational availability norms, leadership behaviour, technology and platform design, workload, and economic precarity, are treated as the conditions under which exposure arises, and the review argues that responses pitched at individual coping are correspondingly limited. The public health implications extend beyond mental health, encompassing cardiovascular risk associated with long working hours, strain on healthcare systems, productivity losses and widening health inequities along gendered and socioeconomic lines. Addressing these challenges requires multilevel interventions, including organisational job redesign, leadership development, enforceable right-to-disconnect policies and greater recognition of recovery as a public health priority. At the same time, there remains a need for more longitudinal and intervention-based research, particularly in non-Western contexts. Full article

The circadian clock, located in the mammalian hypothalamus, regulates biological rhythms with a period of approximately 24 h, influencing nearly all body functions. Its timing is synchronised daily by external cues, primarily light, which align internal rhythms with the environmental cycle. Through this entrainment, the circadian system orchestrates physiological processes such as the sleep–wake cycle, feeding behaviour, gene expression and body temperature regulation. Melatonin, secreted by the pineal gland, also plays a key role as a synchroniser by facilitating sleep onset. Changes in environmental time cues, such as those experienced by shift workers, can disrupt the body’s natural 24-h rhythms. This situation can lead to fatigue, significantly impacting accident rates and productivity, and, in the long term, to an increased risk of various health conditions. A Phase Response Curve (PRC) illustrates how the clock’s phase is affected by stimuli administered at different points in the circadian cycle. In particular, both light and melatonin can induce phase shifts, but the direction and magnitude of this shift depend on the timing of administration. Understanding the PRC enables the design of interventions to realign circadian rhythms and improve adaptation to shift work. This review explores the physiological and clinical effects of circadian disruption in shift workers and discusses strategies to mitigate its impact. Full article

Dementia is a leading cause of disability and death worldwide, yet diagnosis in primary care remains substantially lower than expected, delaying access to treatment, support and future care planning. The Facing Dementia Together Practice Change Program was developed as a co-designed, multicomponent intervention to improve dementia diagnosis in Australian general practice. A mixed-methods process evaluation used the RE-AIM framework with the addition of Appropriateness. The intervention included Primary Health Network (PHN) engagement, GP education, clinical resources, audit and benchmarking reports, specialist support, and a dementia risk-alert tool. Data were collected through surveys, stakeholder interviews, website analytics and program documentation. Clinicians who participated reported increased confidence and changes in dementia-related clinical behaviours, while education, resources and benchmarking were perceived as valuable. However, overall reach was limited by competing clinical priorities, workforce pressures, lack of financial incentives, and PHN implementation challenges. The dementia risk-alert tool was feasible but achieved limited uptake because of software compatibility, usability concerns and incomplete electronic medical record data. Although the program was acceptable to participating clinicians, limited reach constrained its potential impact. These findings highlight organizational, workforce, digital infrastructure and policy factors that influenced implementation of multicomponent interventions in routine primary care. Full article

Mangrove ecosystems underpin the livelihoods of coastal and rural households across the tropics, yet how their ecosystem service (ES) values are associated with livelihood-strategy choices remains unevenly understood. Following a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided protocol, this systematic review searched Web of Science and Scopus for studies published between 2016 and 2026 (database search was run on 27 May 2026); of the 353 records identified and 207 screened after removing 146 duplicates, 133 unique studies were retained; 95 of these contributed evidence to one or more of seven outcome themes, while 38 were retained as contextual or background evidence. The seven themes were graded using a hybrid Grading of Recommendations Assessment, Development and Evaluation (GRADE)/Confidence in the Evidence from Reviews of Qualitative Research (CERQual) approach (zero, high certainty; two, moderate certainty; five, low certainty). A structured assessment of meta-analytic feasibility across six candidate outcome domains found that no domain met the operational requirement of at least three independent studies reporting one outcome construct on a harmonisable metric with usable variance information; therefore, this review reports the direction, consistency, and certainty of associations rather than pooled-effect magnitudes. The corpus shows a pronounced value-epistemology asymmetry, with monetary valuation forming the largest single evidence theme (45 studies, approximately one-third of the corpus) and relational or indigenous framings remaining a smaller but substantive theme (20 studies, about 15%), meaning that household decision-making is incompletely captured. Evidence for mangrove–fishery production linkages and the coastal-protection/ecosystem-based disaster-risk-reduction function was the most consistent and was rated as moderate certainty. However, the fishery evidence provides the more direct connection to livelihood dependence, whereas most coastal-protection estimates are biophysical or aggregate and do not directly demonstrate household livelihood-strategy responses. The five remaining themes rest on low-certainty evidence, with welfare estimates spanning orders of magnitude and value-to-behaviour pathways weakly tested. Asian settings account for roughly half of the evidence (Southeast and South Asia together 45%, 60/133), while African, Latin American, and Pacific Island settings remain under-represented, limiting transferability. Evidence on bundled payments for ecosystem services, blue-carbon governance, and secure community tenure should therefore be treated as context-dependent options for prospective evaluation rather than as established prescriptions. The clearest research priority is quasi-experimental and longitudinal work linking elicited values to observed livelihood behaviour. Full article

Background: The risk of violence is elevated in patients with Schizophrenia Spectrum Disorders (SSD). However, current violence risk assessment approaches rely predominantly on clinical and historical factors and remain limited in predictive accuracy, highlighting the need for more objective complementary markers. Methods: The present study examined the neurobiological differences between violent (n = 66) and non-violent (n = 166) SSD patients, and compared the predictive utility of these neurobiological markers and clinical risk factors, including childhood trauma and psychopathology, in distinguishing violent from non-violent individuals. We further aimed to construct a multimodal predictive model using the strongest predictors from both domains, evaluating whether combining neural and clinical variables improves predictive performance beyond either single domain. Structural and resting-state MRI scans were acquired for patients and healthy controls (n = 504), who were used to calibrate the normative model. Neuroimaging data were analyzed within a normative modelling framework, and univariate associations between neurobiological and clinical factors and violence were examined. Results: A multimodal model integrating neurobiological and clinical measures achieved moderate classification performance (74.7% balanced accuracy), outperforming all individual predictors. The strongest predictors included the medial orbitofrontal cortex, caudal middle frontal gyrus, limbic-default mode network functional connectivity, and childhood sexual abuse. Conclusions: Our findings suggest that alterations in fronto-limbic systems involved in goal-directed decision-making and emotion regulation may contribute to violent behaviour in SSD. Furthermore, the improved performance of the multimodal model supports the potential added utility of integrating neuroimaging markers with established clinical risk factors in violence risk assessment. Full article

Trespassing on railway tracks represents the main cause of accidents in railway transport, often resulting in severe injuries and fatalities. Understanding railway trespassing requires integration of multiple data sources, as accident data alone do not capture its spatial and behavioural characteristics. This study identifies key parameters (variables) for developing a QGIS-based trespassing database. It represents the first step toward creating a comprehensive risk assessment tool for the railway network’s susceptibility to trespassing and the potential risk of trespass-related accidents. The methodology integrates secondary data sources, including accident records, railway infrastructure data, and demographic and socioeconomic data, with primary data collected at trespassing locations (GPS coordinates, behavioural observations, patterns, and environmental characteristics). A key challenge was integrating data from multiple sources into a unified database suitable for GIS spatial analysis. The results include mapping trespassing locations by kilometre position and GPS coordinates, as well as creating a structured multimodal database containing detailed information. The developed database enables spatial analysis, supports the identification of trespassing hotspots and provides a foundation for trespassing prevention. Full article

Environmental contamination by potentially toxic elements (PTEs) poses a persistent threat to wildlife, yet their accumulation and neurotoxic effects in the avian nervous system remain poorly understood. Although birds are widely recognised as valuable bioindicators of environmental pollution, most biomonitoring studies have focused on conventional tissues such as the liver, kidney, blood and feathers rather than on neural tissues, despite the high susceptibility of the nervous system to toxic injury. This review synthesises current knowledge on the bioaccumulation and neurotoxicity of PTEs in the avian nervous system, with emphasis on the brain, retina, optic pathways and spinal cord. Mercury remains the best-characterised avian neurotoxicant, whereas increasing evidence indicates that lead, cadmium and interactions with essential elements also contribute to neural dysfunction through distinct but partially overlapping mechanisms. Taken together, the available evidence indicates that neurotoxicity cannot be interpreted solely based on total elemental concentrations but also depends on chemical speciation, regional and cellular localisation, disruption of neural metal homeostasis and the intrinsic vulnerability of different neural tissues. Despite increasing evidence of PTE accumulation in neural tissues, important knowledge gaps remain regarding tissue-specific susceptibility and the links between neural damage, behavioural impairment and ecological performance. This review highlights the avian nervous system as an underexplored but biologically relevant target of environmental PTE exposure and highlights the need for more integrative approaches combining chemical, histopathological and functional assessments to improve avian biomonitoring and ecological risk assessment. Full article

Background: The discordance between individuals’ self-perceived risk of HIV infection and laboratory-confirmed risk has a significant impact on behaviours related to HIV prevention and timely initiation of treatment. Methods: Data was obtained from the sixth South African National HIV Prevalence, Incidence, and Behaviour Survey. Descriptive statistics were used to summarise the sample characteristics and provide the prevalence of discordance. A multivariable multinomial logistic regression was employed to investigate factors associated with discordant results. Results: Of 34,528 participants, 4.1% (95% Confidence Interval (CI): 3.7–4.5) were classified as HIV-positive with low perceived risk, while 11.5% (95% CI: 10.4–12.6) were classified as HIV-negative with high perceived risk and 1.0% (95% CI: 0.8–1.1) as self-misdiagnosed. Being HIV-positive with low perceived risk was significant among older ages (25–54 years) and lower among other races than Black Africans and those residing in rural informal areas. In contrast, being HIV-negative with high perceived risk of HIV risk was more common among participants aged 25–44 years, as well as those living in rural informal and rural formal areas, but lower among other races than Black Africans. The factor associated with self-misdiagnosis was being female. However, participants aged 15–24 years who were never married were less likely to self-misdiagnose. Conclusion: These findings highlight a significant discrepancy between perceived and laboratory-confirmed HIV risk, underscoring the importance of targeted interventions to improve risk perception accuracy. Enhancing individuals’ understanding of their true risk may lead to better engagement in preventive measures and the timely initiation of treatment. Full article

This study investigated the dynamic volatility connectedness among financial technology (FinTech), green indices, and global uncertainty metrics between June 2018 and May 2025. The research was conducted to understand how technological innovation and sustainability indices interact with systemic risk during periods of extreme global stress, such as the COVID-19 pandemic, the Russia–Ukraine conflict, and the market disruptions of early 2025. The analysis employed a time-varying parameter vector autoregression (TVP-VAR) framework to capture time-varying interdependencies and risk spillovers across multiple market regimes. Key findings indicated that total dynamic connectedness intensified significantly during crisis events, with major spikes occurring during the 2020 pandemic onset and the 2025 shocks possibly related to the “DeepSeek” AI disruption and the US tariff announcements. FinTech indices and green assets consistently functioned as net transmitters of shocks, while uncertainty indices, particularly the VIX, served as net recipients. Notably, the Alternative Finance Index (AFI) exhibited regime-dependent behaviour, transitioning from a transmitter to a recipient during the COVID-19 pandemic. These results imply that innovative and sustainable sectors have evolved into systemic drivers of global market sentiment rather than mere recipients of external shocks. The findings provide critical insights for stakeholders in financial markets, helping them to rethink their current approaches and prevent financial losses amid market upheaval. Full article

This study, part of the PRET-study (NCT06579898), investigated changes in body composition, physical fitness, sarcopenia, activities of daily living (ADL), challenging behaviour, and falls in adults with intellectual disabilities (ID) following participation in a 24-week progressive resistance exercise training (PRET) intervention. A repeated-time-series design with one study group was used. We used multilevel linear regression models and non-parametric tests to investigate changes in body composition (bioelectrical impedance), physical fitness (ID-fitscan), sarcopenia, ADL (Barthel Index, Lawton IADL scale), challenging behaviour (Aberrant Behaviour Checklist), and falls. Thirty-six adults with mild to moderate ID (mean age: 55.6 ± 12.9 years; 52.8% male) participated and 26 completed the intervention. Intention-to-treat and per-protocol analyses showed statistically significant improvements in physical fitness and challenging behaviour. As these analyses concerned multiple secondary outcomes from a study powered for cardiovascular risk factors, these findings should be considered exploratory. Intention-to-treat analyses showed improvements in the five-times chair stand (−2.40 s, 95% CI [−4.06; −0.75]), and reductions in irritability (−1.10, 95% CI [−2.21; −0.00]) and inappropriate speech (−0.75, 95% CI [−1.22; −0.28]). No statistically significant changes were observed for body composition, ADL, or falls and no cases of sarcopenia were identified. The findings suggest that participation in PRET may be associated with improvements in lower body functional muscular endurance and challenging behaviour. Full article

Purpose: Despite the increasing use of digital platforms during health emergencies, little is known about the cognitive and structural mechanisms through which social media quality information influences preventive healthcare behaviour, particularly in low-resource settings. Drawing on the integration of the Protection Motivation Theory and Andersen’s Behavioural Model, this study examines how social media quality information shapes preventive healthcare behaviour in Sierra Leone by investigating the mediating role of risk perception and the moderating role of psychological resilience. Methods: A quantitative, cross-sectional survey approach was adopted, and data were collected from social media users in Sierra Leone, Africa, and analysed using IBM SPSS 25 and SmartPLS 4.1 to evaluate the measurement and structural models. Results: The findings disclose that SMQI significantly influences preventive behaviour both directly and indirectly via RP. Furthermore, RES positively and significantly moderates the relationship between risk perception and preventive healthcare behaviour, acting as a catalyst for action, while access to preventive resources (AcPR) serves as a critical enabling factor. Implications: This study advances health behaviour theory by integrating cognitive, psychological, and structural determinants into a cohesive model and establishes resilience as a vital boundary condition for effective crisis response. The findings offer actionable insights for policymakers and health communicators to design high-quality social media interventions that not only inform citizens but also foster the psychological resilience necessary for sustained health compliance. Full article

Background: Alcohol and tobacco use remain important public health concerns among people living with HIV (PLWH), even after achieving viral load suppression. This study examined the socio-demographic factors associated with alcohol and tobacco use among virally suppressed PLWH in the Eastern Cape Province, South Africa. Methods: A cross-sectional study was conducted among 244 adults receiving antiretroviral therapy with suppressed viral loads at public healthcare facilities in the Eastern Cape Province. Data were collected using the Alcohol Use Disorders Identification Test (AUDIT) and the WHO STEPwise questionnaire. Alcohol use was classified according to the AUDIT, and participants were further categorised into low-risk (AUDIT score < 8) and risky drinking (AUDIT score ≥ 8) for regression analyses. Associations between socio-demographic characteristics and alcohol use were initially examined using cross-tabulations and exact tests where appropriate. Univariable and multivariable binary logistic regression analyses were subsequently performed to identify factors independently associated with risky alcohol use and smoking. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, with statistical significance set at p < 0.05. Results: Of the 244 participants, 57.0% were female, and 61.5% were employed. Based on the total AUDIT score, 60.2% of participants were classified as risky drinkers, while 44.3% were current smokers. In the multivariable analysis, employment was independently associated with risky alcohol use (AOR = 2.03, 95% CI: 1.11–3.73) and current smoking (AOR = 3.75, 95% CI: 1.98–7.08). Compared with single participants, married (AOR = 2.61, 95% CI: 1.25–5.45), separated (AOR = 5.19, 95% CI: 1.98–13.60), and divorced participants (AOR = 3.32, 95% CI: 1.05–10.49) had higher odds of risky alcohol use. Conclusion: Alcohol use and tobacco smoking remain common among virally suppressed PLWH in the Eastern Cape Province. Although viral load suppression is an important treatment outcome, it does not fully reflect broader health behaviours that may compromise long-term health. Integrating routine screening for alcohol and tobacco use, together with targeted behavioural interventions and harm reduction strategies, into comprehensive HIV care may improve long-term health outcomes. Full article

Introduction: Chronic inflammation in Crohn’s disease (CD) is associated with systemic alterations, including the loss of skeletal muscle mass. While nutritional deficits are known to impact clinical trajectories, the specific prognostic value of muscle wasting remains underutilised. The primary objective of this study is to construct a composite score integrating sarcopenia with paraclinical parameters to predict an unfavourable disease outcome (UO) more accurately. Materials and Methods: We conducted a retrospective study of patients with CD who were hospitalized at our institution between January 2020 and June 2024 and were treated with biologics or small molecules. Using previous CT scans, we measured skeletal muscle area (SMA) and skeletal muscle index (SMI) to assess their association with disease outcomes. Univariate and multivariate analyses were performed to identify significant predictors of UO, and Area Under the Curve (AUC) values were calculated to assess the predictive performance and to construct a composite prognostic score. Results: Multivariate analysis in the study group (52 patients) identified sarcopenia (low SMI), faecal calprotectin levels >129 μg/g, and complicated disease behaviour (Montreal B2/B3) as independent predictors of UO. Integrating these parameters into a composite risk score resulted in a promising predictive model with an Area Under the Curve (AUROC) of 0.864, significantly outperforming individual biomarkers. Conclusions: We performed a hypothesis-generating study suggesting that nutritional assessment in CD could provide an important benefit in stratifying patients for whom additional nutritional interventions may enhance the long-term outcomes. Full article