Search Results (6,290)

Testicular germ cell tumors (TGCTs) are highly curable malignancies, yet their clinical management still relies heavily on conventional serum tumor markers, including alpha-fetoprotein, beta-human chorionic gonadotropin, and lactate dehydrogenase, which have limited sensitivity and specificity in several clinically relevant settings. Circulating microRNAs, particularly miR-371a-3p, have emerged as promising liquid biopsy biomarkers with potential applications across the TGCT disease continuum. This narrative review summarizes the current evidence on the biological basis, diagnostic performance, clinical utility, and limitations of circulating microRNAs in TGCTs. MiR-371a-3p demonstrates high diagnostic accuracy for viable non-teratomatous TGCTs and consistently outperforms classical serum tumor markers in primary diagnosis. Its rapid decline after effective treatment and its association with tumor burden support potential roles in chemotherapy monitoring, early relapse detection during surveillance, and the assessment of selected post-chemotherapy residual masses. However, its inability to detect teratoma remains a major biological limitation, particularly in non-seminomatous residual disease and surveillance settings. Additional barriers to implementation include assay heterogeneity, the lack of universally accepted cutoffs, the variable use of serum versus plasma, and the absence of broad regulatory approval. Emerging translational data suggest that miR-371a-3p may also contribute to tumor–microenvironment communication and cisplatin resistance, although these findings remain preclinical. Overall, miR-371a-3p represents one of the most promising biomarkers in TGCT management, but its routine clinical integration will require standardized analytical protocols and prospective validation in marker-guided decision pathways. Full article

Background: Cetuximab-based therapies continue to play an important role in the management of recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) despite the increasing use of immunotherapy. However, data regarding treatment outcomes and prognostic factors remain limited. This study aimed to evaluate treatment outcomes and prognostic factors associated with survival in patients with R/M HNSCC treated with cetuximab-based regimens. Methods: This retrospective single-center cohort study included patients with recurrent/metastatic HNSCC who received cetuximab-based systemic therapy at the Department of Medical Oncology, Manisa Celal Bayar University Faculty of Medicine, between May 2012 and September 2025. Demographic, clinical, laboratory, and PET/CT data were retrospectively analyzed. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method and compared using the log-rank test. Prognostic factors associated with survival were evaluated using univariable and multivariable Cox proportional hazards regression analyses. Results: A total of 57 patients were included in the study. The median age was 65 years, and 91.2% of patients were male. Most patients had ECOG performance status 0–1 (94.7%) and stage IV disease (71.9%). The larynx was the most common primary tumor site (50.9%), while distant lymph node metastasis (63.2%) and lung metastasis (61.4%) were the predominant metastatic sites. Median PFS and OS were 4.6 months and 13.8 months, respectively. Kaplan–Meier analysis demonstrated that patients with a body mass index (BMI) > 25 had longer OS, whereas chronic kidney disease (CKD), primary tumor localization, and best response to first-line treatment were significantly associated with survival. In multivariable Cox regression analysis, chronic kidney disease (CKD) (HR: 5.15, p = 0.004), oral cavity primary tumor localization (HR: 2.55, p = 0.013), progressive disease as the best response to first-line treatment (HR: 4.44, p < 0.001) and the absence of grade 1–2 cetuximab-related dermatologic toxicity (HR: 3.20, p = 0.027) remained independent adverse prognostic factors. BMI was not independently associated with survival in multivariable analysis. Conclusions: Cetuximab-based therapy demonstrated clinically meaningful activity in patients with R/M HNSCC. Comorbidities, primary tumor localization, the absence of grade 1–2 cetuximab-related dermatologic toxicity and treatment response appear to substantially influence survival outcomes. Larger prospective studies are warranted to validate these findings. Full article

This paper examines how the travel intention of students is correlated with their mental health, in terms of stress reduction and psychological wellbeing. The study employs a combined model that integrates the Theory of Planned Behavior and Stress Recovery Theory to determine the role of travel intention. Travel self-efficacy, the pressure of social influence, the value of the travel experience, the perception of affordability, and the attitude towards tourism determines travel intention, leading to stress reduction and psychological wellbeing of students. The paper examines the mediating capacities of travel involvement and social connectedness and the moderating capacities of nature connectedness and travel frequency. Semi-structured interviews with 15 university students and a survey among 604 students in various universities in Bangladesh were used to collect data. Hypotheses were tested using PLS-SEM. Findings indicate that travel intention enhances psychological wellbeing and reduces stress, and travel involvement and social connectedness are important mediators. These relations are mediated by nature connectedness and frequency of travel, which increases the restorative effect of travel. The results indicate that tourism could be a viable approach to student mental health promotion, which has both practical and theoretical consequences on university policy and future tourism psychological studies. Full article

Background: India accounts for one-fifth of global cervical cancer deaths, yet Human Papillomavirus (HPV) vaccination coverage remains low despite the World Health Organization (WHO) recommendations to initiate vaccination at age 9. With the national HPV vaccination campaign in 2026 and its approval for integration into India’s Universal Immunization Programme (UIP), strengthening physician knowledge, beliefs, and confidence in recommending the vaccine is critical. Methods: In 2023, the American Cancer Society and Cancer Foundation of India catalyzed two national medical societies, the Federation of Obstetric and Gynaecological Societies of India and the Indian Academy of Pediatrics, to educate physicians on HPV vaccination using a train-the-trainer (ToT) model. A mixed-methods evaluation, using the RE-AIM Framework, included pre- and post-training surveys assessing changes in knowledge, beliefs, confidence, and intent, as well as monthly engagement surveys and project reports analyzed using descriptive and inferential statistics. A fidelity assessment evaluated consistency of training delivery. Twenty in-depth interviews explored physician reactions and implementation of learnings, analyzed using a rapid approach. Results: A total of 18,206 physicians were trained. The post-training respondent group demonstrated higher HPV vaccination knowledge scores and more favorable responses in confidence, beliefs, and intent than the pre-training respondent group. The fidelity assessment demonstrated consistent delivery overall, with some variability in role play facilitation. Interviews highlighted increased physician confidence, peer knowledge sharing, and community engagement following the training. Medical societies reported strong program adoption and plans for continued efforts. Conclusions: A ToT physician training cascaded through medical societies is a feasible strategy to prepare physicians to recommend the HPV vaccine and address parental concerns at scale. Full article

Common Data Environments (CDEs) have become a cornerstone of information management in BIM-enabled construction projects and a key enabler of ISO 19650 implementation. Within the context of sustainable and Smart Construction, CDEs integrate design, construction, and operational information, supporting informed decision-making throughout the building lifecycle. However, their effectiveness depends not only on software capabilities but also on the configuration of processes, roles, permissions, workflows, and information structures. This paper proposes an ISO 19650-compliant CDE implementation framework for university construction projects. The study combines a literature review on CDEs, BIM/FM, HBIM, and information management with two university case studies: a new laboratory and educational building and a specialized facility integrated with a historic campus. Based on the findings, an eight-step implementation model was developed, covering information requirements, CDE structure, information states (WIP, Shared, Published, Archive), roles, metadata, workflows, site data integration, and information audits. A mapping matrix linking ISO 19650 requirements with CDE configuration elements and an issue management workflow are also presented. Exploratory findings from the two case studies indicate that a properly configured CDE can help reduce information-related risks, improve issue management, and enhance decision traceability; these results should be regarded as illustrative and context-dependent rather than statistically generalized. Although environmental impacts were not directly measured, improved information management may indirectly contribute to more efficient resource use and more sustainable university infrastructure management. Full article

Background/Objectives: Perceived stress and sleep quality are increasingly recognized as important determinants of emotional eating (EE), particularly among university students who are frequently exposed to academic pressures, psychosocial challenges, and lifestyle disruptions. Both stress and sleep quality are closely interconnected, with elevated stress contributing to sleep disturbances and poor sleep further exacerbating psychological distress. The present study aims to simultaneously examine the independent contributions of perceived stress and sleep quality to EE while accounting for other relevant sociodemographic, lifestyle, and anthropometric factors. Methods: This cross-sectional study was conducted among 1297 university students recruited from 10 geographical regions of Greece. Data on sociodemographic characteristics, academic profile, lifestyle behaviors, and anthropometric parameters were collected using standardized and validated assessment instruments. Perceived stress was measured using the Perceived Stress Scale (PSS), while sleep quality was evaluated with the Pittsburgh Sleep Quality Index (PSQI). Emotional eating was assessed using the Emotional Eating subscale of the Three-Factor Eating Questionnaire–Revised 18 (TFEQ-R18), and participants were subsequently classified into tertiles corresponding to low, moderate, and high levels of emotional eating. Results: Perceived stress was independently associated with EE in the multivariable analysis. Compared with students reporting low levels of stress, those experiencing high perceived stress exhibited almost threefold greater odds of being classified in higher emotional eating categories (OR = 2.86; p = 0.0001). Likewise, participants with moderate perceived stress were approximately twice as likely to demonstrate elevated emotional eating levels relative to their low-stress counterparts (OR = 2.01; p = 0.0001). Sleep quality was also independently associated with EE after adjustment for potential confounding factors. Specifically, students characterized by inadequate sleep quality had more than three times the likelihood of belonging to higher emotional eating categories compared with those reporting satisfactory sleep quality (OR = 3.08; p = 0.0001). The multivariable model demonstrated good fit (Likelihood Ratio Test, p < 0.001), and the proportional odds assumption was satisfied (p = 0.46). Conclusions: These findings underscore the important role of psychological distress and sleep health in EE behavior, independent of other sociodemographic, academic, lifestyle, and anthropometric factors. Given the observed associations, interventions incorporating stress-management and sleep-improvement components may represent promising approaches for addressing emotional eating among university students; however, longitudinal and intervention studies are needed to establish causality. Future longitudinal and intervention studies are needed to establish causality among perceived stress, sleep quality, and emotional eating. Full article

Identity development is a central developmental task during emerging adulthood, and religiosity has been proposed as an important factor associated with this process. However, empirical evidence from the Indian context remains limited. This cross-sectional study examined the association between religiosity and positive self-identity among 2137 university students recruited from multiple institutions across India. Data were collected using a self-administered electronic questionnaire completed during scheduled classroom sessions. Pearson’s correlation and multiple linear regression analyses were performed, with the latter adjusted for socio-demographic characteristics. Religiosity showed a significant positive correlation with positive self-identity (r = 0.390, p < 0.001). Regression analysis revealed that after adjusting for covariates (age, gender, religion, family income, and place of birth), religiosity remained a significant independent predictor of positive self-identity (β = 0.348, p < 0.001). These findings indicate that higher religiosity is independently associated with greater positive self-identity, encompassing higher self-confidence, self-esteem, self-satisfaction, ease of self-definition, and inner peace, among Indian university students. The study contributes context-specific evidence on the role of religiosity in positive identity development within the Indian socio-cultural setting. Full article

We introduce a new method of dimensional analysis based on complete systems of units, such as the metric and Planck systems, in which fundamental dimensionless constants arise naturally. In fact, it is the reformulated Planck system that communicates its dimensionless constants to the metric or any other system. The method reveals additional complex dynamical scales and physical effects beyond those amenable to conventional dimensional analysis. We formulate our strategy in simple settings involving pairs of seemingly unrelated constants, and then we extend the analysis to more complicated cases involving combinations of three to five well-known universal constants. In constructions involving several unrelated constants, the method captures increasingly complex effects and places two or more disparate physics areas into a single framework connecting them by never-before-seen combinations of fundamental dimensionless constants, such as the fine-structure constant and the gravitational coupling constant. Thus, this method provides a pathway to blending descriptions of two or more fundamental interactions that have so far eluded a consistent theoretical formulation. Full article

The Witcher 3: Wild Hunt (2015), a role-playing game developed by CD Projekt RED, exhibits enduring appeal even ten years after its release. The game features European folkloric and Gothic aesthetics that highlight its uniqueness and gained good reception among global players. Yet, the mechanism of this transnational and transcultural appeal is still insufficiently researched. This article challenges debates about the ephemeral nature of internet trends as digital folklore, analysing how regional folk traditions converge into cultural globalisation through interactive media such as video games. The main approach of this study is literary and cultural, adopting digital folklore theory, Globalgothic theory, and Benedict Anderson’s imagined communities. This article also examines in-game quests and landscape aesthetics as part of gameplay through close reading. This study finds that the game interprets regional folk traditions into universal Gothic themes through players’ participatory performance, decontextualised narrative design, and virtual world construction. A new form of digital folklore emerges in the Witcher Universe as an imagined community forms in the virtualised reality. At the same time, longstanding folkloric and literary traditions function as an anchor for this rejuvenated digital folklore and community. Full article

Background: Cultured meat (CM) has emerged as a promising, albeit controversial, alternative to conventional livestock production, offering potential benefits in terms of sustainability, animal welfare, and resource efficiency. Despite these potential advantages, consumer acceptance remains uncertain, particularly in countries where CM is not yet commercially available. Objectives: this study investigates the determinants of willingness to try (WTT) cultured meat among Italian university students (n = 335), with particular attention to the role of product-related perceptions and personal values and motivations. Methods: data were collected through an online survey and analyzed using binary logistic regression to identify the main drivers of respondents’ willingness to try CM. Results: the findings suggest that acceptance of CM among university students is driven primarily by familiarity, perceived safety, and ethical considerations, particularly those related to animal welfare, rather than by demographic characteristics or resistance to novel food technologies. Conclusions: these findings offer practical implications for policymakers and industry stakeholders, highlighting the importance of transparent communication strategies emphasizing product safety and animal welfare benefits as a means of increasing familiarity with and acceptance of CM among younger consumers. Full article

Cadmium sulfide has been widely used as a conventional n-type window/buffer layer or heterojunction partner in several p-type thin-film solar cells, including CdTe/CdSeTe-, chalcopyrite-, kesterite-, antimony chalcogenide-, tin sulfide- and iron pyrite-based devices. Its success is related to its ability to form suitable heterojunctions, partially passivate absorber surfaces and provide favorable electronic selectivity. However, the parasitic absorption associated with the relatively narrow band gap of CdS, the toxicity and waste-management issues related to cadmium-containing auxiliary layers and the need for improved band alignment have motivated extensive research on CdS-free window and buffer layers. This review summarizes the main efforts devoted to replacing CdS in thin-film solar cells based on absorbers such as CdTe/CdSeTe, CIS, CIGS, CZTS, CZTSe, CZTSSe, Sb₂S₃, Sb₂Se₃, Sb₂(S,Se)₃, SnS and FeS₂. The most investigated alternative materials, including Zn(O,S), ZnS, In₂S₃, ZnMgO, ZnSnO, TiO₂, SnO₂ and SnS₂, are discussed with emphasis on their optical properties, band alignment, interface quality, deposition methods and impact on device performance. The analysis highlights that CdS replacement cannot be treated as a universal material substitution problem. Instead, each absorber and device architecture requires a specific front-interface design, where chemical compatibility, conduction band offset, defect passivation, optical transparency and process-induced interfacial modifications play a decisive role. CdS-free approaches are relatively mature for CdTe/CdSeTe- and CIGS-based solar cells, whereas kesterite absorbers, antimony chalcogenides and SnS still require further interface engineering. In FeS₂, by contrast, buffer-layer substitution remains secondary to the control of intrinsic surface and bulk electronic defects. This review provides a concise comparison of the most relevant CdS-free front/window materials and identifies key challenges for the future design of sustainable thin-film solar cells. Full article

Background: High tibial osteotomy (HTO) is commonly performed to manage medial compartment knee osteoarthritis by correcting mechanical alignment; however, the role of adjunctive regenerative therapies remains uncertain. Methods: This retrospective study compared leukocyte-rich platelet-rich plasma (LR-PRP) with leukocyte-poor PRP (LP-PRP) in patients undergoing HTO. Forty patients were allocated into three groups: HTO alone (n = 10), HTO with LR-PRP (n = 20), and HTO with LP-PRP (n = 10). Clinical outcomes were assessed preoperatively and at 12 months using the Visual Analog Scale, Oxford Knee Score, and Western Ontario and McMaster Universities Osteoarthritis Index. Cartilage repair appearance was evaluated through second-look arthroscopy using the ICRS grading and Koshino staging systems. Multivariable analysis of covariance (ANCOVA), adjusting for baseline imbalances, was employed to evaluate postoperative outcomes. Results: All groups demonstrated significant improvements in pain and function (p < 0.05), with no significant differences among groups. However, Group B exhibited a greater shift toward lower ICRS grades than Group A (p < 0.05), whereas no significant difference was found between Groups C and A. Arthroscopic findings revealed more complete defect coverage and improved structural integrity in the LR-PRP group. Conclusions: These findings demonstrate a clear discrepancy exists between clinical and structural outcomes; while HTO drives substantial and comparable short-term functional improvements across all cohorts, adjunctive LR-PRP is positively associated with a significantly enhanced arthroscopic cartilage repair appearance compared to LP-PRP or HTO alone. Further prospective studies are needed to validate these findings and elucidate the underlying biological mechanisms. Full article

Background: Mental health nurses work in high-pressure environments where leadership styles strongly influence well-being and job performance. Toxic leadership, including abusive and authoritarian behaviors, can contribute to psychological distress, somatic symptoms, reduced job satisfaction, and lower organizational effectiveness. It may also decrease Organizational Citizenship Behavior (OCB), which reflects voluntary positive workplace behaviors. Intrinsic motivation may help buffer these negative effects by enhancing employees’ internal drive and resilience. Therefore, this study examines the associations between toxic leadership, psychological distress, somatic symptoms, and organizational citizenship behavior among mental health nurses while exploring the potential role of intrinsic motivation. Methods: This descriptive-correlational study, based on Structural Equation Modeling (SEM), was conducted at the Psychiatric Inpatient Department of Mansoura University Hospital. A total of 117 mental health nurses were recruited through simple random samplings. Data were collected using four standardized tools: the Toxic Leadership Scale, the Brief Symptom Inventory (BSI), the Intrinsic Motivation Inventory (IMI), and the Organizational Citizenship Behavior (OCB) Scale, starting from the end of May and completed by the end of June 2024. Data analysis was conducted using IBM SPSS 22 and AMOS 22, employing descriptive statistics, Pearson’s correlations, independent t-tests, and Structural Equation Modeling (SEM). Results: Toxic leadership was positively associated with psychological distress (β = 0.46, p < 0.001). Psychological distress was strongly associated with somatic symptoms (β = 0.99, p < 0.001). Intrinsic motivation was positively associated with organizational citizenship behavior (β = 0.31, p < 0.001). However, intrinsic motivation was not significantly associated with psychological distress or somatic symptoms, and no significant direct association was observed between toxic leadership and organizational citizenship behavior. Conclusions: Toxic leadership was significantly associated with higher levels of psychological distress among mental health nurses, while psychological distress was strongly associated with somatic symptoms. Intrinsic motivation was positively associated with organizational citizenship behavior. However, the hypothesized mediating role of intrinsic motivation was not supported by the structural model. These findings highlight the importance of addressing toxic leadership and promoting supportive workplace environments to enhance nurses’ well-being and organizational outcomes. Relevance for Clinical Practice: Addressing toxic leadership is essential for enhancing nurses’ well-being and organizational outcomes. Interventions targeting leadership behaviors and promoting supportive workplace environments may help reduce psychological distress and its associated somatic symptoms among mental health nurses. In addition, creating workplace conditions that support intrinsic motivation may encourage organizational citizenship behavior and professional engagement, ultimately benefiting clinical practice and patient care quality. Full article

Mainland Portugal has a lichenological tradition spanning more than three centuries, yet it still lacks a modern, critically revised checklist of its lichen biota. This gap is particularly relevant given the increasing role of species checklists as authoritative references for DNA metabarcoding applications and the expansion of large biodiversity datasets, including those derived from citizen science initiatives. Here we present the first comprehensive checklist of lichens and lichenicolous fungi recorded from Mainland Portugal, based on the critical assessment of 43,718 bibliographic records drawn from 381 publications issued between 1788 and 2021. A total of 2012 species and infraspecific taxa are documented from a universe of 4440 taxonomic names, including synonyms. Nomenclature was updated in accordance with the ITALIC 8.0 database. Species distributions are provided by province, following the scheme adopted in Portuguese botanical floras, with additional information on substrates and altitudinal ranges where available. With over 2000 taxa recorded, Mainland Portugal can be considered a lichen-rich territory relative to its land area, comparing favourably with other European checklists. We discuss the factors underlying this diversity, with particular emphasis on the biogeographical position of Portugal at the south-western edge of the European continent. Full article

Sustainable Development Goal (SDG) education is being promoted to foster future leaders of a sustainable society; however, the relationship between SDG education experiences and environmentally conscious behavior and the role of nature connectedness have not been sufficiently examined. This study examined the factor structure of the Sustainability Consciousness Questionnaire (SCQ), the mediating effect of sustainability consciousness, and the moderating effect of nature connectedness among 2347 first-year university students in Japan. Exploratory factor analysis, confirmatory factor analysis, mediation analysis, and moderation analysis confirmed a three-factor structure of the SCQ (Global Sustainability Attitude, Social Norm and Ethics, Daily Environmental Action). A significant partial mediating effect of sustainability consciousness (B = 0.120, 95% CI [0.094, 0.149]) and a significant moderating effect of nature connectedness (p = 0.011) were observed in the relationship between SDG education experience and environmentally conscious behavior; the stronger the connection with nature, the greater the effect of SDG education on behavior. These findings empirically demonstrate the mechanism through which SDG education experiences lead to environmentally conscious behavior and the moderating role of nature connectedness, contributing to sustainability consciousness research and Education for Sustainable Development. These results suggest the importance of fostering psychological connections with nature alongside knowledge provision. Full article