Search Results (48,320)

Background: Teledentistry is widely seen as a promising route to widening access to dental care and narrowing social inequalities. For dental implantology—a technically demanding and costly field that unfolds across several treatment steps—it remains largely unclear whether and, if so, how remote approaches actually make care fairer. The aim of this scoping review was to map the available evidence and organise it in accordance with an established access framework. Methods: A systematic search was conducted, covering PubMed, Scopus, and Web of Science, which was complemented by a manual search. After deduplication, 68 records were subjected to title and abstract screening, and 17 reached the full-text stage. Thirteen studies were obtained (two through supplementary searching), while four could not be retrieved and thus remained unevaluated. This retrieval shortfall (24%) is a material limitation, and it is weighed accordingly throughout. Data were charted using the PCC scheme, and the analysis followed the access model developed by Levesque et al. Results: Five primary studies met the criteria, alongside one conceptual perspective paper without clinical data. Four secondary reviews and five background sources supplied context. The clinical studies were methodologically heterogeneous and mostly small, ranging from case reports to a single randomised pilot study. Structured appraisal revealed that none met all five quality criteria, and only three met the majority of them. Only two of the studies examined implant care directly. The remaining conclusions drew on broader teledentistry or general dental evidence. The findings point to high acceptance, shorter travel distances, and comparable clinical assessments; furthermore, they indicate that, while access has improved, disparities between underserved and better-served groups have not been reduced. Not one source linked teledentistry, implantology, and care equity in any measurable way. Conclusions: The evidence base is scarce, indirect, and rarely framed explicitly around equity. Teledentistry can lower access barriers, yet improved access is not the same as reduced inequality and, through the digital divide, remote care may even deepen existing disparities. This scoping review is therefore best interpreted as identifying an important research gap rather than demonstrating an equity benefit. Targeted, equity-sensitive studies on implantology are needed. Until such data exist, the desired equity benefit remains plausible but unproven. Full article

Research on mixed meals using the INFOGEST protocol has often focused on individual foods, leaving co-ingested matrix associations less well characterized. To address this gap, this study investigated bidirectional associations between steaks cooked to three doneness levels (medium, SM; medium-well, SW; well-done, SD) and red wine during simulated gastrointestinal digestion, focusing on protein oxidation, apparent digestibility, secondary structure, and the apparent bioaccessibility of selected phenolic compounds. Results showed that co-digestion with red wine was associated with lower accumulation of protein oxidation markers across all doneness levels. In the gastrointestinal phase, carbonyl content was 44.5–46.8% lower and free sulfhydryl content was 53.4–59.1% higher than in steak digested alone. SW steak co-digested with wine exhibited the highest mean gastric apparent digestibility (37.7%), and FTIR indicated differences in protein secondary-structure distribution. Furthermore, mixed digests showed higher radical-scavenging activity than when wine was digested alone (an average ABTS increase of 61.4% in the gastrointestinal phase), while the steak matrix altered the digestive recovery and gastric apparent bioaccessibility of several target phenolic compounds. Overall, these findings indicate that steak doneness and red-wine co-digestion are associated with distinct matrix-dependent changes in both protein digestion and apparent phenolic bioaccessibility. Full article

To evaluate freeze–thaw damage and asymmetric deterioration in shallow-buried bias tunnel linings in cold regions, an explainable data-driven predictive framework was developed. Guided by the underlying frost heave mechanisms, an optimal support vector machine (SVM) surrogate model was trained using 200 thermal–mechanical coupled samples generated via Latin hypercube sampling (LHS). The model achieved high predictive accuracy, yielding an R² exceeding 0.98 and a root-mean-square error (RMSE) of only 0.036. Using the Shapley additive explanations (SHAP) algorithm to deconstruct damage evolution mechanisms, results revealed that ambient temperature exerts a stable quasi-linear driving effect on localized tensile stress concentrations in the lining, with an equivalent deterioration gradient of approximately 0.0731 MPa/°C. Meanwhile, cumulative freeze–thaw cycles trigger a steady quantitative accumulation of lining structural deformation. Results indicate that prior to material yield, structural deterioration of tunnel linings under severe cold conditions does not manifest as an abrupt nonlinear transition, but rather as a highly stable quasi-linear accumulation. This finding clarifies the safety evolution trajectory during the early- to mid-term service stages of extreme cold tunnel linings, providing a robust quantitative basis for proactive tunnel operational early warning systems. Full article

Autism spectrum disorder (ASD) has a continuously rising global prevalence, imposing a heavy burden on affected families and society. Emotional and behavioural problems are the most common comorbidities of ASD and severely impair the long-term prognosis of affected children. While mindful parenting represents a validated positive parenting model, the internal mechanisms underlying its association with emotional and behavioural developmental outcomes in children with ASD remain unclear. This study adopted a cross-sectional design. Between April and August 2023, 268 parent–child dyads were recruited via convenience sampling from hospitals and special education settings in Jinan, China. Validated instruments were used to assess mindful parenting, parenting stress, family management, and child emotional and behavioural problems, and data were analysed using path analysis with observed variables. The results showed that the sequential chain mediation pathway was fully consistent with the data for total difficulties, with the total indirect effect accounting for 66.71% of the total association. For prosocial behaviour, the model received only partial support, with a 61.54% total indirect association, as the unique indirect path via parenting stress did not reach statistical significance. These findings indicate that mindful parenting is associated with fewer child difficulties through a sequence involving reduced parenting stress and better family management. For prosocial behaviour, this association appears primarily linked to family management, with no significant unique contribution of parenting stress. The study reveals potential family process mechanisms and can inform the development of family-centred interventions. Full article

The continuous static contraction of the upper limb during overhead work often leads to progressive muscle fatigue, which is the main cause of work-related musculoskeletal disorders (WMSDs) and reduced operational safety. Traditional fatigue detection methods cannot capture subtle early fatigue characteristics under dynamic working conditions, and sensors are difficult to conveniently deploy in harsh environments. This study constructs an upper limb fatigue detection model based on wearable interface pressure signals and proposes a spatiotemporal dual-entropy fusion strategy. Sample entropy evaluates temporal muscle movement regularity, with a 10% incremental rate-of-change threshold for significant fatigue identification, superior fatigue sensitivity, and anti-interference capability. Information entropy reflects the spatial dispersion of pressure amplitude, adopting a 5% rate-of-change threshold for early fatigue warning. Combined with sEMG comparative verification and nonlinear fitting analysis, a hierarchical monitoring framework is established: single-index abnormality indicates slight fatigue, while dual-entropy synchronous elevation represents severe neuromuscular fatigue. The proposed method overcomes the limitations of single-index evaluation, accurately identifies multiple fatigue levels, and reliably monitors fatigue in real time, providing effective technical support for ergonomic monitoring and occupational safety protection in overhead operations. Full article

Background: Health-related quality of life (HRQoL) and job satisfaction are important indicators of nurses and physicians’ wellbeing and system sustainability, particularly under conditions of high clinical demand. Although organizational determinants of nurses and physicians’ wellbeing have received increasing attention, evidence regarding protocol-based work as a specific organizational characteristic remains limited. Methods: A multicenter cross-sectional study was conducted in 11 Greek public hospitals between September 2022 and March 2023. The study included 405 nurses and physicians (214 nurses and 191 physicians). HRQoL was assessed with the SF-36 and job satisfaction with the MSQ-Short Form. Protocol-based work was assessed using a single self-reported dichotomous item referring to the use of standardized clinical protocols during the pandemic. Associations between workplace characteristics and outcomes were examined using multivariable linear regression models. Results: Vitality (57.24 ± 17.61 among nurses and 53.92 ± 16.93 among physicians) and general health (56.58 ± 19.81 and 53.42 ± 16.32, respectively) were the lowest-scoring HRQoL dimensions in both professional groups. Compared with physicians, nurses reported higher mental health (62.52 vs. 58.11, p < 0.05), social functioning (67.17 vs. 58.96, p < 0.05), and overall job satisfaction (3.23 vs. 2.98, p < 0.01), whereas physicians scored higher in physical functioning (83.47, p < 0.05) and bodily pain (72.87, p < 0.05). Conclusions: Several organizational characteristics were associated with wellbeing among nurses and physicians. Protocol-based work showed consistent associations with better HRQoL and job satisfaction across multiple outcomes. However, longitudinal studies are needed to determine whether these associations reflect causal relationships. Full article

Recent advances in Generative AI are creating new opportunities for engineering and geosciences activities. This study examined whether the initial production of Territorial and Environmental Diagnosis (TED) reports could be co-piloted by multi-agent systems. The study proposed a challenge between a classical engineering workflow and a multi-agent framework (MAF) combining specialized agents boosted by LLMs for data retrieval, Data Visualization, writing, statistical description, and publishing within a unified deterministic workflow. To evaluate the effectiveness of the MAF, a blind comparative assessment was conducted using sections of TED reports produced by internal experts for three French municipalities as reference case studies. The framework was tested across several key thematic sections, and MAF outputs were compared with the outputs generated by territorial experts. The evaluation focused on Data Relevance, Writing Quality, Data Visualization, Contextual Relevance, and Overall Rating. The results of our experiments indicate that MAF reduced, within tested conditions, the time required for reporting while maintaining a level of quality comparable to conventional reports. Evaluations confirmed that MAF performed well in themes relying on processing data, while human-produced reports retained an advantage in topics requiring deeper contextual interpretation. These findings support the potential of MAF as co-pilots for TED production in engineering workflows. Full article

The transformation of abandoned open-pit mines into pumped-storage power station reservoirs offers an effective way to optimize China’s energy structure and supports China’s dual-carbon objectives by providing large-scale flexible storage. However, the steep slopes and complex geological conditions formed by mine excavation pose severe challenges to the stability of reservoir slopes. This paper focuses on a pumped-storage power station project converted from an abandoned mine pit in Luanping, Hebei Province. Specifically addressing high and steep slopes containing weak faults, it proposes a stability analysis method for the excavation stage that considers the influence of faults. The analysis assumes dry conditions, excluding reservoir-induced pore water pressure and seepage forces. Adopting the Janbu method and the M-P method within the limit equilibrium framework, safety analyses were conducted on multiple typical analysis sections of the abandoned mine pit before and after excavation. Analytical results indicate that the minimum safety factors derived from the Janbu method pre- and post-excavation are 1.33 and 2.13, respectively, whereas those obtained via the M-P method are 1.40 and 2.47. Given its consistently lower and thus more rigorous estimations, the Janbu method is recommended for conservative engineering design and risk assessment in similar geological settings. It is found that when the fault outcrop daylighting on the slope face constitutes a substantial spatial proportion, the potential sliding surface of the slope will extend from the top of the weak fault along an arc to the bottom of the stepped excavation. This indicates that the position of the fault influences both the sliding mode and the safety performance of the slope. The research findings of this paper could provide technical support for the slope engineering design, excavation and construction of pumped-storage power station reservoirs converted from abandoned mine pits. Full article

Type 2 diabetes mellitus (T2DM) is characterized by skeletal muscle insulin resistance, which contributes to systemic metabolic dysregulation and diabetic myopathy (DM), a complication involving the loss of muscle mass and contractile function. Although hypoxic exercise has demonstrated metabolic benefits in chronic diseases, its efficacy against DM remains unclear. We hypothesized that hypoxic exercise would be more effective than normoxic exercise in ameliorating diabetic myopathy-associated skeletal muscle abnormalities. Accordingly, adult zebrafish underwent an 8-week high-glucose intervention combining high-glucose feeding and glucose immersion to establish a T2DM-associated diabetic myopathy model and were subsequently subjected to 5 weeks of normoxic or hypoxic exercise (28.8 cm/s, corresponding to 70% of critical swimming speed (Ucrit) determined under normoxic conditions, 2 h/day, 5 days/week) to compare their effects on skeletal muscle outcomes. Hypoxic exercise produced greater improvements in glucose tolerance and locomotor performance than normoxic exercise, while the effects on skeletal muscle morphological and atrophy-related indices varied across outcomes. Both normoxic exercise and intermittent hypoxic exposure altered the abundance of mitochondrial quality-control-related proteins in the skeletal muscle of zebrafish with diabetic myopathy, whereas hypoxic exercise produced more pronounced changes in several of these proteins. Moreover, hypoxic exercise more markedly increased the abundance of mitochondrial respiratory-chain proteins than aerobic exercise or intermittent hypoxic exposure alone. Marked reactive oxygen species (ROS) accumulation was observed in the skeletal muscle of zebrafish with diabetic myopathy. Both aerobic and hypoxic exercise effectively reduced excessive ROS production, with hypoxic exercise producing the greater effect. Analysis of Foxo3a and its phosphorylation showed that p-Foxo3a expression decreased most prominently in the T2DM hypoxia exercise (DHE) group, indicating that hypoxic exercise is associated with modulation of Hif1a/Foxo3a-related signaling. Hypoxic exercise was associated with greater Hif1a protein abundance and lower Foxo3a Ser253 phosphorylation than normoxic exercise, accompanied by improved mitochondrial quality control and reduced ROS accumulation. In conclusion, hypoxic exercise ameliorated diabetic skeletal myopathy and was accompanied by modulation of Hif1a/Foxo3a-related signaling, more favorable mitochondrial morphology, altered abundance of mitochondrial quality-control-related and respiratory-chain proteins, and reduced dihydroethidium-detectable oxidative signals. Full article

Atopic dermatitis (AD) is characterized by pruritus and epidermal barrier dysfunction. Tapinarof, a therapeutic aryl hydrocarbon receptor (AHR)-modulating agent, is clinically effective in AD, but its mechanisms in allergen-driven models remain unclear. We evaluated tapinarof in a Dermatophagoides farinae (Df)-induced murine model of AD, focusing on AHR-mediated barrier restoration. AD-like dermatitis was induced in female NC/Nga mice, followed by daily topical tapinarof or betamethasone for four days. Disease severity, transepidermal water loss (TEWL), histopathology, and gene/protein expression were assessed. Tapinarof significantly reduced dermatitis scores and TEWL and, unlike betamethasone, preserved epidermal architecture without suppressing ear swelling. Tapinarof upregulated the AHR-responsive genes Cyp1a1 and Nqo1 and induced Ovol1, an epidermal differentiation-associated transcription factor, with increased CYP1A1, NRF2, NQO1, and OVOL1 protein expression. Tapinarof markedly increased filaggrin (FLG)- and loricrin (LOR)-positive areas in lesional skin compared with vehicle (FLG: 11.3% vs. 3.1%; LOR: 18.9% vs. 3.9%; both p < 0.05), restoring FLG to a level comparable to the no-treatment control, while LOR significantly exceeded it. These findings indicate that tapinarof may restore skin barrier function in allergen-induced AD via AHR-NRF2 and AHR-OVOL1 signaling, supporting its potential as a steroid-sparing topical therapy for long-term AD management. Full article

Background and Objectives: Post-COVID-19 condition (PCC) is a commonly reported disorder that has gained attention from the World Health Organization (WHO). Several studies have examined factors associated with PCC; however, relatively few have combined statistical and machine-learning approaches. Therefore, this study used statistical analysis to identify factors associated with PCC and machine-learning methods to evaluate the relative importance of these factors and their contributions to model predictions of PCC. Materials and Methods: This study employed a cross-sectional observational design in which 963 eligible individuals who had tested positive for COVID-19 were enrolled. Participants were asked about the presence of persistent symptoms lasting for at least 2 months and occurring 3 months after COVID-19 infection, as well as the specific symptoms experienced. The WHO Global COVID-19 Clinical Platform Case Report Form for PCC was used to classify persistent symptoms. Demographic information and medical factors were examined using Poisson regression and machine-learning techniques. Results: A total of 209 (22%) out of 963 reported having PCC with fatigue (45%), followed by bone/joint/muscle pain (34%), one neurological symptom (24%), one pulmonary/respiratory symptom (23%), and one mental health symptom (16%) were the most common persistent symptoms. Modified Poisson regression showed that having exactly two chronic conditions, and experiencing two or more previous COVID-19 infections were significantly associated with the prevalence of PCC. The SHAP beeswarm plot indicated that sex, age, time since last COVID-19 infection, number of chronic conditions, and BMI had the greatest influence on the support vector machine (SVM) predictions. Within the fitted model, female sex, age, a longer time since last COVID-19 infection, the presence of chronic conditions, and higher BMI generally shifted predictions toward the PCC category. Conclusions: Approximately 22% of participants reported persistent symptoms, with fatigue being the most frequently reported, followed by musculoskeletal pain and symptoms affecting other body systems. In the modified Poisson regression analysis, having exactly two chronic conditions and multiple previous COVID-19 infections were significantly associated with higher prevalence of PCC. However, the machine-learning models demonstrated limited discriminative performance. Full article

The cold supply chain (CSC) reverse logistics segment remains underexplored in the risk assessment literature. Existing frameworks apply traditional failure mode and effects analysis (FMEA) with a three-criterion structure (severity, occurrence, detectability), which inadequately captures the time-sensitive and cost-intensive risk environment of CSC reverse logistics. This study proposes an integrated framework combining hazard analysis and critical control points (HACCP)-based node partitioning, an extended five-criterion FMEA incorporating timeliness and economic cost, triangular interval-valued fuzzy number (TIVFN) aggregation via the Aczél–Alsina operator, and cumulative prospect theory (CPT) to prioritize risk modes. Applied to a food-sector reverse CSC, 16 failure modes were identified across six HACCP-based process nodes. Severity and economic cost jointly account for 47.5% of total criterion weight. Monitoring and data management (node P6) consistently emerge as the dominant risk cluster, with data completeness (FM14), sensor accuracy (FM15), and early-warning functionality (FM16) occupying the top three positions across all weight scenarios. Relative to conventional models and the extended RPN, the TIVFN-CPT model assigns FM16 a substantially higher priority, demonstrating that CPT captures asymmetric, loss-averse risk perception that conventional methods fail to encode. Sensitivity analysis across five weight scenarios confirms the structural robustness of the rankings. By extending FMEA to a five-criterion behavioral framework and introducing TIVFNs as an uncertainty-preserving linguistic scale, this study indicates that information quality constitutes a risk factor of comparable priority to physical temperature maintenance, supporting a tiered resource allocation strategy that prioritizes investment at node P6 and targeted upgrades at nodes P1 and P4. Full article

Reducing sodium chloride in meat products is essential for improving their nutritional profile but often impairs technological and sensory quality. This study evaluated the effects of sodium reduction on pork meat products formulated with a fixed potato starch–tara gum system. Model products with varying NaCl levels (0.57%, 1.14%, 1.71%, and 2.28%) were analysed for physicochemical properties, texture, and sensory attributes during storage. Multivariate analysis (PCA, correlation analysis) and a composite quality index were applied. Compared with the control, a 50% reduction in NaCl content (to 1.14%) resulted in increased cooking loss (from 2.66% to 3.22%), increased free water content from 0.73% to 2.23% after 20 days of storage, and reduced hardness (from 20.84 to 16.28 N after 20 days of storage), indicating a weakening of the protein matrix. The tested potato starch–tara gum formulation maintained acceptable water retention and structural properties across the evaluated NaCl levels, although progressive NaCl reduction was associated with deterioration of several quality parameters. Strong correlations between sodium content, hardness, and water-related parameters were observed. While the lowest NaCl level resulted in quality deterioration, the 1.14% variant maintained acceptable properties, demonstrating effective sodium reduction without compromising quality. Full article

Background: People living with multiple sclerosis (MS) are increasingly turning to the Internet for information about their condition and its treatment. However, online health information varies widely in quality, and patients often lack the eHealth literacy needed to distinguish reliable from unreliable sources. Objective: This study examined how people with MS in the United Kingdom seek, evaluate, and judge the quality of online health information, with particular attention to information about medicines, and explored the features that they would value in a curated, quality-assessed information resource. Methods: A cross-sectional online survey was distributed via the MS Trust to adults with MS or their carers in the United Kingdom. The 55-item instrument, adapted from a previously validated questionnaire, captured demographic characteristics, Internet use, eHealth confidence, perceived quality indicators, assessment difficulties, and preferences for a curated information resource. Descriptive statistics summarised the sample, and Spearman’s rank-order correlation tested associations between confidence, perceived importance of quality, and information-checking behaviours. Results: One hundred and fifty-two participants completed the survey. Because the number of individuals reached through the MS Trust’s distribution channels was not recorded, a true response rate could not be calculated; the achieved sample represented approximately 38–40% of the a priori target of 400. Almost all participants (99%) used the Internet to find MS-related information, and 84% sought information about their medicines online. Recommendation by a healthcare professional was the strongest indicator of perceived information quality (17.8%), and MS specialists were the most trusted source overall (32.9%). However, 54.4% of participants expressed concerns about online information quality, and only 47.9% believed that search engines reliably returned high-quality websites. Confidence in evaluating online medicine information correlated strongly and positively with the perceived importance of information quality (ρ = 0.869, p < 0.001, n = 73) and with active checking behaviour (ρ = 0.677, p < 0.001, n = 73). Eighty-eight percent of participants endorsed the development of a single, quality-assessed website for MS-related medicine information, and 80% wished for visible details of how each source had been assessed. Conclusions: Despite high engagement with online information, people with MS remain uncertain about its quality and find independent assessment time-consuming and complex. A curated, transparently assessed information resource, ideally with clinician endorsement and visible quality indicators, was endorsed by the subset of participants who reached these items and represents a candidate direction for future digital health interventions in MS care. Because several preference items were answered by small subgroups (n = 35–79) drawn from an engaged charity membership, these findings are exploratory and require confirmation in more representative samples. Full article

Background: Diagnosis of intestinal perforation in severely injured patients remains challenging. Hyponatremia has been associated with intestinal inflammation in other clinical settings. The aim of this study was to determine whether severely injured patients with an intestinal perforation present lower serum sodium levels compared to severely injured patients without perforation. Methods: A retrospective cohort study was conducted using data from the Swiss Trauma Registry (STR), including 72 severely injured patients with and 61 without intestinal perforation. Serum sodium levels at admission and immediately prior to surgery were retrieved from medical records. Differences in sodium levels were evaluated using linear mixed-effects models to account for repeated measures and group effects (p < 0.05). Results: There was no significant difference in sodium levels between patients with an intestinal perforation compared to controls (mean difference: +0.74 mmol/L, p = 0.204). The time × group interaction indicated a slightly greater decline in sodium from first to last assessment in the perforation group relative to controls (−1.14 mmol/L, p = 0.062); however, these effects were not statistically significant. Conclusions: No significant difference in sodium levels between the patients with and without intestinal perforation undergoing laparotomy in the early phase of hospitalization was found that would have potentially allowed for diagnosis of a hollow viscus organ injury. Full article