Search Results (406)

Background: Despite significant advancements in diabetes care, many individuals with type 2 diabetes (T2D) do not receive optimal care and treatment. Digital interventions promoting behavioral changes have shown promising long-term results in supporting healthier lifestyles but are not implemented in most healthcare offerings, maybe due to lack of general practice support and collaboration. This study evaluates the efficacy of the Digital, Individualized, and Collaborative Treatment of T2D in General Practice Based on Decision Aid (DICTA), a randomized controlled trial integrating a patient-centered smartphone application for lifestyle support in conjunction with a clinical decision support (CDS) tool to assist general practitioners (GPs) in optimizing antidiabetic treatment. Methods: The present randomized controlled trial aims to recruit 400 individuals with T2D from approximately 70 GP clinics (GPCs) in Denmark. The GPCs will be cluster-randomized in a 2:3 ratio to intervention or control groups. The intervention group will receive one year of individualized eHealth lifestyle coaching via a smartphone application, guided by patient-reported outcomes (PROs). Alongside this, the GPCs will have access to the CDS tool to optimize pharmacological decision-making through electronic health records. The control group will receive usual care for one year, followed by the same intervention in the second year. Results: The primary outcome is the one-year change in estimated ten-year cardiovascular risk, assessed by SCORE2-Diabetes calculated from age, smoking status, systolic blood pressure, total and high-density lipoprotein cholesterol, age at diabetes diagnosis, HbA1c, and eGFR. Conclusions: If effective, DICTA could offer a scalable, digital-first approach for improving T2D management in primary care by combining patient-centered lifestyle coaching with real-time pharmacological clinical decision support. Full article

Human Immunodeficiency Virus (HIV) infection remains a major global health issue, with effective antiretroviral therapy (ART) extending life expectancy but also increasing age-related issues like osteopenia and osteoporosis. This cross-sectional study examines bone mineral density (BMD) and related risk factors in Romanian HIV-positive patients, emphasizing regional and therapy influences. The patients varying in HIV infection duration underwent DXA scanning to measure BMD in the lumbar spine, femoral neck, and total femur. A high prevalence of low BMD, especially in the lumbar spine, was identified along with significant associations between reduced BMD and factors such as smoking, alcohol use, vitamin D deficiency and serum phosphorus levels. ART like Protease Inhibitors and Nucleoside Reverse Transcriptase Inhibitors were linked to increased bone loss, emphasizing the multifactorial nature of osteoporosis in HIV-infected individuals and underscore the importance of regular BMD assessments, lifestyle adjustments, and careful management of antiretroviral therapy to minimize fracture risk and enhance overall health and quality of life. Full article

Contrary to what is represented in geospatial databases, places are dynamic and shaped by events. Point clustering analysis commonly assumes events occur in an empty space and therefore ignores geospatial features where events take place. This research introduces relational density, a novel concept redefining density as relative to the spatial structure of geospatial features rather than an absolute measure. Building on this, we developed Space-Time Plume, a new algorithm for detecting and tracking evolving event clusters as smoke plumes in space and time, representing dynamic places. Unlike conventional density-based methods, Space-Time Plume dynamically adapts spatial reachability based on the underlying spatial structure and other zone-based parameters across multiple temporal intervals to capture hierarchical plume dynamics. The algorithm tracks plume progression, identifies spatiotemporal relationships, and reveals the emergence, evolution, and disappearance of event-driven places. A case study of crime events in Dallas, Texas, USA, demonstrates the algorithm’s performance and its capacity to represent and compute criminogenic places. We further enhance metaball rendering with Perlin noise to visualize plume structures and their spatiotemporal evolution. A comparative analysis with ST-DBSCAN shows Space-Time Plume’s competitive computational efficiency and ability to represent dynamic places with richer geographic insights. Full article

Compression–ignition engines emit particulate matter (PM) (soot), prompting the widespread use of diesel particulate filters (DPFs) in the automotive sector. An alternative method for PM reduction involves the use of ultrasonic waves to disperse and modify the structure of exhaust particles. This article presents experimental results of the effects of ultrasonic emitter parameters, including the number, arrangement, and power, along with the engine speed, on the exhaust smoke density. Tests were conducted on a laboratory prototype equipped with six ultrasonic emitters spaced 0.17 m apart. The exhaust source was a diesel engine from a construction excavator, based on the MTZ-80 tractor design, delivering 80 HP and a displacement of 4750 cm³. A regression model was developed to describe the relationship between the engine speed, emitter power and spacing, and smoke density. The optimal configuration was found to involve an emitter power of 319.35 W and a spacing of 1.361 m for a given engine speed. Under the most effective conditions—an engine speed of 1500 rpm, six active emitters, and a total power of 600 W—smoke emissions were reduced by 18%. These findings support the feasibility of using ultrasonic methods as complementary or alternative exhaust gas filtration techniques for non-road diesel engines. Full article

Alternative fuels to fossil fuels have been a focus of research since the 1980s, due to the oil crisis. Biofuels for diesel engines are obtained from various types of fats, primarily vegetable oils. Soybean and rapeseed oil are mainly used to produce biofuels. The aim of the research undertaken was to compare the performance characteristics of a 1.3 JTD engine fueled with methyl esters from hemp compared to biofuels made from rapeseed and fossil fuels. Energy parameters and exhaust emissions were measured. The fuels used were 100% biofuels obtained from vegetable oils by transesterification using methanol and KOH. It was shown to be possible to use HME (hemp methyl esters) biofuels as an alternative fuel to RME (rapeseed methyl esters) or DF (diesel fuel) without significant changes in engine performance. The density and heat of combustion of such fuels results in a 6% reduction in power and 17% in NO_x emissions, as well as a decrease in HC (hydrocarbons), CO₂, and smoke emissions. Full article

Background: To examine the association between allostatic load and the progression of multimorbidity and the role of socioeconomic factors among older Americans. Methods: Data from the Health and Retirement Study (HRS), a longitudinal study of older American adults, were used. Data were included from waves 8 (2006), 10 (2010), 11 (2012), and 13 (2016). Self-reported diagnoses of five chronic conditions (diabetes, heart disease, lung diseases, cancer, and stroke) indicated multimorbidity and were dichotomised to reflect having two or more conditions versus one or fewer. Multimorbidity in 2006 was subtracted from that in 2016 to calculate ten-year change in multimorbidity. Sociodemographic data (age, gender, education, and wealth) were from wave 8 (2006). Behaviours (physical activity and smoking) were from wave 10 (2010). Allostatic load, indicated by five biomarkers (waist circumference, high blood pressure, glycosylated haemoglobin, high-density lipoprotein, and c-reactive protein), was from wave 11 (2012). Structural Equation Modelling (SEM) was used to assess the longitudinal association between the aforementioned factors and the incidence of multimorbidity in 2016. Results: Given that allostatic load was assessed in a subsample of HRS, 8222 were excluded for lack of relevant data. A total of 3336 participants were included in the final analysis. The incidence of multimorbidity in 2016 was 19%. Allostatic load in 2012 was significantly associated with the incidence of multimorbidity in 2016 (estimate 0.10, 95% Confidence Interval (CI) 0.07, 0.14); in other words, for an additional marker of allostatic load, there was an average 0.1 change in the incidence of multimorbidity. Wealth and education (2006) were indirectly associated with multimorbidity through allostatic load and behaviours. Smoking (2010) was positively associated with multimorbidity in 2016, while physical activity showed a negative association. Conclusions: Biological markers of stress indicated by allostatic load were associated with multimorbidity. Adverse socioeconomic conditions appear to induce allostatic load and risk behaviours, which impact the progression of multimorbidity. Full article

Prescribed fire has become an increasingly important strategy for removing biomass from forests and mitigating the risk of severe wildfire. When considering where and to what extent prescribed fire should be applied, land resource managers must consider a host of concerns including biomass density, moisture content, and meteorological conditions. These variables will not only affect how effective the burn will be, but also what sort of smoke is produced by the prescribed fire and how that smoke impacts individuals and local communities. After briefly summarizing how prescribed fire practices have evolved, this review describes how the properties of prescribed fire smoke depend on prescribed fire conditions and the methods used to measure molecular and particulate species in prescribed fire smoke. The closing section of this review identifies areas where advances in smoke monitoring and characterization can continue to improve our understanding of prescribed fire behavior. Full article

Background: The Mediterranean diet is considered one of the healthiest and safest diets for preventing chronic diseases. The primary objective of this study was to assess the association between adherence to the Mediterranean diet and the occurrence of prediabetes in a representative population of Bialystok, Poland. Prediabetes is a condition characterized by elevated blood glucose levels that are higher than normal but not yet in the diabetic range, indicating an increased risk of developing type 2 diabetes. Methods: The study participants were selected into healthy control (HC) and prediabetic (PreD) groups based on age and gender. Biochemical measurements included total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), fasting glucose (FG), glycated hemoglobin (HbA1c), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6). Additionally, blood pressure, handgrip strength, anthropometric parameters, and body composition were measured. Information on patients’ social data, medical history, and lifestyle history was collected using questionnaires developed for this study. A standardized questionnaire, the Satisfaction with Life Scale (SWLS), was used to assess life satisfaction. Dietary total antioxidant capacity (DTAC) and dietary total polyphenol intake (DTPI) were determined using a 3-day nutritional interview and appropriate databases containing information on polyphenols and the antioxidant potential of food products. To assess adherence to the Mediterranean diet recommendations, a 9-item Mediterranean Diet Index (MDI) was used. Results: It was found that the mean MDI for the entire group was low (3.98 ± 1.74), and the HC was characterized by a significantly higher MDI compared to the PreD. A statistically significant positive correlation was found between MDI and HDL-C, whereas a negative correlation was found between MDI and FG, homeostatic model assessment for insulin resistance (HOMA-IR), diastolic blood pressure (DBP), IL-6, body mass index (BMI), waist-hip ratio (WHR), waist circumference, visceral fat mass, android/gynoid fat ratio. Conclusions: Abdominal obesity was shown to significantly reduce life satisfaction. In model 3, after adjusting for age, sex, dietary energy intake, alcohol consumption, and smoking, each additional MDI point indicated a 10% lower risk of prediabetes. Full article

Background/Objectives: In patients with acute ischemic stroke (AIS), the first pass effect (FPE) refers to the complete recanalization of an occluded vessel (TICI = 2C/3) with a single thrombectomy attempt. Achieving complete vessel recanalization is associated with better functional outcomes compared to lower reperfusion rates (TICI < 2B). There is no consensus on which thrombectomy technique provides the best recanalization results for AIS patients. Furthermore, there is a paucity of tools available to predict FPE prior to mechanical thrombectomy (MT). The objective of this study is to develop a radiomics model based on brain NCECT to predict which patients are more likely to achieve a FPE with thromboaspiration MT. Methods: The thrombi of 91 patients were semi-automatically segmented on NCECT. A total of 1167 radiomic features (RFs) were extracted for each patient. Some clinical data (age, gender, cardiovascular risk factors, smoking or alcohol abuse, clot density and clot laterality) were also collected. Results: A LASSO regression analysis identified nine RFs with nonzero coefficients. A logistic regression model for FPE prediction was developed with nine RFs and eight clinical variables. A total of six RFs were found to be statistically associated with FPE. The clinical variables did not demonstrate a statistically significant association with the likelihood of achieving FPE (p > 0.05). The prediction of which patients are likely to achieve FPE obtained an AUC, accuracy, sensitivity and specificity of 0.890, 0.813, 0.815 and 0.811, respectively (p < 0.05). Conclusions: Radiomics can help identify patients who are more likely to achieve FPE with thromboaspiration. Full article

Background: Patients with chronic kidney disease (CKD) face an elevated risk of cardiovascular disease (CVD), particularly those with estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m². Aims: To assess low-density lipoprotein cholesterol (LDL-C) values and the proportion of pre-dialysis patients achieving national and international targets. Methods: This was a retrospective audit (May–October 2024) of 272 patients aged >18 years attending pre-dialysis clinic (estimated glomerular filtration rate <30 mL/min/1.73 m²) at the Renal Unit, Birmingham Heartlands Hospital. Data on age, sex, ethnicity, body mass index, smoking status, CVD status, hypertension, diabetes, lipids (including LDL-C using the Friedewald and Sampson algorithms) and lipid-lowering therapy were collected from the hospital electronic records. Statistical analyses evaluated factors that were associated with LDL-C (linear/multiple regression) and statin therapy (Chi square). Results: The median (interquartile range) calculated LDL-C values were 2.2 (1.7–2.8) mmol/L and 2.3 (1.7–2.9) mmol/L using the Friedewald and Sampson algorithms respectively. Age and statin therapy were independently associated with LDL-C. Using the Friedewald algorithm, 83.8%, 70.6% and 60.3% did not achieve LDL-C targets of 1.4 mmol/L, 1.8 mmol/L and 2.0 mmol/L respectively, these figures were higher when the Sampson algorithm was applied. Only 18 and 3 of the patients were on ezetimibe and inclisiran respectively, whilst not a single patient was on bempedoic acid or proprotein convertase subtilisin/kexin type 9 inhibitors. Conclusion: Our data highlight deficiencies in the management of LDL-C in advanced CKD. We would recommend greater awareness of LDL-C targets and the use of combination lipid-lowering therapy following optimisation of statin therapy. Full article

Background: Diabetic foot syndrome (DFS) constitutes a serious clinical challenge in the treatment of diabetes. The aim of this study was to assess social support and acceptance of the disease in patients with diabetic foot syndrome and their relationship with the metabolic control of diabetes. Methods: This was an observational, single-center study, conducted in 80 people hospitalized in the general and vascular surgery department. This study included adult patients with type 1 or type 2 diabetes, diagnosed with DFS. The mean age of the patients was 65.63 years, with the median age of 62 years. The youngest patient was 27, and the oldest was 94 years old. Men constituted 71.25% of the study group, women 28.75%. The following data were collected: the results of laboratory tests and measurements, the Acceptance of Illness Scale (AIS), and the Social Support Scale (S4-MAD) scores. Results: Abnormal values of non-high-density lipoprotein cholesterol (mean (M) = 120.76 mg/dL) and low-density lipoprotein cholesterol (M = 144.56) were shown in all the patients. Abnormal low-density lipoprotein values occurred in 98.75% of the patients (M = 148.21 mg/dL), and 83.75% of the participants had abnormal values of the systolic pressure (M = 145 mmHg) and total cholesterol. Glycated hemoglobin was abnormal in 61.25% of the subjects (M = 8.95%). The average score on the Acceptance of Illness Scale was 18.4 points in the study group. Out of the 100 possible points in the subscales of social support, the patients obtained an average of 46.5 points in the nutrition dimension, 40 for physical activity, 47.1 for glycemic self-control, 27.4 for foot care, and 68.9 for smoking. Conclusions: Patients with diabetic foot syndrome are characterized by poor acceptance of the disease and receive moderate social support. Patients receive the highest support in terms of cigarette smoking and glycemic self-control, with the lowest in foot care. The patient’s acceptance of the disease and the social support received are unrelated to the patient’s goals of disease control. Higher social support received by the DFS patients is associated with a greater acceptance of the disease. Full article

The inherent flammability and toxic smoke emission of epoxy resins (EPs) pose significant challenges to their advanced engineering applications. To address this limitation, we developed a novel flame-retardant additive through the organic modification of layered double hydroxides (LDHs) using a ternary MgAlLa hydrotalcite structure intercalated with phosphotungstic acid (PWA). This innovative design established a synergistic mechanism by combining the catalytic carbonization effect of lanthanum with the radical scavenging capability of PWA. The optimized MgAlLa-PWA/EP composite demonstrated remarkable flame retardancy and smoke suppression improvements, exhibiting 77.9% and 62.4% reductions in the peak heat release rate (pHRR) and total heat release (THR), respectively, compared to pure EP. Particularly noteworthy was the 72.6% decrease in total smoke release (TSR), accompanied by a significant elevation of the limiting oxygen index (LOI) value to 26.8% and achievement of UL-94 V-0 rating. Microstructural analysis revealed that the modified composite formed a continuous and uniform layer with increased density during combustion, effectively inhibiting oxygen exchange, smoke diffusion, and heat transfer. This study provides a novel strategy for designing multi-element synergistic LDHs additive for high-efficiency flame retardancy and smoke suppression of EP. Full article

Polylactic acid (PLA) is a biodegradable polymer served as thermal management material, and the heat transfer performance is closely related to its pore structure theoretically, but it is unclear how the structure affects its heat transfer. Therefore, a novel approach is proposed to address this issue by numerical simulations at low complexity and cost; three series of porous PLA are investigated with various structures in pore shape, size, and interval by fire dynamic simulation (FDS) and theoretical modeling, respectively. Meanwhile, the relationship between the hole structure and heat release rate (HRR) is developed by defining a new characteristic shape factor (Sc). It demonstrates that adjusting the pore structure of PLA significantly alters its heat transfer, evidenced by significant variations in HRR and smoke density. Additively, the approach for evaluating heat transfer is elucidated, encompassing the hole closure, vortex heat dissipation effect, and narrow variable speed effect. It provides some theoretical basis for designing porous thermal management materials. Full article

Background: Alpha-1 antitrypsin deficiency (AATD) is a genetic disorder associated with an increased risk of developing chronic obstructive pulmonary disease (COPD) with variable phenotypic expression among different genotypes. While the PiZZ genotype is well characterized, the clinical and structural progression of PiSZ individuals remains less defined. This study evaluates genotype-specific disease trajectories and the impact of augmentation therapy over a two-year follow-up. Methods: A prospective observational cohort study was conducted, including 74 AATD patients (41 PiSZ, 33 PiZZ), stratified by augmentation therapy status. Disease progression was assessed through lung function decline (forced expiratory volume in one second [FEV1], diffusing capacity for carbon monoxide [DLCO], carbon monoxide transfer coefficient [KCO]) and densitometric changes (15th percentile lung density [PD-15], percentage of lung voxels below −950 Hounsfield units [HU-950]). Mixed-effects models and multivariable regression analyses were performed to evaluate genotype-specific progression patterns and treatment effects. Results: Results: PiZZ individuals exhibited significantly greater annual decline in lung function and densitometric parameters compared to PiSZ individuals, with more pronounced loss in basal lung regions and with greater decline in advanced stages, in contrast to the PiSZ genotype, which showed greater progression in earlier stages. Augmentation therapy was associated with a significant reduction in PD-15 decline in both genotypes, with the greatest benefit observed in PiZZ patients and in those diagnosed within five years of disease onset. Smoking and frequent exacerbations were identified as independent risk factors for accelerated disease progression. Conclusions: PiZZ individuals experience a more aggressive disease trajectory than PiSZ individuals in the absence of treatment. Augmentation therapy effectively mitigates disease progression in both genotypes, with greater efficacy when initiated early. Smoking and frequent exacerbations were identified as independent risk factors for accelerated disease progression. These findings underscore the importance of genotype-specific monitoring and personalized therapeutic strategies in AATD to optimize clinical outcomes. Full article

Background/Objectives: Little is currently known of the impact of heated tobacco on health. The aim of this study is to evaluate the impact of heated tobacco use on selected health assessment parameters among people aged 18–30 to determine the effect on health status. Methods: A case-control study was conducted from April 2022 to February 2025. A total of 195 young, healthy adult residents of Lodz, Poland, took part. The participants were divided into three groups: IQOS (I-Quit-Ordinary-Smoking) smokers who had never smoked or who had quit smoking six months previously (n = 65); daily smokers who had smoked at least five cigarettes per day for at least one year and had not used any other smoking substitutes for at least one year (n = 65); and people who have never smoked or used tobacco products (n = 65). Blood samples from 37 IQOS users (57%), 28 traditional cigarette smokers (43%), and 45 non-smokers (69%) were submitted for laboratory analysis. The tested parameters were determined in the diagnostic laboratory of the Bonifratów Hospital in Lodz. Results: No significant differences (p > 0.05) were found between the groups with regard to blood count (white blood cell count (WBC), red blood cell count (RBC), lymphocytes, monocyte number (MONO), hemoglobin concentration (HGB)), biochemical biomarkers (C-reactive protein (CRP), fibrinogen, apolipoprotein A1 (apo A1), apolipoprotein B (apo B), glucose), or lipid profile (total cholesterol, triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL)). The cigarette smokers demonstrated significantly higher uric acid levels compared to the IQOS users and non-smokers: 5.22 vs. 4.77 vs. 4.40 mg/dL (p < 0.01). The IQOS users demonstrated significantly higher platelet count levels compared to cigarette smokers and non-smokers: 290.27 vs. 267.14 vs. 256.33 × 10³/ μL (p < 0.05). Among the IQOS users (n = 37), the level of glucose (ρ = −0.47; p = 0.01), WBC (ρ = −0.36; p = 0.03), lymphocytes (ρ = −0.38; p = 0.02), and uric acid (ρ = −0.34; p = 0.04) was negatively correlated with the daily number of heated tobacco sticks. The HDL level was positively correlated (ρ = 0.39; p = 0.02) with the daily number of heated tobacco sticks. Conclusions: Further cohort studies assessing the health status of young users of heated nicotine products and prospective analyses are necessary. Full article