Search Results (1,553)

Background/Objectives: Chronic kidney disease (CKD) is a major cause of morbidity and mortality. Evidence on routine management and patient-reported outcomes in Greece is limited. The SPIRIT study assessed real-world treatment patterns, disease management, and quality of life (QoL) among CKD patients in Greece. Methods: This was a prospective, multicenter, observational study in Outpatient Nephrology Clinics of fifteen National Health System (NHS) Hospitals in Greece enrolling adults with estimated glomerular filtration rate (eGFR) calculated using the chronic kidney disease epidemiology collaboration (CKD-EPI) equation (CKD-EPI eGFR) between 15 and <60 mL/min/1.73 m², with a 12-month follow-up. Results: A total of 305 CKD patients participated in the study (40.0% classified as stage G3a, 39.0% G3b, and 21.0% G4), with a mean age of 69.3 years. Antihypertensives were administered to 84.3%, 84.1%, and 85.1% of patients at baseline, 6, and 12 months, respectively, mostly calcium channel blockers, while lipid-lowering agents were administered to 63.3%, 64%, and 63.2% at baseline, 6, and 12 months, respectively, predominantly statins (95.3%, 95.9%, and 96.5% of lipid-lowering users). Interestingly, renin-angiotensin-aldosterone system (RAAS) inhibitors were administered to a total of 160 patients, 91.9% of whom had hypertension, while sodium-glucose cotransporter 2 (SGLT2) inhibitors were administered to 45 patients, with 66.7% of them suffering from CKD and type 2 diabetes. SGLT2i use increased from 15.3% at baseline to 35.4% at 12 months. Mean CKD-EPI eGFR remained stable (mean 40.1, 41.3, and 40.7 mL/min/1.73 m²), while median urine albumin-to-creatinine ratio (UACR) increased from 145.2 mg/g at baseline to 253.4 mg/g at 6 months and 246.6 mg/g at 12 months. Statistically significant improvements (p < 0.05) were observed between 6 and 12 months in specific domains of the Kidney Disease QoL-Short Form (KDQOL-SF) v1.3. Conclusions: The study provides real-world evidence on stage-related treatment patterns, routine management, and QoL in CKD outpatients in Greece. Full article

Throughout his eighth-century BC prophecy, Hosea unequivocally frowned upon the socio-political and cultic instability, as well as the corrupt rulers of his time. He challenged many social ills, including swearing, lying, murder, corruption, stealing, bloodshed (4:2), drunkenness (4:11, 18), divination (4:12), idolatry (4:13, 17; 8:4–6, 11; 10:1, 5–6; 11:2; 13:12), pride (5:5; 7:10), and sexual promiscuity (4:13–14, 18). He symbolically and metaphorically placed emphasis on covenant theology (1–3), justice and worship (4–8), judgment (9–10), and reassurances of divine compassion, restoration and salvation for those who repent (11–14). To the benefit of all who read the prophecy of Hosea, this essay argues contextually, historically, and theologically that echoes of Hosea’s historical past are loudly heard in today’s Nigerian stories. Although Nigerian stories may currently be plagued with idolatry, religious abuse, tribal rivalries, modern slavery, unfaithfulness, poor leadership, political upheavals, poverty, corruption at all levels, and violence in the society’s fabric, there is still hope, as preached by the prophet Hosea. For readers of Hosea with a repentant spirit, God’s light of restoration still shines at the end of the tunnel. Full article

Background/Objectives: Artificial intelligence (AI) is being applied across palliative and end-of-life care, including prognostication, symptom detection, clinical documentation, communication support, decision support and care coordination. General AI reporting guidelines exist, but none captures the value-sensitive requirements specific to palliative care, which is integrated from the diagnosis of a serious illness and spans the whole trajectory, alongside disease-directed treatment, to the end of life and bereavement. We aimed to develop an evidence-informed checklist to guide the design and the transparent reporting of AI tools in this setting. Methods: We conducted a narrative review of the literature on AI in palliative care, prognostic communication, surrogate decision-making, digital-health co-design, algorithmic fairness, explainability, AI governance and existing reporting guidelines (TRIPOD+AI, CONSORT-AI, SPIRIT-AI, DECIDE-AI). During revision, the search was formalised and re-executed in PubMed (25 August 2026), each item was graded for certainty of evidence, and the checklist was piloted on four published studies. Rather than reusing generic requirements, we derived each item from a tension specific to serious illness, named the failure modes those tensions produce, and mapped where the framework diverges from generic guidance. Results: PALLI-AI comprises seven domains—Purpose set by goals of care; Alignment with total suffering and dignity; Lived experience, family and bereavement; Learning data and the equity of access; Interpretability and prognostic communication; Accountability in serious illness; and Implementation and palliative outcomes—operationalised as 22 items, each with a researcher and a developer formulation. We name six failure modes specific to this setting, including the self-fulfilling prognosis, the algorithmic surrogate and abandonment by automation, and we set out, domain by domain, what the framework adds beyond existing guidelines. In the pilot, all items were ratable; safeguards against the self-fulfilling prognosis, decedent data governance and answerability were unreported across studies. Conclusions: PALLI-AI is a pragmatic, non-prescriptive checklist intended to raise the trustworthiness of AI tools for people approaching the end of life. It is a starting point for formal consensus development and empirical validation, not a finished standard. Full article

The escalating environmental crisis has intensified scholarly attention on literature that inquiries into the relationship between humans and nature. This study addresses an existing gap in ecocritical research by applying Deep Ecology to selected passages from Easterine Kire’s novels, Son of the Thundercloud (2016), Don’t Run, My Love (2017), A Respectable Woman (2019), and Spirit Nights (2022), to analyse the portrayal of nature’s intrinsic value and biodiversity. Through close analysis of selected passages, the analysis investigates how Easterine Kire’s narratives represent landscapes, plants, animals, and ecological relationships as living, primary factors. The selected passages question anthropocentric perspectives by foregrounding the interconnectedness of all life forms and advocating an ecocentric worldview. The study highlights how Kire’s Fiction represents profound ecological ethics and sustainable human–environment relationships through culturally grounded ecological perspectives. Full article

This paper offers a diachronic and ecoanthropological analysis of the existence, function, and treatment of sacred waters within Macedonian monasteries, from the High Middle Ages and Byzantine rule (eleventh century) to the National Revival period of the nineteenth century. Across this centuries-long span, the sanctity of water underwent a significant ontological and spatial transformation, shaped by complex relationships of ecclesiastic, cultural, historical, social and political factors. The paper’s central argument traces a shift from a strictly ecclesiastic and theological framework toward a vernacularized, folkloric sacrality of the water. In the medieval period, the sanctity of water depended chiefly on the liturgical act of epiclesis, the institutionalized consecration effected through invocation of the Holy Spirit, whereas in the period from the late 18th to the beginning of the 20th century happened an unprecedented proliferation of localized “holy water” springs. Their sanctity was regarded as immanent, independent of sacerdotal phenomena. Where medieval hagiasmata were dedicated predominantly to the Theotokos and to the Life-giving Spring (Baloukli), the 19th century brought a marked democratization of sacred waters. The sacral topography of monasteries came to include springs dedicated to a wide pantheon of saints or to specific days of the week (Wednesday, Friday, and Sunday waters, associated with St. Paraskevi, St. Nedela/Kyriaki, St. George, and St. Demetrius). This diversification finds little grounding in official theological doctrine; its sources lie instead in the deep syncretism of folk religion and in enduring traces of pre-Christian belief. Read through an ecoanthropological lens, the paper argues that the sacralization of water functioned not only as a religious phenomenon but also as a cultural mechanism for establishing a sustainable, reciprocal relationship between human communities and the natural environment. Sacred springs operated as biocultural reservoirs in which spiritual ethics contributed directly to the long-term conservation of vital hydrological resources and sacred landscapes. Full article

Limestone karst habitats in tropical Asia support specialized and geographically restricted plant diversity, yet many areas remain incompletely explored. During botanical surveys of limestone habitats in northeastern Thailand, a distinctive, yellow-flowered population of Boesenbergia was discovered in Phu Pha Man District, Khon Kaen Province. Morphological observations were conducted on living plants in the natural population and spirit-preserved material, supplemented by comparisons with protologues, published descriptions, and herbarium material. Patterns of phenetic similarity among ten selected Boesenbergia taxa were evaluated using 32 morphological characters, Gower distance, UPGMA clustering, and principal coordinates analysis (PCoA). The population is described here as Boesenbergia calcicola Boonma, Saensouk & P.Saensouk, sp. nov. It is morphologically most comparable to B. petiolata but differs by its conspicuously exserted inflorescence, shorter bracts and flowers, distally puberulent floral tube, smaller puberulent lateral staminodes, and distinctive labellum color pattern. Phenetic analyses were used to summarize patterns of overall morphological similarity among the examined taxa. The species is currently known only from its limestone type locality at approximately 385 m a.s.l. and is provisionally assessed as Data Deficient (DD). This discovery further documents localized Boesenbergia diversity associated with limestone karst habitats in northeastern Thailand. Full article

Background: Prostate cancer is one of the most commonly diagnosed cancers in men. Robot-assisted radical prostatectomy (RARP) is one of the recommended surgical treatment options; however, knowledge regarding changes in illness acceptance, psychological adjustment, and quality of life after surgery remains limited. Objective: To evaluate changes in illness acceptance, psychological adjustment, and quality of life in patients undergoing RARP. Materials and Methods: A total of 150 patients diagnosed with prostate cancer and scheduled for RARP were enrolled. Longitudinal analysis was performed in 93 patients who completed both study assessments. Evaluations were conducted before surgery and 3–4 months postoperatively using a self-developed questionnaire, the Acceptance of Illness Scale (AIS), the Mini-Mental Adjustment to Cancer (Mini-MAC), the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), and the prostate cancer-specific module (EORTC QLQ-PR25). Results: Following RARP, illness acceptance did not change significantly after Holm adjustment (p_Holm = 0.465). Psychological adjustment showed an adverse postoperative pattern, characterised by increased anxious preoccupation, helplessness–hopelessness, and destructive style, together with reduced fighting spirit and constructive style. After adjustment across 25 paired outcome comparisons, significant increases remained in emotional and cognitive functioning scores, while constipation and diarrhoea decreased significantly. Sexual activity also decreased significantly after surgery. Among participants who completed both assessments, incontinence-aid use increased from 15/93 (16.1%) before surgery to 38/93 (40.9%) at follow-up (exact two-sided McNemar test, p < 0.001). Conclusions: During the early postoperative period following RARP, favourable changes were observed in selected quality-of-life scores, whereas illness acceptance did not change significantly after adjustment for multiple comparisons. At the same time, psychological adjustment showed an adverse pattern, characterised by reduced fighting spirit and constructive style together with increased anxious preoccupation, helplessness–hopelessness, and destructive style. Decreased sexual activity and increased incontinence-aid use further illustrate the multidimensional nature of early postoperative recovery. These exploratory findings indicate that favourable changes in selected quality-of-life outcomes do not necessarily coincide with improved psychological adaptation and support the inclusion of psycho-oncological assessment and support in postoperative care. Full article

This study examined the effect of grape ripening on the distillate quality of Hetianhong table grapes across three stages of maturity (17, 20, and 24 °Brix). Through the application of HS-SPME-GC-MS, a total of 72 volatile aroma compounds were identified. As the grapes matured from 17 to 24 °Brix, there was an 8.48-fold increase in volatile fatty acids, accompanied by a rise in ester concentrations, while significant reductions were observed in naphthalene derivatives, aldehydes/ketones, and terpenols. Notably, the distillate at 20 °Brix demonstrated the highest concentration of higher alcohols, the richest aroma and superior sensory attributes. The 2-methyl-1-propanol concentration was 15.70 times greater at 20 °Brix than at 24 °Brix, while octanoic acid concentration was 97.93 times higher at 20 °Brix compared to 17 °Brix. Overall, Hetianhong table grapes are ideal for distilled spirits, with optimal maturity modulating the final flavor profile. This research supports value-added processing of these grapes. Full article

In the early 20th century and before, architectural styles were distinguished by the various cultures of different regions. However, under rapid globalization, these styles have become similar and seem interchangeable, disconnected from the city and human environment. This phenomenon is known as architectural homogenization. In response to this issue, the research aims to reconsider architectural typology as a strategic tool to reinforce architectural identity through a new proposed methodological approach—the Typology–Identity Matrix Model. The model is grounded in matrix and cross-impact analysis; it examines how typological approaches promote different architectural identity dimensions and uses a ternary scoring system to evaluate their relationships. Furthermore, by applying this model to both qualitative and quantitative analysis, the research could derive a range of design attempts significant for forming architectural identity. In literature and design practices, little research applies typology to form architectural identity; the research bridges these two concepts with the original Typology–Identity Matrix Model. In this way, the designed architecture could integrate the site’s characteristics and spirits, while offering new interpretations in the contemporary context. The outcomes provide practical support for contemporary architectural design and help advance disciplinary awareness at the theoretical level. Full article

This study examines the mediumistic paintings of Guo Fengyi (郭鳳怡 1942–2010) through the lens of Daoist inner contemplation (neiguan 內觀) and traditional Chinese medicine. Guo developed distinctive self-cultivation techniques, including Ziran Chaoneng Gong (自然超能功 Natural Superpower Qigong), Qi’e Gong (企鵝功 Penguin Qigong 氣功), and Liu Ling Shuzi Gong (劉陵數字功 Liu Ling Numerology Qigong), which resonate with ancient Chinese practices of Zhouyi (周易) divination, shamanic ritual, and Daoist visualization. Through sustained spiritual practice, she experienced what she understood as mystical revelations transmitted by the High Masters. Vivid visionary images repeatedly emerged in her consciousness, accompanied by an overwhelming sense of being guided by an unseen spiritual agency to depict an unknown transcendent realm. Following these experiences, she created nearly one thousand mediumistic paintings. Her work delves into inner landscapes of consciousness and energetic experience, expanding visual art research into the domain of “inner vision”. This study argues that Guo’s art challenges ocular-centric creative paradigms: her mode of “seeing” operates through the supersensory “eye of spirit” rather than physical sight, and artistic creation becomes a process of receiving higher-dimensional messages rather than singular self-expression. Her practice offers a critical reference for recovering the spiritual dimension in contemporary art and provides theoretical perspectives for comparative studies of international mediumistic artists such as Hilma af Klint (1862–1944) and Georgiana Houghton (1814–1884). Full article

Modern healthcare systems, grounded in the logic of Western natural science, compartmentalize the mind and body, thereby privileging physical phenomena while excluding non-scientific or metaphysical understandings of illness. Within this context, Taiwan’s flourishing body–mind–spirit movements represent an important counter-discourse that challenges biomedical reductionism by reasserting the unity of corporeal and spiritual. Drawing on ethnographic research of the contemporary Taiwanese spiritual organization GW (pseudonym), this study examines how its teachings and practices articulate an alternative ontology of illness and healing. GW interprets certain ailments as manifestations of karmic or spiritual disturbances, and advocates meditative discipline, and bodily training as a means of restoring balance. The group’s framework situates the body not as a passive object of treatment but as an active site of transformation, reviving the Chinese tradition of self-cultivation. The analysis argues that GW exemplifies a modern revival of the tradition of self-cultivation within a scientifically oriented society. Full article

As an integrated educational model that combines inquiry-based learning with travel experiences, study travel plays a significant role in fostering students’ social responsibility, innovative spirit, and practical abilities, and has attracted growing attention worldwide. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this study conducts a systematic review of the literature published between 1950 and 2025. It identifies six major themes corresponding to the three stages of study travel. Through bibliometric analysis, the research delineates publication trends, core journal distributions, and keyword co-occurrence networks in the field. The findings indicate that experiential learning, constructivism, and transformative learning theory constitute the dominant theoretical foundations in current scholarship. Moreover, a notable “learning–travel imbalance” is observed, whereby educational processes and learning outcomes receive substantially more scholarly attention than travel attributes, industry logic, and managerial dimensions. This paper offers a systematic mapping of the knowledge terrain and theoretical architecture in international study travel research, clarifies existing gaps, and suggests directions for future interdisciplinary integration and for deeper synthesis of “learning” and “travel” in both research and practice. Full article

Traditional villages serve as the material carriers of traditional Chinese culture. Their cultural spaces, as concentrated reflections of rural humanistic spirit, face multiple crises, including the rupture of intergenerational transmission, functional decline, and spatial isolation. In mountainous counties, where the terrain is complex, resources are scattered, and locations are peripheral, the challenges of protecting and revitalizing cultural spaces are especially acute, yet holistic understanding at the county scale remains insufficient. Focusing on the 25 nationally listed traditional villages in Suichang County, Zhejiang Province, this study selected four representative villages as case studies: Hengkeng (steep-slope mountain), Caihe (gentle-slope hilly), Dushan (mountain-enclosed valley), and Changlian (river-valley plain). We established a comprehensive framework integrating a qualitative “text–space mutual corroboration” interpretation with space-syntax accessibility and isovist-based visibility analysis. The results demonstrate that cultural space nodes exhibit systematically higher accessibility and visibility than ordinary residences, and the coupling between the two dimensions differs sharply by type. Specifically, lineage culture spaces display high–high synergy; religious belief spaces show a low-accessibility–high-visibility mismatch; ritual education spaces occupy a moderate-accessibility–low-visibility position; meanwhile, basic livelihood and daily life spaces are accessibility-dominated. Furthermore, geographical type governs the coupling mode, shifting from linear mismatch on steep slopes, through axial synergy on gentle hills and centripetal aggregation in valleys, to axial serialization on plains. Based on these findings, four adaptive-reuse strategies are distilled. Complemented by a baseline information database and a prospective intelligent-evaluation framework, they provide transferable methodological guidance for planning and revitalizing the cultural spaces of traditional villages in mountainous counties. Full article

This article examines the Filioque controversy as a thousand-year-old aporia in Roman Catholic–Orthodox relations, focusing on the 1995 Vatican Clarification, The Greek and Latin Traditions about the Procession of the Holy Spirit. It explores whether the dispute is a fundamental ontological disagreement regarding the hypostatic origin of the Spirit or a linguistic byproduct of translating the Greek term ekporeusis into the Latin processio. The study analyzes diverse theological responses to “the Clarification”. Roman Catholic perspectives investigate contemporary “reconceptions”—including simultaneous, nonsequential models and nonlinear geometric metaphors—while attempting to reconcile the “Monarchy of the Father” with the dogmatic authority of the Councils of Lyon II and Florence. Conversely, Orthodox theologians emphasize patristic rigor, insisting on a strict distinction between “Theology” (eternal life) and “Economy” (historical actions) while rejecting “Rahner’s Rule”. Ultimately, the research highlights that the unilateral canonical addition of the Filioque remains the primary ecclesiological barrier to unity. The article asserts that only deep, synodal dialogue, rather than administrative clarifications, can resolve this historical impasse and restore a common confession of faith. Full article

Based on three years of sustained personal observations and extensive on-site interviews, this study is the first to investigate the bird totem worship customs of the Dong ethnic minority in southeast Guizhou, China. The Dong-inhabited regions of southeast Guizhou possess a long-standing tradition of bird totem worship, which has permeated every aspect of local people’s daily life, serving as a living museum where ancient bird totem worship continues to thrive in the present day. Through investigation and research, we can clearly perceive that bird totem worship here is no longer merely evidence of primitive thinking as previously discussed in academic circles, nor is it an endangered intangible cultural heritage. Instead, it represents emotional resonance with a more modern spirit and open-ended identity construction. Faced with the era of the internet and new media, they have broken free from the constraints of totem concepts and taboos, instead embracing creative totem will, totem activities, totem behaviors, and intelligent totems, thereby endowing totems with new belief content and forms of expression. They have transcended the preconceived concepts and fixed thinking about totems in academic discourse, making it an important vehicle for maintaining community relations, strengthening ethnic solidarity, inheriting ethnic culture, and continuing local civilization. Through the contemporary reconstruction of collective behavior, the traffic empowerment of internet short videos, and complex functional transformations, they have constructed a brand-new totem value system in the context of the internet and new media era, organizing a multi-dimensional, comprehensive social ecological view and civilizational value system. It is precisely through this continuous evolution, expansion, and activation in response to changing times that totems have acquired sustained vitality and creativity, providing a vivid case study for the contemporary transformation and creative development of ancient totemic beliefs. This is also the significant importance of field investigation—it enables us to gain entirely new value cognition and different theoretical perspectives from the living site of totem practices. Full article