Search Results (8,872)

This article examines how the insecure and precarious legal status of adoptees gives rise to vulnerabilities, with a particular focus on the citizenship of foreign-born adoptees. The primary objective of this work is to identify vulnerabilities associated with U.S. citizenship rules. While adoption is often assumed to guarantee both familial belonging and a legal status of citizenship, the U.S. legal framework frequently reveals gaps that leave adoptees in vulnerable positions. By tracing how administrative requirements, adoptive parents’ lack of due diligence, and fragmented legal pathways create insecurity, this article shows that the law itself may generate or exacerbate vulnerabilities it purports to resolve. Drawing on the concepts of vulnerability and navigating the intersection of family law and immigration law, the analysis highlights how citizenship is more than a legal status, affecting deeper issues of identity-building and belonging. The article concludes by underscoring the need for a protective, adoptee-centered, coherent approach to citizenship rules, one that offers better legal permanence for adoptees. Full article

Background and Aim: People with HIV (PWH) have historically been excluded from cancer immunotherapy trials due to concerns over immune dysregulation and safety. This systematic review evaluates the safety, efficacy, and immunologic outcomes of Programmed death-1 (PD-1) inhibitors in PWH diagnosed with non-small-cell lung cancer (NSCLC). Methods: Following PRISMA guidelines, a systematic search was conducted across PubMed, Scopus, Web of Science, and Medline through January 2025. Studies were included if they reported outcomes of ICIs in PWH with NSCLC. Data extraction included progression-free survival (PFS), overall survival (OS), immune-related adverse events (irAEs), antitumor response, HIV viral control, and immunologic parameters. Study quality was assessed using the Joanna Briggs Institute (JBI) checklist. Results: Six cohort studies (n = 762 patients) met inclusion criteria. ICIs used included nivolumab, pembrolizumab, atezolizumab, and durvalumab, with treatment durations ranging from 3.1 to 5.4 months. Median PFS ranged from 3.0 to 6.3 months, and OS ranged from 10.0 to 66.0 months. Overall response rates (ORRs) varied from 13% to 75%, and disease control rates (DCRs) ranged from 47% to 62.5%. irAEs occurred in 25% to 75% of patients, with 6–20% experiencing grade 3–4 events. Corticosteroids were required in 13–29% of patients, and treatment discontinuation due to toxicity occurred in up to 30%. Most patients had controlled HIV, with CD4 counts typically above 300 cells/μL and undetectable viral loads. Conclusions: ICIs appear safe and effective in PWH with NSCLC, with toxicity and efficacy outcomes comparable to the general population. While immunotherapy should not be withheld based solely on HIV status, better standardization in reporting HIV-related variables is needed to optimize patient selection and management. Full article

The growing demand for air connectivity, coupled with the forecasted increase in passengers by 2040, implies an exigency in the aviation sector to adopt sustainable approaches for net zero emission by 2050. Sustainable Aviation Fuel (SAF) is currently the most promising short-term solution; however, ensuring its overall sustainability depends on reducing the life cycle carbon footprints. A key challenge prevails in hydrogen usage as a reactant for the approved ASTM routes of SAF. The processing, conversion and refinement of feed entailing hydrodeoxygenation (HDO), decarboxylation, hydrogenation, isomerisation and hydrocracking requires substantial hydrogen input. This hydrogen is sourced either in situ or ex situ, with the supply chain encompassing renewables or non-renewables origins. Addressing this hydrogen usage and recognising the emission implications thereof has therefore become a novel research priority. Aside from the preferred adoption of renewable water electrolysis to generate hydrogen, other promising pathways encompass hydrothermal gasification, biomass gasification (with or without carbon capture) and biomethane with steam methane reforming (with or without carbon capture) owing to the lower greenhouse emissions, the convincing status of the technology readiness level and the lower acidification potential. Equally imperative are measures for reducing hydrogen demand in SAF pathways. Strategies involve identifying the appropriate catalyst (monometallic and bimetallic sulphide catalyst), increasing the catalyst life in the deoxygenation process, deploying low-cost iso-propanol (hydrogen donor), developing the aerobic fermentation of sugar to 1,4 dimethyl cyclooctane with the intermediate formation of isoprene and advancing aqueous phase reforming or single-stage hydro processing. Other supportive alternatives include implementing the catalytic and co-pyrolysis of waste oil with solid feedstocks and selecting highly saturated feedstock. Thus, future progress demands coordinated innovation and research endeavours to bolster the seamless integration of the cutting-edge hydrogen production processes with the SAF infrastructure. Rigorous techno-economic and life cycle assessments, alongside technological breakthroughs and biomass characterisation, are indispensable for ensuring scalability and sustainability. Full article

Objective: This study aimed to explore the direct relationships between social determinants and behavioral clusters, as well as their potential indirect associations mediated by edentulism. Methods: Information on social variables (collected in Wave 3, 2006/07), edentulism (Wave 5, 2010/11), and health-related behaviors (Wave 7, 2014/15) was drawn from the English Longitudinal Study of Ageing (ELSA). Baseline sociodemographic characteristics, including age, gender, ethnicity, education, and wealth, were accounted for. Latent class analysis (LCA) was applied to four behavioral indicators—smoking status, alcohol consumption, fruit and vegetable intake, and physical activity—to identify behavioral clusters. A confirmatory factor analysis (CFA) was then used to construct a latent variable representing social support and social networks. Two structural equation models (SEM) were developed to examine both the direct associations between social support/network and behavioral clusters, and the indirect associations mediated by edentulism. Results: In LCA, the two-class model was the best fit for the data. Class 1 (risky behaviors) had 7%, while Class 2 (healthy behaviors) had 93%. In SEM Model 1, higher social support/network levels predicted being in the healthy cluster directly (SC = 0.147) and indirectly (SC = 0.009). In Model 2, accounting for wealth and education, higher levels of social support/network maintained the direct association with the healthy cluster (SC = 0.132), but the indirect path lost significance. Conclusions: This study found that greater social support was associated with healthier behaviors, and this relationship may be mediated by edentulism. Health policies that encourage social interaction could therefore improve both general and oral health. Full article

General self-efficacy is identified as a modifiable determinant of adolescent mental health and well-being. This study sought to better understand how conditions in different environments of adolescents’ lives and socio-demographic factors are associated with adolescents’ general self-efficacy. We conducted a hierarchical multi-variable linear regression analysis based on survey data from 2021 of a large population-based sample of Norwegian adolescents (n = 15,040). We found that better Relation to peers (β = 0.20, 95% CI [0.18; 0.22]) and Academic/social relation to teachers (β = 0.13, 95% CI [0.11; 0.14]), Perceived neighbourhood safety (β = 0.08, 95% CI [0.06; 0.10]), and Participation in physical activities (β = 0.07, 95% CI [0.06; 0.09]) had medium to small positive associations with adolescents’ general self-efficacy, whilst Parental involvement, Participation in organized music/cultural leisure activities, and Perceived access to neighbourhood leisure arenas had negligible associations with general self-efficacy. Boys reported a stronger general self-efficacy than girls (β = −0.17, 95% CI [−0.19; −0.16]) and Age and Socio-economic status had small positive associations with general self-efficacy (β = 0.08, 95% CI [0.07; 0.10] and 0.04, 95% CI [0.02; 0.06], respectively). We found some small moderation effects by socio-demographic factors in the associations between environmental factors and general self-efficacy. Our findings suggest that general self-efficacy-promoting initiatives that target adolescents apply a multi-sectorial and multi-level approach and pay particular attention to gender differences. A focus on facilitating adolescents’ experiences of mastery and access to relevant successful role models and supportive behaviour by adults and peers in the various contexts seems to be of particular importance. Full article

At present, the design of autism rehabilitation centers in China generally fails to meet the rehabilitation needs of patients, making it difficult to achieve the health and well-being goals of sustainable development. In this context, restorative environment theory, with its potential to improve spatial environments and enhance well-being, has gradually become a key driving force in the environmental design process. Therefore, this literature review employs a combined approach of macro-level quantitative and micro-level qualitative research methods based on the Web of Science (WOS) database. First, 5953 relevant literature sources were analyzed to reveal the research background, current status, hot topics, and future development trends of the theory of restorative environment and rehabilitation centers for children with autism. Through keyword network visualization, seven primary clusters were identified: #0 environmental design, #1 burnout, #2 Autism specturn disorder, #3 Attention deficit hyperactivity disorder, #4 caregiver, #5 domiciliary care, # 6 stroke. These clusters were further synthesized into four core design elements: lifecycle-spanning design, family collaboration and community engagement design, green sustainable environment design, and culturally inclusive and diverse physical and mental development design. Subsequently, a multi-level case analysis was conducted using 24 global autism-friendly design examples to validate the practical applicability of these core elements. Finally, based on the research findings, the discussion section proposes environmental design strategies for autism rehabilitation centers tailored to the Chinese context.These strategies aim to enhance the well-being of children with autism and contribute to the achievement of Sustainable Development Goal 3 (SDG3). Full article

The central image of Yakushi Nyorai in the Kondō of Yakushi-ji is a statue closely associated with the imperial household. This study centers on the iconography of the Four Directional Deities and grotesque figures on the pedestal of this statue, while drawing comparative references to related imagery from both China and Japan, in order to reassess the intended meaning behind the iconographic program and, by extension, the original purpose of the statue’s creation. The analysis suggests that the twelve grotesque figures, enclosed within bell-shaped niches on all four sides of the pedestal’s midsection, likely represent the Twelve Divine Generals, who collectively symbolize the Pure Land of Yakushi in conjunction with the Medicine Buddha above. The grotesque figures situated outside the niches on the north and south faces take on the posture of supportive yakṣa and additionally carry the iconographic attributes of beast-demons. Positioned at the lowest register, the Four Directional Deities are interpreted as forming a directional entourage of ascension—either to immortality or to rebirth in the Pure Land. Taken together, these visual elements strongly suggest that the central image of Yakushi Nyorai may have been created as a posthumous votive offering for the soul of Empress Jitō. Full article

Background: Trastuzumab–deruxtecan (T-DXd), a new-generation antibody drug conjugate, has greatly improved the survival and clinical benefit rates of patients affected by advanced HER2-positive/HER2-low breast cancer according to the results of controlled clinical trials with a manageable safety profile. Data from randomized clinical trials can provide valuable information for the management of patients in everyday clinical practice, including those who would typically be excluded from such trials due to not meeting the inclusion criteria. Methods: In this narrative review, we describe and discuss real-world studies in the literature on the use of T-Dxd in HER2-positive and HER2-low MBC patients, providing a critical analysis of the specific settings of clinical interest. Results: Using a PubMed search, we identified nine real-world studies on T-DXd that are available in the literature. A total of 7146 patients have been included in these retrospective studies. A total of 5/9 studies also included HER2-low MBC patients. In the majority of cases, patients had high disease burden with lung and liver involvement. We then reviewed and discussed clinical areas of interest, including heavily pretreated patients, poor performance status, HER2-positive versus HER2-low disease, brain metastasis, elderly patients, lung toxicity, safety profile, and dose modifications. Conclusions: Our analysis confirms the activity of the drug described in real-world studies and shows a favorable safety profile, with manageable adverse effects. Full article

Objectives: This cross-sectional case–control study, conducted at the Department of Physiotherapy, Academy of Physical Education, in Katowice, between July 2022 and April 2023, aimed to assess the overall health status (OHS) of patients with mild-to-moderate cubital tunnel syndrome (CuTS) compared with a healthy control population. Methods: The SF-36 questionnaire was used to evaluate the following domains: physical functioning (PF), role limitations due to physical health problems (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role limitations due to emotional problems (RE), and mental health (MH). Results: A total of 152 participants were enrolled in the study. The CuTS and control groups consisted of 82 and 70 individuals, respectively. The CuTS group had significantly lower scores in most domains when compared with the control group; however, no significant difference was observed in the BP domain. Notably, the VT domain showed a statistically significant difference in favor of the CuTS group, indicating slightly higher perceived vitality despite functional limitations. Conclusions: Mild and moderate forms of CuTS are associated with significant deterioration in general health, encompassing both physical and psychological components, as assessed by the SF-36 questionnaire; however, no significant difference was observed in the BP domain, suggesting that the burden of CuTS may manifest more strongly in functional, psychosocial, and mental health aspects rather than in generalized pain perception. These findings highlight the importance of a comprehensive evaluation and management strategy that addresses both physical and psychosocial dimensions of patient care. Full article

Background: College students face significant stress from academic demands and high pressures, which can contribute to long-term physical and mental health issues. Existing stress-relief strategies are not always immediately available to this population, highlighting the need for accessible, low-cost solutions. Methods: This randomised controlled trial examined the effects of nature exposure on stress and well-being in a sample of 29 healthy college students compared to a healthy control group (n = 28). The intervention group engaged in 30 min walks in a natural environment four times per week over a four-week period. Stress levels and general well-being were assessed using validated self-report questionnaires administered before and after the intervention period, allowing for a comparison of changes in mental health outcomes between an intervention and control group. Eye-tracking analysis during a battery of cognitive tests assessed cognitive functioning. Findings: The intervention was associated with a greater reduction in psychological distress over time (β = −2.98, p = 0.007) and showed a trend toward reduced burnout symptoms (β = −0.12, p = 0.08) compared to the control group. These associations are independent of sex, age, BMI, smoking status, COVID-19 history, and previous diagnosis of mental illness. An increase in the number of saccades during the visual working memory task was observed in the intervention group compared to controls (β = 5.01, p = 0.046), while saccadic activity in other tasks remained unchanged. No significant effects were found for the neurocognitive performance measures. Conclusions: These findings suggest that short-term nature exposure may support psychological well-being and mental engagement in young adults. Our research highlights the use of walking in nature as a realistic and accessible strategy to promote mental health and neurocognitive functioning among students. Full article

This review examines the current status and future potential of plasma-induced acidification (PIA) as a sustainable method for managing nitrogen-rich organic waste streams such as livestock slurry and digestate. Conventional acidification using sulfuric or nitric acid reduces ammonia (NH₃) emissions but raises concerns related to safety, cost, and environmental impacts. Plasma-assisted systems offer an alternative by generating reactive nitrogen and oxygen species (RNS/ROS) in situ, lowering pH and stabilizing ammonia (NH₃), as ammonium (NH₄⁺), thereby enhancing fertiliser value and reducing emissions of NH₃, methane (CH₄), and odours. Key technologies such as dielectric barrier discharge (DBD), corona discharge, and gliding arc reactors show promise in laboratory-scale studies, but barriers like energy consumption, scalability, and N₂O trade-offs limit commercial adoption. The paper reviews the mechanisms behind PIA, compares it to conventional approaches, and assesses its agronomic and environmental benefits. Valorisation opportunities, including the recovery of nitrate-rich fractions and integration with biogas systems, align plasma treatment with circular economy goals. However, challenges remain, including reactor design, energy efficiency, and lack of recognition as a Best Available Technique (BAT). A roadmap is proposed for transitioning from lab to farm-scale application, involving cross-sector collaboration, lifecycle assessments, and policy support to accelerate adoption and realise environmental and economic gains. Full article

The UNHCR reported that over 123.2 million people were forcibly displaced worldwide by the end of 2024, with the mental health of refugees emerging as a critical issue. In the UK, asylum seekers and refugees make up around 13% of immigrants and the number is increasing year on year. The Immigration and Asylum Act 1999 aimed to ensure that most cases of asylum seekers would be decided fairly, and within six months. However, it has been argued that long wait times and systemic inequalities and inequities within the asylum system have contributed to heightened mental health problems among refugees even once they gain refugee status. The present study aimed to examine the factors that refugees perceive as limiting their ability and willingness to access mental health services in the UK. A systematic review of 15 relevant articles followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Results highlight intersecting perceived limitations to accessing mental health services, such as language difficulties, cultural disconnection regarding mental health including stigma and prejudice, mistrust of services as well as structural barriers including general service limitations and the involuntary transient nature of many refugees’ lives. Policy recommendations emphasize integrating ethnic minority organizations into services, developing culturally adapted services that take into consideration the views of refugees, and ensuring holistic approaches to address socio-economic determinants. Full article

This paper proposes a terminal area energy management (TAEM) guidance system using an online ground track predictor (GTP) for an uncrewed space vehicle (USV). Based on the current geometric range method for each separate phase, we establish a real-time range-to-go calculation method for generating reference commands online. The method ensures continuous range-to-go variation through status flags and an integrated range, thereby avoiding sudden command changes at subphase transitions, which may reduce longitudinal tracking stability. To enhance adaptability in an initial low-energy state, the system tracks the low-energy reference trajectory to provide an additional lift-to-drag margin, thus preventing an overly low terminal velocity. The results of numerical simulations with multiple uncertainties validate the proposed guidance strategy. Moreover, the flight test results confirm its ability to direct the USV to the target position with the desired energy state in real-world conditions. Full article

This perspective piece extrapolates knowledge of mitochondriology to the clinical aspects of cardiovascular disease (CVDs) development. The aim was to deepen the understanding of the etiopathogenesis of CVDs by conceptualizing the systemic involvement of mitochondrial dysfunction mechanisms in their follow-up. A theoretical comparison of mitochondrial status and mitochondrial dysfunction across stages of the cardiovascular continuum was performed based on a systematic analysis of the scientific literature data using general scientific, theoretical, and logical methods and normative rules. Conceptual aspects of the involvement of mitochondrial dysfunction (MD) mechanisms at each stage of the CVDs continuum were identified. MD is a dynamic, complex, multifactorial process that is characterized by quantitative and qualitative changes in the mitochondrial pool of human body cells during the development of CVDs. MD is a fundamental participant in the pathogenesis of CVDs, predetermining the nature and features of the clinical manifestation and course of the disease in each patient. MD has distinctive features at each stage of the catamnesis of CVDs and can be classified according to this principle. The development of objective methods for assessing the degree of MD and its classification criteria is a promising task for future scientific research. Full article

Maternal stress during gestation can alter offspring physiology, behaviour, and immune function. In pigs, such ‘prenatal stress’ is known to increase stress sensitivity, but the potential to automatically detect such sensitivity has remained unexplored. Automatic detection of facial expression has successfully identified differences in pigs dependent on their stress status. This study progresses this work by demonstrating that, for the first time, using a deep learning framework applied to facial analysis, stress-linked phenotypes can be learned from one generation and detected in the next. Using a dataset of over 7000 facial images from 18 gestating sows and 53 of their daughters, we trained and evaluated five state-of-the-art deep learning architectures across six independent daughter cohorts. Attention-based models significantly outperformed CNN-based models, with the Vision Transformer (ViT) model achieving a mean accuracy of 0.78 and an average F1-score of 0.76. Grad-CAM visualisations showed that the ViT consistently attended to biologically relevant facial regions, such as the eyes and snout, whereas CNNs often focused on diffuse or non-informative areas, resulting in reduced low-stress recall and greater batch sensitivity. Models trained on maternal facial images successfully predicted stress responsiveness in daughters from unrelated lineages, indicating that the model captured generalisable facial cues of stress rather than familial resemblance. This approach supports previous work showing that machine vision can detect putatively stress-related alterations to facial expression in pigs. Future application of this approach could offer a scalable, non-invasive tool for early detection of stress in livestock production systems, opening new avenues for welfare-oriented precision livestock management and informed breeding strategies aimed at improving stress resilience. Full article