Browse Articles

Risk-sensitive joint inventory-maintenance strategy for bearing health management under prognostic uncertainty: an uncertainty-aware deep reinforcement learning approach

Perspectives of community-dwelling older adults with chronic diseases on Baduanjin practice: A qualitative study

Background With the accelerating aging of China’s population, Baduanjin has been promoted as a community-based exercise to enhance public health, particularly among older adults with chronic diseases. As a traditional Chinese exercise with a long history and profound cultural connotations, Baduanjin has attracted a large number of practitioners. However, the factors underlying the sustained practice of Baduanjin remain insufficiently explored. Objective This study aims to explore the factors underlying the persistence of older adults with chronic diseases in practicing Baduanjin. Methods A qualitative research approach was adopted in this study. 25 practitioners participated in semi‑structured face‑to‑face interviews. Thematic analysis was employed to analyze the data and generate core themes. Results The factors driving community-dwelling older adults with chronic diseases to persist in practicing Baduanjin were analyzed across five dimensions: perceived safety and learning-practice ease, improvements in physical health, promotion of mental well-being, enhancement of social functioning, and appreciation of traditional culture. Conclusion Community-dwelling older adults with chronic diseases maintain long-term Baduanjin practice not only due to its perceived safety and ease of learning and practice, but also because it embodies the essence of traditional Chinese culture. Moreover, regular practice contributes to improved physical health, promoted mental well-being, and enhanced social functioning in this population. Accordingly, Baduanjin shows considerable potential as a community-based exercise intervention to support health promotion among community-dwelling older adults with chronic diseases.

Personalized training and orthopedic inserts bring significant benefits in the posturographic assessment of patients with early gonarthrosis – a randomized controlled trial

Abstract Knee osteoarthritis (KOA) results from cartilage degeneration and abnormal load distribution, leading to impaired biomechanics and postural control. Foot abnormalities such as hypermobility, flat feet, and pronation—common in KOA—may contribute to the degeneration process of the knee joint structures. Stabilization and proprioceptive exercises, as well as orthopedic inserts, can modify these factors by improving muscle function and redistributing load. However, studies directly comparing their effectiveness using objective assessment methods are lacking. Postural control plays a key role in KOA because it reflects the integration of balance systems. The aim of the study was to evaluate the effect of these interventions and their combination on postural balance in centre of pressure (COP) and clinical outcomes (KOOS – knee injury and osteoarthritis outcome score) in patients with early KOA. Participants were randomly divided into four groups: “Exercises” (n = 43), “Orthopaedic insoles” (n = 43), “Mixed” (n = 39), “Control” (n = 41). During the qualification process, a posturographic examination was performed on a force platform with eyes open and closed in a standing position. Participants were also assessed using the KOOS questionnaire. The obtained data were analyzed in Statistica 13 using the Wilcoxon signed-rank test and the Kruskal–Wallis ANOVA test. A significance level of p = 0.05 was used. Posturographic parameters such as sways length and mean speed with eyes open and closed improved, and the ellipse area of the center of gravity decreased in the mixed group (p = 0.001). The largest clinical effects were observed for sways length with eyes open (d = 2.512) between the control and exercise groups and for sways length with eyes closed (d = 2.172), ellipse area with eyes open (d = 1.361), and mean speed with eyes closed (d = 2.193) between the control and mixed groups. Quality of life (QoL) and functioning improved statistically, and significant between-group differences were found for pain, symptoms, physical activities of daily living (ADL), sports/recreation, and QoL (p < 0.001). However, there were no significant differences between the exercise group and the orthopedic insole group in terms of symptoms, ADL, sports/recreation, and QoL. A significant clinical effect was observed on the KOOS pain score between the insoles and exercise groups (d = 1.122). The combined use of orthopedic insoles and exercises is the most effective method of rehabilitation. Trial registration: The study was registered in the international Research Registry database ( https://www.researchregistry.com/ ) under registration number researchregistry11661.

Pathways of health care for people living with multimorbidity in two Southern African countries

Multimorbidity, the presence of multiple chronic conditions in one person, is a growing global health concern. Integration of chronic care services is urgently needed, especially in low-resource settings including in Southern Africa, where care has been fragmented by vertical and siloed disease approaches. Many countries share similar challenges of integration, presenting rich opportunities for shared learning. Yet, rarely are these opportunities capitalised upon, in part because of a lack of systematic knowledge about the similarities and differences in health system contexts, challenges and current progress towards integration. As part of an inter-country collaboration, we sought to answer the questions: What are the common and distinct characteristics of the care pathways for people living with multimorbidity in Malawi and Zimbabwe, and the opportunities and challenges that emerge through such a country-level comparison? We used an iterative, qualitative research design that involved a desk review of relevant indicators, policies and strategies; key informant interviews, collaborative workshops, and the development of case studies of service integration in practice. Thematic analysis and comparison of challenges of integration across different levels of care revealed uneven funding for different diseases, a lack of both ‘vertical’ and ‘horizontal’ integration, frequent stockouts of drugs and diagnostic equipment, especially for noncommunicable diseases (NCDs), and inadequate training and support for clinicians. In both countries, progress towards decentralising and integrating chronic disease care at national level, has occurred through inclusion of specific NCDs into HIV programmes. This is prone to leave out comprehensive chronic care for people that are not living with HIV and reproduces verticalised programming. We suggest that a promising avenue for wider scale-up of decentralised, non-HIV-dependent integrated care lies in the expansion of an Integrated Chronic Care Clinic (IC3) model that provides comprehensive health system integration for all chronic diseases. Further cross-country learning and feasibility assessment is needed to advance this model.

Selective isotope separation of 169Er for medical applications

Environmental footprint quantification and optimization methods for digital poster design based on life cycle assessment

Digital poster design has become a dominant visual communication medium, yet its environmental impacts remain poorly understood despite assumptions of inherent sustainability. This research developed a specialized life cycle assessment methodology to quantify and optimize the environmental footprint of digital poster systems. The framework encompasses five lifecycle stages from design creation through data deletion, employing real-time monitoring and dynamic data collection across a six-month case study with a digital marketing agency. Assessment results revealed total carbon emissions of 7.45 kg CO₂-eq per functional unit, with distribution infrastructure and display operations contributing 89% of lifecycle impacts. Implementation of comprehensive optimization strategies achieved 28.6% reduction in climate change impact through hardware efficiency improvements, temporal scheduling, and cloud platform adoption. Sensitivity analysis identified data center PUE as the most influential parameter, while geographic variations significantly affected regional impacts. The methodology advances LCA application in digital systems by incorporating workload-specific assessments and providing actionable optimization guidance. These findings demonstrate that systematic environmental management can achieve substantial impact reductions while maintaining creative excellence, supporting the digital design industry’s transition toward genuine sustainability rather than merely shifting environmental burdens between lifecycle stages.

RSM optimization of Tetracycline-loaded PLGA nanoparticles in chitosan/HPMC hydrogels for sustained antibacterial delivery

Limited efficacy of a therapeutic anti-CD40 monoclonal antibody to inhibit activated CD4 T cell autoimmunity in vitro

Iscalimab is a nondepleting anti-CD40 monoclonal antibody, expected to suppress immune responses by blocking the costimulation by antigen-presenting cells through CD40-CD40L ligation. This therapeutic antibody indeed inhibited proliferation of B lymphocytes and TNF production by dendritic cells and is being tested in clinical trials to treat B cell mediated autoimmune diseases. Since iscalimab showed limited clinical benefit and did not improve kidney and liver transplantation outcomes compared to standard tacrolimus treatment, we studied whether a biosimilar of iscalimab affects T cell responses in vitro. For this, we stimulated autoreactive effector and alloreactive naïve CD4 T cells in the presence of anti-CD40 antibody and measured the impact on cell proliferation. While we confirmed the capacity of iscalimab biosimilar antibody to bind to B cells and dendritic cells and to completely inhibit proliferating B cells, it showed limited to no efficacy to inhibit proliferation of diabetogenic beta-cell specific effector CD4 T cell clones. The CD40 blockade also did not affect the induction of proliferation of naïve alloreactive CD4 T cells, by dendritic cells. Based on our in vitro data pointing to minimal inhibition of T cells by CD40 blockade, we propose that iscalimab may not suffice to accomplish durable benefit as intervention strategy to treat type 1 diabetes or other T cell mediated diseases.

Wave energy converters as offshore wind farm guardians: a pathway to resilient ocean systems

Empowering rural governance with digital technology: Deep learning models for automated detection of rural buildings using remote sensing images

Building detection from drone imagery represents a transformative approach to rural governance by enabling precise spatial data acquisition for critical applications including illegal construction monitoring, disaster assessment, and cadastral mapping. However, automated detection systems face persistent challenges including extreme scale variations in rural buildings, complex background interference from vegetation and shadows leading to boundary ambiguity, and severe scarcity of high-quality annotated datasets that limit model generalization. To overcome these limitations, this study introduces an integrated framework featuring three innovative components: the Multi-scale Hybrid Attention module employs parallel convolutional pathways with channel and spatial attention to dynamically capture multi-scale features while suppressing background noise; the Dynamic Feature Pyramid Network utilizes content-aware routing to adaptively fuse hierarchical features for optimal scale-invariant representation; and the Progressive Contrastive Learning strategy leverages both labeled and unlabeled data through hard sample mining to enhance discriminability under data constraints. Extensive experiments validate the model’s efficacy, achieving a mean Intersection over Union (MIoU) of 87.3%, pixel accuracy (PA) of 94.2%, and mean Average Precision (mAP) of 89.6% on the Massachusetts Buildings Dataset, substantially surpassing benchmarks like U-Net (80.1% MIoU), SegNet (78.9% MIoU), and DeepLabV3+ (82.4% MIoU), with ablation studies confirming critical module contributions (e.g., MIoU drops to 81.5% without MHA). The framework demonstrates robust cross-dataset generalization (72.3% MIoU on Chinese rural data) and effective problem resolution, establishing a scalable solution for intelligent rural governance through accurate building extraction. The dataset and code used in this study have been uploaded to the GitHub website: https://github.com/xiexie1234567890/rural_building_detection/tree/main .

Geospatial mapping, risk assessment and multivariate analysis of naturally occurring radionuclides and potentially toxic elements in agrarian soils of SAS Nagar, Punjab, India

Dynamic postural stability in individuals with ACL reconstruction versus healthy controls with insights into sex differences: A cross-sectional study

Objectives To compare dynamic postural stability, measured by time to stabilization (TTS) and postural stability indices (PSI), after double-leg counter-movement jump (CMJ) landing in individuals 9–24 months following anterior cruciate ligament reconstruction (ACLR) and healthy controls. Additionally, to explore the effect of sex and ACLR status on postural stability. Methods This cross-sectional laboratory-based study included 41 participants: 21 individuals (10 females) 9–24 months post-ACLR and 20 healthy controls (10 females). Participants performed double-leg countermovement jumps (CMJs) on force plates, landed, and maintained the landing position for 10 seconds. Time to stabilization (TTS), defined as the time (s) required for the ground reaction force to reach and maintain a stable state following landing, and postural stability index (PSI), a composite measure of the ability to maintain equilibrium during the transition from dynamic to static conditions, were calculated and compared between groups. Results The ACLR group exhibited significantly higher TTS values than healthy controls, indicating a longer duration to achieve stability. Specifically, the resultant vector TTS when combined from both force plates (RVTTS-C), and the vertical TTS in the operated leg (VTTS-op) was higher in the ACLR than the healthy controls (p = 0.03, p = 0.02, respectively). Furthermore, males with ACLR demonstrated higher VTTS combined (VTTS-C) and VTTS-op than females post-ACLR (p = 0.03, p < 0.01, respectively) and higher VTTS-op compared to healthy males (p = 0.03). There were no differences in PSIs between groups. Conclusion Our study revealed significant deficits in dynamic postural stability in individuals post ACLR, with notable sex differences. The findings suggest a need for targeted neuromuscular rehabilitation to improve landing stability post ACLR and reduce the risk of secondary injury. Further research is needed to understand sex-specific postural stability mechanisms for tailored rehabilitation.

Demographic and regional disparities in concurrent respiratory and renal failure mortality: a CDC WONDER analysis, 1999–2024

Abstract Concurrent respiratory and renal failure carries exceptionally high mortality, yet population-level trends remain understudied. We analyzed temporal trends and demographic disparities in US mortality for this dual-organ failure from 1999 to 2024. We analyzed mortality data via CDC WONDER for deaths citing both respiratory (J96) and renal failure (N17–N19). Age-adjusted mortality rates (AAMRs) per 100,000 persons were extracted. Temporal trends were assessed using Joinpoint regression to estimate the Annual Percent Change (APC) with 95% confidence intervals (CIs). From 1999 to 2024, 894,269 US deaths involved concurrent respiratory and renal failure. AAMR increased from 5.76 to 14.01 per 100,000 population, rising from 1999 to 2011 (APC: 3.96), remaining stable during 2011–2018 (APC: −0.10; P = 0.90), sharply increasing during 2018–2021 (APC: 25.36), and declining from 2021 to 2024 (APC: −8.17). AAMR nearly doubled during 2020–2022 compared with 1999–2019 (16.37 vs. 8.06). Mortality was higher in men (12.01 vs. 7.66), non-Hispanic Blacks (15.42), and in the South and West, with non-metropolitan rates surpassing metropolitan areas in later years. Mortality from concurrent respiratory and renal failure more than doubled in the U.S. over the past two decades, with substantial disparities by sex, race/ethnicity, and geography. The sharp pandemic-era increase and persistent socio-regional inequities underscore a growing public health burden that warrants focused clinical attention and resource allocation.

Screening for HFpEF in pacemaker patients: Study design and protocol of the PM-HFpEF study

Background Heart failure with preserved ejection fraction (HFpEF) is common in older multimorbid patients and is associated with substantial morbidity and mortality. Pacemaker (PM) patients may be particularly vulnerable given the clustering of conventional HFpEF risk factors and the hemodynamic effects of long-term right ventricular pacing. Nevertheless, HFpEF is rarely systematically assessed in device clinics. Objectives To determine the prevalence of HFpEF in a cohort of permanent PM patients using a structured guideline-aligned screening protocol and to characterize their clinical, functional, and pacing-related profiles. Methods PM-HFpEF is a single-center, prospective, cross-sectional study conducted at a tertiary hospital in Portugal. Eligible adults with conventional transvenous pacemakers and right ventricular apical pacing implanted between January 2018 and December 2022 will be invited to attend a one-day screening visit. The protocol includes clinical assessment, N-terminal pro-B-type natriuretic peptide testing, 12-lead electrocardiography, comprehensive transthoracic echocardiography, routine device interrogation, frailty assessment (the Portuguese-validated version of the Edmonton Frail Scale), and health-related quality-of-life evaluation using the 12-item Kansas City Cardiomyopathy Questionnaire. Exercise diastolic stress echocardiography using an upper-limb ergometer will be performed when resting findings are inconclusive. HFpEF will be adjudicated according to the 2021 European Society of Cardiology diagnostic definition. Discussion The PM-HFpEF study is designed to provide robust estimates of HFpEF prevalence within a real-world PM population, together with detailed characterization of their clinical and device-related profiles. This information may help inform future clinical assessment and research strategies for this often-overlooked yet clinically significant group of patients.

Integrating remote sensing and multi-criteria decision analysis for groundwater zoning in the Eastern Desert of Egypt

Abstract The Eastern Desert of Egypt is a hyper-arid region where groundwater serves as the primary alternative to surface water for sustainable development. However, comprehensive assessments of groundwater potential across this vast and geologically complex region remain limited. This study addresses this gap by developing a spatial model for delineating groundwater potential zones (GWPZ) using an integrated approach that combines remote sensing, Geographic Information Systems (GIS), and the Analytical Hierarchy Process (AHP). Seven key thematic layers, precipitation, lithology, slope, drainage density, soil type, land use/land cover (LULC), and lineament density, are selected, standardized, and weighted based on hydrogeological relevance. These layers are integrated through a weighted overlay analysis in a GIS environment. The resulting GWPZ map is initially classified into five categories: very high, high, moderate, low, and very low potential. The very high and very low potential zones have very small areas in the final output due to the region’s arid conditions and hydrogeological limitations. The remaining zones covered the study area as follows: high potential (7.7%), moderate (54.5%), and low potential (37.7%). Model reliability is assessed through two complementary validation approaches. First, 370 groundwater wells with available location data are spatially overlaid on the GWPZ map, showing limited overlap with high recharge zones, as most wells target deep fossil aquifers not influenced by present-day surface conditions. Second, a supplementary validation using three independent surface-derived indicators: Topographic Wetness Index, curvature, and lineament–stream intersection density, demonstrated strong agreement with the GWPZ output. The integration of these two validation methods confirms the robustness of the model for mapping shallow groundwater recharge potential in arid environments. This framework offers a scalable, data-driven approach to support groundwater exploration and strategic water resource planning in similar regions worldwide.

A next generation of the schema therapy model of personality pathology: A cross-cultural and international study protocol

Background Personality disorders are highly prevalent worldwide imposing substantial personal and social challenges. Schema Therapy is an effective psychotherapeutic approach for personality pathology and other complex characterological problems. New scientific insights prompted a re-evaluation of its theoretical underpinnings leading to a reformulated Schema Therapy theory. Furthermore, the assumed cross-cultural universality of the Schema Therapy model has not been tested. Aims This project has two primary aims: (1) To develop revised instruments based on the reformulated theory that are psychometrically sound and valid across diverse cultures and languages. (2) To validate the Schema Therapy-related constructs and their inter-relationships across cultures. Methods New draft versions of the Young Schema Questionnaire, Schema Coping Inventory, and Schema Mode Inventory were developed. Before dissemination, these instruments will undergo rigorous psychometric evaluation to refine item sets and ensure linguistic and conceptual consistency. A minimum of 100 adult mental health patients and 100 non-patients from each participating country will complete the revised instruments. Sociodemographic and mental health-related variables will also be assessed. Statistical analyses will evaluate (a) internal consistency, (b) unidimensionality, (c) cross-cultural invariance, (d) factorial validity (if possible), and (e) known-group validity. Malfunctioning items will be deleted, and subscales will be shortened, if possible, targeting internal consistency of ≥.80. Expected outcomes This study is expected to yield optimized versions of the three instruments aligned with the reformulated theory. These findings will inform subsequent international studies to further assess the structural and cross-cultural validity of the revised scales. The resulting empirically validated scales will be openly accessible, facilitating worldwide utilization. Discussion This protocol outlines the first international study based on the reformulated theory, aiming to extend the psychopathological coverage and enhance the cross-cultural application of evidence-based treatments for personality pathology. Results will be disseminated through peer-reviewed publications and conference presentations. Potential limitations are discussed.

Integrative multiomic analysis reveals co-ordinated alternative splicing in human bone marrow stromal stem cells

Prognostic factors associated with visual field recovery in non-arteritic anterior ischemic optic neuropathy

This study aimed to identify baseline prognostic factors associated with visual field (VF) recovery in patients with non-arteritic anterior ischemic optic neuropathy (NAION). This retrospective study included 38 patients (41 eyes) diagnosed with NAION. VF recovery was defined as an improvement of ≥3 dB in mean deviation (MD) at 3 months. Baseline demographic characteristics, systemic vascular risk factors, visual function tests, and retinal nerve fiber layer (RNFL) thickness measured by optical coherence tomography (OCT) were analyzed. Eleven eyes (26.8%) were classified as the recovery group. Compared with the non-recovery group, the recovery group had significantly better baseline best-corrected visual acuity (BCVA) (P = 0.034) and lower glycated hemoglobin levels (P = 0.033). Baseline VF impairment was significantly less severe in the recovery group, with higher MD (P = 0.049) and visual field index (VFI) values (P = 0.014). No significant association was observed between topical eye drop treatment, including brimonidine and netarsudil, and visual field recovery (p = 0.723). Baseline BCVA strongly correlated with BCVA at 1, 3, and 6 months (all P < 0.001). Multivariate analysis confirmed that better baseline MD (P = 0.041) and higher VFI (P = 0.036) were independently associated with VF recovery. However, RNFL thickness measured at initial visit by OCT did not reliably predict recovery. These findings highlight that baseline functional status remain as the most important predictor of visual field recovery in NAION.

Association of calcimimetic use with lower mortality in elderly patients with low body mass index and inflammation compared with non-users

Supporting patients using a digital self-management intervention for symptoms of fatigue, pain, and urgency/incontinence in Inflammatory Bowel Disease: a mixed methods process evaluation of trial facilitators

Background A randomised controlled trial (RCT) of a facilitator-supported digital programme (IBD-BOOST) for symptom management in Inflammatory Bowel Disease found no difference in disease-specific quality of life and symptom relief compared with controls. Process evaluation is necessary to inform the interpretation of trial outcomes. This study evaluated facilitator adherence to intervention delivery and facilitator perspectives on training, intervention delivery and supervision during the trial, and implementation. Methods A mixed-methods process-evaluation study nested within an RCT. A randomised sample of participant-facilitator in-programme messages during the intervention were assessed using a bespoke fidelity assessment framework. Semi-structured interviews were conducted with nineteen facilitators pre and post intervention delivery and assessed using reflexive thematic analysis. Results Facilitators adhered to the trial protocol for intervention delivery achieving high fidelity throughout. Qualitative interviews revealed facilitators valued the IBD-BOOST intervention and felt the training and on-going supervision equipped them well for the task. Facilitators expressed concerns regarding workload-related time constraints during the trial and cautioned that similar implementation challenges may arise if the intervention were delivered within routine clinical care. Conclusion This process evaluation demonstrated that, although the overall trial outcomes were unsuccessful, this was not attributable to facilitator infidelity in intervention fidelity or a lack of enthusiasm for the intervention. Instead, other factors, including participant engagement, may have played a significant role in the limited effectiveness observed. Further investigation is needed to identify and address these contributing factors, which could include barriers to participant engagement or potential misalignment between the intervention design and the needs and expectations of its target population.