Search Results (4,183)

Background: Immunization coverage has increased substantially in the Western Pacific Region, saving millions of lives and supporting disease elimination efforts. However, gaps in coverage and inequitable vaccine access persist, leaving millions unvaccinated. Wealth-based inequalities remain a critical barrier to achieving equitable immunization coverage and maximizing the health benefits of vaccination programs. Methods: We analyzed full immunization coverage among 1-year-olds in 10 middle-income countries of the Western Pacific Region using data from the WHO Health Inequalities Data Repository. National and wealth quintile-specific coverage rates and within-country inequalities were assessed using absolute and relative measures (difference, ratio, slope index of inequality, and relative index of inequality). Trends over time were examined in countries with longitudinal data (n = 5), identifying pro-rich or pro-poor changes based on shifts in quintile-specific coverage. We also calculated the population attributable risk (PAR) and fraction (PAF) to estimate the potential increase in national coverage if wealth-based inequalities were eliminated. Findings: Substantial gaps in immunization coverage persist across all countries studied (n = 10), but with substantial between- and within-country disparities. Coverage was higher among the richest quintiles in half of the countries, with the rest showing no significant disparities. Trends in inequalities were mixed: Cambodia, Mongolia, and Viet Nam experienced pro-poor improvements over time; the Philippines saw widening pro-rich inequalities; and Lao PDR showed little change. Population attributable risks (PAR) showed that eliminating wealth-based inequalities could increase national coverage significantly in five countries (Fiji, Lao PDR, Papua New Guinea, Samoa, and Tonga), with relative gains that could increase national coverage by up to 50% while achieving equity gains. Conclusions: Addressing wealth-based inequalities in immunization could drive substantial gains in national coverage across the Western Pacific Region. Sustained, equity-oriented approaches are essential to achieving universal vaccine access and ensuring no population is left behind. Inequality patterns can guide equity-focused policies to reach underserved and disadvantaged populations. Full article

Background/Objectives: The recent development of four-dimensional X-ray velocimetry (4DXV) technology (three-dimensional space and time) provides a unique opportunity to obtain preclinical quantitative functional lung images. Only single-scan measurements in non-survival studies have been obtained to date; thus, methodologies enabling animal survival for repeated imaging to be accomplished over weeks or months from the same animal would establish new opportunities for the assessment of pathophysiology drivers and treatment response in advanced preclinical drug-screening efforts. Methods: An anesthesia protocol developed for animal recovery to allow for repetitive, longitudinal scanning of individual animals over time. Test–retest imaging scans from the lungs of healthy mice were performed over 8 weeks to assess the repeatability of scanner-derived quantitative imaging metrics and variability. Results: Using a murine model of fibroproliferative lung disease, this longitudinal scanning approach captured heterogeneous progressive changes in pulmonary function, enabling the visualization and quantitative measurement of averaged whole lung metrics and spatial/regional change. Radiation dosimetry studies evaluated the effects of imaging acquisition protocols on X-ray dosage to further adapt protocols for the minimization of radiation exposure during repeat imaging sessions using these newly developed image acquisition protocols. Conclusions: Overall, we have demonstrated that the 4DXV advanced imaging scanner allows for repeat measurements from the same animal over time to enable the high-resolution, noninvasive mapping of quantitative lung airflow dysfunction in mouse models with heterogeneous pulmonary disease. The animal anesthesia and image acquisition protocols described will serve as the foundation on which further applications of the 4DXV technology can be used to study a diverse array of murine pulmonary disease models. Together, 4DXV provides a novel and significant advancement for the longitudinal, noninvasive interrogation of pulmonary disease to assess spatial/regional disease initiation, progression, and response to therapeutic interventions. Full article

Background/Objectives: Aortic stenosis (AS) leads to progressive left ventricular (LV) pressure overload, adverse myocardial remodeling, and eventual functional decline. While traditional parameters such as left ventricular ejection fraction (LVEF) may remain preserved until advanced stages, they are insufficiently sensitive to early dysfunction. Global longitudinal strain (GLS) offers improved detection but remains load-dependent. In contrast, non-invasive myocardial work (MW)—derived from pressure-strain loops—offers a more load-independent assessment of myocardial function. This systematic review and meta-analysis aimed to evaluate the effects of transcatheter aortic valve implantation (TAVI) on MW indices in patients with severe AS. Methods: We performed a systematic review and meta-analysis of studies reporting non-invasive myocardial work parameters before and after TAVI (PROSPERO ID: CRD420250517138). Databases were searched through 31 March 2025. Pooled mean differences in global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were calculated using random-effects models. Sensitivity analyses and meta-regression were conducted to explore heterogeneity and the influence of baseline characteristics. Results: Eleven studies encompassing 1493 patients were included. TAVI was associated with a significant reduction in GWI (−236.67 mmHg% [95% CI: −373.82 to −99.52]; I² = 97.0%; p = 0.002) and GCW (−243.71 mmHg% [95% CI: −407.38 to −80.03]; I² = 97.4%; p = 0.006). No significant changes were observed in GWW or GWE. Meta-regression showed age and baseline LVEF significantly influenced GWE changes, but not other parameters. Conclusions: TAVI leads to a significant reduction in GWI and GCW, reflecting decreased myocardial workload and afterload relief. These findings support the utility of MW indices as valuable tools for assessing myocardial adaptation post-TAVI and potentially guiding clinical decision-making. Full article

Accurate interpretation of physical test results is essential to objectively measure parameters both at a single point in time and throughout longitudinal assessments. This is particularly relevant for tests of speed and change of direction, which are among the most commonly used assessments for soccer players at different levels. This study aimed to quantify the impact of start-line distance (30 cm vs. 100 cm) on linear sprint splits (5–30 m), change-of-direction (COD), and T-test performance in elite youth soccer players, while also examining potential order effects. The study involved 82 youth soccer players (14–19 y; 180.68 ± 6.97 cm; 71.65 ± 7.91 kg; BMI 21.90 ± 1.57) from an elite academy, divided into two groups. The first group started trials at 30 cm from the starting line, then at 100 cm, while the second group performed in the reverse order. All participants underwent a standard sequence of tests: anthropometric measurements, 5, 10, 20, and 30 m sprints, change-of-direction running, and the T-test. The longer start (100 cm) improved sprint times with large effects tapering with distance: 5 m (Hedges’ g = 1.00, 95% CI 0.80–1.25; Δ = 0.076 s, 0.060–0.093; 6.99%), 10 m (g = 1.37, 1.14–1.68; Δ = 0.102 s, 0.086–0.119; 5.63%), 20 m (g = 1.58, 1.36–1.88; Δ = 0.112 s, 0.096–0.127; 3.66%), 30 m (g = 1.48, 1.26–1.80; Δ = 0.114 s, 0.097–0.131; 2.71%). COD also improved (rank-biserial r = 0.516, 0.294–0.717; Δ = 0.075 s, 0.034–0.116; 1.00%) and the T-test improved (g = 0.61, 0.37–0.86; Δ = 0.107 s, 0.068–0.145; 1.26%). Order effects on Δ were evident for 30 m (Welch t = −3.05, p_Holm = 0.0157, d = −0.67) and COD (MWU p_Holm = 0.0048, r = −0.43). Protocols must specify and report the start geometry; the order should be randomised or counter-balanced, particularly for 30 m and COD. Full article

Human–machine trust has shifted over the past three decades from trust in automation to trust in AI, while research paradigms, disciplines, and problem spaces have expanded. Centered on AI in healthcare, this narrative review offers a longitudinal synthesis that traces and compares phase-specific changes in theory and method, providing design guidance for human-AI systems at different stages of maturity. From a cross-disciplinary view, we introduce an Interdisciplinary Human-AI Trust Research (I-HATR) framework that aligns explainable AI (XAI) with human–computer interaction/human factors engineering (HCI/HFE). We distill three core categories of determinants of human-AI trust in healthcare, user characteristics, AI system attributes, and contextual factors, and summarize the main measurement families and their evolution from self-report to behavioral and psychophysiological approaches, with growing use of multimodal and dynamic evaluation. Finally, we outline key trends, opportunities, and practical challenges to support the development of human-centered, trustworthy AI in healthcare, emphasizing the need to bridge actual trustworthiness and perceived trust through shared metrics, uncertainty communication, and trust calibration. Full article

The COVID-19 pandemic caused the world to pause temporarily on an almost planetary scale. The creation and diffusion of knowledge about environmental planning and public health are now almost taken for granted. However, such processes were rather different in pre-pandemic times. It took a substantial dose of labor and resources to generate the information needed to produce useful and usable knowledge, and especially to make it available to others in a timely and effective way. As automobility has come to occupy center stage in the lives of an increasing number of suburbanized dwellers, it has taken multiple energy and public health crises, bold leadership, and the real threat of climate change to create the conditions needed to bolster sustainable Non-Motorized Transportation (NMT) as a complement to cleaner and more convenient mass transit options in cities. How does knowledge about sustainable NMT get created? How are sustainable NMT innovations diffused? How can technological and societal transitions to more sustainable realities be nurtured and augmented? This article utilizes a longitudinal and integrated knowledge creation and diffusion model with a Participatory Planning Process to analyze the adoption of measures aimed at reducing the negative consequences of too much automobility and encouraging higher levels of walking, cycling, and mass transportation. The research methods comprised autoethnographic, qualitative, and policy evaluation techniques. The study makes use of the means and ends matrix to discuss cases from five distinct realms: personal, academic, institutional, volunteering NGO, and private sector. The key findings and lessons learned promote scenarios of managed degrowth and sustainable urban transitions. Full article

Background: Endothelial cells (EC), crucial components of the vascular system, are adaptable cells that maintain homeostasis and respond to pathological events through structural and functional plasticity. Hepatocyte growth factor (HGF) is a multifunctional cytokine that has been demonstrated to have protective and disruptive influence on the blood barrier function. In endothelial biology, its role is also poorly characterized. The present study explores the impact of supraphysiological concentrations of HGF on mouse brain endothelial cells (MBECs), scrutinizing how it alters their integrity and morphology. Methods: Two groups of MBECs—control (CTR) and experimental (EXP)—were analyzed at two time points: early passage (p5) and late passage (p41). The EXP-groups (p5 and p41) were treated with HGF at a concentration of 4 µL/mL. Cellular morphology was assessed with brightfield microscopy; protein expression and localization of the tight junction marker (ZO-1) and the endothelial marker (Factor VII related antigen/von Willebrand factor, vWf) were analyzed using Western blotting, immunocytochemistry, and confocal microscopy. Intercellular barrier function was estimated via Transendothelial Electric Resistance (TEER) and Transendothelial Dextran Permeability (TEDP) assays. Results: Microscopical analysis demonstrated a change in the morphology of the MBECs from a longitudinal, spindle-like shape to a rounded, more spheroid, cobblestone-like morphology under high-dose HGF treatment. Western blotting revealed a progressive decrease of ZO-1 expression in the EXP-groups. The expression of vWf did not show significant differences. Qualitative immunocytochemical staining: vWf showed consistent expression across all groups. ZO-1 displayed a punctate, well-defined membrane and cytoplasmic localization pattern in the CTR-groups at p5 and p41. In contrast, the p5 EXP-group demonstrated a shift to a more diffuse cytoplasmic pattern. At p41, the EXP-group displayed a markedly reduced ZO-1 signal with no clear-cut membrane localization. Confocal analysis: ZO-1: punctate membrane-associated localization in CTR-groups at p5 and 41. The EXP-groups at p5 and p41 confirmed the diffuse cytoplasmic ZO-1 distribution. Phalloidin: well-organized actin cytoskeleton in CTR-groups, but rearrangement and stress fiber disorganization in the EXP-groups, especially at p41. The merged images confirmed reduced co-localization of ZO-1 with actin structures. Barrier function: TEER values dropped significantly in HGF-treated cells. TEDP to small and medium molecular weight dextran increased markedly under HGF treatment. Conclusions: Our data demonstrate that supraphysiological doses of HGF in an in vitro MBEC-barrier-like model disrupt TJ organization, leading to morphological changes and functional weakening of the MBEC-barrier-like structure, as shown by uncoupling between ZO-1/F-actin cytoskeleton, reduced TEER, and increased size-selective paracellular permeability (TEDP). Full article

Instagram is a hugely popular social media site; however, it has also been cited in many times as being a source of low self-esteem, unhappiness, and body dissatisfaction. Despite this, there is potential to use Instagram as a self-care delivery system and create positive changes in users’ mental health by showing them a specific type of image. In this paper, we use Stress Reduction Theory to demonstrate that viewing images of nature on Instagram can improve well-being (H1), by increasing feelings of connectedness with nature (H2). Furthermore, we posit this same influence will elicit more altruistic behaviour from users (H3). In a laboratory experiment, participants accessed images using either the #naturephotography hashtag, or a control hashtag (#bookshelves). Analyses showed that, in line with the proposed positive effects of SRT, viewing natural images improved well-being and positive emotions, and this was at least partially mediated by increased connectedness to nature. Future studies that use a more longitudinal approach, and examine how images can be presented within a more robust psychiatric intervention are then discussed. Full article

Background: The relationship between total cholesterol (TC) levels and mortality in older adults is complex and may differ from younger populations. While hypercholesterolemia is a known midlife risk factor, this association may weaken or reverse with age. Biological differences in cholesterol metabolism—particularly hormonal changes—may contribute to sex-specific mortality risks, but this remains underexplored. We examined the association between TC and all-cause mortality in older adults, assessing sex-specific differences. Methods: We used data from the InCHIANTI study, a longitudinal, population-based study conducted in Tuscany, Italy. From the original cohort (N = 1453), 999 participants ≥65 years with baseline TC and mortality data were included. TC levels were categorized as <200 mg/dL, 200–239 mg/dL, and ≥240 mg/dL. The primary outcome was all-cause mortality over 6-years. Kaplan–Meier curves and Cox proportional hazards models assessed mortality risk across TC categories in the overall population and by sex. Restricted cubic splines explored non-linear associations. Models were adjusted for age, sex (only in overall population), BMI, physical activity, diabetes, COPD, hypertension, eGFR, polypharmacy and frailty. Results: A threshold effect was observed: mortality risk rose sharply below ~200 mg/dL and remained stable above. Compared to the <200 mg/dL group, intermediate and high TC levels were associated with lower mortality risk (HR 0.72; 95% CI: 0.53–0.99 and HR 0.71; 95% CI: 0.49–1.02, respectively). In sex-stratified analyses, this pattern was pronounced in women but weaker and not statistically significant in men. Results held after excluding statin users and were confirmed by spline analysis. Conclusions: In older adults, particularly women, low TC may signal underlying vulnerability, including malnutrition or inflammation. Full article

Background/Objectives: Thyroid dysfunction (hypo- and hyperthyroidism) and cancer incidence have increased over the past decades, possibly linked to environmental contributions from endocrine disrupting chemicals (EDCs). Glyphosate is one of the most widely used herbicides globally and has endocrine-disruptive properties. Because of the sensitivity of the thyroid gland to endocrine disruption and the increased glyphosate exposure worldwide, this comprehensive review aimed to summarize studies investigating the link between glyphosate/glyphosate-based herbicides (GBHs) and thyroid dysfunction in human, animal, and in vitro studies. Methods: PubMed, Scopus, and Embase were used to search for original studies assessing glyphosate or GBH exposure and thyroid-related outcomes through December 2024. Data were extracted on study design, population or model, exposure, and thyroid outcomes. A total of 28 studies, including 9 human, 3 in vitro, and 16 animal studies were included. Results: Human studies showed mixed findings with some suggesting associations between glyphosate exposure and altered thyroid hormone levels, while others found no significant effects. Animal studies, particularly in rodents and amphibians, showed thyroid hormone disruption and altered gene expression, especially after perinatal or developmental exposure. In vitro studies reported changes in thyroid-related gene transcription and cell viability, however at concentrations exceeding those seen in humans. Conclusions: While there is some evidence that glyphosate may disrupt thyroid function, differences in study populations, exposure assessment methods, species models, and exposure doses complicated the comparison and summarization of the results. Further mechanistic and longitudinal studies are needed to clarify the thyroid-specific risks of glyphosate exposure. Full article

Background/Objectives: Understanding the psychological determinants of vaccine uptake is critical for effective public health strategies, particularly during prolonged pandemics. The Health Belief Model is widely used to examine vaccine behavior, yet its applicability in longitudinal and policy-intensive contexts remains underexplored. This study assessed how two core Health Belief Model constructs—perceived severity of and susceptibility to COVID-19—related to vaccine intentions and uptake over time, and how these perceptions varied by demographic characteristics. Methods: Data came from Optimise, a longitudinal cohort study of adults in Victoria, Australia, conducted between September 2020 and August 2022. Perceived severity of and susceptibility to COVID-19 were measured monthly, alongside COVID-19 vaccine intentions and uptake. Generalized Estimating Equations evaluated associations between these two Health Belief Model constructs and vaccine outcomes over time. Separate models identified demographic predictors of perceived severity and susceptibility. Results: Perceived severity of COVID-19 was positively associated with intention to receive further COVID-19 vaccine doses (OR = 2.53, 95% CI: 1.26–5.07) and the total vaccine doses received (OR = 2.74, 95% CI: 1.58–4.76), with these associations changing over time as vaccine mandates were lifted and the pandemic context evolved. Perceived susceptibility to COVID-19 showed no significant associations with vaccine outcomes. Older age, presence of a chronic health condition, and lower employment status was associated with higher perceived severity. In contrast, perceived susceptibility was higher among high-income earners but lower among older adults and the unemployed. Conclusions: The predictive value of two Health Belief Model constructs was context- and time-dependent. Perceived severity consistently predicted vaccine uptake once mandates were lifted, while susceptibility did not. Our findings highlight the importance of context-sensitive behavioral frameworks when designing vaccine promotion strategies during extended public health crises. Full article

This paper investigates the combustion characteristics of promising decarbonized fuel mixtures—methane/hydrogen (CH₄/H₂) and ammonia/hydrogen (NH₃/H₂)—with a focus on how they interact with external electric fields. The key findings are that these flames possess significant electrochemical properties, allowing for non-intrusive control over their stabilization, shape, and structure using relatively weak electric fields. The research combines experimental techniques like volt-ampere characteristic (VAC) measurement and advanced Hilbert visualization to analyze flame deformation, temperature distribution, and species concentration. Two orientations of the electric field were considered: transverse and longitudinal. For the transverse field, an assessment of the degree of flame deformation was made, indicating the preservation of the laminar combustion regime. In the longitudinal electric field, a change in the combustion stabilization mode was observed, which was detected through visualization and current-voltage characteristics (CVC). Full article

Living kidney transplantation offers the best results for end-stage renal disease patients, but concerns about cardiovascular risk after nephrectomy for kidney donors have been raised. We aimed to estimate the contribution of renal function to endothelial dysfunction (ED) and subclinical inflammation in a non-interventional, prospective, multicenter, longitudinal study with two cohorts: living kidney donors and their transplant recipients (registered clinical trial NCT02515643). The measured glomerular filtration rate (mGFR) by iohexol clearance, estimated GFR according to the CKD-EPI and MDRD-4 formulas, and levels of endothelial dysfunction (sVCAM-1, sICAM-1, E-selectin, von Willebrand Factor, pentraxin, and urinary albumin-to-creatinine ratio) and subclinical inflammation biomarkers (sIL-6, sTNF-R1, sTNF-R2, sTWEAK, and high-sensitivity C-reactive protein) were determined at baseline and 1-year follow-up. Fifty pairs of donors and recipients were recruited between 2015 and 2018. Among the endothelial dysfunction biomarkers, sVCAM-1 increased in donors and decreased in recipients (p < 0.01) while, among the inflammation biomarkers, sTNFR1 and sTNFR2 significantly increased in donors and decreased in recipients (p < 0.001). After transplantation, parallel increases and decreases in ED and subclinical inflammation biomarkers were observed in the donor and recipient cohorts, respectively. Long-term follow-up is needed to characterize the cardiovascular risk associated with these changes. Full article

Background: Elite athletes are frequently subjected to high-intensity training regimens, which can result in cumulative physical stress, overtraining, and potential health risks. Monitoring autonomic responses to such load is essential for optimizing performance and preventing maladaptation. Objective: The present study aimed to assess changes in autonomic regulation immediately and two hours after training in athletes, using an integrated framework (combining time- and frequency-domain HRV indices with nonlinear and recurrence quantification analysis). It was investigated how repeated assessments over a 4-month period can reveal cumulative effects and identify athletes at risk. Special attention was paid to identifying signs of excessive fatigue, autonomic imbalance, and cardiovascular stress. Methods: Holter ECGs of 12 athletes (mean age 21 ± 2.22 years; males, athletes participating in competitions) over a 4-month period were recorded before, immediately after, and two hours after high-intensity training, with HRV calculated from 5-min segments. Metrics included HRV and recurrent quantitative analysis. Statistical comparisons were made between the pre-, post-, and recovery phases to quantify autonomic changes (repeated-measures ANOVA for comparisons across the three states, paired t-tests for direct two-state contrasts, post hoc analyses with Holm–Bonferroni corrections, and effect size estimates η²). Results: Immediately after training, significant decreases in SDNN (↓ 35%), RMSSD (↓ 40%), and pNN50 (↓ 55%), accompanied by increases in LF/HF (↑ 32%), were observed. DFA α1 and Recurrence Rate increased, indicating reduced complexity and more structured patterns of RR intervals. After two hours of recovery, partial normalization was observed; however, RMSSD (−18% vs. baseline) and HF (−21% vs. baseline) remained suppressed, suggesting incomplete recovery of parasympathetic activity. Indications of overtraining and cardiac risk were found in three athletes. Conclusion: High-intensity training in elite athletes induces pronounced acute autonomic changes and incomplete short-term recovery, potentially increasing fatigue and cardiovascular workload. Longitudinal repeated testing highlights differences between well-adapted, fatigued, and at-risk athletes. These findings highlight the need for individualized recovery strategies and ongoing monitoring to optimize adaptation and minimize the risk of overtraining and health complications. Full article

Clostridioides difficile is an obligate anaerobe and is primarily transmitted via the fecal–oral route. Data characterizing the microbiome changes accompanying transitions from non-colonized to C. difficile colonized subjects are currently lacking. In this retrospective cohort study, we examined 16S rRNA gene sequencing data in a total of 481 fecal samples belonging to 107 patients. Based on C. difficile status over time, patients were categorized as Negative-to-Positive, Negative Control, and Positive Control. A linear mixed effects model was fitted to investigate the changes in the Shannon α-diversity index over time. Zero-inflated negative binomial/Poisson mixed effects models or generalized linear mixed models with negative binomial/Poisson distribution were used to investigate the changes in taxon counts over time among different groups. A total of 107 patients were eligible for the study. The median number of stool samples per patient was 3 (IQR 2–4). A total of 42 patients transitioned from C. difficile negative to positive (Negative-to-Positive), 47 patients remained negative throughout their tests (Negative Control) and 18 were always C. difficile positive (Positive Control). A significant difference in microbiome composition between the last negative samples and the first positive samples were shown in Negative-to-Positive patients, ANOSIM p = 0.022. In Negative-to-Positive patients, the phylum Pseudomonadota and family Enterobacteriaceae increased significantly in the first positive samples compared to the last negative samples, p = 0.0075 and p = 0.0094, respectively. Within the first 21 days, Actinomycetota decreased significantly over time in the Positive Control group compared to the other two groups (p < 0.001) while Bacillota decreased in both the Negative-to-Positive group and Positive Control. These results demonstrate that the transition from C. difficile negative to C. difficile positive is associated with alterations in gut microbial communities and their compositional patterns over time. Moreover, these changes play an important role in both the emergence and intensification of the gut microbiome dysbiosis in patients who transitioned from C. difficile negative to positive and those who always tested positive. Full article