Search Results (1,845)

This study evaluated chemical safety indicators in 38 commercial fish sauces from Thailand, South Korea, Taiwan, and Vietnam sold in Taiwan. We quantified key nitrogenous compounds, biogenic amines, preservatives, and sodium levels, and further characterized metabolite profiles using untargeted ¹H nuclear magnetic resonance (¹H-NMR) spectroscopy. Vietnamese fish sauces exhibited the highest total nitrogen content and lowest pH, indicating superior fermentation quality. Sodium concentrations ranged from 5037 to 12,637 mg/100 mL, and nearly 40% of products, particularly Thai and Korean, exceeded the permitted labeling tolerance (≤120%), highlighting substantial labeling inaccuracies. Preservative analysis revealed the unauthorized or excessive use of benzoates and sorbates in several samples, indicating regulatory non-compliance. Preservative analysis revealed that three of seven Taiwanese samples contained dehydroacetic acid above the regulatory limit of 1 g/kg, with sample C6 both mislabeled and showing the highest concentration (3.22 g/kg). Among the ten Vietnamese samples, two exceeded the permissible limits for combined preservative use, and samples D2–D5 contained triacetin, a non-listed food additive, in violation of current regulations. Notably, South Korean fish sauces contained histamine concentrations up to 539.85 ± 318.88 ppm, with several samples surpassing the Taiwanese regulatory limit of 400 ppm, raising significant food safety concerns. Metabolomic analysis differentiated products by country, with formic acid, acetate, branched-chain amino acids, and alanine contributing to the distinct profiles of Thai and Taiwanese fish sauces. Collectively, our results provide critical insights into the quality and safety of fish sauce products, highlighting the importance of monitoring biogenic amines and ensuring accurate labeling to comply with food safety regulations. Full article

Background: Class II is considered one of the most common malocclusions, influencing 37% of schoolchildren in Europe and 33% of orthodontic patients in the United States. When this type of malocclusion is combined with increased overjet with proclined teeth and maxillary excess, then moving maxillary molars distally is suggested. According to the recent literature, modern appliances that lack patient cooperation can be combined with temporary anchorage devices to provide absolute and skeletal anchorage while supporting the non-compliance appliances to eliminate their side effects, such as anterior and posterior anchorage loss along with maxillary molar inclination and rotation. To counteract these limitations, the Advanced Molar Distalization Appliance (amda^®), a non-compliance appliance for maxillary molar distalization supported by two mini-implants (MIs) with anterior abutments, was recently developed. Methods: In this preliminary prospective clinical trial, eight consecutive patients treated with the amda^® are evaluated through lateral cephalometric radiographs, while its application, construction, and anchorage is presented and discussed. The evaluation of dentoalveolar and skeletal changes has been made with 14 variables measured on the pre- and post-cephalometric radiographs before and immediately after maxillary molar distalization (T₀ and T₁, respectively), along with cephalometric superimpositions by the structural method. Results: In total, the mean distal molar movement was 4.2 ± 1.37 mm, the mean distal tipping was 1.7 ± 1.9 degrees, and the vertical movement was 1.6 ± 2.6 mm. Conclusions: The amda^® seems to provide an ideal option for treating patients with Class II malocclusion, achieving bodily movement of the maxillary molars with only minimal distal tipping and no anchorage loss. Full article

Introduction: Myotonic dystrophies (DM) are progressive genetic disorders with multisystemic involvement, particularly affecting the muscular, respiratory, and neuropsychological systems. Myotonic dystrophy type 1 (DM1), or Steinert’s disease, may lead to severe respiratory complications, including sleep-disordered breathing and hypercapnia, often requiring noninvasive ventilation to manage respiratory failure. However, adherence to NIV remains a major challenge, often influenced by cognitive and psychological factors such as apathy and depression. This study aims to investigate the presence of depression and SDB in patients with DM1 initiating NIV, and to evaluate factors influencing adherence to ventilatory support. Materials and Methods: We selected 13 adult patients (≥18 years) with diagnosis of Steinert’s disease with respiratory impairment who needed to start respiratory support. Dysphagia was assessed in all patients at baseline by a videofluoroscopic swallow study. Beck’s Depression Inventory II was administered for measuring the severity of depression. The Montreal Cognitive Assessment was used as a screening tool to detect signs of neurocognitive disorders. We evaluated adherence to NIV. Results: The study population presented with sleep-disordered breathing, as indicated by a median apnea–hypopnea index (AHI) of 24 events per hour (IQR: 14.2–34.5) and an oxygen desaturation index (ODI) of 25 events per hour (IQR: 18–33). Adherence to NIV was obtained in seven patients. No difference in baseline lung function was observed. Adherent subjects had moderate hypercapnia at baseline; pCO2 was 52 vs. 49 mmHg. Non-adherent patients showed a higher prevalence of depression with a median BDI-II score of 18 vs. 6 in adherent patients. The findings highlight that psychological factors, especially depression, play a crucial role in adherence to NIV. Interestingly, depression was not linked to initial respiratory measurements but showed a significant association with nocturnal oxygen desaturation. This suggests that relying solely on clinical and respiratory assessments may not be adequate to predict or improve treatment adherence. Conclusions: Incorporating psychological evaluations and addressing mental health issues, such as depression, are essential steps to enhance NIV compliance and overall DM1 patient outcomes. A multidisciplinary approach combining respiratory and psycho-emotional interventions is crucial for effective disease management. Full article

Background: Plantar fascitis is a common cause of heel pain in adults. Although various conservative treatments have been studied, comparative real-world effectiveness remains underreported. Objective: To retrospectively evaluate and compare the clinical effectiveness of percutaneous neuromodulation, extracorporeal shockwave therapy (ESWT), and custom foot orthoses in patients with plantar fasciitis. Methods: A retrospective observational study was conducted from January 2020 to December 2023 at a podiatric clinic. Inclusion and exclusion criteria were applied to medical records, and 120 patients were divided into three groups according to treatment, with 7 patients excluded due to non-compliance with follow-up. Pain intensity (VAS) and functional improvement (FFI) were assessed at baseline, 1 month, and 6 months post-treatment. Statistical analysis included paired t-tests, ANOVA, effect size (Cohen’s d), and 95% confidence intervals. The STROBE checklist was followed. Results: All three interventions showed significant improvement in pain and function at 6 months (p < 0.05). Neuromodulation achieved the highest pain reduction (VAS mean difference −6.2, d = 1.02), followed by ESWT (d = 0.78) and orthoses (d = 0.65). Functional scores improved similarly across all groups, with no significant difference at 6 months (p = 0.12). Conclusions: Percutaneous neuromodulation demonstrated greater clinical effectiveness in pain reduction compared to ESWT and orthoses, although functional outcomes were similar. Further prospective studies are needed to confirm these findings. Full article

Background/Objective: The long-term implications of spinal interventional pain procedures (IPPs) remain underexplored. This study aimed to evaluate pain intensity, overall health quality, and disability over a four-year period following an IPP, while also assessing physical therapy (PT) compliance, the need for repeated procedures, and analgesic consumption. Methods: A prospective observational study with retrospective registration was conducted on patients with chronic spinal pain at Hamad Medical Corporation (HMC), Qatar. Patients were assessed using the Numeric Rating Scale (NRS), the Oswestry Disability Index (ODI), and the EuroQol 5-Dimension Index (EQ-5D). Additional tools included the EQ-Health Visual Analog Scale and the Patient Global Impression of Change (PGIC). Follow-ups were performed at 6, 12, 24, 36, and 48 months. Results: A total of 766 patients were initially recruited, of whom 174 met the inclusion criteria. All patients demonstrated significant improvement across all outcome measures compared to the baseline. No significant differences were observed in pain or functional outcomes between PT-compliant and non-compliant groups. By the end of this study, 56.9% of patients reported reduced analgesic use, while 43.1% reported increased use. The patient satisfaction data showed that 55% (62/113) of those receiving a single IPP were satisfied, compared to 54% (33/61) in the multiple IPP group. The PGIC satisfaction scores revealed no statistically significant differences (p = 1). Overall health status, as measured by the EQ-5D Health scale, also showed no meaningful differences between groups. Conclusions: Despite several limitations, patients reported sustained improvement and satisfaction four years post-IPP. PT compliance did not appear to significantly influence long-term outcomes. Further research is needed to identify factors affecting post-IPP recovery and medication usage. Full article

This study investigates the operation and management of an advanced Italian liquid waste treatment platform, focusing on its dual-line configuration and the challenges posed by increasingly heterogeneous waste streams. The main objectives are to (i) characterize the technological and operational features of the system, (ii) evaluate strategies for dealing with variable waste compositions and non-compliant inputs, and (iii) propose governance measures to strengthen cooperation between producers and operators. The methodology integrates the analysis of operational data from 2022 to 2024 (waste volumes, European Waste Catalogue Codes, reagent consumption, sludge production, and energy use) with a critical assessment of acceptance procedures and monitoring protocols. Results show a 10% increase in liquid waste treated over the study period, a growing predominance of complex EWC codes, higher oxygen demand in the thermophilic reactor, and seasonal fluctuations in sludge production. At the same time, the plant achieved stable or improved performance indicators, with specific energy consumption decreasing to 2.08 kWh/kg COD removed in 2024. The study concludes that modular, flexible treatment systems, supported by rigorous waste characterization and real-time decision-making, are essential to ensuring efficiency, regulatory compliance, and long-term environmental sustainability in liquid waste management. Full article

Background and Objectives: Osteoarthritis (OA) is a chronic, degenerative joint disease. The main symptoms include pain that can cause loss of function and stiffness, as well as swelling, reduced range of motion, crepitus, joint deformity, and muscle weakness. It leads to irreversible structural changes, that in advanced stages can require surgical interventions. The aim of this review was to summarize the current literature about the role of virtual reality (VR), exergames and digital technologies in patients with knee osteoarthritis before or after total knee arthroplasty, to understand if it is possible to prevent and reduce the symptoms and if these new technologies are more effective than conventional rehabilitation therapies. Materials and Methods: We conducted a systematic search of PubMed, Cochrane Library, Scopus, and PEDro from inception to November 2024. The review adhered to the PRISMA 2020 guidelines, and the protocol was prospectively registered in PROSPERO (registration number: CRD42024541890). We included randomized controlled trials (RCTs) enrolling participants aged 60 years or older, in which VR or telerehabilitation programs were compared with conventional rehabilitation approaches. Eligible studies had to report at least one of the following outcomes: pain, functionality, stability, or adherence. Two independent reviewers screened titles and abstracts, assessed full-text eligibility, extracted data, and evaluated the risk of bias using the Cochrane Risk of Bias 2 (RoB 2) tool. Results: Fourteen randomized controlled trails (RCTs) (1123 participants; mean age 68.2 years) were included. VR and telerehabilitation generally outperformed conventional rehabilitation for pain (8/13 studies, −0.9 to −2.3 VAS points) and functionality (7/13 studies, WOMAC improvement 8–15%, TUG −1.2 to −2.8 s). Compliance was higher in most technology-assisted programs (6/7 studies, 70–100% adherence). Stability outcomes were less consistent, with only 1/4 studies showing clear benefit. One study favored conventional rehabilitation for functionality. Overall risk of bias was low-to-moderate, with heterogeneity mainly driven by intervention duration, platform type, and supervision level. Conclusions: Structured telerehabilitation, non-immersive VR, and interactive online exercise programs, especially those offering real-time feedback, show comparable or superior benefits to conventional rehabilitation in older adults with knee OA or after TKA, particularly for pain reduction, functional gains, and adherence. These approaches enhance accessibility and home-based care, supporting their integration into clinical practice when in-person therapy is limited. Full article

Accurate and reliable characterization of current transformer (CT) performance is essential for maintaining grid stability and power quality in modern electrical networks. CT measurements are key to effective monitoring of harmonic distortions, supporting regulatory compliance and ensuring the safe operation of the grid. This paper addresses a method for the characterization of CTs across an extended frequency range from 50 Hz up to 150 kHz, driven by increasing power quality issues introduced by renewable energy installations and non-linear loads. Traditional CT calibration approaches involve measurement setups that offer ppm-level uncertainty but are complex to operate and limited in practical frequency range. To simplify and expand calibration capabilities, a calibration system employing a sampling ammeter (power analyzer) was developed, enabling the direct measurement of CT secondary currents of an unknown CT and a reference CT without any further auxiliary equipment. The resulting expanded magnitude ratio uncertainties for the wideband CT calibration system are 10 ppm ($k=2$) up to 10 kHz and less than 120 ppm from 10 kHz to 150 kHz; these uncertainties do not include the uncertainty of the reference CT. Additionally, the operational conditions and setup design choices, such as instrument warm-up duration, grounding methods, measurement shunt selection, and cable type, were evaluated for their impact on measurement uncertainty and repeatability. The results highlight the significance of minimizing parasitic impedances at higher frequencies and maintaining consistent testing conditions. The developed calibration setup provides a robust foundation for future standardization efforts and practical guidance to characterize CT performance in the increasingly important supraharmonic frequency range. Full article

Background/Objectives: The intranasal (IN) route of administration is a promising non-invasive approach for brain targeting, bypassing the blood–brain barrier and enhancing bioavailability. Citalopram hydrobromide (CT), a widely prescribed sparingly water-soluble selective serotonin reuptake inhibitor (SSRI), faces challenges with oral and intravenous administration, including delayed onset, adverse effects, and patient compliance issues. Methods: This study aimed to develop a novel thermoresponsive polymeric micelle (PM) system based on Pluronic^® copolymers (Pluronic F127 and Poloxamer 188) improving CT’s solubility, stability, and nasal permeability for enhanced antidepressant efficacy. A preliminary study was conducted to select the optimized formulation. The preparation process involved using the thin-film hydration method, followed by freeze-drying. Comprehensive evaluations of optimized formulation characteristics included Z-average, polydispersity index (PdI), thermal behavior (lower critical solution temperature, LCST), encapsulation efficiency, X-ray powder diffraction (XRPD), thermodynamic solubility, and biological stability. Additionally, in vitro CT release and CT permeability in nasal conditions were studied. Stability under storage was also evaluated. Results: The optimized CT-PM formulation showed nanoscale micelle size (Z-average of 31.41 ± 0.99 nm), narrow size distribution (polydispersity index = 0.241), and a suitable thermal behavior for intranasal delivery (lower critical solution temperature (LCST) ~31 °C). Encapsulation efficiency reached approximately 90%, with an amorphous structure confirmed via XRPD, leading to a 95-fold increase in CT solubility. The formulation demonstrated appropriate biological and physical stability. In vitro studies showed a 25-fold faster CT release from optimized formulation compared to the initial CT, while CT-PM permeability in nasal conditions increased four-fold. Conclusions: This novel nanoscale thermosensitive formulation is a value-added strategy for nasal drug delivery systems, offering enhanced drug solubility, rapid drug release, stability, and improved permeability. This smart nanosystem represents a promising platform to overcome the limitations of conventional CT administration, improving therapeutic outcomes and patient compliance in depression management. Full article

This paper presents an enhanced pseudo-rigid body model (PRBM) integrated with the LuGre friction law to analyze the dynamic behavior of flexure-hinge-based piezoelectric stick–slip actuators (PSSAs). The PRBM captures flexure compliance through Lagrangian dynamics, while Newtonian mechanics describe the piezoelectric stack and slider motion. Non-linear contact effects, including stick–slip transitions, are modeled using the LuGre formulation. A mass–spring–damper model (MSDM) is also implemented as a baseline for comparison. The models are solved in MATLAB Simulink version R2021a and validated against experimental data from a published prototype. The enhanced PRBM achieves strong agreement with experiments, with a root mean square error of 20.19%, compared to 51.65% for the MSDM. By reformulating the equations into closed-form expressions, it removes symbolic evaluations required in the standard PRBM, resulting in one to two orders of magnitude faster simulation time while preserving accuracy. Stable transient simulations are achieved at fine time steps ($\Delta t={10}^{-8}$ s). A systematic parametric study highlights preload force, flexure stiffness, friction coefficients, and tangential stiffness as dominant factors in extending the linear frequency–velocity regime. Overall, the PRBM–LuGre framework bridges the gap between computationally intensive finite element analysis and oversimplified lumped models, providing an accurate and efficient tool for design-oriented optimization of compliant piezoelectric actuators. Full article

Although approximately half of global lithium consumption is used in the rechargeable battery industry, lithium is also in demand for other specialized applications, such as high-temperature lubricants, ceramics, glass, and pharmaceuticals. The growing need for efficient lithium recovery and recycling underscores the importance of fast and accurate analytical tools for determining lithium concentrations in non-compliant and waste materials generated by industrial processes. In this paper, we present a machine learning-based procedure utilizing Laser-Induced Breakdown Spectroscopy (LIBS) to accurately quantify lithium concentrations in lithium-rich non-compliant materials derived from the industrial production of enamels used for coating metallic surfaces. This procedure addresses challenges such as strong self-absorption and matrix effects, which limit the effectiveness of conventional univariate calibration methods. By employing a multivariate approach, we developed a single model capable of quantifying lithium content across a wide concentration range. A comparison of the LIBS results with those obtained using conventional laboratory analysis (Inductively Coupled Plasma–Optical Emission Spectrometry, ICP-OES) confirms that LIBS can deliver the speed, precision, and reliability required for potential routine applications in the lithium recovery and recycling industry. Full article

Buffer zones around protected areas (PA) face complex governance challenges as territorial transitions accelerate globally, yet limited consensus exists on their definition, ecosystem service (ES) priorities, and management strategies. This study employed a three-round Delphi methodology with 23 transdisciplinary experts to build consensus on buffer zone governance around Cerro Castillo National Park in Chilean Patagonia, using the IPBES ecosystem services framework to structure the analysis. Round 1 employed open-ended questions to explore expert perspectives, Round 2 evaluated 56 statements and 15 strategic components using structured questionnaires, and Round 3 refined non-consensus items. Experts achieved 76.7% overall consensus across three thematic areas: PA interface conceptualization (79.2% consensus on 24 statements), ES assessment (91.2% consensus on 34 statements), and territorial transition strategies (15 components evaluated). Water-related services achieved unanimous agreement across multiple IPBES categories, revealing their potential as boundary objects bridging conservation and development perspectives. Educational approaches and voluntary compliance emerged as high-feasibility strategic components, while regulatory frameworks showed high importance but implementation uncertainty. The study demonstrates that structured expert consultation can identify collaborative pathways for buffer zone governance, with water services providing concrete entry points for multi-stakeholder cooperation and education-based strategies offering promising implementation pathways for sustainable territorial transitions. Full article

Deforestation monitoring is critical to support compliance with regulatory frameworks such as the EU Deforestation Regulation (EUDR), which requires that products containing or derived from beef, cocoa, coffee, palm oil, rubber, soy, and timber are deforestation-free after 31 December 2020. Earth observation (EO) offers a means to assess deforestation, yet map-based verification remains technically limited and uncertain. This study addresses the lack of a systematic assessment of global Forest/Non-Forest (FNF), Tree Cover/Non-Tree Cover (TC/NTC) and Land Use/Land Cover (LULC) datasets by identifying and evaluating 21 publicly available global forest/tree cover reference maps for their alignment with EUDR criteria. This goes beyond merely treating these datasets as simply “fit” or “not fit” for the purpose of the EUDR, but rather aims to assess how well each dataset meets the needs compared to others, acknowledging strengths, weaknesses, and trade-offs. The 21 datasets are reviewed based on EUDR-related parameters (temporal proximity, spatial resolution, and forest definition) as well as accuracy metrics. From this broader review, eight datasets are shortlisted based on their alignment with key regulatory requirements. However, most datasets fail to fully meet all EUDR requirements, particularly forest definitions, with only two datasets satisfying all indicators. Notably, all datasets are unable to distinguish forests from other non-forest, tree-based systems. Reported accuracy metrics reveal a general overestimation of forest areas, while canopy height-based maps tend to underestimate tree cover, potentially excluding forested regions. Regional comparisons show more consistent estimates in South America, while Europe and North America display greater variability. These findings support informed decision-making by companies and policymakers for selecting suitable datasets, while also highlighting conflicts and challenges associated with the use of global forest/tree cover maps for regulatory compliance. Full article

Background and Aim: Mechanical ventilatory support is often required in patients with acute respiratory distress syndrome (ARDS). However, early differences in ventilatory mechanics and severity scores between COVID-19 and non-COVID-19 ARDS patients remain unclear. This study aimed to compare respiratory parameters and clinical severity scores in COVID-19 and non-COVID-19 ARDS patients managed in the emergency department (ED) and evaluate their association with in-hospital mortality. Methods: In this retrospective cohort study, adult patients with ARDS (PaO₂/FiO₂ < 300 mmHg) who received mechanical ventilation in the ED were included. Ventilator parameters and clinical severity scores (SOFA, APACHE II, PSI, and Charlson Comorbidity Index) were recorded at the 120th minute after intubation. Patients were categorized as COVID-19 or non-COVID-19 ARDS, and outcomes were compared between survivors and non-survivors. Logistic regression was used to identify independent predictors of in-hospital mortality. Results: A total of 70 patients were enrolled (32 COVID-19, 38 non-COVID). Plateau pressure, driving pressure, and PEEP were significantly higher in COVID-19 patients, while compliance was without statistical significance. Overall, in-hospital mortality did not differ significantly between the COVID-19 (53.1%) and non-COVID-19 groups (71.1%, p = 0.12). Mechanical power (21.6 vs. 16.8 J/min, p = 0.01) and Charlson Comorbidity Index (6 vs. 5.5, p = 0.02) were significantly higher in non-survivors across the full cohort. Among clinical scores, SOFA was significantly higher in the COVID-19 group (p = 0.02), and APACHE II was significantly higher in non-survivors within the COVID-19 subgroup (p = 0.02). In multivariate analysis, mechanical power and Charlson Comorbidity Index were associated with mortality. Conclusions: COVID-19 patients with ARDS exhibited higher early ventilatory pressures than non-COVID-19 patients, yet early respiratory mechanics were not independently associated with mortality. Mechanical power and Charlson Comorbidity Index were significantly associated with in-hospital mortality. These findings underscore the need to consider both ventilatory load and systemic health status in early outcome assessments of ARDS patients. Full article

The cold-chain supply of perishable fruits continues to face challenges such as fuel wastage, fragmented stakeholder coordination, and limited real-time adaptability. Traditional solutions, based on static routing and centralized control, fall short in addressing the dynamic, distributed, and secure demands of modern food supply chains. This study presents a novel end-to-end architecture that integrates multi-agent reinforcement learning (MARL), blockchain technology, and generative artificial intelligence. The system features large language model (LLM)-mediated negotiation for inter-enterprise coordination, Pareto-based reward optimization balancing spoilage, energy consumption, delivery time, and climate and emission impact. Smart contracts and Non-Fungible Token (NFT)-based traceability are deployed over a private Ethereum blockchain to ensure compliance, trust, and decentralized governance. Modular agents—trained using centralized training with decentralized execution (CTDE)—handle routing, temperature regulation, spoilage prediction, inventory, and delivery scheduling. Generative AI simulates demand variability and disruption scenarios to strengthen resilient infrastructure. Experiments demonstrate up to 50% reduction in spoilage, 35% energy savings, and 25% lower emissions. The system also cuts travel time by 30% and improves delivery reliability and fruit quality. This work offers a scalable, intelligent, and sustainable supply chain framework, especially suitable for resource-constrained or intermittently connected environments, laying the foundation for future-ready food logistics systems. Full article