Search Results (11,248)

This study investigates the economic viability of a new composting station dedicated to the recycling of date palm by-products. A field experiential analysis was performed in the Figuig Oasis (Morocco), providing the first evidence on the agronomic quality of the compost. The compost produced from date palm by-product was compared to cattle manure and unamended soil and can be considered as a good-quality amendment, demonstrating its ability to enhance soil fertility. Second, a socio-economic survey was conducted to explore farmers’ perceptions and adoption of sustainable agricultural practices. A total of 201 farmers out of 450 farmers registered in Figuig’s municipal administration were surveyed. In terms of fertilisation, farmers preferred locally produced organic fertiliser when available in order to improve soil organic matter content and reduce dependence on chemical inputs. The selling price for the compost was set at 0.14 EUR/kg to reflect the current market price for compost and the willingness of about 38% of the farmers surveyed to buy it. Third, a detailed cost/benefit analysis was performed, with a breakdown of the station’s operational and investment expenses. This illustrates the minimum scale needed to generate a viable business model. Financial projections show that increasing production capacity from 350 tonnes/year to 3500 tonnes/year reduces unit production costs while increasing profits. As illustrated by the application of the Ecocanvas framework, the socio-economic analysis reveals the potential to generate positive environmental, economic, and social impacts, as the circular approach could be replicable and scalable in similar oases agro ecosystems. Full article

Background: Rare diseases affect fewer than 1 in 2000 people, but collectively, they impact millions. Their diagnosis and management present challenges due to low prevalence, clinical heterogeneity, and a lack of standardized protocols. Nurses play a key role in assisting and caring for these patients by providing direct care, emotional support, and health education. Objective: The objective of this systematic review is to update the existing knowledge on nurses’ level of understanding regarding rare diseases, as a decline in their training can compromise the quality of care and access to early detection. Methodology: A bibliographic search was conducted in Scopus, PubMed, CINAHL, SciELO, and Cochrane Library, selecting studies published between 2014 and 2024 on rare disease knowledge. The PRISMA model was followed, and the review was registered with PROSPERO under code CRD42024580656. Result: Ultimately, 24 studies were included. The main results showed a significant gap in nursing education concerning rare diseases. Conclusion: Continuous education, telemedicine, and the integration of health technologies were highlighted as improving competencies in rare diseases. Therefore, it is a priority to increase nursing training in rare diseases at all levels. Full article

Background: Elective surgery soon after SARS-CoV-2 infection is linked to high morbidity, but the risk > 7 weeks post-infection is uncertain. Methods: A PROSPERO-registered systematic review (CRD42023416842) following PRISMA 2020 searched PubMed, Web of Science, WHO COVID Database, Wiley, Google Scholar, and Scopus (Jane 2020–July 2025) for studies reporting postoperative outcomes in patients with confirmed COVID-19 ≥ 7 weeks before elective surgery. Primary endpoints were cardiopulmonary, neurological, renal and thrombotic complications, ICU/hospital stay and 30-day mortality. Results: Thirteen observational studies (38,055 patients) met inclusion criteria. In patients operated ≥7 weeks after mild or asymptomatic infection, overall mortality rate was 2.27% (607/26,688), with no significant excess versus uninfected controls. Pneumonia (1.66%), pulmonary embolism (1.47%), arrhythmias (2.57%) and myocardial injury (1.06%)—did not exceed baseline surgical rates. Thrombosis occurred in 2.8% but lacked a clear association with prior infection. Conversely, individuals with previous moderate-to-severe disease or recent COVID-19-related hospitalization showed higher complication rates, especially in complex procedures such as coronary bypass. Conclusions: Evidence to date indicates that COVID-19 history beyond seven weeks does not independently raise perioperative morbidity or mortality for most elective procedures. Full article

Gingivitis is a common and reversible inflammatory condition caused by dental plaque accumulation, which, if left untreated, can progress to periodontitis. Conventional oral care products like chlorhexidine (CHX) and fluoride are effective in plaque control but are often associated with adverse effects such as dental staining and mucosal irritation. This systematic review aimed to compare the efficacy and safety of natural versus conventional toothpastes and mouthwashes in managing plaque-induced gingivitis. The review followed PRISMA guidelines and was registered in PROSPERO (No. 1008296). A systematic search was conducted across PubMed, Web of Science, and Scopus for English-language clinical studies published between 2015 and 2025. Eligible studies included randomized controlled trials and clinical trials on human subjects with plaque-induced gingivitis. Exclusion criteria were studies on animals, in vitro experiments, review articles, and studies lacking control groups. Data extracted included intervention type, sample characteristics, clinical indices (PI, GI, SBI), inflammatory biomarkers, adverse events, and patient adherence. A narrative synthesis was conducted due to study heterogeneity. Fifteen studies were included. Natural products such as neem, green tea, aloe vera, and propolis demonstrated comparable effectiveness to CHX and fluoride in reducing gingival inflammation and plaque indices, with a lower incidence of side effects. In particular, natural formulations showed superior tolerability and better patient compliance, especially in long-term use. However, variability in concentration and the formulation of natural products limits their clinical standardization. In conclusion, natural oral care products appear to be effective and better-tolerated alternatives to conventional agents in managing gingivitis. Nonetheless, further long-term, standardized clinical trials are needed to confirm their efficacy and define optimal formulations. Full article

Background: High-ability students, despite their potential, may underachieve academically. The existing literature suggests the presence of subtypes, such as perfectionistic or creative high-ability students, who underachieve for different reasons. However, empirical work identifying these profiles and linking them to underachievement remains limited. Methods: We analyzed self-reported data by 930 high-ability adolescents across Hong Kong, the Netherlands, Taiwan, and the United Kingdom. We conducted a pre-registered confirmatory latent profile analysis on five dispositions theoretically relevant to underachievement: creativity, academic self-efficacy, self-regulation, perfectionistic standards, and self-criticism. We examined how these profiles related to underachievement risk, measured by academic performance and self-perceived underachievement. Results: Four profiles emerged. Two aligned with underachievement-related theories, namely the “self-satisfied” profile (low self-criticism, high self-regulation and creativity; prevalent in Asia) and the “maladaptively perfectionistic” profile (high self-criticism but low creativity, academic self-efficacy, and self-regulation; prevalent in Western Europe). Academic performance did not differ across profiles. However, adolescents in the “self-satisfied” profile were less likely to self-perceive as underachievers, while those in the “maladaptively perfectionistic” group were more likely. Interestingly, self-perception as underachievers in both profiles was positively linked with academic performance. Conclusions: These findings provide empirical evidence on subtypes among high-ability students that may differentially present underachieving risks. Full article

This study investigates the mediating role of self-awareness within the broader framework of business acumen, emphasizing its connection to entrepreneurial accounting proficiency and financial performance in community enterprises across Thailand. The purpose is to advance theoretical understanding by integrating metacognition theory and the resource-based view (RBV), and to provide practical insights for strengthening grassroots entrepreneurship. Using survey data from 210 enterprises, a hybrid Structural Equation Modeling–Artificial Neural Network (SEM–ANN) approach is applied to capture both linear and nonlinear relationships among cognitive, technical, and financial variables. The results confirm that accounting proficiency has a significant and positive effect on self-awareness with value of 0.125. However, self-awareness does not exert a direct influence on financial performance. These findings suggest that self-awareness may function as a cognitive enabler, facilitating the translation of entrepreneurial skills into effective decision-making, rather than serving as an independent predictor of financial outcomes. Empirical patterns further reveal that commercial enterprises report higher self-awareness than service firms, unregistered enterprises show greater awareness than registered ones, and financially stable firms display lower awareness, suggesting complacency or overconfidence. In contrast, regular participation in training significantly enhances awareness, underscoring the role of continuous learning. Full article

In sport, pain is often normalized, leading athletes to train or compete despite discomfort. This can shape their response to pain, with catastrophizing potentially triggering fear of movement, avoidance behaviors, and increased pain. While previous research has examined the relationship between pain and catastrophizing in individuals with chronic pain, few studies have explored these effects in the sports population. This study investigated the effects of a pain neuroscience educational program on catastrophizing and injury rates in youth female and male athletes. This parallel randomized trial included an intervention group (IG) and a control group (CG), both undergoing a 12-week program on healthy habits in sport. The IG received additional pain neuroscience information. Catastrophizing levels were collected before and after using the Pain Catastrophizing Scale. Injury rates were registered during the study. The results revealed a decrease in catastrophizing levels in the IG compared to baseline (p = 0.028, d = 0.32, 95%CI [0.03, 0.61]). In the IG, only males showed improvements (p = 0.041, d = 0.47, 95%CI [0.08, 0.86]). Injury rates were similar between groups (CG = 26.2%, IG = 27.8%; p > 0.05). Pain education may reduce catastrophizing in youth athletes, particularly males, although effects may vary by sex and context. Full article

The Spanish Constitution of 1978 recognizes the fundamental right of freedom of conscience and religion, the principle of equality and non-discrimination on religious grounds, and the principle of secularism and neutrality of the state. However, the legislative development of these principles is strongly stratified, and different levels of rights can be distinguished, depending on whether we are speaking about confessions with an agreement (Catholic Church, evangelicals, Jews, and Muslims), those with a mere declaration of well-known roots (Church of Jesus Christ of Latter-day Saints, Jehovah’s Witnesses, Buddhists, Orthodox, and Bahá’ís), and the rest of the confessions merely registered in the Register of Religious Entities (Hinduism, Taoism, Sikhism, Church of Scientology, etc.). Only the Catholic Church has access to the income tax allocation, and only denominations with an agreement enjoy the main tax benefits, or religious teaching in schools. The declaration of notorious rootedness has very limited effects at present (recognition of marriage and the mere expectation of signing a cooperation agreement with the state, provided there is political will to do so). It is, therefore, necessary to opt for a model of common law, which is more neutral and applies equally to all religious groups. Full article

This review explores the application of chemometric techniques for the authentication, characterization, and adulteration detection of Cypriot agri-food products registered under European Union quality schemes, including Protected Designation of Origin (PDO) and Protected Geographical Indication (PGI). Given the increasing global demand for premium and geographically linked food products, ensuring their authenticity and integrity has become critical. Although Halloumi cheese, wines, and Zivania are the most researched Cypriot products, additional studies are still needed. Chemometrics, when coupled with spectroscopy, offers robust analytical tools for distinguishing genuine products from their imitations by characterizing them. This review provides an overview of certified Cypriot products and focuses on published applications where chemometric approaches have been used to assess product origin, composition, and adulteration. The paper concludes with current challenges, methodological limitations, and future directions for expanding the role of chemometrics in food integrity verification within the context of EU geographical indications. Full article

Dysfunctions and disorders of the craniomandibular system are accompanied by pathophysiological changes of muscle groups in the throat/neck and facial area, e.g., pain in the jaw and muscles of mastication and disturbance of occlusion, leading to teeth injury (loss of dental hard tissue, fractures/sensibility disorders, etc.). For muscular dysfunctions, even in the context of psychosomatic disorders and chronic stress, hippotherapy is particularly suitable, since it helps actively to relieve muscle tensions. In the current project we combined hippotherapy with progressive muscle relaxation (PMR) to achieve a synergistic effect. The horses used for therapy (two mares and five geldings between seven and twenty-one years old) were especially suitable because of their calm temperament. In two cases, trained therapy horses were used; in five other cases, the patients used their own horses, which were not specially trained. Right from the beginning, the project was accompanied by veterinary support. Conditions of horse keeping (active stable, same-sex groups, no boxes) were assessed as well as the horses themselves prior to, during, and after each therapy unit. In patients, cortisol, as a quantifiable parameter for stress, was measured before and after each therapy unit. From before the start until the end of each therapy unit of 15 min, the heart rate variability (HRV) of both patients and horses was registered continuously and synchronously. In addition, the behavior of the horses was monitored and recorded on video by an experienced coach and a veterinarian. The stress load during the tension phases in the therapy units was low, perceivable in the horses lifting their heads and a slightly shortened stride length. Likewise, the horses reflected the patients’ relaxation phases, so that at the end of the units the horses were physically and psychically relaxed, too, noticeable by lowering their necks, free ear movement, and a decreasing heart frequency (HF). Altogether, the horses benefited from the treatment, too. Obvious stress signs like unrest, head tossing, tail swishing, or tense facial expressions were not noticed at any time. Twenty jumpers served as a control group in different situations (training, tournament, and leisure riding). Full article

Background/Objectives: Preventive oral health education plays a key role in preparing future healthcare professionals to promote and maintain good oral hygiene. Individually Trained Oral Prophylaxis (iTOP) is a structured, personalized educational program that emphasizes correct brushing techniques and interdental cleaning. This study aimed to evaluate the long-term effectiveness of a single-session iTOP intervention on clinical oral health outcomes among medical and dental students. Methods: A 2-year prospective cohort study included 82 first- and fourth-year medical and dental students at the University of Mostar, Bosnia and Herzegovina. The researchers randomly assigned participants to an iTOP intervention group or a control group. The primary analysis used multivariable linear mixed-effects models for repeated measures, adjusted for study program, academic year, smoking status, and baseline oral-hygiene habits, with effect sizes reported alongside 95% confidence intervals. Clinical periodontal parameters—plaque index, bleeding on probing, and probing depth—were assessed at baseline, three months, and two years. All participants received professional cleaning and oral hygiene kits. Only the intervention group received personalized iTOP training, consisting of a single session with brief reinforcement at the 3-month follow-up. This study was registered at ClinicalTrials.gov (NCT07085013). Results: Seventy-six students completed the follow-up. The iTOP group had significantly lower plaque index and bleeding scores at both follow-up points (p < 0.001) compared to the control group. Baseline differences were observed between subgroups (medical vs. dental; younger vs. older students), but these diminished over time. At the 2-year follow-up, only the plaque index remained significantly improved, while other clinical parameters returned to values comparable to baseline. Conclusions: The iTOP program resulted in significant short-term improvements in oral health among medical and dental students. For sustained long-term outcomes, iTOP or similar structured oral health education programs should be integrated into medical and dental curricula. Enhancing oral health awareness among healthcare providers may ultimately contribute to improved public oral health outcomes. Given the single-center design and the single-session nature of the intervention, the results should be interpreted with caution. Full article

The road transport sector alone is responsible for 15% of global energy-related emissions, while it accounts for 90% of the greenhouse gas emissions from the transport sector in the Philippines. Throughout the history of the Philippine Energy Plan (PEP), electric vehicles (EVs) have not been explicitly included as part of the plan. However, upon the enactment of the Electric Vehicle Industry Development Act (EVIDA) or the Republic Act 11697 guided by the Comprehensive Roadmap for the Electric Vehicle Industry (CREVI), EVs have gained attention in the Philippines. Hence, the inclusion of EVIDA in the current and latest Philippine Energy Plan (2023–2050) is hoped to reduce GHG emissions from road transport and utilize clean energy for EVs. This paper aims to critique the recent PEP targets and assess their shifts and drivers concerning the enactment of EVIDA. Through the analysis of recent data, there has been a significant rise in registered EVs due to policy implementation and incentives given for EVs. This, however, is far from the set targets of both CREVI and PEP 2023–2050. Common barriers are the lack of EV industry demand and the lack of transport planning of Local Government Units (LGUs). Full article

Objective: The aim of this systematic review was to compare the impact of various dietary patterns on cancer mortality, recurrence, remission, quality of life, and prostate-specific antigen (PSA) in non-metastatic prostate cancer patients. Methods: Ovid Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus databaseswere searched from inception to March 2024. Dietary interventions or observational studies investigating dietary patterns in men with non-metastatic prostate cancer with at least one primary outcome related to mortality, recurrence, remission, quality of life or PSA/PSA doubling time were included. Two independent reviewers conducted article selection, data extraction, and quality assessment. Results: Sixteen eligible articles were included. Adherence to a Mediterranean dietary pattern was linked to lower overall mortality and increased quality of life and adherence to a Prudent diet was associated with both lower overall and cancer-specific mortality risk. A plant-based dietary pattern is associated with increased quality of life. Contrastingly, a Western diet was associated with a higher cancer-specific mortality and overall mortality and high-inflammatory, hyperinsulinaemic, and insulin-resistant diets with increased recurrence. Conclusions: Despite the heterogeneity and inconsistencies of PCa literature, there is fair evidence that suggests unprocessed foods with healthier dietary patterns of Mediterranean and prudent diets confer a beneficial effect on overall and cancer-specific mortality, recurrence, and quality of life whereas, a more Western and unhealthier diet generates the opposite. The increased risk of bias prevents conclusive interpretation of these results and, hence, detracts from its clinical implementation. Future research should focus on increasing sample sizes and robustness and standardisation in study design. Full article

This paper proposes a methodology for implementing a custom-developed explainability model for credit rating using behavioral data registered during the lifecycle of the borrowing that can replicate the score given by the regulatory model for the solidarity economy in Colombia. The methodology integrates continuous behavioral and financial variables from over 17,000 real credit histories into predictive models based on ridge regression, decision trees, random forests, XGBoost, and LightGBM. The models were trained and evaluated using cross-validation and RMSE metrics. LightGBM emerged as the most accurate model, effectively capturing nonlinear credit behavior patterns. To ensure interpretability, SHAP was used to identify the contribution of each feature to the model predictions. The presented model using LightGBM predicted the credit risk assessment in accordance with the regulatory model used by the Colombian Superintendence of the Solidarity Economy, with a root-mean-square error of 0.272 and an R² score of 0.99. We propose an alternative framework using explainable machine learning models aligned with the internal ratings-based approach under Basel II. Our model integrates variables collected throughout the borrowing lifecycle, offering a more comprehensive perspective than the regulatory model. While the regulatory framework adjusts itself generically to national regulations, our approach explicitly accounts for borrower-specific dynamics. 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