Search Results (5,276)

Background/Objectives: Lipedema is a chronic, progressive disorder of the adipo-fascial tissue characterized by abnormal subcutaneous fat accumulation, inflammation, fibrosis, pain, and edema. Despite its considerable impact on patients’ quality of life, it remains underdiagnosed. Recent studies have suggested a potential overlap between lipedema and hypermobility spectrum disorders (HSDs), both involving connective tissue dysfunction. This work explores the shared pathophysiological features of lipedema and HSD, highlighting clinical correlations, comorbidities, and the need for integrated diagnostic and therapeutic approaches. Methods: A cross-sectional observational study was conducted through an online survey targeting individuals with lipedema and a control group with lymphedema. The questionnaire assessed symptoms typically associated with HSD, including musculoskeletal, gastrointestinal, urogynecological, vascular, and neuropsychological manifestations. Descriptive statistics were used to evaluate clinical patterns in both groups. Results: Among the lipedema patients, 44% reported joint hypermobility and 60% recalled being hypermobile during childhood. High rates of pediatric overweight (50%), low muscle tone (55%), and exercise-induced fatigue (70%) were observed. Adult symptoms included joint pain (notably in the ankles, knees, cervical spine, sacrum, and feet), digestive issues (50%), and thyroid disorders (24.4%). Compared with the control group, patients with lipedema showed significantly more connective tissue-related motor deficits and systemic symptoms. Conclusions: Connective tissue laxity may play a critical role in the pathogenesis of lipedema, contributing to multisystemic manifestations through vascular, lymphatic, gastrointestinal, and musculoskeletal involvement. The high prevalence of HSD-like features calls for a paradigm shift in the understanding of lipedema as a systemic disorder. Early identification of connective tissue alterations, especially in children with familial predisposition, could enable timely interventions, potentially mitigating disease progression. A multidisciplinary, evidence-based approach is essential for accurate diagnosis and effective management. Full article

Value alignment between employees and organizations is a salient concern in sustainable human resource management (sHRM). Previous research has mainly treated person–organization (P–O) fit as a static condition assessed at entry, while little is known about its processual nature across the employee lifecycle or about how assessments relate to organizational responses to misfit. Addressing this gap, the present study examines how organizations operationalize value alignment across stages, methods, and remedial responses using original multidimensional indices. A cross-sectional survey of 104 HR managers in Poland was conducted, introducing the Fit Stage Score (assessment points across the lifecycle), the Fit Method Score (breadth of diagnostic tools), and the Misfit Response Score (remedial actions applied when misfit occurs). Results show that foreign-owned firms rely on more diverse diagnostic methods, sectoral variation appears only in the number of assessment stages, and neither executive gender nor ownership form has systematic effects. The strongest finding is the robust association between broader assessments and broader remedial measures, confirming the existence of an integrated “assessment–response bundle.” The study advances theory by providing empirical evidence for a dynamic, multidimensional view of P–O fit. Practically, it highlights that organizations can strengthen alignment by expanding assessment methods and coupling them with concrete remedial strategies such as training, mentoring, or internal mobility. Full article

In the context of China’s increasingly competitive agricultural product branding, authenticity has become a pivotal mechanism for shaping consumer trust and willingness to pay. This study takes Perceived Brand Authenticity (PBA) as its focal construct and builds a chained mediation framework incorporating experiential quality (EQ) and consumer trust. Employing a dual-evidence strategy that combines structural discovery and causal validation, the study integrates Jaccard similarity clustering and PLS-SEM to examine both behavioral patterns and psychological mechanisms. Drawing on 636 valid survey responses from across China, the results reveal clear segmentation in channel choice, certification concern, and premium acceptance by gender, age, income, and education. Younger and highly educated consumers rely more on e-commerce and digital traceability, while middle-aged, older, and higher-income groups emphasize geographical indications and organic certification. The empirical analysis confirms that PBA has a significant positive effect on EQ and consumer trust, and that the chained mediation pathway “PBA → EQ → Trust → Purchase Intention” robustly captures the transmission mechanism of authenticity. The findings demonstrate that verifiable and consistent authenticity signals not only shape cross-group consumption structures but also strengthen trust and repurchase intentions through enhanced experiential quality. The core contribution of this study lies in advancing an evidence-based framework for sustainable agricultural branding. Theoretically, it reconceptualizes authenticity as a measurable governance mechanism rather than a rhetorical construct. Methodologically, it introduces a dual-evidence approach integrating Jaccard clustering and PLS-SEM to bridge structural and causal analyses. Practically, it proposes two governance tools—“evidence density” and “experiential variance”—which translate authenticity into actionable levers for precision marketing, trust management, and policy regulation. Together, these insights offer a replicable model for authenticity governance and consumer trust building in sustainable agri-food systems. Full article

In recent years, there has been growing recognition that reducing environmental pollution, particularly from building emissions, is essential for improving residents’ well-being. Buildings contribute substantially to worldwide greenhouse gas and pollutant emissions, making effective mitigation strategies a priority in achieving Sustainable Development Goals (SDGs). Using data from the 2021 China General Social Survey (CGSS), this study examines the relationship between perceived building environmental pollution and residents’ well-being, as well as the mechanism underlying this relationship, through an ordered probit model. The results indicate that higher levels of building environmental pollution significantly reduce residents’ well-being. To explore heterogeneity, the sample was further divided by urban–rural differences, local environmental protection expenditure level, and geographic region. The research found that residents with lower environmental protection expenditures, residents in rural areas and those in the central region are more likely to be negatively affected by building environmental pollution, with the correlation coefficients being −0.111, −0.104 and −0.101 respectively. Furthermore, the analysis indicates that annual income, the number of children, and type of work have moderating effects on this relationship, with correlation coefficients of 0.047, −0.054, and −0.095 respectively. Overall, this study provides empirical evidence for perceiving the social impact of building pollution in the context of building-related emissions and offers policy-related insights for strengthening environmental protection measures in the construction industry to enhance residents’ well-being. Full article

Background: Engaging in physical activity (PA) is especially significant for adolescents, as this is a key developmental stage for establishing lifelong habits. While the physical, mental, and cognitive health benefits of PA are well-documented, less is known about its relationship with adolescents’ life satisfaction (LS). Most existing evidence often involves small sample sizes, focusing particularly on developed regions, and few studies use large-scale comparative data. Methods: This study examines the association between adolescents’ LS and PA using data from the 2022 Programme for International Student Assessment (PISA), the world’s largest comparative education survey of adolescents. Our analysis included 399,794 adolescents from 64 high- and middle-income countries and economies. We used three-level multilevel regressions. Results: We found that, after controlling for individual, family, and school factors, PA is positively and significantly associated with LS. This finding holds for the pooled sample and across the 64 countries analysed. For most countries, we did not find a significant gender moderator effect, suggesting that the positive association between PA and LS did not vary by gender. Conclusions: The findings suggest a global health promotion strategy to promote PA amongst adolescents as a normative developmental process necessary for their well-being and mental health. Full article

Densely integrated microarchitectures spanning three-dimensional integrated circuits (3D-ICs), chiplet-based designs, and system-in-package (SiP) assemblies make heat a first-order security concern rather than a mere reliability issue. This review consolidates the landscape of thermal side-channel attacks (TSCAs) on densely integrated microarchitectures: we systematize observation vectors and threat models, clarify core concepts and assumptions, compare the most credible evidence from the past decade, and distill the main classes of defenses across the hardware–software stack. We also explain why hardening against thermal leakage is integral to cyber–physical system (CPS) security and outline the most promising research directions for the field. The strategic relevance of this agenda is reflected in current policy and funding momentum, including initiatives by the United States Department of Homeland Security and the Cybersecurity and Infrastructure Security Agency (DHS/CISA) on operational technology (OT) security, programs by the National Science Foundation (NSF) on CPS, and Canada’s Regional Artificial Intelligence Initiative and Cyber-Physical Resilience Program (RAII, >CAD 35 million), to bridge advanced microelectronics with next-generation cybersecurity. This survey offers a clear, high-level map of the problem space and a focused baseline for future work. Full article

Background/Objectives: Antimicrobial resistance (AMR) is a major global health threat, with children at higher risk due to developmental differences in drug metabolism, limited treatment options and inappropriate antibiotic use. Pediatric antimicrobial stewardship programs (ASPs) face implementation challenges, often relying on adult-based guidelines and limited pediatric-specific evidence. This study aimed to identify and prioritize the most critical areas for pediatric ASP intervention development through a structured, multi-round Delphi consensus process with experts in antimicrobial stewardship and infectious diseases. Method: A four-round modified Delphi process was conducted to identify and prioritize key pediatric ASP interventions. Experts in antimicrobial stewardship and infectious diseases were recruited through an existing clinical trial. Using an iterative survey and in-person discussions, experts provided input on priority areas, which were thematically grouped and refined across rounds. Structured feedback supported real-time refinement and consensus-building. Results: Twenty experts participated in the process, generating 25 priority items in Round 1 through open-ended responses. These were narrowed to seven key priorities through structured voting and discussion. The final items were clustered into three intersecting themes: Care Settings, Prescriptions, and Strategies. Care Settings focused on high-impact areas such as outpatient clinics and intensive care units, where misuse is common and/or care is complex. The prescriptions theme prioritized shorter durations and narrow-spectrum agents. The strategy theme highlighted the need for outcome-based metrics, improved diagnostic stewardship, and routine tracking of patient outcomes to guide and assess stewardship efforts. Conclusions: This expert consensus identified key priorities for pediatric ASPs, providing a foundation for future interventions. Findings can be used to inform policy and practice, improving the appropriate use of antimicrobials in pediatrics and combating AMR. Full article

African trypanosomiasis is a protozoan disease that affects both humans and animals. Human African Trypanosomiasis (HAT) is a Neglected Tropical Disease targeted for elimination in 2030. Although WHO has not reported HAT from Nigeria in the last decade, there are published studies reporting seroprevalence, parasite detection/isolation, and animal reservoirs potentially involved in HAT transmission in Nigeria. Interestingly, the burden of Animal African Trypanosomiasis (AAT) continues to increase. In this study, we synthesized published reports on the prevalence of HAT and AAT in Nigeria from 1993–2021, the trypanosome species involved, the spread of animal reservoirs, and the variability in diagnostic methodologies employed. A scoping review was performed following the methodological framework outlined in PRISMA-ScR checklist. Sixteen eligible studies published between 1993 and 2021 were reviewed: 13 for AAT and 3 for HAT. Varying prevalence rates were recorded depending on the diagnostic methods employed. The average prevalence reported from these studies was 3.3% (HAT), and 27.3% (AAT). Diagnostic methods employed include microscopy, PCR and Card Agglutination Test for Trypanosomiasis (CATT). Cattle, pigs, and dogs were identified as carriers of human-infective trypanosomes. This study highlights the scarcity of HAT epidemiological studies/data from Nigeria, the high prevalence, complex epidemiology, limited attention and surveillance of African Trypanosomiasis in Nigeria. Remarkably, WHO records do not reflect the published data showing evidence of HAT prevalence/cases in Nigeria. Unfortunately, diagnostics challenges and unrealistic disease reporting protocols seem to limit HAT reporting from Nigeria. Therefore, adequately coordinated epidemiological surveys and targeted intervention policies are imperative to ascertain the true epidemiological status of HAT in Nigeria and prevent disease re-emergence towards achieving WHO’s elimination targets. The presence of animal carriers of human-infective trypanosomes underscores the importance of a one-health approach to combat African trypanosomiasis effectively. Full article

National-scale long-term forest ecosystem surveys based on systematic sampling offer a robust framework for detecting temporal growth trends of specific tree species across regions. The National Forest Inventory (NFI) of the Republic of Korea serves as a vital source for analyzing long-term forest dynamics on a national scale by providing regularly collected large-scale forest data. However, various limitations, such as the lack of individual-level and spatial interaction data, restrict the development of reliable individual tree growth models. To overcome this, distance-independent models, compatible with the structure and data resolution of the NFI, provide a practical alternative for simulating individual tree and stand-level growth by utilizing straightforward attributes, such as diameter at breast height (DBH). This study aimed to analyze the growth patterns and construct species-specific models for two major plantation species in South Korea, Pinus koraiensis and Larix kaempferi, using data from the 5th (2006–2010), 6th (2011–2015), and 7th (2016–2020) NFI survey cycles. The sampling points included 117 and 171 plots for P. koraiensis and L. kaempferi, respectively. An additional matching process was implemented to improve species identification and tracking across multiple survey years. The final models were parameterized using a distance-independent model, integrating the estimation of potential diameter growth (PG) and a modifier (MOD) function to adjust for species- and site-specific variabilities. Consequently, the models for each species demonstrated strong performance, with P. koraiensis showing an R² of 0.98 and RMSE of 1.15 (cm), and L. kaempferi showing an R² of 0.98 and RMSE of 1.14 (cm). This study provides empirical evidence for the development of generalized and scalable growth models using NFI data. As the NFI increases in volume, the framework can be expanded to underrepresented species to improve the accuracy of underperforming models. Ultimately, this study lays a scientific foundation for the future development of tree-level simulation algorithms for forest dynamics, encompassing mortality, harvesting, and regeneration. Full article

Driven by the green and low-carbon transformation of urban logistics, the integration of crowdsourced delivery and green transportation is considered an important pathway to achieving sustainable last-mile delivery. This study focuses on urban crowdsourced delivery using cargo bikes and develops an extended behavioral model based on the Theory of Planned Behavior (TPB). The model systematically examines the key factors influencing the public’s behavioral intention (BI) to participate as crowdshippers. While retaining the core structure of TPB, the model incorporates external variables—perceived risk (PR), policy support (PS), and infrastructure conditions (IC)—to improve its explanatory power and applicability to real-world delivery scenarios. A questionnaire survey was conducted in South Korea, yielding 600 valid responses. The results indicate that usage attitude and perceived behavioral control exert significant positive effects on BI. PR has a significant negative effect on both attitude and BI. PS indirectly enhances BI by improving attitudes, whereas IC primarily influences BI by strengthening the public’s sense of control. This study not only expands the theoretical explanatory power of the TPB model in the context of green crowdsourced delivery but also provides empirical evidence for policymakers and platform operators. Full article

Major immunization programs and initiatives have prioritized the advancement of equity in immunization. Over the past decade, the World Health Organization has made contributions to understanding inequalities in immunization, including global analyses of immunization inequality as well as tools for knowledge dissemination and capacity strengthening. This article provides an overview of these contributions, highlighting key findings of scholarly reports and journal articles and identifying areas for further research and development to expand monitoring efforts and enhance their impact. Global analyses have primarily drawn from household survey data to explore inequalities related to economic status, education, gender, and geography. Reports and articles address childhood immunization, COVID-19 vaccine indicators, and maternal tetanus protection. Inequalities were reported across all dimensions, with variation by country and income grouping. Time trends generally suggest persistent, though narrowing, inequalities. Areas for further development include the following: increasing awareness and political support for advancing equity in immunization; expanding the collection, availability, and use of disaggregated immunization data; continuous capacity building of inequality monitoring, especially at national and subnational levels; adapting inequality monitoring practices to changing contexts and priorities; strengthening the links between data/evidence and action/impact; and building on existing partnerships and collaborations. Full article

The introduction of the European Union (EU) Joint Clinical Assessment (JCA) under Regulation (EU) 2021/2282 marks a transformative step in harmonizing health technology assessments (HTAs) across EU member states. This article explores the implications of JCA, particularly in oncology, for member states who utilize cost-effectiveness (CE) analysis and health technology developers (HTDs) who produce this evidence. The JCA framework attempts to standardise the assessment of relative clinical effectiveness and safety across the EU to input into national appraisals. Importantly, it excludes economic evaluations that may be required nationally, necessitating HTDs to align their CE models with the JCA PICO (Population/Intervention/Comparator/Outcome) parameters outlined by member states. This article discusses the challenges and opportunities for aligning JCA and CE modelling outcomes, contrasting evidence requirements between JCA and CE frameworks. It highlights the potential increase in complexity due to the diverse comparators in PICO surveys, necessitating the use of indirect comparison methodologies. It further underscores the importance of early communication between HTDs and HTA bodies to ensure timely, relevant, and pragmatic decision-making. By sharing national PICOs upfront to support national evidence generation, the JCA framework’s potential to aid high-quality decision-making and improve patient access to innovative medicines can be maximised. Full article

Interest in consumer behavior regarding agri-food products is growing, particularly in the context of sustainable and local consumption. This study examines consumer perceptions of certified mountain products in Romania, with a specific focus on cow’s milk. A structured survey was conducted among 576 respondents from the Bucharest–Ilfov metropolitan area, representing the target population of regular food consumers. The data were analyzed using descriptive and comparative statistical methods in SPSS, including chi-square tests and contingency coefficients, to evaluate consumer awareness, attitudes, and their willingness to pay. The results reveal that although awareness of the “mountain product” label is high (88.9%), its direct influence on purchase decisions remains limited, with price, brand, and origin playing stronger roles. Nevertheless, 95% of respondents expressed willingness to pay a premium price, and over 70% associated mountain certification with health benefits and higher quality. These findings highlight both the potential and current limitations of certification as a market-based tool to support sustainable consumption and the economic resilience of mountain areas. The study contributes empirical evidence from a less explored national context. It offers insights for policymakers, producers, and retailers seeking to strengthen short food supply chains and consumer trust in certified labels. Full article

Macroplastic pollution is a growing environmental concern, threatening the marine environment. Despite growing awareness of marine plastic pollution, few studies have assessed the effectiveness of in situ technologies such as safety nets for macroplastic interception. This study aims to evaluate the effectiveness of safety net (SN) systems in intercepting macroplastic debris in the different zones of recreational Yugang Park Beach (YPB), Zhanjiang Bay, China. Safety nets were installed at stations representing different hydrodynamic conditions, and macroplastic debris (2.5–80 cm) was collected and analyzed for size, color, and shape characteristics. Two survey comparisons revealed a higher debris density in the winter survey (1.8 ± 0.3 items m²) than in the summer survey (1.5 ± 0.3 items m²). Most debris fell within the 10–40 cm range, with transparent low-density polyethylene plastic bags being the dominant type, particularly in the winter survey (80.7%). Statistical analysis indicated that plastic size was likely related to net retention characteristics, while tidal influences accounted for a major portion of spatial variability in debris accumulation. These findings suggest that SN systems are effective tools for macroplastic interception and could inform evidence-based coastal management strategies to reduce plastic pollution in similar coastal environments. Full article

Background: Cervical cancer remains a significant global public health concern, with human papillomavirus (HPV) vaccination serving as an effective preventive measure. Despite its proven efficacy, HPV vaccine uptake in Jordan remains low. This study aimed to assess the knowledge, attitudes, and practices (KAP) influencing HPV vaccine recommendation among healthcare professionals. Methods: A cross-sectional survey was conducted between August 2023 and February 2024 among 304 healthcare professionals and trainees in Amman, Jordan, using a pre-validated questionnaire. Descriptive statistics, correlational analyses, and Firth’s penalized logistic regression were employed to examine predictors of vaccine recommendation behavior. Results: Positive attitudes (OR = 3.89; p < 0.001) and active clinical practice (OR = 5.02; p < 0.001) were strong predictors of HPV vaccine recommendation. Unexpectedly, higher knowledge scores were associated with reduced likelihood of recommending the vaccine (OR = 0.44; p = 0.032). Significant variation in KAP scores was observed across professional groups, with physicians and academic staff demonstrating higher levels of engagement. Conclusions: Attitudes and practical engagement were more influential than knowledge alone in shaping HPV vaccine recommendation behavior among healthcare professionals. These findings underscore the need for interventions that not only enhance knowledge but also foster supportive attitudes and strengthen clinical advocacy skills. The results provide actionable evidence to inform targeted strategies for increasing HPV vaccine uptake and reducing cervical cancer incidence in Jordan. Full article