Given the aging global population, identifying heart failure (HF) phenotypes has become crucial, as distinct disease characteristics can influence treatment and prognosis in older adults. This study aimed to analyze the association between clustering of cardiovascular risk factors and HF in older adults. A cross-sectional epidemiological study was conducted with 1322 older adults (55% women, mean age 70.4) seen in primary health care. Diagnosis of HF was performed by a cardiologist based on diagnostic tests and medical history. Cardiovascular risk factors included hypertension, diabetes, hypercholesterolemia, and smoking. Using logistic regression, potential associations were tested. Individual risk factor analysis showed that older adults with hypertension, diabetes, or hypercholesterolemia had up to 7.6 times higher odds to have HF. The cluster where older adults had only one risk factor instead of none increased the odds of HF by 53.0%. Additionally, the odds of older patients having HF ranged from 3.59 times for the two-risk factor cluster to 20.61 times for the simultaneous presence of all four factors. The analysis of clusters substantially increasing HF risk in older adults revealed the importance of individualizing subgroups with distinct HF pathophysiologies. The clinical significance of these clusters can be beneficial in guiding a more personalized therapeutic approach. Full article

Osteoporosis, characterized by reduced bone density and increased fracture risk, affects over 200 million people worldwide, predominantly older adults and postmenopausal women. The disruption of the balance between bone-forming osteoblasts and bone-resorbing osteoclasts underlies osteoporosis pathophysiology. Standard treatment includes lifestyle modifications, calcium and vitamin D supplementation and specific drugs that either inhibit osteoclasts or stimulate osteoblasts. However, these treatments have limitations, including side effects and compliance issues. Natural products have emerged as potential osteoporosis therapeutics, but their mechanisms of action remain poorly understood. In this study, we investigate the efficacy of natural compounds in modulating molecular targets relevant to osteoporosis, focusing on the Mitogen-Activated Protein Kinase (MAPK) pathway and the gut microbiome’s influence on bone homeostasis. Using an in silico and in vitro methodology, we have identified quercetin as a promising candidate in modulating MAPK activity, offering a potential therapeutic perspective for osteoporosis treatment. Full article

Although research has shown that moral distress harms mental health in diverse populations, information on potential moderators of such associations is scarce. In a sample of sub-Saharan African nurses, we examined the link between moral distress and depressive symptoms. We explored for whom and when such relationships may hold with regard to gender, age, and work experience. Participants consisted of 398 nurses drawn from a tertiary healthcare institution in southeastern Nigeria. Data were collected using the Moral Distress Questionnaire (MDQ) for clinical nurses, and the Center for Epidemiological Studies Depression Scale Revised (CEDS-R). Hayes regression-based macro results for the moderation effects indicated that the association of high moral distress with increased depressive symptoms was robust for women but not significant for men. Although older age and higher years of nursing experience were associated with reduced symptoms of depression, nurses’ age and years of work experience did not moderate the relationship between moral distress and depressive symptoms. To promote mental well-being and preserve the integrity of nurses, gender-based differentials in how morals contribute depressive symptoms should be considered in policy and practice. Full article

Multiple natural frequencies may be encountered when analyzing the essential natural vibration of a symmetric mechanical system or sub-structure system or a system with special parameters. The transfer matrix method (TMM) is a useful tool for analyzing the natural vibration characteristics of mechanical or structural systems. It derives a nonlinear eigen-problem (NEP) in general, even a transcendental eigen-problem. This investigation addresses the NEP in TMM and proposes a novel method, called the determinant-differentiation-based method, for calculating multiple natural frequencies and determining their multiplicities. Firstly, the characteristic determinant is differentiated with respect to frequency, transforming the even multiple natural frequencies into the odd multiple zeros of the differentiation of the characteristic determinant. The odd multiple zeros of the first derivative of the characteristic determinant and the odd multiple natural frequencies can be obtained using the bisection method. Among the odd multiple zeros, the even multiple natural frequencies are picked out by the proposed judgment criteria. Then, the natural frequency multiplicities are determined by the higher-order derivatives of the characteristic determinant. Finally, several numerical simulations including the multiple natural frequencies show that the proposed method can effectively calculate the multiple natural frequencies and determine their multiplicities. Full article

Mathematical modeling is widely used for describing infection transmission and evaluating interventions. The lack of reliable social parameters in the literature has been mentioned by many modeling studies, leading to limitations in the validity and interpretation of the results. Using data from the European MSM Internet survey 2017, we developed a network model to describe sex acts among MSM in Belgium. The model simulates daily sex acts among steady, persistent casual and one-off partners in a population of 10,000 MSM, grouped as low- or high-activity by using three different definitions. Model calibration was used to estimate partnership duration and homophily rates to match the distribution of cumulative sex partners over 12 months. We estimated an average duration between 1065 and 1409 days for steady partnerships, 4–6 and 251–299 days for assortative high- and low-activity individuals and 8–13 days for disassortative persistent casual partnerships, respectively, varying across the three definitions. High-quality data on social network and behavioral parameters are scarce in the literature. Our study addresses this lack of information by providing a method to estimate crucial parameters for network specification. Full article

Background and objectives: while acute ischemic stroke is the leading cause of epilepsy in the elderly population, data about its risk factors have been conflicting. Therefore, the aim of our study is to determine the association of early and late epileptic seizures after acute ischemic stroke with cerebral cortical involvement and electroencephalographic changes. Materials and methods: a prospective cohort study in the Hospital of the Lithuanian University of Health Sciences Kaunas Clinics Department of Neurology was conducted and enrolled 376 acute ischemic stroke patients. Data about the demographical, clinical, radiological, and encephalographic changes was gathered. Patients were followed for 1 year after stroke and assessed for late ES. Results: the incidence of ES was 4.5%, the incidence of early ES was 2.7% and the incidence of late ES was 2.4%. The occurrence of early ES increased the probability of developing late ES. There was no association between acute cerebral cortical damage and the occurrence of ES, including both early and late ES. However, interictal epileptiform discharges were associated with the occurrence of ES, including both early and late ES. Full article

Pyridoxal and pyridoxal 5′-phosphate are aldehyde forms of B₆ vitamin that can easily be transformed into each other in the living organism. The presence of a phosphate group, however, provides the related compounds (e.g., hydrazones) with better solubility in water. In addition, the phosphate group may sometimes act as a binding center for metal ions. In particular, a phosphate group can be a strong ligand for a gold(III) ion, which is of interest for researchers for the anti-tumor and antimicrobial potential of gold(III). This paper aims to answer whether the phosphate group is involved in the complex formation between gold(III) and hydrazones derived from pyridoxal 5′-phosphate. The answer is negative, since the comparison of the stability constants determined for the gold(III) complexes with pyridoxal- and pyridoxal 5′-phosphate-derived hydrazones showed a negligible difference. In addition, quantum chemical calculations confirmed that the preferential coordination of two series of phosphorylated and non-phosphorylated hydrazones to gold(III) ion is similar. The preferential protonation modes for the gold(III) complexes were also determined using experimental and calculated data. Full article

Multi-layer complex structures are widely used in large-scale engineering structures because of their diverse combinations of properties and excellent overall performance. However, multi-layer complex structures are prone to interlaminar debonding damage during use. Therefore, it is necessary to monitor debonding damage in engineering applications to determine structural integrity. In this paper, a damage information extraction method with ladder feature mining for Lamb waves is proposed. The method is able to optimize and screen effective damage information through ladder-type damage extraction. It is suitable for evaluating the severity of debonding damage in aluminum-foamed silicone rubber, a novel multi-layer complex structure. The proposed method contains ladder feature mining stages of damage information selection and damage feature fusion, realizing a multi-level damage information extraction process from coarse to fine. The results show that the accuracy of damage severity assessment by the damage information extraction method with ladder feature mining is improved by more than 5% compared to other methods. The effectiveness and accuracy of the method in assessing the damage severity of multi-layer complex structures are demonstrated, providing a new perspective and solution for damage monitoring of multi-layer complex structures. Full article

Metabolic syndrome (MS) is a widespread disease in developed countries, accompanied, among others, by decreased adiponectin serum levels and perturbed lipoprotein metabolism. The associations between the serum levels of adiponectin and lipoproteins have been extensively studied in the past under healthy conditions, yet it remains unexplored whether the observed associations also exist in patients with MS. Therefore, in the present study, we analyzed the serum levels of lipoprotein subclasses using nuclear magnetic resonance spectroscopy and examined their associations with the serum levels of adiponectin in patients with MS in comparison with healthy volunteers (HVs). In the HVs, the serum levels of adiponectin were significantly negatively correlated with the serum levels of large buoyant-, very-low-density lipoprotein, and intermediate-density lipoprotein, as well as small dense low-density lipoprotein (LDL) and significantly positively correlated with large buoyant high-density lipoprotein (HDL). In patients with MS, however, adiponectin was only significantly correlated with the serum levels of phospholipids in total HDL and large buoyant LDL. As revealed through logistic regression and orthogonal partial least-squares discriminant analyses, high adiponectin serum levels were associated with low levels of small dense LDL and high levels of large buoyant HDL in the HVs as well as high levels of large buoyant LDL and total HDL in patients with MS. We conclude that the presence of MS weakens or abolishes the strong associations between adiponectin and the lipoprotein parameters observed in HVs and disturbs the complex interplay between adiponectin and lipoprotein metabolism. Full article

A series of novel binuclear PNP ligands based on the cyclohexyldiamine scaffold were synthesized for this study. The experimental results showed that positioning the two PNP sites at the para-positions of the cyclohexyl framework led to a significant enhancement in the catalytic activity for selective tri/tetramerization of ethylene. The PNP/Cr(acac)₃/MAO(methylaluminoxane) catalytic system exhibited relatively high catalytic activity (up to 3887.7 kg·g⁻¹·h⁻¹) in selective ethylene oligomerization with a total selectivity of 84.5% for 1-hexene and 1-octene at 40 °C and 50 bar. The relationship between the ligand structure and ethylene oligomerization performance was further explored using density functional theory calculations. Full article

Remote passive sonar detection with underwater acoustic vector sensor (UAVS) has attracted increasing attention due to its merit in measuring the full sound field information. However, the accurate estimation of the direction-of-arrival (DOA) remains a challenging problem, especially under low signal-to-noise ratio (SNR) conditions. In this paper, a novel convolution (COV)-based single-vector acoustic preprocessing method is proposed on the basis of the single-vector acoustic preprocessing model. In view of the theoretical analysis of the classical single-vector acoustic DOA estimation method, the principle of preprocessing can be described as “to achieve an improved denoising performance in the constraint of equivalent amplitude gain and phase response.” This can be naturally guaranteed by our proposed COV method. In addition, the upper bound with matched filtering (MF) preprocessing is provided in the consideration of the optimal linear signal processing for weak signal detection under Gaussian noise. Numerical analyses demonstrate the effectiveness of our proposed preprocessing method with both vector array signal processing-based and intensity-based methods. Experimental verification conducted in South China Sea further verifies the effectiveness of our approach for practical applications. This work can lay a solid foundation in improving underwater remote vector acoustic DOA estimation under low SNR, and can provide important guidance for future research work. Full article

Cervical esophageal reconstruction is vital to improve the quality of life in cancer surgery patients. Microsurgery is crucial in providing vascularized tissue for defect repair, particularly in secondary cases with a higher risk of failure due to larger defects and damage from previous surgery and radiotherapy. The purpose of this study was to describe the clinical characteristics of a series of patients who underwent secondary repair of esophageal defects and provide practical information for the management and treatment of such cases based on the authors’ experience and the literature review. Methods: We retrospectively reviewed the electronic medical records of the Plastic Surgery Clinic at the University of Trieste to identify cases of patients who underwent secondary esophageal microsurgical reconstructions following oncological surgery. Patient demographics, the etiology of esophageal defects, previous surgical history, and preoperative assessments were collected from medical records. Surgical techniques utilized for reconstruction, such as pedicled flaps or free tissue transfers, were documented along with intraoperative information. Postoperative outcomes, including complications, graft viability, and functional outcomes, were evaluated during follow-up. Results: We treated 13 cases of secondary esophageal reconstructions between 2011 and 2022. Most commonly, Antero-Lateral Thigh (ALT) flaps were used in 10 cases, while 2 cases employed a radial forearm flap (RFF), and 1 case employed a chimeric parascapular flap. No flap failures occurred during a median 50-month follow-up. One ALT flap patient experienced postop stricture but maintained swallowing ability. A single tracheoesophageal fistula occurred in an RFF patient with a history of radiotherapy and complete lymph node dissection. Conclusions: Cervical esophageal reconstruction significantly impacts patients’ quality of life by restoring oral feeding and phonation. When local flaps fall short, microsurgical reconstruction with intestinal flaps is valuable but is burdened by limitations. For challenging secondary cases, ALT or RFF flaps emerge as safer options due to their robust pedicles, yielding low complication rates and positive functional outcomes. Full article

The concept of active aging has become central to the public debate in many Western countries, given the increasing aging of the population and the future challenges associated with it. This phenomenon is tightly intertwined with choices regarding the retirement period, which can be postponed for different reasons by individuals in a society. The purpose of this paper is to understand the personal and family characteristics that influence future choices about retirement date in Italy. Utilizing data provided by the Bank of Italy in the Survey on Household Income and Wealth (SHIW), a logistic regression is performed to observe the impact of different covariates on the hypothesized retirement date of individuals close to retirement, i.e., over the age of 50 who are still in working status. The results show that the decision to delay retirement has increased in recent years, and is influenced by personal (e.g., matrimonial status), work, and economic factors. In addition, these factors have different impacts between males and females. Full article

The present study investigated the potential use of blackmouth catshark (Galeus melastomus) skins for gelatin production by employing a combined alkaline and acidic process. The yield of dry gelatin was relatively high (13.95%), showing a high protein content (87.80%), but low moisture (10.64%), ash (1.34%) and lipid (0.03%) contents, on a wet weight basis. Fish skin gelatin showed better color properties (>L*, <+b* values) than porcine skin gelatin and exhibited similar gel strength (315.4 g) and higher viscosity (5.90 cP) than the latter (p < 0.05). Although the electrophoretic study revealed that fish skin gelatin was degraded to a lesser extent than its mammalian counterpart, the resulting fish skin gelatin gels melted at a significantly lower temperature (T_m = 21.5 °C), whereas the reverse process (i.e., gelling) also occurred at a lower temperature (T_s = 10.6 °C) and required more time (t_s = 29.5 min) compared to porcine skin gelatin gels (T_m = 30.4 °C, T_s = 19.4 °C and t_s = 20.7 min). These differences were attributed to the different imino acid content, which was greater in mammalian gelatin (p < 0.05). The results suggested that the skins from blackmouth catshark can be potentially used as an alternative raw material for gelatin production, which will fill the needs of more diverse cultures that do not consume pork- or cow-related products. Full article

Under many interactive environments in the real world, there is often a need to evaluate the minimization effects and subsequent allocation outcomes derived from these interactions under multiple considerations. For instance, in the context of product sales, it is necessary to evaluate how to minimize the manufacturing costs of various producing factors, and sometimes, from a holistic perspective, it may even be necessary to evaluate situations with minimal sales benefits. On the other hand, in order to evaluate related effects derived from interactions and subsequent allocation outcomes, many game-theoretical studies are based on interactive models to formulate evaluating mechanisms, and then they apply axiomatic processes to analyze the rationality of these mechanisms. Therefore, this study first proposes a mechanism for evaluating the minimization effects and subsequent allocation outcomes under multiple considerations. Additionally, considering that different environmental impacts result from varying participation factors, this study also presents several weighted derivatives based on participation factors and their behaviors. Concurrently, we utilize axiomatic results to demonstrate the mathematical correctness and practicality for these evaluating mechanisms. Full article

Adolescents are particularly vulnerable to inadequate provision of mental health and addictions care, as services have been traditionally conceptualized to serve the needs of children or adults. Additionally, rural communities have been largely excluded from research investigating mental healthcare access and exhibit unique barriers that warrant targeted interventions. Finally, perspectives from the target population will be most important when understanding how to optimize adolescent mental health and addictions care. Therefore, the purpose of this study was to identify what adolescents in a rural town perceive as barriers to accessing mental health services. We conducted a cross-sectional survey study with high school students to generate ranked lists of the top perceived individual-level, community-level, and overall barriers. A total of 243 high school students responded to the survey. Perceived barriers were predominantly at the community level. Overall, the top barriers reported were a lack of awareness and education regarding mental health, resources, and the nature of treatment. Students who had previously accessed mental health services identified primary barriers related to mental health professionals, whereas students who had not accessed care reported fear and uncertainty as primary barriers. Modifiable community-level factors related to (1) mental health literacy and (2) mental healthcare professionals were identified by adolescents as the main perceived barriers to accessing mental health and addiction services in a rural town. The findings of this preliminary study should inform intervention strategies and further rigorous research for this traditionally underserved target population. Full article

The heat of hydration, mechanical properties, pozzolanic activity, and microscopic characteristics of cement pastes incorporating co-combusted fly ash (CCFA) were investigated, and the disparities between the CCFA/cement system and the coal fly ash (CFA) binding system were also compared. The results indicate a decrease in the heat of hydration for both CFA and CCFA samples, with a more pronounced trend observed as the fly ash content increased from 10% to 30%. The distinction in the early hydration between CFA and CCFA samples primarily manifested in the rate of heat release, potentially correlated with variations in the active Al₂O₃ content in the fly ash. Neither CFA nor CCFA samples exhibited significant cementitious activity at 3 days, functioning solely as inert fillers in the cement paste. By 3 and 28 days, the mechanical properties of both CFA and CCFA samples were inferior to those of pure cement paste. However, by 180 days of hydration, the compressive strength of CCFA-blended mortar notably increased, with the highest strength observed in the 10% CCFA-blended sample. Both CFA and CCFA samples produced the secondary hydration product C-A-S-H and demonstrated comparable consumption of calcium hydroxide (CH). These findings underscore the potential of CCFA as a supplementary cementitious material (SCM) and lay a foundation for its widespread adoption. Full article

This experimental study investigates the damage effects of nanosecond pulse laser irradiation on silicon solar cells. It encompasses the analysis of transient pulse signal waveform characteristics at the cells’ output and changes in electrical parameters, such as I–V curves before and after laser irradiation under varying laser fluence and background light intensities, and explores the underlying action mechanisms of laser irradiation. The study reveals that as the laser fluence increases up to 4.0 J/cm², the peak value of the transient pulse signal increases by 47.5%, while the pulse width augments by 88.2% compared to the initial transient pulse signal. Furthermore, certain parameters, such as open-circuit voltage, short-circuit current, and peak power obtained, from the measured I–V curve indicate a threshold laser fluence for functional degradation of the solar cell at approximately 1.18 ± 0.42 J/cm². Results obtained from laser irradiation under different background light intensities underscore the significant influence of background light on laser irradiation of silicon cells, with the most severe damage occurring in the absence of light. Moreover, findings from laser irradiation at multiple locations on the silicon cell demonstrate a linear decrease in the output voltage of the silicon cell with an increase in the number of irradiation points. Full article

The aim of this study was to analyze the physical and chemical characteristics of chicken droppings (n = 73), which were collected during different age periods and classified by visual inspection into normal (N) and abnormal (A). Significant differences were found in the texture, pH, dry matter (DM), fatty acids (FAs), short-chain fatty acids (SCFAs), and volatile compounds (VCs) between the tested dropping groups (p ≤ 0.05). The age period of the chicken had a significant influence on the color coordinates, texture, pH, DM, and SCFA contents in N and A as well as on all FAs content in N (p ≤ 0.05). Droppings from the N group had a harder texture, lower values of a* and b* color coordinates, higher DM content, higher level of linoleic FA, and lower level of α-linolenic FA than the droppings from the A group in each age period (p ≤ 0.05). The predominant SCFA was acetic acid, the content of which was significantly lower in the N group compared to that of the A group. The alcohol and organic acid contents were the highest in most of the A group at different age periods, while ketones dominated in the N and A groups. In conclusion, the majority of the tested dropping characteristics were influenced by the age period. While certain characteristics demonstrate differences between N and A, a likely broader range of droppings is required to provide more distinct trends regarding the distribution of characteristics across different droppings. Full article

Adjacent cyclic explosions significantly impact the stability of underground anchored caverns. Based on the similar model test of the vault explosion of the anchored cavern, the dynamic analysis finite element software ANSYS/LSDYNA(18.0) was used to establish a model of the straight wall side explosion of the underground anchored cavern and conduct a numerical simulation. When the total amount of explosion load is the same, we compared the stress time history curve, displacement time history curve, tunnel wall displacement, and circumferential strain curve of the surrounding rock in the underground anchored cavern (under both a high-level single-side blast and a low-level cyclic side blast). We obtained the dynamic response rules of the surrounding rock. By comparing the damage evolution process of the surrounding rock in the two situations, the damage accumulation law of the surrounding rock was analyzed. At the same time, the axial stress distribution characteristics of underground anchor cavern anchors under the action of cyclic explosion were studied. The findings demonstrate that when the total level of blast load adjacent to the cavern is the same, the displacement and circumferential peak strain of surrounding rock and the axial stress of rock bolt in the high-level single explosion are greater than those in the low-level cyclic explosion. However, compared to a single explosion, the rock mass suffers more damage in the cyclic explosion. This study will provide engineers with information that will assist them with a better understanding of the cumulative damage mechanisms of surrounding rock, as well as the stress characteristics of rock bolts under dynamic loads near the explosion site, which will be used to design underground caves with anti-blast features. Full article

This study aimed to evaluate the earliest changes in the structure and function of the peripheral microcirculation using capillaroscopy and transcutaneous oxygen pressure measurement in children and adolescents with type 1 diabetes mellitus at baseline and during post-occlusive reactive hyperemia (PORH) in the function of diabetes duration. Sixty-seven patients with type 1 diabetes mellitus (T1D), aged 8 to 18 years, and twenty-eight age- and sex-matched healthy subjects were included in the analysis. Diabetic patients were divided into subgroups based on median disease duration. The subgroups differed in chronological age, lipid levels, and thyroid hormones. Capillaroscopy was performed twice: at baseline and then again after the PORH test. Transcutaneous oxygen pressure also was recorded under baseline conditions during and after the PORH test. Comparison of capillaroscopy and transcutaneous oxygen pressure parameters at rest and after the PORH showed no statistically significant difference between the subgroups. This remained true after adjusting for variables that differentiated the two subgroups. However, in the group of patients with long-standing diabetes, significant negative correlations were observed between the Coverage value after the PORH test and capillary reactivity with TcPO₂_zero (biological zero). Significant positive correlations were also found between distance after the PORH test and TcPO₂_zero. The results of our study indicate that in patients with a shorter duration of diabetes, the use of multiple tests provides a better characterization of the structure and function of microcirculation because the onset of dysfunction does not occur at the same time in all the tests. Full article

For complex equipment, it is easy to over-evaluate the impact of failure on production by estimating the reliability level only through failure probability. To remedy this problem, this paper proposes a statistical evaluation method based on fuzzy failure data considering the multi-state characteristics of equipment failures. In this method, the new reliability-evaluation scheme is firstly presented based on the traditional statistical analysis method using the Weibull distribution function. For this scheme, the failure-grade index is defined, and a fuzzy-evaluation method is also proposed by comprehensively considering failure severity, failure maintenance, time, and cost; this is then combined with the time between failures to characterize the failure state. Based on the fuzzy failure data, an improved adaptive-failure small-sample-expansion method is proposed based on the classical bootstrap method and the deviation judgment between distributions of the original and newborn samples. Finally, a novel reliability-evaluation model, related to the failure grade and its membership degree, is established to quantify the reliability level of equipment more realistically. Example cases for three methods of the scheme (the failure-grade fuzzy-evaluation method, the sample-expansion method, and the reliability-evaluation modeling method) are presented, respectively, to validate the effectiveness and significance of the proposed reliability-evaluation technology. Full article