An Analysis and Evaluation of Kumpfer's Resilience Framework.

The transformation of critical infrastructure such as energy systems toward sustainability imposes a multitude of challenges that are social-technical in nature and require interdisciplinary collaboration. Resilience has received growing attention as a concept to bridge different scientific disciplines in research on energy systems, given their social, ecological, and technical elements. However, a resilience framework that is suitable for merging notions of resilience as a measurable property with notions of resilience as a social construction or an observatory scheme is still a desideratum. Against this backdrop, we present a cross-epistemic resilience (CER) framework for interdisciplinary research on energy and other social-ecological-technical systems. In particular, we introduce the distinction between positivist first-order and constructivist second-order observations and identify four modes of inquiry in resilience research. Our CER framework contributes to interdisciplinary resilience research by pointing out how assumedly incompatible perspectives are able to inform and constructively irritate each other and, hence, enhance the overall understanding of energy systems. The framework has been tested in a radically interdisciplinary research project. We draw on electricity systems as our prime example to illustrate the application of our arguments and concepts.

Chinese culture places a high value on saving face and not bringing shame to the family. This study aimed to examine the associations between face-saving and help-seeking among U.S. Chinese older adults who experienced elder mistreatment (EM). Data were retrieved from the PINE study. Regression analyses were performed. Most EM victims sought help from informal sources only (48.21%), followed by no help (26.79%), informal plus formal help (19.64%), and formal help only (5.36%). For EM screening, face-saving was associated with informal help-seeking intentions (p < .05). For EM subtypes, face-saving was associated with overall help-seeking intentions for financial exploitation (p < .05), but not on physical mistreatment, psychological mistreatment, and caregiver neglect. Face-saving was not associated with help-seeking behaviors. Study findings underscore the significance of a unique cultural value in understanding EM help-seeking intentions among Chinese older adults. Cultural constructs should be considered in future EM research in diverse populations.

This study explores the influence of different parenting styles democratic, authoritarian, and permissive on the intensity of gadget use and its negative impacts on children aged 1-8 years in Bima City. Utilizing a mixed-methods approach, the research design included literature review, hypothesis formulation, data collection via online questionnaires, and data analysis. Quantitative data were analyzed using regression techniques, and qualitative data provided contextual depth. The findings reveal significant differences in gadget use intensity and associated negative outcomes, including reduced social skills and hearing problems, depending on parenting style. Democratic and authoritarian parenting were linked to higher gadget use, while permissive parenting exhibited a wide range of use patterns, from high usage to complete abstention. The study underscores the importance of effective parental monitoring and engagement to manage children's screen time and mitigate adverse effects. Limitations include a localized sample and reliance on self-reported data, suggesting the need for further research in diverse populations. These findings have important implications for parenting strategies and public health policies, emphasizing the need for targeted interventions to educate parents on managing children’s digital habits and promoting healthy development. Future research should further investigate these relationships and develop comprehensive support strategies for parents.

BackgroundMetabolic syndrome (MetS) contributes to an increased risk of cardiovascular diseases. Traditional metrics like body mass index (BMI) have limitations in discerning fat distribution. The purpose of this study was to evaluate the diagnostic accuracy of traditional and novel anthropometric indices in metabolic syndrome and its components in the south coast of Iran.MethodsIn this cross-sectional study, 2694 adults aged 35 to 70 were included. Comprehensive anthropometric and biochemical data were collected and analyzed. There were eight anthropometric indices evaluated in this study, including a body shape index (ABSI), body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), body roundness index (BRI), abdominal volume index (AVI), weight-adjusted waist index (WWI) and waist-height ratio (WHtR).ResultsWHtR (AUC: 0.766 for males, 0.799 for females), BRI (AUC: 0.766 for males, 0.799 for females), and AVI (AUC: 0.769 for males, 0.793 for females) were the best predictors of MetS. ABSI had the weakest correlation with metabolic variables.ConclusionsAVI, WHtR, BRI, and WHR were superior to other measures as anthropometric indexes for determining MetS and its components. The study contributes valuable insights into the utility of traditional and novel metrics in clinical practice, highlighting the need for standardized diagnostic approaches and further research in diverse populations.

BackgroundThis systematic review and meta-analysis investigates the relationship between haemoglobin (Hb) concentrations and obstructive sleep apnea syndrome (OSAS). MethodsFollowing PRISMA guidelines, we searched PubMed, EMBASE, and Cochrane Library from inception to March 8, 2024. Eligible studies included cross-sectional, cohort, and case-control designs comparing Hb concentrations in OSAS patients and healthy controls. Two reviewers independently screened records and extracted data. The risk of bias was assessed using the Joanna Briggs Institute checklist. ResultsA total of 27 studies involving 6499 OSAS subjects and 5199 controls were included. Hb concentrations were significantly higher in OSAS patients compared to controls (SMD: 0.28; 95 % CI: 0.18 to 0.39; I2 = 84.4 %). Subgroup analysis by OSAS severity showed that severe OSAS patients had higher Hb concentrations than those with mild/moderate OSAS. Sensitivity analyses confirmed the robustness of the findings. However, 7 studies reported opposite results, indicating possible regional or methodological differences. ConclusionHb concentrations are elevated in OSAS patients, with higher levels observed in severe cases. The significant heterogeneity and the predominance of studies from Turkey highlight the need for further research in diverse populations. Limitations include potential publication bias and variability in study designs.

Long COVID has been associated with persistent neurological symptoms that impair cognitive function and quality of life, raising questions about the role of genetic factors in symptom severity and persistence. Apolipoprotein E (APOE) polymorphisms, known for their relevance in neurodegenerative diseases, may significantly influence neurological outcomes in long COVID patients. This study aimed to investigate the relationship between APOE polymorphisms, specifically single nucleotide polymorphisms (SNPs) rs7412 and rs429358, and neurological and cognitive symptoms in long-term COVID patients. APOE genotypes were identified through the analysis of SNPs rs7412 and rs429358. Cognitive and behavioral assessments were conducted using the Mini-Mental State Examination (MMSE), the Pfeffer Functional Activities Questionnaire, the Beck Inventory for mood assessment and the Epworth Sleepiness Scale (ESS). Statistical analyses included Mann-Whitney U test, chi-square or Fisher's exact test, and odds ratio calculation, using R Studio and GraphPad Prism. The results indicated that the ε2ε3 genotype was associated with lower scores on the BECK, suggesting fewer depressive symptoms, while the ε3ε3 genotype was linked to an increase in depressive symptoms. Furthermore, analyses of APOE alleles showed an opposite pattern concerning daytime sleepiness: carriers of the ε2 allele exhibited greater daytime sleepiness, whereas ε3 allele carriers reported less sleepiness, as measured by the ESS. The analysis of the rs7412 SNP revealed significant impacts on both BECK and ESS scores. These findings suggest that APOE polymorphisms, particularly the ε2 and ε3 alleles, play a crucial role in modulating neurological and cognitive symptoms associated with long COVID. The results highlight the potential of genetic screening to identify patients at higher risk of persistent cognitive and emotional alterations, emphasizing the importance of personalized management strategies and the need for further research in diverse populations.

Background: African American women are more likely to be diagnosed with colorectal cancer than women from other racial/ethnic groups. Differences in adherence to cancer prevention recommendations may contribute to disparities. Adherence to cancer prevention guidelines has previously been shown to be associated with lower breast cancer incidence, but previous study populations have included few African Americans. Objective: The purpose of this study was to evaluate adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations and colorectal cancer incidence in the Black Women's Health Study (BWHS). Methods: In this ongoing prospective cohort of African American women (analytic cohort N = 49,103), 354 incident colorectal cancers were diagnosed between baseline (1995) and 2011. Adherence scores for seven WCRF/AICR recommendations (adherent = 1 point, non-adherence level 1 = 0.5 points, non-adherence level 2 = 0 points) were created using questionnaire data and summed to an overall adherence score (maximum = 7). Diet-specific recommendations were additionally summed for a diet only score (maximum = 5). Recommendation adherence and incidence of colorectal cancer combined and colon cancer only were evaluated using baseline and time-varying data in Cox regression models. Results: Guideline adherence was low with 8.5% of women (5.6% among women who later developed colorectal cancer) adhering to more than four recommendations at baseline. Adherence to a greater number of WCRF/AICR recommendations was not statistically significantly associated with colorectal cancer risk in time-varying or baseline models. In time-varying analyses, the HR (per 0.5 point increase) was 0.98 (95% CI: 0.84-1.15) and 0.51 (95% CI: 0.23-1.10) among women who adhered to &amp;gt;4 compared to &amp;lt;3 recommendations. Similarly, colon cancer evaluated alone was not statistically significantly associated with breast cancer incidence in time-varying (&amp;gt;4 vs. &amp;lt;3 recommendations HR = 0.54, 95% CI: 0.23-1.26) or baseline models (&amp;gt;4 vs. &amp;lt;3 recommendations HR = 0.72, 95% CI: 0.39-1.34). Regardless of modeling approach, adherence to dietary recommendations or individual recommendations was not associated with colon only or combined colorectal cancer risk. Conclusions: Further research in diverse populations is essential to evaluate the validity of existing recommendations, and to assess whether there are alternative recommendations that are more beneficial for colorectal cancer prevention in specific populations. Citation Format: Sarah J. O. Nomura, Chiranjeev Dash, Lynn Rosenberg, Jeffrey Yu, Julie R. Palmer, Lucile L. Adams-Campbell. Is adherence to the WCRF/AICR cancer prevention recommendations associated with colorectal cancer in African American women in the Black Women's Health Study. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1744.

Research in diverse populations has often found that thin media images negatively affect women’s state body image, with many women reporting lower body satisfaction after exposure to pictures of thin models than before exposure. However, there is evidence that theistic affirmations might buffer against the negative effect of media on body image. Furthermore, religiosity and the Islamic body covering are discussed as protective factors against a negative trait body image. However, there is no experimental research on veiled Muslim women’s state body image. Therefore, the current study experimentally investigated whether the body satisfaction of veiled Muslim women (n = 66) decreased after exposure to thin media images compared to pictures of furniture as a control condition. Christian women (n = 90) and atheist women (n = 74) were included as control groups, and participants were randomly assigned to the two conditions. Prior to the experimental session, participants’ trait body image was assessed using an online questionnaire comprising questions about body satisfaction, thin-ideal internalization, pressure to be thin, and physical appearance comparisons. It was found that veiled Muslim women had a more positive trait body image than did Christian women and atheist women. Accordingly, veiled Muslim women reported lower levels of thin-ideal internalization, pressure to be thin, and physical appearance comparisons than did Christian women and atheist women. The experimental findings showed that body satisfaction decreased in the experimental condition and not in the control condition, but no significant differences in pre-post changes emerged between the three groups. As the pre-post changes in body satisfaction did not differ between the three groups, veiling might not buffer against the negative effect of thin media images on state body image. Nevertheless, given the more positive trait body image of veiled Muslim women compared to Christian and atheist women, veiling might positively influence body image in the longer term. However, as additional analyses including unveiled Muslim women did not reveal differences between veiled and unveiled Muslim women, future studies should test the assumption that affiliation to Islam might be more decisive for a positive trait body image than veiling.

ABSTRACTInterest in the Level of Personality Functioning (LPF), defined by Criterion A of the Alternative Model for Personality Disorders (AMPD), is growing. LPF includes self‐functioning (identity, self‐direction) and interpersonal functioning (empathy, intimacy). While LPF is crucial for understanding personality dysfunction, its ability to distinguish personality disorders from other conditions remains debated. The DSM‐5 Levels of Functioning Questionnaire–Short Form (DLOPFQ‐SF) is a promising LPF measure, but further research in diverse populations is needed. This study examined the internal structure and psychopathological correlates of the DLOPFQ‐SF in an Italian nonclinical sample. Specifically, it assessed the tool's factor structure and relations with the Hierarchical Taxonomy of Psychopathology (HiTOP) and positive adjustment. A sample of 1183 Italian participants (46.2% female, mean age = 31.3 ± 14.8) completed the DLOPFQ‐SF and other self‐report measures. Exploratory and confirmatory factor analyses showed a three‐factor structure comprising Identity, Empathy, and Intimacy. Structural equation modeling (SEM) explored links between the three DLOPFQ‐SF dimensions, HiTOP dimensions (internalizing, externalizing‐antisocial, antagonism, detachment, psychoticism), and positive adjustment. In general, SEM analyses showed that higher LPF scores were associated with increased psychopathology and reduced well‐being. The three subscales demonstrated specific links to distinct psychopathological outcomes, thereby supporting the construct validity of the DLOPFQ‐SF. Despite the removal of the Self‐Direction scale, the instrument proved useful in capturing key aspects of LPF across self and interpersonal domains, reinforcing its relevance within a dimensional model of psychopathology.

The digital revolution-including smartphones, wearable devices, mobile applications, and online platforms- has fundamentally transformed modern human lifestyle and health behaviors. This narrative review synthesizes evidence on the positive and negative impacts of social media and smart technologies on the six pillars of lifestyle medicine: nutrition, physical activity, stress management, substance use, restorative sleep, and social connection. We conducted a narrative review of English-language, peer-reviewed literature from 2010 to 2025. Searches were performed in PubMed/MEDLINE, Scopus, Web of Science, and PsycINFO, supplemented by Google Scholar and reference-list screening. Across pillars, (SMAT) can enable self-monitoring, goal-setting, personalized feedback, and remote coaching. Evidence is strongest for physical activity and dietary self-management, particularly when interventions include behaviour change techniques (e.g., prompts, gamification, and social support) and clinician input. Digital mindfulness and cognitive-behavioral programs show modest reductions in perceived stress and improvements in sleep outcomes in selected populations. However, excessive screen time and evening device use are consistently associated with poorer sleep, digital fatigue, and reduced wellbeing. Social platforms can enhance peer support and accountability, but can also amplify misinformation, unhealthy comparison, and exposure to marketing or norms that promote risky substance use. Healthcare professionals, educators, and policymakers should promote evidence-based and balanced SMAT use by assessing digital health literacy, guiding purposeful engagement, monitoring for harms such as sleep disruption and anxiety, and addressing inequities in access. Hybrid models that combine digital tools with counseling, education, and family- or community-based support appear most promising for sustained behavior change. Regulatory oversight, app validation, data privacy protections, and long-term research in diverse populations are essential to ensure safe, effective, and equitable implementation.

From 2019-2023, the United States Food and Drug Administration has cleared 9 novel obstructive sleep apnea-detecting wearables for home sleep apnea testing, with many now commercially available for sleep clinicians to integrate into their clinical practices. To help clinicians comprehend these devices and their functionalities, we meticulously reviewed their operating mechanisms, sensors, algorithms, data output, and related performance evaluation literature. We collected information from PubMed, United States Food and Drug Administration clearance documents, ClinicalTrials.gov, and web sources, with direct industry input whenever feasible. In this "device-centered" review, we broadly categorized these wearables into 2 main groups: those that primarily harness photoplethysmography data and those that do not. The former include the peripheral arterial tonometry-based devices. The latter was further broken down into 2 key subgroups: acoustic-based and respiratory effort-based devices. We provided a performance evaluation literature review and objectively compared device-derived metrics and specifications pertinent to sleep clinicians. Detailed demographics of study populations, exclusion criteria, and pivotal statistical analyses of the key validation studies are summarized. In the foreseeable future, these novel obstructive sleep apnea-detecting wearables may emerge as primary diagnostic tools for patients at risk for moderate-to-severe obstructive sleep apnea without significant comorbidities. While more devices are anticipated to join this category, there remains a critical need for cross-device comparison studies as well as independent performance evaluation and outcome research in diverse populations. Now is the moment for sleep clinicians to immerse themselves in understanding these emerging tools to ensure our patient-centered care is improved through the appropriate implementation and utilization of these novel sleep technologies. Chiang AA, Jerkins E, Holfinger S, etal. OSA diagnosis goes wearable: are the latest devices ready to shine? J Clin Sleep Med. 2024;20(11):1823-1838.

The NIMH Research Domain Criteria (RDoC) initiative seeks to utilize multidimensional patterns of socio-cognitive behavior to improve understanding of mental illness. We aimed to evaluate the psychometric properties of a subset of RDoC tasks. Specifically, we investigated two positive valence tasks and five cognitive tasks. Participants (N = 320) were recruited through an online research platform. We used generalizability theory to estimate reliability, and factor analysis to examine factor structure. Reliability was average to excellent with some notable exceptions. Factor analysis results raised concerns about whether the factor structure of task scores aligns with the proposed RDoC model. Effects of cognitive manipulations generally supported the construct representation of tasks. Results indicate that the majority of RDoC task scores examined have acceptable reliability or can be made reliable through modest increases in task length. Future research in diverse populations is needed to better understand the factor structure of RDoC cognitive and positive valence measures.

Background: Heel pain is a common musculoskeletal complaint among adults, significantly impacting quality of life. Recent studies suggest a strong association between isolated gastrocnemius tightness and heel pain, although comprehensive research in diverse populations remains scarce. Understanding the relationship between gastrocnemius tightness and heel pain is crucial for developing effective treatment strategies. Objective: This study aimed to investigate the association of isolated gastrocnemius tightness with heel pain in a Pakistani adult population, focusing on the prevalence of gastrocnemius tightness among individuals presenting with heel pain and the effectiveness of specific diagnostic tests in identifying this condition. Methods: A prospective cross-sectional study was conducted involving 223 participants from various hospitals in Lahore, Pakistan. The study population comprised adults aged 30 to 60 years experiencing heel pain. Diagnostic assessments included the Windlass and Silfverskiöld tests to evaluate plantar fasciitis and gastrocnemius tightness, respectively. Data on age, gender, and test outcomes were collected and analyzed using SPSS version 25.0, employing descriptive statistics, Pearson's correlation, and significance testing to explore the association between heel pain and gastrocnemius tightness. Results: The average age of participants was 42.24 ± 4.973 years, with a gender distribution of 59.6% females and 40.4% males. The Windlass test was positive in 89.2% (199) of participants, while the Silfverskiöld test showed a positive outcome for gastrocnemius tightness in 79.8% (178) of cases. A significant correlation was found between the results of the Windlass and Silfverskiöld tests (Pearson correlation = .691, p &lt; .000), indicating a strong association between isolated gastrocnemius tightness and heel pain. Conclusion: This study confirms a significant association between isolated gastrocnemius tightness and heel pain among adults in Lahore, Pakistan. The findings underscore the importance of assessing gastrocnemius tightness in patients presenting with heel pain and suggest that targeted interventions addressing this condition could enhance treatment outcomes.

This cross-sectional, nationwide, population-based study aimed to elucidate sex differences in psychiatric comorbidities of Attention-deficit/hyperactivity disorder (ADHD) across children, adolescents, and adults. We analyzed data from Taiwan’s comprehensive healthcare database, including 112,225 individuals diagnosed with ADHD, categorized by age (0–12, 13–18, ≥18 years) and sex. Psychiatric comorbidities were assessed using ICD-9-CM codes, focusing on age and sex-specific prevalence. Among the cohort, 83.50% were children (0–12 years) presenting primarily with learning disabilities and tics, while adolescents (13–18 years; 11.88%) had higher instances of oppositional defiant and conduct disorders. In adults (≥18 years; 4.62%), the prevalence of anxiety, depression, bipolar disorder, and substance misuse was notably higher. Males under 18 predominantly had ADHD, whereas females exhibited increased vulnerability to emotional disorders. In adulthood, males showed greater susceptibility to most psychiatric comorbidities, except sleep disorders. The study highlights the evolving nature of ADHD-related psychiatric comorbidities across different life stages, with distinct sex-based patterns. The transition from childhood to adulthood sees an increased prevalence of various psychiatric conditions, particularly impacting adult males. These findings underscore the need for age- and sex-specific therapeutic approaches in ADHD management. The cultural context of the study necessitates further research in diverse populations for broader applicability of the findings.

U.S. Air Force remotely piloted aircraft (USAF RPA) personnel face diverse stressors negatively affecting psychological health and military readiness. Prior research in diverse populations supports predictable impact of the COVID-19 pandemic on occupational stressors, burnout, and more distal outcomes. Extending earlier studies linking broad variables (e.g., COVID-19 threat → work stress → burnout), the current study tests and refines an expanded mediation model based on multiple distinct pandemic concerns, occupational stressors, and burnout facets as antecedents of psychological distress mid-pandemic in RPA personnel (N=496). Differential representation of demands, resources, and rewards evident across distinct occupational stressors in light of job demands/resources theory guided specification of mediated pathways. SEM analysis yielded moderate fit. Following removal of non-significant paths and addition of two interpretable direct paths, fit was improved, yielding seven dominant pandemic concern → occupational stressor → burnout → psychological distress pathways. In support of domain specification, five 'hub' variables (pandemic-driven change, personal stressors, workload, leader communication, and exhaustion) emerged as key intervention targets in mitigating distress in the USAF RPA community and similar populations during future pandemic-related crises.