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Article
Computer Science and Mathematics
Artificial Intelligence and Machine Learning

Yuyang Bai

,

Zheyuan Liu

,

Han Yan

,

Zhangchen Xu

,

Yixin Wan

,

Canyu Chen

,

Zehong Wang

,

Xiangchi Yuan

,

Yue Huang

,

Guangyao Dou

+10 authors

Abstract: Once a large language model is released, training-time alignment is hard to revise; yet deployment introduces context-specific risks that the original training cannot anticipate: evolving safety policies, jurisdictional constraints, retrieval contamination, and adaptive adversarial prompting. In this paper, we unify inference-time techniques for trustworthy generation across safety, privacy, fairness, and factuality under a single framework: the inference-time control plane, with three tiers of intervention -- External Controls (Context Engineering, Guardrails, Decoding Strategies), which act around the model; Internal Manipulations (Representation Engineering, Unlearning, Pruning), which act inside it; and System-Level Orchestration (Multi-Agent Systems), which coordinate several models. We also introduce a meta-axis evaluation framework that crosses the four trustworthiness dimensions with five evaluation axes (effectiveness, locality, generality, interpretability, efficiency), and describe representative metrics at each intersection. We identify four cross-cutting open problems: brittleness under adaptive adversaries, the control-utility tradeoff, verification of removal, and the composition of layered interventions. A curated paper list is available at https://github.com/leopoldwhite/Awesome-Inference-Time-Trustworthiness.

Article
Engineering
Industrial and Manufacturing Engineering

Hsin-Hui Huang

,

Haoran Mu

,

Eulalia Puig Vilardell

,

Vijayakumar Anand

,

Darius Gailevičius

,

Saulius Juodkazis

Abstract: Trends in Micro- and Nano-Lithography required for future development of large area applications ranging from high-packing-density electronics to solar cells are surveyed and outlined. Strategies to use direct laser writing to define etch masks over large areas by: i) fixed beam moving stage and ii) moving beam moving stage approaches are presented. The extension of planar 2D and stacked 2D (or 2.5D) fabrication methods into 3D micro- and nano-fabrication is discussed. One of the essential future characteristic of 3D nanolithography is real-time feedback capability. This can be realised via inherent 3D-capable holography, which bridges lithographic exposure control, wavefront sensing, and adaptive feedback, providing a pathway to stitch free, large area 3D patterning. The future of micro-fabrication is expected to evolve via highly specialised 3D architecture design and reduction of post-processing steps.

Article
Public Health and Healthcare
Public Health and Health Services

Asmita Patel

,

Justin Keogh

Abstract: Physical activity (PA) can provide protective benefits for prostate cancer (PCa) survivors. Healthcare practitioners are ideally positioned to promote PA to their PCa patients. This study was designed to identify how practitioners have advised and supported their PCa patients to try and overcome barriers to PA. A secondary aim was to identify if there were differences in the types of PA advice provided based on practitioner specialty and number of years in practice. Participants were 13 healthcare practitioners from Auckland, New Zealand who provide biomedical (urology, oncology) and allied health services (physiotherapy) to men who have received a diagnosis of PCa. Participants were individually interviewed and data was analyzed using an inducive thematic approach. Four main themes and three sub-themes were identified. Physical activity advice did not appear to differ based on practitioner specialty or length of time in practice, rather, PA advice was provided to help counteract the associated side effects of specific PCa treatments. Verbal information, encouragement and resources were provided to help support PA. Specialist cancer nurses can provide long-term PA advice and support. Individualized exercise programs through physiotherapy can benefit men receiving active PCa treatment, as well as for men in remission experiencing treatment-related side effects.

Article
Computer Science and Mathematics
Mathematics

Xianghui Wen

,

Di Zhao

,

Hongyi Li

Abstract: Suppose \( A=I-PQ^T, \) where both \( P \)and \( Q \) are \( n\times 3 \) complex matrices and det\( (Q^T P)\neq 0 \). By analyzing the Jordan canonical form of the coefficient matrix \( A, \) we find all the anti-commuting solutions \( X, \) which satisfy \( AX=-XA, \) of the Yang-Baxter-like matrix equation(YBME) \( AXA=XAX \).

Article
Physical Sciences
Optics and Photonics

Aristides Marcano Olaizola

,

Walique Richardson

,

Sonia Wabukoya

Abstract: We studied the Stokes signals generated by the Raman photoexcitation of dissolved oxygen in water. When a water sample is pumped with intense nanosecond radiation, Stokes signals of different origins are generated. These signals form a characteristic nonlinear diffraction pattern, exhibiting a central spot and concentric rings whose radii depend on the Stokes wavelengths. Most of the Stokes signals correspond to the stretching vibrations of water molecules. However, we also observed a small contribution from dissolved oxygen molecules. This contribution can be separated from the others using appropriate spectroscopic filters and analyzed with a spectrometer. We report on Stokes components assigned to singlet oxygen excitation detected in the central spot, as well as in the diffraction pattern’s ring structure. The signal detected from the ring exhibits a single peak, while that from the ring itself shows a two-peak structure. The two observed peaks are interpreted as Stokes signals corresponding to Raman transitions to the two lowest vibrational sublevels of the singlet-oxygen electronic state. We also report exponential growth in the Stokes signal, in agreement with the standard stimulated Raman theoretical model.

Article
Engineering
Mining and Mineral Processing

Xiaodong Dai

,

Lei Li

,

Anqi Liu

,

Chengcheng Zhang

,

Jianhua Zhang

Abstract: Turbulent drag reduction (DR) using polymers is a critical technique for energy conserva-tion in fluid transport systems. Traditional monitoring methods relying on pressure transducers are intrusive and lack real-time turbulence characterization. This study pro-poses a novel non-intrusive intelligent monitoring system based on Fiber Bragg Grating (FBG) sensing and Artificial Intelligence (AI). An experimental setup was constructed to investigate the DR performance of polymer solutions. FBG sensors were utilized to capture the optical spectrum shift induced by turbulent flow fluctuations. A deep learning model was trained to correlate the optical signal features with the drag reduction rate. Results demonstrated that the AI model achieved high prediction accuracy (R² > 0.95), effectively replacing complex fluid dynamic calculations with optical signal analysis. This work provides a promising approach for real-time, non-intrusive monitoring of fluid flow characteristics in industrial applications.

Article
Engineering
Aerospace Engineering

Giorgio Filippoli

,

Beniamino M. Perri

,

Niko Terzaroli

,

Stefano Cacciola

,

Carlo E. D. Riboldi

,

Lorenzo Trainelli

Abstract: Characterizing the highly complex aero-propulsive interaction in Distributed Electric Propulsion (DEP) aircraft, may require automated flight testing procedures with dedicated maneuvers, which introduce specific safety challenges. This paper investigates an accident involving a distributed electric propulsion research demonstrator, named SwitchMaster, during an automated flight-test mission for aerodynamic model identification. The event occurred during a scheduled pitch excitation maneuver and resulted in a loss of control followed by ground impact. The investigation is based on flight logs, telemetry analysis, and structured accident investigation methods, including the ICAO ADREP taxonomy and the Swiss Cheese Model. The results show that the accident resulted from the combination of asymmetric trim acquisition, open-loop control surface fixation, insufficient real-time safety barriers, ineffective maneuver interruption, and delayed recovery authority. The paper is concluded with safety recommendations, software improvements and lessons learnt to enhance the reliability of automated flight testing for DEP aircraft.

Article
Biology and Life Sciences
Agricultural Science and Agronomy

Wenyu Chen

,

Yongjie Liu

,

Minghao Sun

,

Jiabao Cheng

,

Xing Shen

,

Zhongping Chai

Abstract: Postharvest quality deterioration of Korla fragrant pear (Pyrus sinkiangensis Yu) severely constrains its market value, yet the regulatory role of pre–harvest soil management in shaping postharvest performance remains poorly understood. This study investigated how green manure species modulate postharvest quality trajectories and their underlying soil–fruit linkages. Three pre–harvest treatments were imposed: control (CK), sweet clover (CM), and alfalfa (MX). Fruits were harvested and stored at 4 °C, with sampling at 1, 5, 10, 15, and 20 d. A critical quality transition was identified at 15 d, characterized by the concurrent peaking of soluble sugars, organic acids, vitamin C, and anthocyanins alongside an optimal sugar–acid ratio. Beyond this inflection point, CM and MX diverged markedly: CM enhanced soluble sugar accumulation, anthocyanin retention, and ester volatile production—most notably hexyl acetate, which increased over 14.4–fold—thereby generating a pronounced fruity aroma bouquet. Conversely, MX sustained higher amino acid and vitamin C levels and conferred superior late–storage stability, evidenced by a threefold lower coefficient of variation in sugar–acid ratio relative to CK. partial least squares structural equation modeling (PLS–SEM) revealed soil fertility as the principal driver of fruit quality, but the fidelity of soil–to–fruit transmission was species–dependent. MX achieved near–complete explanatory power (R²= 0.971), whereas CM exhibited attenuated transmission fidelity (R²= 0.777), with network analysis further indicating that CM inverted the polarity of key soil–fruit correlations. These findings demonstrate that green manure identity governs postharvest quality through divergent soil–fruit coupling pathways: alfalfa optimizes nutrient transmission efficiency and stabilizes nutritional quality, whereas sweet clover promotes sugar–aroma accumulation at the cost of reduced soil–fruit conversion fidelity. Species–specific green manure selection thus offers a viable strategy for targeted modulation of postharvest traits in Korla fragrant pear.

Review
Computer Science and Mathematics
Computer Science

Jinhao Shen

,

Huahui Yi

,

Wentao Hu

,

Yiyang Jiang

,

Wengyu Zhang

,

Xiao-Yong Wei

,

Qing Li

Abstract: Foundation-model agents now use reusable skills for tool use, long-horizon planning, and adaptation across related tasks. The term, however, is used loosely. It may describe a prompt package, an executable workflow, a learned routine, or an artifact distributed through a repository. That looseness makes it hard to compare methods, measure progress, or discuss security and governance with precision.We study agent skills as reusable and adaptive units of competence between model capability and situated task execution. The survey separates skills from nearby constructs such as prompts, tools, memory, and policies, then organizes the literature around representation, lifecycle and orchestration, evaluation, security and governance, and application domains. Across these areas, skill quality is only one part of the story. Useful skills also depend on abstraction choices, retrieval and composition mechanisms, ecosystem structure, and infrastructure security. We treat agent skills as a research object in their own right and identify open problems in automatic induction, cross-environment transfer, longitudinal evaluation, and trustworthy sharing in open agent ecosystems. A public paper list is available at https://github.com/JinhaoShen/awesome-agent-skill-papers.

Article
Engineering
Marine Engineering

Haitao Xu

,

Hong Zhou

,

Xiao Xu

Abstract: To ensure the operational safety of the OCTABUOY platform used for offshore wind turbine installation in shallow waters, an eight-point symmetric mooring system was designed based on its octagonal structural configuration. The system provides high horizontal stiffness and balanced load distribution, enhancing stability under complex environmental conditions.Physical model tests were conducted under combined wind, wave, and current loading, considering multiple wave directions, environmental cases, and five draft conditions. The mooring tensions and six-degree-of-freedom motions were systematically analyzed to evaluate system performance and safety.Results show that the proposed mooring system effectively limits platform motions and maintains stable load-sharing characteristics. The minimum safety factor under the most unfavorable condition exceeds the design requirement. In addition, the system demonstrates good redundancy: after single-line failure, remaining mooring lines redistribute loads without progressive collapse. Draft and wave incident angle significantly influence peak tensions and motion responses, with smaller drafts and oblique wave directions producing relatively higher loads.The experimental results confirm the reliability and safety margin of the eight-point mooring system and provide practical guidance for the engineering application and operational assessment of the OCTABUOY platform in shallow-water wind installation projects..

Review
Medicine and Pharmacology
Endocrinology and Metabolism

Richard Z. Cheng

,

Thomas E. Levy

,

Ron Hunninghake

Abstract: Bioidentical hormone replacement therapy (BHRT) traditionally operates within a triad consisting of sex hormones, thyroid hormones, and adrenal glucocorticoids. Despite widespread adoption, a substantial proportion of patients experience persistent dysglycemia, adrenal instability, fluctuations in symptom control, and inconsistent responses to therapy even when laboratory values appear biochemically normalized. These clinical patterns suggest that an essential regulatory element is missing from the current BHRT conceptual model. This narrative review proposes the Insulin–Cortisol–Vitamin C (ICV) Axis as a previously unrecognized hormonal network central to metabolic and endocrine homeostasis. Insulin profoundly influences sex-hormone binding globulin (SHBG), estradiol and testosterone bioavailability, progesterone responsiveness, thyroid hormone conversion, mitochondrial ATP production, and cortisol reactivity—yet insulin is rarely evaluated in BHRT. Cortisol, in turn, directly modulates insulin sensitivity and metabolic function, while vitamin C is required for cortisol synthesis, adrenal recovery, endothelial nitric oxide signaling, mitochondrial redox regulation, and antioxidant defense. Together, disturbances in these three components can generate characteristic clinical presentations frequently encountered in BHRT practice. In parallel, emerging evidence—including metabolic insights from GLP-1 receptor agonist therapy—indicates that vitamin C status and oxidative stress modulation play broader roles in insulin sensitivity and hormonal signaling than previously recognized. Integrating these findings, the ICV Axis provides a systems-level framework capable of explaining BHRT treatment failures, variable patient responses, and persistent symptomatology despite standard hormone optimization. The purpose of this review is to synthesize biochemical, endocrine, and nutritional evidence supporting this new axis, and to outline a clinically actionable update to BHRT incorporating insulin dynamics and vitamin C sufficiency. Recognition of the ICV Axis represents a conceptual advancement that can improve therapeutic outcomes across metabolic, endocrine, and integrative medical practice.

Article
Engineering
Architecture, Building and Construction

Amer Alazawi

,

Oday Alchalabi

,

Ashraf Alhafody

,

Abdul Ghafoor Nizamani

Abstract: The reconstruction of Mosul after 2017 has produced a residential landscape in which design intent systematically fails to survive construction. While existing scholarship examines the materiality and symbolism of post-conflict façades, it neglects the process conditions under which aesthetic specifications are overridden. This study examines the relationship between form and materiality in contemporary Mosul residential architecture through a mixed-methods design: formal visual analysis of twelve recently completed façades and a structured survey of forty-five practising architects. Visual analysis reveals a sophisticated design language of controlled complexity (orthogonal massing articulated through contrasting materials) that is rarely realised in built form. Survey data show that architects are excluded from construction supervision in seventy-six per cent of projects, with client intervention affecting seventy per cent. Architectural oversight emerges as the primary determinant of aesthetic integrity: projects most consistently achieve material–form coherence where architects retain supervisory authority, whereas exclusion produces four distinct pathologies: material substitution, execution degradation, language override, and ornamental hollowing. The study advances the concept of an aesthetics of interruption, understood as the systematic degradation of designed form–material relationships through the fragmentation of professional authority. It demonstrates that aesthetic degradation in post-conflict reconstruction stems not from design incapacity but from broken process structures. Preserving architectural quality requires contractual frameworks mandating designer supervision and material-substitution protocols that protect design intent.

Article
Chemistry and Materials Science
Metals, Alloys and Metallurgy

Changming Fang

,

Zhongping Que

,

Zhongyun Fan

Abstract: Commercial aluminum (Al) metals contain unavoidably iron (Fe) and silicon (Si) as impurities. Due to its low solubility and high chemical affinity to Al, Fe exists in the form of Fe-containing intermetallic compounds (Fe-IMCs) which act crucially in solidification processes, determining the micro-structure and consequently the mechanical performance of the cast parts. Meanwhile, Si as impurity or addition may join the binary Fe-IMCs. Here, we investigate the Si stabilization effects on the frequently observed Al-rich Fe-IMCs in a comprehensive and systematical way using a first-principles density-functional theory (DFT) approach. The study revealed different Si stabilization effects on the cubic α- and hexagonal αʹ-phase, as well as other binaries: Al12Fe, η-Al6Fe, τ4-, β- and θ-phases. The enhancement of stability for the α-phase is moderate while it is strong for the αʹ-phase. For the stability series (from higher to lower) is θ-Al13Fe4 > η-Al6Fe >α-Al4.75Fe in the binary system, while it becomes τ4-(Al,Si)5Fe>β-Al4.5SiFe >αʹ-(Al,Si)4.174Fe for the ternary Fe-IMCs. The information obtained here helps understand the formation of Fe-IMCs particles during casting of Al-Si alloys, and design of novel Al alloys of fine micro-structures and desired mechanical performances of the products from the primary Al and the scraps and wastes.

Article
Environmental and Earth Sciences
Remote Sensing

Carina Cristiane Korb

,

Laurindo Antonio Guasselli

,

Thiago Bazzan

,

Tássia Fraga Belloli

,

Ananda Müller Postay de Lima

,

Ana Lucia Freitas

Abstract: Floodplain wetlands are dynamic and biodiverse environments that provide important ecosystem services. This study analyzes the temporal and spatial dynamics of hydrogeomorphological attributes, vegetation, and water in floodplain wetlands. The methodology consisted of applying PCA in temporal (T) and spatial (S) modes, decomposing spectral indices (NDVI, NDMI, MNDWI) to identify variability patterns associated with ENSO events. The results revealed that C2 was the main descriptor of hydrological anomalies, with strong temporal synchrony between vegetation vigor (NDVI) and the expansion of the water surface (MNDWI), contrasting with the water stress response captured by NDMI. PCA highlighted environmental heterogeneity within the floodplain, with peatland areas standing out as zones of high spatial complexity and greater water retention capacity. Temporal variability responded primarily to climatic extremes, whereas spatial variability was modulated by hydrogeomorphology.

Review
Public Health and Healthcare
Health Policy and Services

Julius Cudjoe

,

Wisdom Kwabla Atatsi

,

Bernard Kwabena Adjei

,

Seyram Gockel Ashong

Abstract: ntroduction: Despite multi-decade reforms aimed at Universal Health Coverage (UHC), out-of-pocket (OOP) expenditure remains a primary barrier to healthcare access in Sub-Saharan Africa (SSA). While macro-level financing policies are well-documented, the agency of the "street-level" health workforce in navigating these policies at the point of care is under-researched. This scoping review aims to map the perceptions, experiences, and discretionary practices of primary care workers that mitigate or exacerbate OOP payments in Sub-Saharan Africa. Methods: Following the Arksey and O'Malley (2005) framework, a comprehensive search of PubMed, Scopus, and Google Scholar will be conducted for studies published between 2012 and 2025. Data extraction will focus on the frontline practices of primary care staff. Analysis will be guided by Street-Level Bureaucrat Theory, examining how worker discretion, resource scarcity, and client interactions shape the implementation of financial risk protection. Discussion: The findings will provide a critical lens on the "implementation gap" in health financing, shifting the focus from top-down policy design to the frontline actors who ultimately determine the financial burden faced by patients.

Article
Environmental and Earth Sciences
Pollution

Elena Marra

,

Barbara Baesso Moura

,

Elena Paoletti

,

Andrea Viviano

,

Jacopo Manzini

,

Ryoji Tanaka

,

Yasutomo Hoshika

Abstract: Tropospheric ozone (O3) is a phytotoxic air pollutant that can impair visible foliar injury (O3 VFI) and reduces photosynthesis in sensitive forest species. Viburnum lantana L. has been widely used as an in situ bioindicator of O3 pollution in mountainous areas of Europe; however, field-observed O3-induced VFI as well as critical levels (CLs) established to protect forests, have not been validated. This study validated field-observed O3 effects in V. lantana through experiments carried out in a Free-air O3 eXposure infrastructure (FO3X) and determined which O3 metric (exposure-based—AOT40 or flux-based—POD1) best explains O3 effect on leaf physiology and VFI. V. lantana saplings were subjected to ambient air (AA) conditions and elevated O3 levels at 1.5× and 2.0× AA. Throughout the experimental period (T1: 2-month and T2: 3.5-month O3 exposure) measurements were taken for the Plant Injury Index (PII), light-saturated net photosynthetic rate (Asat), stomatal conductance (gs), leaf color index (SPAD), and the maximum photochemical efficiency of photosystem II (Fv/Fm). O3 VFI was first observed in 2.0× after 16 days. As a result, O3 treatment influenced PII, which was significantly higher in the 2.0× (9.06 ± 3.24) than in the 1.5× and AA treatments (1.31 ± 0.62 and 1.29 ± 0.71) at T2. The Asat, SPAD, and Fv/Fm were significantly affected by O3 treatments; no significant difference in gs was found. POD1 better explained variability in O3 VFI and physiological parameters, with CLs proposed for V. lantana of 1.61 mmol m2 and 1.22 mmol m2 for a 4% reduction of Asat and gs, and a CL of 7.82 mmol m2 for the onset of O3 VFI.

Article
Medicine and Pharmacology
Oncology and Oncogenics

Francesco Cellini

,

Leonardo Consoletti

,

Massimo Di Maio

,

Diego Maria Michele Fornasari

,

Gianpaolo Fortini

,

Marta Gentili

,

Marco Krengli

,

Ernesto Maranzano

,

Silvia Natoli

Abstract: Background: Cancer pain remains highly prevalent and undertreated despite established guidelines. In Italy, Law 38/2010 mandates systematic pain assessment, yet only 26% of clinicians routinely evaluate pain at each clinical visit, and fewer than one-quarter have received formal training in pain medicine or palliative care. A national multidisciplinary roundtable, convened in Rome in March 2025, formally identified four systemic gaps – insufficient education, fragmented care pathways, unclear professional roles, and challenges in implementing shared diagnostic and therapeutic pathways – and planned the development of a structured Delphi consensus. Methods: A Delphi study was conducted in accordance with CREDES guidelines. The Steering Committee, comprising representatives of six Italian scientific societies (AIRO, AIOM, AISD, Federdolore-SICD, SICP, ACD-SIAARTI) and a patient advocacy group (Fondazione Nora e Alberto Gentili), developed 15 clinical statements addressing pain assessment, management, referral criteria, monitoring, and documentation. Sixty-six Italian clinicians from various specialties were invited to participate. Consensus was defined as ≥75% agreement (scoring 4 or 5 on a 5-point Likert scale). Results: Fifty-six clinicians completed the voting rounds (response rate: 84.8%), representing medical oncology, radiation oncology, pain therapy, and palliative care specialties. All statements reached consensus in the first round (78–100%), precluding the need for a second voting round. Panelists’ qualitative comments informed minor wording refinements; substantial content was unchanged. Conclusions: The Delphi process produced a validated, multidisciplinary clinical pathway for cancer pain management in the Italian NHS - National Health System. The pathway establishes structured roles for the clinical reference physician and specialist consultants, objective decision thresholds for analgesic titration and referral, and minimum requirements for standardized pain documentation. These consensus-based statements provide actionable clinical guidance that may help address analgesic undertreatment and support the implementation of Law 38/2010 across Italian oncology centers.

Article
Biology and Life Sciences
Other

Dong Yu

,

Nan Geng

,

Lin Fan

,

Yanmei Qin

,

Shangshang Sun

,

Hao Chen

,

Rouyu Wang

,

Xiaoping Liao

,

Chun You

Abstract: Enhancing the soluble expression of heterologous proteins in chassis microorganisms is critical for fundamental biological research and synthetic biology-driven industrial ap-plications. Current methods for designing DNA sequences to ensure high soluble expres-sion often rely excessively on high-frequency codons while overlooking optimal codon context, leading to suboptimal outcomes. To address these limitations, we developed an integrated deep learning framework combining a synonymous codon generation (SCG) model and a gene expression level prediction (GELP) model. The SCG model captures co-don usage patterns in Escherichia coli using large-scale genomic data, whereas the GELP model leverages gene expression data to prioritize sequences with high soluble expression potential. We validated our approach by optimizing the DNA sequences of two industrial enzymes, α-glucan phosphorylase (αGP) and isoamylase (IA), achieving 20.52-fold and 3.05-fold increases in soluble expression, respectively, relative to the wild type. This study provides a powerful tool for designing DNA sequences that confer high soluble expression and for understanding the relationship between DNA sequence and protein expression. Notably, SCG-GELP reveals a protein surface-targeted codon optimization strategy that substantially enhances soluble protein yield. The framework is publicly accessible at https://scg-gelp.biodesign.ac.cn, and its open-source code and trained models are availa-ble on GitHub at https://github.com/yuddecho/SCG-GELP.

Article
Medicine and Pharmacology
Endocrinology and Metabolism

Bogdan Mihai Pascu

,

Irina Bojoga

,

Anca Bălănescu

,

Paul Cristian Bălănescu

,

Ioan Gherghina

Abstract: Background and Objectives: GLP-1 receptor agonists (GLP-1 RAs) are effective weight-loss therapies, but data on body composition changes in pediatric obesity remain scarce. The primary objective was to evaluate the effects of GLP-1 RAs on body composition in children with obesity. Materials and Methods: We conducted a retrospective study of children with obesity evaluated at the National Institute for Mother and Child Health “Alessandrescu-Rusescu”, Bucharest, Romania, who initiated weekly injectable GLP-1 RA therapy (semaglutide) between January and December 2025. Patients were assessed at baseline and after a median follow-up of 5 months. Eight of ten participants with complete paired data were included in the final analysis; two were excluded because one was non-responder with weight gain and suspected non-compliance, while one responder could not maintain the standing position for bioimpedance measurement. Bioimpedance analysis and anthropometry were performed at both visits. Paired data were analyzed using Wilcoxon signed-rank tests. Results: Eight children (4 boys, 4 girls; mean age 14.9±1.8 years) completed the study. Significant Body Mass Index (BMI) Z-score improvements were observed (CDC: -0.14, p=0.012; WHO: -0.37, p=0.012), with median weight reduction of 4.75 kg (p=0.036). While absolute muscle mass showed non-significant change (-1.3 kg, p=0.362), predicted muscle mass percentage increased significantly (+1.9%, p=0.012), suggesting selective fat loss. Fat-free mass percentage increased (+2.0%, p=0.012) with reciprocal fat mass reduction (absolute: -3.85 kg, p=0.017; percentage: -2.0%, p=0.012). Fat-free mass index remained stable (-0.67 kg/m², p=0.161). No serious adverse events occurred. Sensitivity analysis (n=10) confirmed the robustness of the results, with BMI Z-score improvements remaining significant. Conclusions: GLP-1 RA therapy in children with obesity leads to notable improvements in BMI Z-scores and beneficial body composition changes, suggesting muscle mass preservation along with weight loss, even at submaximal doses. These findings support conducting a larger prospective study with body composition as the primary endpoint.

Article
Social Sciences
Education

Ying S. Hsu

Abstract: Reflection is widely recognized as a pathway to deeper learning in higher education, yet many students struggle to engage in reflective tasks meaningfully. This study examined how student engagement and reflective performance developed across a seven-session structured reflective learning sequence in an undergraduate course. A longitudinal quantitative design was employed, including 59 students for participation data and 38 students for performance analysis. The instructional design incorporated teacher-led scaffolding, including exemplars, feedback, and structured prompts, with optional AI-supported assistance in later sessions. Results showed that engagement patterns were non-linear. Submission rates increased following the introduction of exemplars and feedback, declined when higher-order reflection was first introduced, and stabilized in later sessions, with the lowest participation observed in the final integrative task. Reflective performance also differed across stages. Step 1 (descriptive reflection) scores improved progressively, whereas Step 2 (analytical reflection) scores remained consistently high among students who completed substantive responses. The gap between attempted and completed Step 2 responses decreased over time. These findings suggest that reflective learning develops gradually and is sensitive to instructional conditions. The study highlights reflection as a staged developmental process and underscores the role of structured support in facilitating student engagement and performance.

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