Key Determinant Research Articles

Enhancing Sustainable Development Competence in Undergraduates: Key Determinants in the Context of “Dual-Carbon” Targets

Sustainable development is vital for achieving balanced progress across the economic, environmental, and health domains, and it is closely tied to the global drive for addressing climate change and environmental challenges. In this context, reaching the “Dual-Carbon” targets—carbon peaking and carbon neutrality—have become critical priorities both domestically and internationally. As a result, the cultivation of Dual-Carbon professionals is essential for driving sustainable development. This paper investigates the sustainable development capacity of Dual-Carbon professionals through an empirical study of 613 undergraduates in China utilizing Astin’s I-E-O theoretical model. This research examines the impact of course experience, self-efficacy, and learning engagement on sustainable development capacity. The results demonstrate that the course experience has a significant positive direct effect on sustainable development capacity. Moreover, self-efficacy mediates the relationship between the course experience and sustainable development capacity, while both self-efficacy and learning engagement serve as chain mediators. Based on these findings, this paper offers practical strategies to enhance the sustainable development capacity of Dual-Carbon undergraduates, providing valuable insights for the education and training of future Dual-Carbon professionals.

Conformational Flexibility and Net Charge are Key Determinants for the Antimicrobial Activity of Peptide Uy234 Against Multidrug-resistant Bacteria

BackgroundThe antimicrobial activity of two peptides, Uy234 derived from the venom of the scorpion Urodacus yaschenkoi and a consensus peptide QnCs-Buap, was evaluated. We tested different pathogenic bacteria: Acinetobacter baumannii, Klebsiella pneumoniae, Salmonella enterica, Bacillus subtilis, Enterococcus spp. and Staphylococcus aureus, including one methicillin resistant (MRSA) and two multidrug resistant (MDR) clinical isolates. In contrast to the QnCs-Buap peptide, Uy234 showed relevant growth inhibitory activity on A. baumannii and B. subtilis, and mostly on S. aureus strains.ObjectiveThe present research focused on elucidating the mechanism for this antibacterial activity.MethodologyWe carried out an in-depth analysis of the composition, structure, flexibility, and physicochemical properties of both peptides.ResultsWe found a crucial role of the C-terminal amide and composition in favoring the formation of a dense H-bond network in the Uy234 peptide. This H-bonding network slightly stiffens the peptide and keeps it in a preordered conformation in the aqueous phase.ConclusionsWe hypothesize that, given that Uy234 is a very short peptide (18 aa), it could have a destabilizing effect and favor micellization phenomena instead forming pores. In contrast, the QnCs-Buap peptide (13 aa), having only the positive charge at the N-terminal end and being significantly more hydrophobic and rigid, is not capable of overcoming the energy barrier to disturb the membrane. We propose that Uy234 peptide can be a scaffold to develop new derivatives with high potential against infections caused by diverse multidrug-resistant bacteria.Graphical

Consensus on drivers of maintenance treatment choice and patterns of care in advanced ovarian cancer

ObjectivesMaintenance therapies, including poly (ADP-ribose) polymerase (PARP) inhibitors and/or bevacizumab, have substantially improved the prognosis of patients with advanced ovarian cancer. Owing to the variability in treatment strategies across Europe,...

Daily glycome and transcriptome profiling reveals polysaccharide structures and correlated glycosyltransferases critical for cotton fiber growth.

Cotton fiber is the most valuable naturally available material for the textile industry and the fiber length and strength are key determinants of its quality. Dynamic changes in the pectin, xyloglucan, xylan, and cellulose polysaccharide epitope content during fiber growth contribute to complex remodeling of fiber cell wall (CW) and quality. Detailed knowledge about polysaccharide compositional and structural alteration in the fiber during fiber elongation and strengthening is important to understand the molecular dynamics of fiber development and improve its quality. Here, large-scale glycome profiling coupled with fiber phenotype and transcriptome profiling was conducted on fiber collected daily covering the most critical window of fiber development. The profiling studies with high temporal resolution allowed us to identify specific polysaccharide epitopes associated with distinct fiber phenotypes that might contribute to fiber quality. This study revealed the critical role of highly branched RG-I pectin epitopes such as β-1,4-linked-galactans, β-1,6-linked-galactans, and arabinogalactans, in addition to earlier reported homogalacturonans and xyloglucans in the formation of cotton fiber middle lamella and contributing to fiber plasticity and elongation. We also propose the essential role of heteroxylans (Xyl-MeGlcA and Xyl-3Ar), as a guiding factor for secondary CW cellulose microfibril arrangement, thus contributing to fiber strength. Correlation analysis of profiles of polysaccharide epitopes from glycome data and expression profiles of glycosyltransferase-encoding genes from transcriptome data identified several key putative glycosyltransferases that are potentially involved in synthesizing the critical polysaccharide epitopes. The findings of this study provide a foundation to identify molecular factors that dictate important fiber traits.

Longitudinal Analysis of Sweet Taste Preference Through Genetic and Phenotypic Data Integration

Understanding the genetic basis of sweet taste preference is crucial for potential implications in diet-related health outcomes, such as obesity. This study identified genes and single nucleotide polymorphisms (SNPs) associated with sweet taste preferences over time. Data from the American Nurses’ Health Study (NHS1) and Health Professionals Follow-up Study (HPFS) cohorts were analyzed. Using tools like PLINK and METAL for genetic associations and FUMA for functional annotation, the study identified eight SNPs associated with sweet taste preferences. Notably, rs80115239 and rs12878143 were identified as key determinants of the highest and lowest associations with sweet taste preferences, respectively. Individuals with the rs80115239 (AA) genotype displayed a higher preference for sweet tastes, including chocolate and cake, but a lower preference for physical activity, fruits, and vegetables, particularly in females from the NHS1 cohort, linking this genotype to a higher obesity risk. Conversely, those with the rs12878143 (CC) genotype preferred fruits, vegetables, coffee, and tea, with a lower preference for sweetened beverages, but the correlation with obesity risk was less clear due to inconsistent data. In conclusion, these findings highlight the genetic influences on sweet taste preference and their potential role in personalized dietary recommendations and obesity management strategies.

Practical H2 supply from ammonia borane enabled by amorphous iron domain

Efficient catalysis of ammonia borane (AB) holds potential for realizing controlled energy release from hydrogen fuel and addressing cost challenges faced by hydrogen storage. Here, we report that amorphous domains on metallic Fe crystal structures (R-Fe2O3 Foam) can achieve AB catalytic performances and stability (turnover frequency (TOF) of 113.6 min−1, about 771 L H2 in 900 h, and 43.27 mL/(min·cm2) for 10×10 cm2 of Foam) that outperform reported benchmarks (most <14 L H2 in 45 h) by at least 20 times. These notable increases are enabled by the stable Fe crystal structure, while defects and unsaturated atoms in the amorphous domains form Fe-B intermediates that significantly lower the dissociation barriers of H2O and AB. Given that the catalyst lifetime is a key determinant for the practical use in fuel cells, our R-Fe2O3 Foam also provides decent H2 supply (180 mL H2/min, AB water solution of 7.5 wt% H2) in a driven commercial car fuel cell at stable power outputs (7.8 V and 1.6 A for at least 5 h). When considered with its facile synthesis method, these materials are potentially very promising for realizing durable high-performance AB catalysts and viable chemical storage in hydrogen powered vehicles.

Modulation of d-Orbital Interactions in Dual-Atom Catalysts for Enhanced Polysulfide Anchoring and Kinetics in Lithium-Sulfur Batteries.

Modulating the electronic structure is essential for improving the anchoring and catalytic capabilities of catalysts in lithium-sulfur batteries (LSBs). This study delves into the modulation of d-orbitals in transition metal dual-atom catalysts (DACs) supported by boron nitride and graphene (BNC) hybrid sheets for LSBs. This study reveals that the d-band center of the DACs, a key determinant of material chemical properties, is primarily determined by the electronic configuration of the dyz and dx2-y2 orbitals. Furthermore, the interaction between dz2 of transition metals and S_3 p orbitals is critical for the binding strength of LiPSs. By understanding these interactions, the functionality of DACs can be customized for optimal performance in LSBs. For example, the MnCrBNC catalyst with 10 d-electrons exhibits the optimal d-band center and demonstrates exceptional LiPSs binding capability, the lowest Li2S decomposition energy barrier, and the lowest Gibbs free energy of reaction for the rate-determining step of sulfur reduction. This study elucidates the fundamental mechanisms for designing high-performance LSB catalysts through electronic structure modulation.

How do gender norms contribute to stunting in Ntchisi District, Malawi? a qualitative study.

Despite adequate food production and nutrition intervention coverage, stunting remains an enduring problem in Ntchisi, Malawi. Globally, gender and social norms are known to influence nutritional outcomes in children. This study explores how gender norms contribute to child stunting, in Ntchisi district, Central Malawi. Informed by the UNICEF Framework for Malnutrition, nine focus group discussions were conducted with a target population of mothers (n = 24), fathers (n = 23) purposively targeted through growth monitoring sessions, and members of policy and health treatment committees (n = 21), spanning three different areas of Ntchisi district. Data were analysed through inductive thematic analysis, guided by the framework for Research in Gender and Ethics (RinGs). Three primary themes were identified: 1) gender unequal decision making on the consumption, sale and distribution of food; 2) enshrined community norms influence feeding practices underpinned by gender-based violence; and 3) policy disconnections and gaps that reinforce gender norms regarding nutrition. Themes encompassed practices across household, health treatment, and policy level. Gender norms that underpin inequalities in decision making for production and consumption of food undermine children's nourishment and contributes towards sustained child malnutrition in Ntchisi. Existing policy documents should revise their guidelines to incorporate gender norms as key determinants of malnutrition.

State-level trends in access to Medicaid family planning services, 2008-2023.

To characterize the landscape of policies that determine eligibility for family planning services through Medicaid programs and describe trends in eligibility and its determinants over time. Secondary data were collected for all states in the United States for the years 2008 through 2023. Data on economic and demographic characteristics came from the American Community Survey (ACS). Our descriptive study characterized state adoptions of Medicaid family planning section 1115 waivers and state plan amendments (SPA) and their eligibility criteria. We then estimated the proportion of women aged 19-44 years who were eligible for family planning services through Medicaid and identified the key determinants of changes in eligibility, by state and year. Information on state Medicaid policies was extracted from documentation on the Centers for Medicare & Medicaid Services website. When estimating the eligible population sizes, the denominator was women aged 19-44 years, the group most likely to be eligible for Medicaid family planning programs. Supplemental data on program enrollment or utilization were collected from states' websites and reports. Though eligibility limits for family planning through Medicaid generally increased over time, the proportion of women aged 19-44 years eligible for at least limited benefits decreased from 45.0% in 2012 to 39.4% in 2022, largely because of increases in household income. Trends varied considerably across states and by eligibility pathway. Among women with incomes below the poverty level, the proportion who were not eligible for Medicaid family planning services decreased from 6.3% in 2013 to 1.5% in 2022. Our data demonstrated substantial geographic and temporal variation in eligibility for family planning services through Medicaid. We identified key drivers of eligibility changes that may have important implications for health services analyses of means-tested public programs.

AI-Driven Particulate Matter Estimation Using Urban CCTV: A Comparative Analysis Under Various Experimental Conditions

Despite the high public interest in particulate matter (PM), a key determinant for indoor and outdoor activities, the current PM information provided by monitoring stations (e.g., data per administrative district) is insufficient. This study employed the closed-circuit television (CCTV) cameras densely installed within a city to explore the spatial expansion of PM information. It conducted a comparative analysis of PM estimation effects under diverse experimental conditions based on AI image recognition. It also fills a gap by providing an optimal analysis framework that comprehensively considers the combination of variables, including the sun’s position, day and night settings, and the PM distribution per class. In the deep learning model structure and process comparison experiment, the hybrid DL-ML model using ResNet152 and XGBoost showed the highest predictive power. The classification model was better than the ResNet regression model, and the hybrid DL-ML model with the post-processed XGBoost was better than the single ResNet152 model regarding AI prediction of PM. All four experiments that excluded the nighttime, added the solar incidence angle variable, applied the distribution of PM per class, and removed the outlier removal algorithm showed high predictive power. In particular, the final experiment that satisfied all conditions, including the exclusion of nighttime, addition of solar incidence angle variable, and application of outlier removal algorithm, derived predictive values that are expected to be commercialized.

Identifying Key Determinants of Islamic Customer Perceived Value: A Mixed-Method Study

The concept of customer perceived value is crucial for businesses to understand consumer behavior and gain a competitive edge; however, research on Muslim consumers remains scarce. This study seeks to identify the indicators and factors that shape Islamic customer perceived value, particularly within tertiary education institutions. A mixed-methods approach was employed, beginning with qualitative research using focus group discussions and interviews, followed by quantitative analysis through principal component analysis. The focus groups included students, lecturers, and experts, while 118 respondents completed the questionnaires. The findings uncovered 21 indicators and 6 key factors, namely: Islamic academic standards, Islamic attitudes, Islamic performance, Islamic physical attributes, Islamic organizational values, and Halal food and beverage offerings. These results advance the understanding of Islamic marketing and provide valuable insights for universities when formulating marketing strategies aligned with Islamic principles.

Evaluating the Effectiveness of Nivolumab in Metastatic Lung Cancer Among Patients Aged 65 and Older.

Background: Lung cancer remains the leading cause of cancer-related mortality globally, predominantly affecting older individuals. Despite the increasing use of immune checkpoint inhibitors (ICIs) like nivolumab in non-small cell lung cancer (NSCLC), the efficacy and safety in elderly patients, particularly those aged 65 and above, remain underexplored due to their underrepresentation in clinical trials. Methods: This retrospective study analyzed data from 60 elderly patients (≥65 years) with metastatic NSCLC who received nivolumab as second-line or later therapy between January 2020 and May 2023. Results: The median age was 67 years, with a predominance of males (78%). Nivolumab was administered for a median of 8 cycles, with 33.3% of patients receiving 15 or more cycles. The median OS was 23 months, and the 1-, 3-, and 5-year survival rates were 93.3, 54.1, and 18.6%, respectively. Multivariate analysis identified adenocarcinoma histology, fewer than 15 cycles of nivolumab, and non-response to prior therapies as independent predictors of poor OS. Nivolumab treatment was generally well-tolerated, with 45% of patients experiencing at least grade 1 toxicity. Conclusions: Nivolumab is effective and well-tolerated in elderly patients with metastatic NSCLC, providing survival benefits comparable to those observed in younger populations. The number of treatment cycles and initial response to therapy are key determinants of survival, underscoring the importance of continued treatment in this age group.

Overexpression of ALDOC Promotes Porcine Intramuscular and Intermuscular Fat Deposition by Activating the AKT-mTORC1 Signaling Pathway.

Skeletal muscle fat accumulation, a common complication of obesity, has garnered increasing attention. For livestock animals, intramuscular fat content is a key determinant of meat quality and directly influences consumer preferences for different meat products. However, genes effectively regulating intramuscular and intermuscular fat (IIMF) deposition remain largely unexplored. To address this gap, we employed transcriptome sequencing of muscle from pigs with high and low IIMF contents, uncovering Aldolase C (ALDOC) as a novel key gene controlling IIMF. ALDOC overexpression significantly enhanced the IIMF content both in vivo and in vitro. Mechanistic investigations revealed that ALDOC activates the AKT-mTORC1 axis to promote lipid accumulation in myotubes and intramuscular adipocytes. Notably, the mTORC1 inhibitor rapamycin abrogated ALDOC's proadipogenic effect. Our findings establish ALDOC as a novel key gene regulating IIMF deposition and identify the ALDOC-AKT-mTORC1 signaling pathway as a promising therapeutic target for treating skeletal muscle fat infiltration and improving pork quality.

Analyzing Unimproved Drinking Water Sources and Their Determinants Using Supervised Machine Learning: Evidence from the Somaliland Demographic Health Survey 2020

Access to clean and safe drinking water is a fundamental human right. Despite global efforts, including the UN’s “Water for Life” program, a significant portion of the population in developing countries, including Somaliland, continues to rely on unimproved water sources. These unimproved sources contribute to poor health outcomes, particularly for children. This study aimed to investigate the factors associated with the use of unimproved drinking water sources in Somaliland by employing supervised machine learning models to predict patterns and determinants based on data from the 2020 Somaliland Demographic and Health Survey (SHDS). Secondary data from SHDS 2020 were used, encompassing 8384 households across Somaliland. A multilevel logistic regression model was applied to analyze the individual- and community-level factors influencing the use of unimproved water sources. In addition, machine learning models, including logistic regression, decision tree, random forest, support vector machine (SVM), and K-nearest neighbor (KNN), were compared in terms of accuracy, sensitivity, specificity, and other metrics using cross-validation techniques. This study uses supervised machine learning models to analyze unimproved drinking water sources in Somaliland, providing data-driven insights into the complex determinants of water access. This enhances predictive accuracy and informs targeted interventions, offering a robust framework for addressing water-related public health issues in Somaliland. The analysis identified key determinants of unimproved water source usage, including socioeconomic status, education, region, and household characteristics. The random forest model performed the best with an accuracy of 93.57% and an area under the curve (AUC) score of 98%. Decision tree and KNN also exhibited strong performance, while SVM had the lowest predictive accuracy. This study highlights the role of socioeconomic and community factors in determining access to clean drinking water in Somali Land. Factors such as age, education, gender, household wealth, media access, urban or rural residence, poverty level, and literacy level significantly influenced access. Local policies and resource availability also contribute to variations in access. These findings suggest that targeted interventions aimed at improving education, infrastructure, and community water management practices can significantly reduce reliance on unimproved water sources and improve the overall public health.

Barriers and Willingness to Continue Using Telehealth Services Beyond the COVID-19 Pandemic from the Perspectives of Oral and Maxillofacial Surgeons in Australia: A Mixed-Method Study.

Patient demand for oral and maxillofacial telehealth services increased during COVID-19. To explore the potential for their continued use post-COVID-19, an assessment was conducted by examining the association between the clinical and socio-demographic characteristics of consultants and the perceived facilitators and barriers influencing their future intent. Practicing oral and maxillofacial consultants were recruited through purposive and snowball sampling methods. Data were collected through surveys and key informant interviews. Chi-square tests were used to determine whether consultants' clinical and socio-demographic characteristics and perceptions were associated with a willingness to use telehealth in the future. Coded interview transcripts were analyzed thematically to identify the main themes influencing their willingness. Among the 42 respondents, 82% expressed a willingness to continue using telehealth services with the majority having at least 2 to 3 years (p = 0.028) of experience utilizing these services. The four main themes impacting consultants willingness include the accessibility of oral and maxillofacial healthcare, challenges addressing patient needs, the uncertainty of diagnostic accuracy and effectiveness as a post-operation observation tool. Most oral and maxillofacial consultants favored the routine use of telehealth services beyond COVID-19. Concern for patients' needs was a key determinant of their continued use. Co-designing strategies to eliminate barriers and unmet needs for consultants and patients may improve oral and maxillofacial telehealth uptake.

Stand structure and Brazilian pine as key determinants of carbon stock in a subtropical Atlantic forest.

Understanding the drivers of variations in carbon stocks is essential for developing the effective management strategies that contribute to mitigating climate change. Although a positive relationship between biodiversity and the aboveground carbon (AGC) has been widely reported for various Brazilian forest types, representing a win-win scenario for climate change mitigation, this association has not been commonly found in Brazilian subtropical forests. Therefore, in the present study, we aimed to evaluate the effects of Araucaria angustifolia, stand structure and species diversity in shaping AGC stocks in Brazilian subtropical mixed forest. We hypothesized that the effects on the AGC of stand structure and diversity would be mediated by A. angustifolia. We also evaluated the expectation of higher carbon stocks in protected forest as a result of their positive correlation with biodiversity conservation. We found that stand structure, followed by A. angustifolia, played the most important role in shaping the AGC stock. Our hypothesis was partially confirmed, the indirect effects of A. angustifolia on stand structure being found to have shaped the AGC. Similarly, our expectation was partially supported, with the higher AGC in the protected area being related not to diversity, but rather to the presence of larger trees, denser stands, and a greater abundance of A. angustifolia. Although the win-win strategy between diversity conservation and carbon storage is not a peculiarity of Araucaria forests, we highlight the potential of these forests as a nature-based climate solution, maintaining high levels of carbon storage in harmony with the provision of keystone socio-economic resources.

Genetic Variation, Polyploidy, Hybridization Influencing the Aroma Profiles of Rosaceae Family.

The fragrance and aroma of Rosaceae plants are complex traits influenced by a multitude of factors, with genetic variation standing out as a key determinant which is largely impacted by polyploidy. Polyploidy serves as a crucial evolutionary mechanism in plants, significantly boosting genetic diversity and fostering speciation. This review focuses on the Rosaceae family, emphasizing how polyploidy influences the production of volatile organic compounds (VOCs), which are essential for the aromatic characteristics of economically important fruits like strawberries, apples, and cherries. The review delves into the biochemical pathways responsible for VOC biosynthesis, particularly highlighting the roles of terpenoids, esters alcohols, aldehydes, ketones, phenolics, hydrocarbons, alongside the genetic mechanisms that regulate these pathways. Key enzymes, such as terpene synthases and alcohol acyltransferases, are central to this process. This review further explores how polyploidy and hybridization can lead to the development of novel metabolic pathways, contributing to greater phenotypic diversity and complexity in fruit aromas. It underscores the importance of gene dosage effects, isoenzyme diversity, and regulatory elements in determining VOC profiles. These findings provide valuable insights for breeding strategies aimed at improving fruit quality and aligning with consumer preferences. Present review not only elucidates the complex interplay between genomic evolution and fruit aroma but also offers a framework for future investigations in plant biology and agricultural innovation.

A value chain modeling approach for upscaling the production of fine flavor cocoa in Arauca (Colombia)

AbstractThe fine flavor cocoa (FFC) market offers additional income for small farmers. Despite the potential of several Latin American countries to produce FFC, their lack of standardized postharvest processes hinders compliance with high‐quality standards demanded by the FFC market, as these processes have a direct impact on cocoa's organoleptic characteristics. This work supports the design of a collective postharvest transformation model that coordinates the main steps in the cocoa agri‐food chain: transport of the cocoa harvest, classification, fermentation, drying, storage, and commercialization. Our methodology includes a modeling scheme combining optimization and simulation models, considering variability in the processes, and covering operational (transport and resource allocation), tactical (design and sizing of the processing plant), and strategic (sales dynamics) decisions across the cocoa value chain. We illustrate this methodology in a case study in Arauca, Colombia. Our findings emphasize the importance of combining these operational and strategic models since their inputs and outputs are interconnected influencing the decision‐making within the cocoa value chain. Our study also identifies key determinants for the postharvest design, highlighting the postharvest center capacity, FFC prices, and the market selling mode (export or local).

Outcomes of Nonagenarian Patients in Vascular Surgery Service in a Tertiary Institution.

With the world population growing and aging, nonagenarians have become a distinct patient cohort with specific characteristics that render the prediction of outcomes essential. We aimed to investigate the specific characteristics of this patient's cohort in a tertiary vascular center. Retrospective analysis was conducted for all consecutive patients 90 years and above referred or treated in the Department of Vascular Surgery between January 2017 and December 2022 for vascular pathologies. The main endpoint was to analyze the type of vascular services required for nonagenarians. Additional endpoints involved evaluation of treatment outcomes during the study period based on medical records. The analysis was patient-based. A total of 148 nonagenarians were included in the study. In all, 71 (48%) of the patients underwent surgery, whereas 77 (52%) had conservative treatment. Most of the patients were referred for peripheral arterial (PAD; 56, 37.8%) and aortic-related (39, 26.4%) diseases. Other pathologies encountered involved acute limb ischemia (ALI; 25, 16.9%), carotid diseases (12, 8.1%), renal/dialysis-related consultations (8, 5.4%), and referrals from other departments (12, 5.4%). Urgent interventions were performed in 27% of the cases. Indications for surgery included PAD Rutherford Stages IV, V, and VI; symptomatic and ruptured aortic aneurysms; ALI Rutherford Stages I, IIa, and IIb; symptomatic and near total occlusion asymptomatic carotid disease; and dialysis-related procedures for patients with chronic renal failure on regular hemodialysis. Perioperative complications were experienced in 22 patients (14.9%), the 30-day reintervention rate was 7.4%, and 30-day mortality was 4.7%. The overall length of hospital stay for operated patients was a median of 8 nights. The proportion of nonagenarians in the population is growing and so is their referral to vascular surgery. Satisfactory short-term treatment outcomes can be achieved in this highly selected cohort of patients. Thirty-day mortality is higher in patients undergoing urgent procedures. Follow-up mortality was higher in the operated nonagenarians as compared with those who were treated conservatively. Careful patient selection and thorough preparation are crucial to enhance clinical outcomes. Further research on therapy outcomes of nonagenarians will enable physicians to make better evidence-based approaches to individual patients and should be encouraged. The study highlights the growing need to manage vascular diseases in nonagenarians, emphasizing that age alone should not exclude patients from surgical interventions. By demonstrating acceptable short-term outcomes with careful patient selection, this research challenges the traditional bias against operating on the elderly. Clinicians should refine risk assessment and treatment plans, particularly when balancing surgical and conservative options. Comorbidities, rather than age, are key determinants of patient suitability, encouraging more individualized, evidence-based approaches in this expanding demographic.

People consistently view elections and civil liberties as key components of democracy.

How do people around the world define democracy? Answering this question is critical as countries face democratic backsliding and authoritarian governments promote alternative notions of democracy. Indeed, some scholars argue that people from different backgrounds understand democracy differently. By contrast, we discovered very consistent views about what constitutes a "democratic" country from conjoint survey experiments conducted in Egypt, India, Italy, Japan, Thailand, and the United States. Across countries (N = 6150) and diverse subgroups within countries, people similarly emphasized free and fair elections and civil liberties as being the key determinants of democracy. Countries that produce desirable social and economic outcomes are also considered more democratic, but these and other factors exert a smaller and less consistent effect than elections and civil liberties.