Blepharospasm-related dry eye is a complex multifactorial comorbidity involving neural, ocular surface, and psychological factors, currently facing core challenges including unclear pathogenesis, ambiguous clinical assessment and diagnostic criteria, non-standardized treatment, and lack of multidisciplinary collaboration. The article proposes that a "dry eye-blepharospasm" vicious cycle may exist with significant individual differences; symptom overlap easily leads to misdiagnosis without unified diagnostic standards or objective indicators; while botulinum toxin type A (BTX-A) is effective, controversies remain regarding dosage and efficacy, necessitating standardization of basic treatments like artificial tears; and establishing a multidisciplinary treatment (MDT) model is urgently needed in clinical practice. Consequently, the authors suggest elucidating mechanisms through multidimensional approaches such as animal models and functional imaging, classifying patients into three subtypes (sensory-triggered, movement-originated, and crossover types) based on onset sequence to establish standardized diagnostic processes, standardizing BTX-A administration with a "low-dose, multi-point, superficial injection" strategy and combination therapies, integrating ophthalmology, neurology, rehabilitation, and psychology resources to build an MDT model, and utilizing artificial intelligence and mobile health technologies for individualized long-term management. Future research should focus on the interaction between neuroinflammation and ocular surface injury, and explore precise combination strategies of BTX-A with novel anti-dry eye medications.

Koumine from Gelsemium elegans Benth Suppresses Colorectal Cancer Metastasis by Inhibiting Vasculogenic Mimicry Formation through Epithelial-Mesenchymal Transition and Cytoskeleton Remodeling.

The ATHENA (Advanced Tool for Holistic Evaluation and Nurturing of Abilities) competency framework proposes a multidimensional approach to human performance structured around five interdependent dimensions (cognition, conation, knowledge, emotion, and sensori-motion), operationalized through 60 fine-grained facets. Although ATHENA is grounded in contemporary psychological theory and supported conceptually by multivariate research in intelligence, creativity, and skill acquisition, empirical evidence regarding the clarity and practical comprehensibility of its facets remains limited. This study investigates the extent to which instructional designers and human resource development (HRD) professionals—two groups who routinely operationalize competencies for learning, assessment, and workforce development—understand and evaluate the semantic clarity and usability of the 60 facets. Seventy-five practitioners completed a structured evaluation of the ATHENA framework facets, which are designed to be used in a hybrid intelligence system for competency management. This article presents the theoretical background, methodological design, and results concerning users’ comprehension of the framework’s components. The findings support, in general, the compatibility of ATHENA’s facets and practitioners’ conceptions.

Abstract With the motivation to explore China’s nationally determined contributions (NDCs) toward a net zero emission future, we examine whether green technology innovation mitigates carbon dioxide (CO 2 ) emission thereby improving environmental quality across five of the most populous provinces (consisting of 85 cities) for the period between 2007 and 2019 in a multidimensional panel approach with an endogeneity robustness from two-step system generalized method of moments (GMM). The results show green technology innovation, economic output (GDP), and financial development spur CO 2 emission in the across the provinces. Meanwhile, especially in the whole panel, green technology innovation is dependent on the level of industrial structure (a moderation effect), but this interaction effect fails to show desirable outcome in the province-specific cases. Additionally, in each of Guangdong, Henan, Hunan, Shandong, and Sichuan provinces, carbon emission is triggered by an increase in GDP and financial development. Additionally, green technology innovation (i) worsens carbon emission through the moderating effect of advanced industrial structure and industrial structure rationalization in Guangdong and Sichuan provinces (ii) worsens carbon emission through the moderating effect of rationalization of industrial structure in Henan, Sichuan, and Shandong provinces. These findings have vital policy insight toward improving the quality of green innovations in China. Graphical Abstract

A multidimensional approach to sialorrhea management in elderly patients: Insights from the theory of unpleasant symptoms.

Cyclodextrin: A spectroscopic and in-silico investigation as a size-dependent cytoplasmic protein stabilizer.

Global climate change poses an increasingly serious challenge not only to environmental systems but also to the economic and social spheres, particularly affecting labour market dynamics and the ability of states to provide decent and sustainable employment. The ongoing transition to a green or low-carbon economy requires a fundamental rethinking of the legal and institutional frameworks governing labour relations. As economies restructure themselves in response to environmental imperatives, labour laws must evolve to support this transformation, while ensuring the protection of workers' rights and the creation of fair and inclusive labour markets. This article examines the principles of sustainable employment in the context of climate change, focusing on the need to harmonize environmental policies with labour laws and employment strategies. Sustainable employment in this context refers not only to the creation of jobs in environmentally responsible sectors ('green jobs'), but also to the social dimension of the transformation of work - ensuring social justice, inclusion and resilience in the face of climate-induced economic shifts. The paper examines both international legal standards and national approaches, highlighting the importance of integrating global frameworks such as the International Labour Organization Just Transition Guidelines and the Paris Agreement into national policies and legislation. A detailed legal analysis is provided, highlighting how these international commitments can inform national labour law reforms to support a just and sustainable transition. Special attention is paid to the experience of the Republic of Moldova and its legal capacity to adapt to climate-related challenges in the world of work. Comparative insights are drawn from countries such as Germany, Canada and Belarus, which have adopted progressive legal and policy frameworks to address employment challenges related to climate change. For example, Germany's integration of climate and employment strategies, Canada's federal support for workers affected by the energy transition and Belarus's state employment programs offer valuable models. The article formulates a number of proposals for improving the current legislation for the Republic of Moldova. These include the development of national sustainable employment strategies, legal guarantees for retraining and upgrading workers, creating incentives for creating environmentally friendly jobs and aligning labour market institutions with environmental goals. The article formulates a number of conclusions justifying that adapting labour legislation to climate challenges requires a comprehensive, multidimensional approach that balances environmental responsibility with social justice, economic development and legal certainty.

Transitions in frailty states and associated factors: a multistate analysis of the Italian Longitudinal Study on Aging population-based cohort.

The demand for high-performance applications of covalent organic frameworks (COFs) under harsh conditions drives the need for reaching both outstanding crystallinity and high stability, while these two properties necessitate contradictory structural features and are thus challenging to achieve simultaneously. We herein report a multidimensional supramolecular approach to manipulating both crystallinity and stability of COFs by harnessing in-plane and out-of-plane interactions with greatly enhanced performance in applications. The introduction of triple three-center hydrogen bonds into the linkage enhances in-plane local rigidity and planarity, while embedding electron-withdrawing heteroatoms into the linker mitigates out-of-plane electrostatic repulsion. The integration of the two structural features into a single COF results in profoundly enhanced interlayer π-π stacking interactions, ultimately providing considerably higher crystallinity and stability than those of control COFs, as well as significantly improved performance under harsh conditions, as exemplified by palladium separation from simulated high-level liquid waste. This work establishes a hybrid supramolecular approach to improving both crystallinity and stability of COFs toward prominent applications.

Asset-based millets production interventions for livelihood improvement in semi-arid Telangana: A multidimensional livelihood capital approach

Nutritional status and frailty in rheumatoid arthritis: A multicenter observational study (T-FLAG).

Uncovering multidimensional patterns of insufficient effort responding: A latent profile analysis integrating survey data and cognitive task performance.

Traditional medicine is increasingly promoted worldwide as a tool to achieve universal access to healthcare. Herbal medicines have formed the basis of healthcare throughout the world and are still widely used, playing a major role in the international health market. However, several factors influence the potential quality of phytotherapy. The diversity of herbal medicines, their various uses and preparation methods, the pluralism in access to these treatments, and the variability in the chemical composition of raw materials depending on their environment are all critical elements. This study compares the regulatory frameworks and quality control practices for plant-based health products in six countries: Benin, Burkina Faso, Guinea, Mali, Peru and France. It also provides an overview of the market in these countries. To do so, we compiled and highlighted key information from WHO guidelines, national legal documents, public databases on product registration and markets, and conducted interviews with health organisation experts. The main findings indicate that West African countries face challenges related to regulatory enforcement and limited industrial and research capacity. In contrast, Peru experienced an initial surge in production following regulation in 1997 and gained international recognition for Amazonian plants, but saw a decline after the 2009 U.S.-Peru Free Trade Agreement due to more stringent standards. France, while notable for its pharmacopoeia, struggles to implement quality control given the high volume of dietary supplements available. Based on these comparative insights, the paper recommends a multidimensional approach: promoting stakeholder training in good practices, developing robust pharmacopoeias, facilitating dialogue between traditional and allopathic medicines, and building shared infrastructures for research and quality control. These strategies, informed by successful practices across countries, aim to support the safe and equitable development of herbal health products worldwide.

Asthma management is ongoing a paradigm shift from symptom control and exacerbation prevention toward the more comprehensive goal of clinical remission. This review is timely because biologic therapies, precision medicine, and improved understanding of immunopathological mechanisms have made remission a realistic therapeutic goal. By integrating clinical, functional, and biological outcomes, remission offers a more comprehensive framework for assessing long-term disease control. Recent evidence demonstrate that biologic drugs, such as Mepolizumab, Omalizumab, Dupilumab, Benralizumab, and Tezepelumab, allow clinical remission to be achieved in many patients affected by severe asthma particularly those who show a phenotyping polarized toward T2-High. Lifestyle change, particularly weight loss and smoking cessation, early intervention, and the use of allergen immunotherapy may increase the chances of achieving remission. Real-world data confirm that remission rates vary depending on the definition applied, going from clinical to complete remission, highlighting the lack of a universally shared definition of remission and the need for standardized criteria. Clinical remission in asthma is now a feasible target. Achieving this goal requires a multidimensional approach that integrates biologics, early treatment, comorbidity management, and lifestyle interventions. Standardized definitions and biomarkers are essential to guide therapeutic decisions and predict long-term outcomes.

Aims: Fibromyalgia syndrome (FMS) may be under-recognized in hemodialysis populations, where chronic inflammation, musculoskeletal complaints, and reduced health-related quality of life (HRQoL) frequently overlap. This study evaluated the prevalence of FMS in hemodialysis and examined its associations with pain, activities of daily living, HRQoL, and routine dialysis/laboratory parameters. Methods: In this cross-sectional study, 127 adults were analyzed: 69 patients receiving maintenance hemodialysis (dialysis group) and 58 non-dialysis patients with FMS diagnosed using the ACR 2011 criteria and the 2016 revision (FMS group). Within the dialysis cohort, participants were stratified as FMS(+) (n=38) and FMS(–) (n=31). Pain intensity was assessed using a 0–10 Visual Analog Scale (VAS), functional independence with Katz Activities of Daily Living (ADL), and HRQoL with SF-36 (domain scores and summary measures). Dialysis/laboratory variables included pre- and post-dialysis blood urea nitrogen (BUN), Kt/V, parathyroid hormone (PTH), sodium (Na), and calcium (Ca). The primary outcome was SF-36 Role Limitations–Emotional. Multivariable logistic regression (dialysis cohort) and ROC analyses were performed to evaluate predictors of FMS. Results: The prevalence of FMS within the hemodialysis cohort was 55.1% (38/69). Between-group comparisons (dialysis vs FMS) showed higher BMI in the FMS group (28.7 ± 4.8 vs 25.3 ± 5.7; p<0.001), while VAS pain and Katz ADL scores were similar. SF-36 summary scores were higher in the FMS group (PCS, p=0.039; MCS, p=0.008; Total, p=0.012). At the domain level, General Health (45.1 ± 16.1 vs 38.6 ± 13.5; p=0.015) and Role Limitations–Emotional (62.0 ± 40.2 vs 28.5 ± 38.4; p<0.001) were higher in the FMS group. Within the dialysis cohort, Role Limitations–Emotional remained higher in FMS(+) patients (36.8 ± 39.3 vs 18.2 ± 35.3; p=0.024), and post-dialysis BUN was higher in FMS(+) patients (27.5 ± 13.4 vs 19.8 ± 4.3; p=0.008). In multivariable analysis, only post-dialysis BUN was independently associated with FMS (OR=1.10; 95% CI 1.02–1.19; p=0.012). Discrimination was moderate for post-dialysis BUN alone (AUC=0.684) and improved slightly with the multivariable model (AUC=0.726). Conclusion: FMS was common among hemodialysis patients and was associated with differences in emotional role functioning and higher post-dialysis BUN. These findings support a multidimensional approach to screening in dialysis care that integrates symptom-based FMS assessment with HRQoL profiling and selected biochemical signals.

Purpose Soccer referees are exposed to high aerobic and anaerobic demands during match play, yet evidence regarding training strategies that simultaneously enhance speed and agility in this population remains limited. This study aimed to examine the effects of a 12-week concurrent training program on sprint and agility performance in soccer referees and to evaluate the sustainability of these effects through a follow-up assessment. To our knowledge, few intervention studies have simultaneously examined both sprint speed and agility performance in soccer referees and evaluated whether these adaptations are retained during a follow-up period. Importantly, the inclusion of a follow-up assessment provides evidence on the retention of training-induced adaptations, which has rarely been examined in referee populations under applied field-based training conditions. Methods Fifty male soccer referees officiating in amateur leagues were assigned to a control group (n = 25) or an experimental group (n = 25). Both groups completed standard referee training twice weekly for 12 weeks, while the experimental group additionally performed concurrent training sessions combining endurance-based interval running and strength–power exercises twice per week. Sprint and agility performance were assessed using the 100 m sprint test and the Illinois Agility Test at pre-test, post-test, and 7-week follow-up. Data were analyzed using two-way mixed repeated measures ANOVA. Results Significant Group × Time interaction effects were observed for both sprint and agility performance (p < 0.01) with moderate-to-large interaction effects. The experimental group demonstrated greater improvements in 100 m sprint and Illinois Agility Test performance compared with the control group following the intervention. Importantly, these performance gains were largely maintained at follow-up, indicating sustained training adaptations. Conclusion A 12-week concurrent training program integrated into standard referee conditioning resulted in significant and sustained improvements in speed and agility performance. These findings highlight the effectiveness of concurrent training as a multidimensional approach to enhancing physical capacities that are critical for soccer refereeing and support its practical implementation within referee training programs. These results support the integration of concurrent training into referee conditioning programs to improve movement efficiency and match positioning capacity. Practitioners may consider concurrent training as a feasible strategy to improve and maintain key physical qualities required for match positioning across competitive phases.

Correlative analysis between ocular surface features and carotid plaque : A multimodal machine learning framework.

Auditory stimulation during non-rapid eye movement (NREM) sleep effectively enhances slow oscillations (SOs) and slow-wave activity (SWA) when precisely timed to certain phases of the SO. However, timing precision remains a core challenge. Recent evidence suggests that heart rate (HR) components may provide effective complementary timing cues. This study examined which HR phases are associated with stronger stimulation responses using continuous phase analysis and evaluated a multidimensional phase-comparison approach that integrates HR and EEG SO phases. Polysomnography (PSG) recordings from 133 adolescents were analyzed. Auditory tones were delivered randomly every 15-30seconds during NREM sleep. Instantaneous phases of EEG SO (~0.8Hz) and HR components in the low-frequency (LF; 0.04-0.15Hz) and high-frequency (HF; 0.15-0.4Hz) bands were extracted for continuous phase analysis. Tone-evoked SO amplitude and SWA were further compared across three phase-locking strategies: unimodal (SO-only or HR-component-only) and combined (EEG-HR). Responses were largest when tones occurred near the HR-LF up-peak and HR-HF down-peak. Phase analyses showed that tones occurring at the optimal HR component phases were accompanied by increases in SO amplitude by up to ~22μV and SWA by 12%, indicating that peripheral signals can serve as strong, independent timing cues. SO-only phase-locking also produced notable effects (~18μV SO amplitude, 19% SWA increase). Combining SO and HR phases yielded the greatest effects, with increases of ~38μV in SO amplitude and 32% in SWA. Oscillatory phases derived from heart rhythms provide effective timing information that may be useful for closed-loop auditory stimulation and reflect brain-heart coupling during sleep. A multidimensional phase-based approach that integrates EEG slow oscillations with instantaneous heart rate phases may support more precise control and stronger enhancement of deep sleep than unimodal approaches, suggesting a new framework for closed- loop neuromodulation.

As the population ages, kidney transplantation (KT) is increasingly considered for older adults with advanced chronic kidney disease (CKD). However, frailty, cognitive impairment, and malnutrition complicate transplant decision-making. A Comprehensive Geriatric Assessment (CGA) offers a multidimensional approach, but the relative contribution of individual CGA domains to transplant eligibility and receipt remains unclear. We conducted a retrospective observational study of 164 older adults with advanced CKD seeking KT and underwent CGA by a geriatrician at an urban academic center from September 2021 to July 2024. Associations between CGA domains and KT listing and receipt were evaluated using logistic regression analyses, adjusting for age and other clinical covariates. Of the 164 participants, 139 (84.8%) were listed, and 24 (17.3%) received KT among them. While higher levels of functional status, as measured by activities of daily living (ADL), were associated with KT listing, instrumental ADL and gait speed were significantly associated with transplantation. Even after adjusting for age, better cognitive function, as assessed through clinical evaluation and Montreal Cognitive Assessment (MoCA), was also positively associated with both outcomes. Age-adjusted nutritional status was independently associated with transplant listing eligibility. Individual domains of CGA, particularly physical function, cognition, and nutrition, are independently associated with KT decision-making among older adults. Incorporating focused geriatric assessments into kidney transplant evaluation may improve risk stratification and reduce disparities in transplant access.

Infrastructure development is a key factor in driving economic growth, particularly in developing countries like Indonesia, which face geographical challenges and regional disparities. This study aims to analyse the effect of road, electricity, and clean water infrastructure on Gross Regional Domestic Product (GRDP) across all provinces in Indonesia, with a focus on the dimensions of inclusiveness and spatial equity. The main issue raised is the inequality in infrastructure distribution between regions that hinders equitable economic growth. This study provides a new contribution through a multidimensional approach that not only assesses the economic impact of infrastructure but also takes into account social and sustainability aspects. In addition, the use of cross-section data from all provinces in 2023 and the application of multiple linear regression with classical assumption tests are methodological advantages that have not been widely used in previous studies. The method used is a quantitative approach with multiple linear regression analysis, using secondary data from BPS in 2023. The independent variables consist of road, electricity, and clean water infrastructure, while the dependent variable is GRDP. The classical assumption test was carried out to ensure the validity of the empirical model. The results of the study show that only the electricity infrastructure has a significant effect on GRDP, while road and clean water infrastructure do not have a statistically significant effect. However, all three remain strategically important in supporting long-term development. The conclusion of this study emphasises that infrastructure development must be inclusive and spatially equitable. The government needs to prioritise development in the 3T (frontier, outermost, and disadvantaged) regions and prioritise infrastructure quality, not just quantity, in order to encourage sustainable and equitable economic growth throughout Indonesia.