Search Results (336)

As direct detection methods of Borrelia burgdorferi are limited, serology plays an important role in diagnosing Lyme disease (LD). There are various types of Lyme serological tests with varying diagnostic accuracy, so it is necessary to compare and rank them. The aim of this study is to compare the accuracy of various serological diagnostic methods for LD using network meta-analysis (NMA). We searched the Cochrane Library and PubMed databases for all serological diagnostic accuracy studies published from the discovery of LD until June 2024. After screening, we assessed the quality of the included studies with QUADAS-C and extracted relevant data. We calculated the Q* index of the receiver operating characteristic curve for each diagnostic test. Meta-disc 2.0 and Stata 15.0 were used to perform traditional meta-analysis and NMA with the gold standard (the comprehensive evaluation) as a reference. We then compared the Q* index values between different methods using two-by-two comparisons and ranked them accordingly. A total of 52 studies with 181,032 participants, including 5318 patients with LD, were included. These studies covered 14 diagnostic methods. The results of the NMA suggest that modified two-tiered testing (MTTT), C6 enzyme immunoassay (EIA), and standard two-tiered testing (STTT) rank in the top three among the 14 methods in terms of Q* index, with MTTT being the highest, followed by C6 EIA and STTT. MTTT and C6 EIA have higher overall diagnostic performance, and their accuracy is not inferior to that of the widely used STTT (PROSPERO CRD42022378326). Full article

On 10 May 2024, a super geomagnetic storm with a minimum Dst index of less than −400 nT occurred. It has attracted a significant amount of attention in the literature. Using total electron content (TEC) observations from a global navigation satellite system (GNSS), in situ electron density data from the Swarm satellite, and corresponding simulations from the thermosphere–ionosphere–electrodynamics general circulation model (TIEGCM), the dynamic poleward shift of the equatorial ionization anomaly (EIA) during the main phase of the super geomagnetic storm has been explored. The results show that the EIA crests moved poleward from ±15° magnetic latitude (MLat) to ±20° MLat at around 19.6 UT, to ±25° MLat at 21.2 UT, and to ±31° MLat at 22.7 UT. This poleward shift was primarily driven by the enhanced eastward electric field, neutral winds, and ambipolar diffusion. Storm-induced meridional winds can move ionospheric plasma upward/downward along geomagnetic field lines, causing the poleward movement of EIA crests, with minor contributions from zonal winds. Ambipolar diffusion contributes/prevents the formation of EIA crests at most EIA latitudes/the equatorward edge. Full article

The present study analyzes the global ionospheric response to the intense geomagnetic storm of 10–11 October 2024 (SYM—H minimum of −346 nT), using observations from COSMIC—2 and Swarm satellites, GNSS TEC, and Digisondes. Significant uplift of the F-region was observed across both Hemispheres on the dayside, primarily driven by equatorward thermospheric winds and prompt penetration electric fields (PPEFs). However, this uplift did not correspond with increases in foF2 due to enhanced molecular nitrogen-promoting recombination in sunlit regions and the F2 peak rising beyond the COSMIC—2 detection range. In contrast, in the Southern Hemisphere nightside ionosphere exhibited pronounced Ne depletion and low hmF2 values, attributed to G-conditions and thermospheric composition changes caused by storm-time circulation. Strong vertical plasma drifts exceeding 100 m/s were observed during both the main and recovery phases, particularly over Ascension Island, driven initially by southward IMF—Bz-induced PPEFs and later by disturbance dynamo electric fields (DDEFs) as IMF—Bz turned northward. Swarm data revealed a poleward expansion of the Equatorial Ionization Anomaly (EIA), with more pronounced effects in the Southern Hemisphere due to seasonal and longitudinal variations in ionospheric conductivity. Additionally, the storm excited Large-Scale Travelling Ionospheric Disturbances (LSTIDs), triggered by thermospheric perturbations and electrodynamic drivers, including PPEFs and DDEFs. These disturbances, along with enhanced westward thermospheric wind and altered zonal electric fields, modulated ionospheric irregularity intensity and distribution. The emergence of anti-Sq current systems further disrupted quiet-time electrodynamics, promoting global LSTID activity. Furthermore, storm-induced equatorial plasma bubbles (EPBs) were observed over Southeast Asia, initiated by enhanced PPEFs during the main phase and suppressed during recovery, consistent with super EPB development mechanisms. Full article

Green roofs (GRs) are emerging as effective tools for mitigating urban runoff, particularly in cities facing challenges related to increased impervious surfaces and flooding risks. This study evaluates the potential hydrological performance of GR retrofitting in São José dos Campos, Brazil, based on municipal legislation, focusing on the effects of reducing the Effective Impervious Area (EIA) in urban watersheds. Using a range of projected EIA reduction scenarios (Mandatory, Incentivized, and Ideal), this study compares key hydrological indicators such as peak flow attenuation, runoff volume reduction, and hydrograph delay during rainfall events with different return periods. The results show that retrofitting with GRs significantly attenuates peak flows and delays runoff, with the ‘Ideal’ scenario (EIA = 16%) achieving peak flow reductions of up to 41% and runoff volume reductions of 35%. However, the effectiveness of GRs diminishes for high-intensity rainfall events, suggesting that GRs are most effective for frequent, low-intensity storms. These findings demonstrate the potential of GRs in reducing flooding risks in urban environments, highlighting the importance of integrating GRs into broader sustainable drainage systems. This study further emphasizes that while financial support is crucial for promoting GR adoption, it alone is not sufficient. Policies should be complemented by educational efforts and urban regulatory measures to ensure widespread adoption and long-term impact. This research provides urban planners and stakeholders with evidence to enhance urban resilience, sustainability, and effective flood risk management. Full article

Phase stability at low radio frequencies is severely impacted by ionospheric propagation delays. Radio interferometers such as the giant metrewave radio telescope (GMRT) are capable of detecting changes in the ionosphere’s total electron content (TEC) over larger spatial scales and with greater sensitivity compared to conventional tools like the global navigation satellite system (GNSS). Thanks to its unique design, featuring both a dense central array and long outer arms, and its strategic location, the GMRT is particularly well-suited for studying the sensitive ionospheric region located between the northern peak of the equatorial ionization anomaly (EIA) and the magnetic equator. In this study, we observe the bright flux calibrator 3C48 for ten hours to characterize and study the low-latitude ionosphere with the upgraded GMRT (uGMRT). We outline the methods used for wideband data reduction and processing to accurately measure differential TEC ($\delta \mathrm{TEC}$) between antenna pairs, achieving a precision of< mTECU (1 mTECU = ${10}^{-3}$ TECU) for central square antennas and approximately mTECU for arm antennas. The measured $\delta \mathrm{TEC}$ values are used to estimate the TEC gradient across GMRT arm antennas. We measure the ionospheric phase structure function and find a power-law slope of $\beta =1.72\pm 0.07$, indicating deviations from pure Kolmogorov turbulence. The inferred diffractive scale, the spatial separation over which the phase variance reaches $1{\mathrm{rad}}^2$, is ∼6.66 km. The small diffractive scale implies high phase variability across the field of view and reduced temporal coherence, which poses challenges for calibration and imaging. Full article

The REPowerEU Plan calls for a massive speed-up of renewable energy, which can undermine nature conservation. We explored the impact of an industrial-scale wind power project planned inside a Natura 2000 site (Special Protected Areas for birds) in the mountains of Central Evvoia, in Greece. If approved, the project could cause significant land artificialization, land take, and habitat fragmentation, having a land take intensity of 4.5 m²/MWh. An important part of forested land (14%) would be artificialized. The wilderness character would sharply decline from 49% to 4%, with a large roadless area (51.4 km²) shrinking by 77% and a smaller one (16.1 km²) lost. The project greatly overlaps with the Natura 2000 network (97%), a regional Key Biodiversity Area and Important Bird Area (84%), and a potential Global Key Biodiversity Area (27%). It might affect 23 globally threatened and 44 endemic species. This case study is a typical example of the poor implementation of the Natura 2000 and EIA legislation and highlights their recurring inability to prevent harmful human activities across Europe from affecting protected species of European interest and ecosystem functions. We conclude with policy recommendations to help increase renewables’ sustainability and minimize land artificialization in the EU. Full article

Diagnosis of histoplasmosis is challenging. A rapid, sensitive, and specific method is essential. Serum is a non-invasive and easy sample to obtain in any hospital. The diagnostic accuracy of different techniques that use serum has been evaluated. Forty-one serum samples from patients with proven or probable histoplasmosis were analyzed. Different diagnostic techniques based on the detection of antibodies (ID Fungal Antibody System), antigens (Histoplasma GM EIA and Platelia^TM Aspergillus Ag), and DNA (“in-house” real-time PCR (RT-PCR) were tested and compared. Additionally, the quantification of cytokines and biomarkers related to histoplasmosis was performed. Global results from 27 samples in which all the tests were performed showed that the sensitivity of the Histoplasma GM EIA kit was 87.5% in patients with disseminated infection and HIV as an underlying disease; in immunocompetent (IC) patients, it was 54.5%. The detection of Histoplasma spp. with the ID Fungal Antibody System was positive in 90.9% of IC and in 62.5% of HIV patients. The Platelia-Asp kit had a low performance in both groups of patients (37.5% in HIV and 9% in non-HIV), and, finally, RT-PCR was better in immunosuppressed patients (44% in HIV vs. 27% in non-HIV). The combination of diagnostic techniques increased the detection of Histoplasma infection in inmunosupressed patients. Overall, patient groups infected with H. capsulatum (Hc) showed higher IL-8, IL-6, IL-1β, TNF-α, and IL-18 median values compared to non-Hc-infected controls. The effectiveness of diagnostic techniques on serum samples is highly influenced by the patient’s clinical presentation and underlying condition. Consequently, a thorough assessment of the patient’s clinical presentation and disease phenotype is crucial in selecting the most suitable diagnostic method. Full article

Early determination of the Shiga toxin type of Shiga toxin-producing Escherichia coli (STEC) is crucial for guiding STEC-infected patients for proper and timely treatment and patient care. Most diagnostic microbiology laboratories rely on PCR assays to detect the presence of stx1 and/or stx2 and enzymatic immunoassays (EIA) to detect the presence of the Shiga toxins 1 and/or 2 in STEC-positive stool samples. Occasionally, the stool samples test positive for STEC by PCR assays but test negative for the presence of Shiga toxins. Insufficient toxin production under laboratory conditions is the main culprit of this discordance. To test whether EIA-based STEC detection could be improved, various clinical STEC strains were treated with mitomycin C, which is a commonly used inducer of Shiga toxin production. A dose-dependent increase in Shiga toxin production, in response to mitomycin C doses of up to 500 ng/mL, was observed without any bactericidal effects. Depending on the serotype, 5–50 times more Shiga toxin 2 was produced than Shiga toxin 1. Shiga toxin production was not induced by the mitomycin C treatment in certain STEC serotypes carrying the toxin subtypes stx1a, stx2a, 2b, 2f, or 2h. This diversity in toxin production indicates that other factors may determine toxin expression in certain STEC strains, which warrant further exploration. Full article

Background/Objectives: Anti-cyclic citrullinated peptide (anti-CCP) antibodies are highly specific markers for rheumatoid arthritis (RA). Over the past decade, novel automating detection systems have been developed for anti-CCP detection. The present study aimed to evaluate the diagnostic performances of three fully automated anti-CCP assays in comparison to a conventional manual enzyme-linked immunosorbent assay (ELISA). Methods: One hundred ninety-nine patients with rheumatic symptoms (100 with RA and 99 without RA) were tested for anti-CCP autoantibodies using four assays: a manual-ELISA (EUROIMMUN^®), two chemiluminescence immunoassays (CLIAs) performed on the MAGLUMI X3^® and iFlash 1800^® platforms, and an enzyme immunoassay (EIA) run on the UNI^® analyzer. Results: The Kappa statistic indicated a moderate qualitative agreement among the EUROIMMUN, iFlash, and UNI assays (0.734 ≤ ĸ ≤ 0.778), while the MAGLUMI anti-CCP assay showed only weak-to-moderate agreement with the others (0.510 ≤ ĸ ≤ 0.628). A strong positive correlation was observed between anti-CCP levels measured by the four assays (0.747 ≤ rho ≤ 0.839). At the manufacturers’ cut-off values, sensitivities ranged from 76% to 99% and specificities from 69.7% to 99%, depending on the assay. However, at a fixed specificity of 95%, all the four assays showed good diagnostic performances for RA, with sensitivities ranging from 80% to 89% and positive likelihood ratios (LRs+) from 16 to 17.8. Conclusions: Our results revealed that at the manufacturers’ cut-offs, the UNI anti-CCP assay was the most valuable alternative to the conventional ELISA for diagnosing RA in our cohort. Nevertheless, after an appropriate adjustment of the thresholds, all the evaluated assays showed good diagnostic performances for RA. Full article

Background/Objective. Toxin-producing strains of Clostridioides difficile (C. diff) are the most commonly identified cause of healthcare-associated infection in the elderly. Risk factors include advanced age, hospitalization, prior or concomitant systemic antibacterial therapy, chemotherapy, and gastrointestinal surgery. Patients with unspecified and new-onset diarrhea with ≥3 unformed stools in 24 h are the target population for C. diff infection (CDI) testing. To present data on the risks of laboratory misdiagnosis in managing CDI. Materials. In two general hospitals, we examined 116 clinical stool specimens from hospitalized patients with acute diarrhea suspected of nosocomial or antibiotic-associated diarrhea (AAD) due to C. diff. Enzyme immunoassay (EIA) tests for the detection of C. diff toxins A (cdtA) and B (cdtB) in stool, automated CLIA assay for the detection of C. diff GDH antigen and qualitative determination of cdtA and B in human feces and anaerobic stool culture were applied for CDI laboratory diagnosis. MALDI-TOF (Bruker) was used to identify the presumptive anaerobic bacterial colonies. The following methods were used as confirmatory diagnostics: the LAMP method for the detection of Salmonella spp. and simultaneous detection of C. jejuni and C. coli, an E. coli Typing RT-PCR detection kit (ETEC, EHEC, STEC, EPEC, and EIEC), API 20E and aerobic stool culture methods. Results. A total of 40 toxigenic strains of C. diff were isolated from all 116 tested diarrheal stool samples, of which 38/40 produced toxin B and 2/40 strains were positive for both cdtA and cdtB. Of the stool samples positive for cdtA (6/50) and/or cdtB (44/50) by EIA, 33 were negative for C. diff culture but positive for the following diarrheal agents: Salmonella enterica subsp. arizonae (1/33, LAMP, culture, API 20E); C. jejuni (2/33, LAMP, culture, MALDI TOF); ETEC O142 (1/33), STEC O145 and O138 (2/33, E. coli RT-PCR detection kit, culture); C. perfringens (2/33, anaerobic culture, MALDI TOF); hypermycotic enterotoxigenic K. pneumonia (2/33) and enterotoxigenic P. mirabilis (2/33, culture; PCR encoding LT-toxin). Two of the sixty-six cdtB-positive samples (2/66) showed a similar misdiagnosis when analyzed using the CLIA method. However, the PCR analysis showed that they were cdtB-negative. In contrast, the LAMP method identified a positive result for C. jejuni in one sample, and another was STEC positive (stx1+/stx2+) by RT-PCR. We found an additional discrepancy in the CDI test results: EPEC O86 (RT-PCR eae+) was isolated from a fecal sample positive for GHA enzyme (CLIA) and negative for cdtA and cdtB (CLIA and PCR). However, the culture of C. diff was negative. These findings support the hypothesis that certain human bacterial pathogens that produce enterotoxins other than C. diff, as well as intestinal commensal microorganisms, including Klebsiella sp. and Proteus sp., contribute to false-positive EIA card tests for C. diff toxins A and B, which are the most widely used laboratory tests for CDI. Conclusions. CDI presents a significant challenge to clinical practice in terms of laboratory diagnostic management. It is recommended that toxin-only EIA tests should not be used as the sole diagnostic tool for CDI but should be limited to detecting toxins A and B. Accurate diagnosis of CDI requires a combination of laboratory diagnostic methods on which proper infection management depends. Full article

This paper investigates the effects of a Corotating Interaction Region (CIR)/High-Speed Stream (HSS)-driven geomagnetic storm from 13 to 23 October 2003, preceding the well-known Halloween storm. This moderate storm exhibited a prolonged recovery phase and persistent activity due to a High-Intensity Long-Duration Continuous AE Activity (HILDCAA) event. We focus on low-latitude ionospheric responses induced by Prompt Penetration Electric Fields (PPEFs) and Disturbance Dynamo Electric Fields (DDEFs). To assess these effects, we employed ground-based GNSS receivers, Digisonde data, and satellite observations from ACE, TIMED, and SOHO. An empirical model by Scherliess and Fejer (1999) was used to estimate equatorial plasma drifts and assess disturbed electric fields. Results show a ∼120 km uplift in hmF2 due to PPEF, expanding the Equatorial Ionization Anomaly (EIA) crest beyond 20° dip latitude. DDEF effects during HILDCAA induced sustained F-region oscillations (∼100 km). The storm also altered thermospheric composition, with [[O]/[N₂] enhancements coinciding with TEC increases. Plasma irregularities, inferred from the Rate of TEC Index (ROTI 0.5–1 TECU/min), extended from equatorial to South Atlantic Magnetic Anomaly (SAMA) latitudes. These results demonstrate prolonged ionospheric disturbances under CIR/HSS forcing and highlight the relevance of such events for understanding extended storm-time electrodynamics at low latitudes. Full article

Managing land-use activities sustainably in mountainous regions requires addressing the interconnected impacts of geophysical, socioeconomic, cultural, and geopolitical stressors. This complexity is exemplified in roadbuilding across highland Asia, where insufficient planning, incomplete environmental impact assessments (EIAs), and governance gaps often result in lasting “toeprints”—subtle yet significant unintended consequences. Drawing on specific case studies within Yunnan, China; Central Asia’s Belt and Road Initiative (BRI); and the Kedarnath Disaster in India, this perspective highlights the risks of rapid infrastructure development without holistic, long-term planning and explores the underlying issues of these problems. While mountain roads enhance connectivity, mobility, and short-term economic prosperity, they frequently impose environmental and social costs that offset their intended benefits. Poorly designed roads in the mountains of northwest Yunnan and Central Asia have triggered landslides, sedimentation, habitat fragmentation, and disruptions to local livelihoods and cultural practices. In contrast, road improvements to the remote Kedarnath Temple in the Himalaya led to the overcrowding of religious pilgrims who were killed and stranded during a major flood and sediment disaster in 2013. These case studies emphasize the need for transdisciplinary research, community engagement, and regulatory frameworks that integrate disaster risk reduction, climate resilience, and sustainability for the benefit of all stakeholders. By aligning infrastructure projects with robust planning frameworks, development practitioners and policymakers can better balance economic, environmental, and social priorities, minimizing unintended impacts while fostering resilient and equitable outcomes in fragile mountain landscapes. Full article

This study explores hydrogen’s potential as a sustainable energy source for Brunei, given the nation’s reliance on fossil fuels and associated environmental concerns. Specifically, it evaluates two hydrogen production technologies; steam methane reforming (SMR) and alkaline water electrolysis (AWE), through a techno-economic framework that assesses life cycle cost (LCC), efficiency, scalability, and environmental impact. SMR, the most widely used technique, is cost-effective but carbon-intensive, producing considerable carbon dioxide emissions unless combined with carbon capture to yield “blue hydrogen”. On the other hand, AWE, particularly when powered by renewable energy, offers a cleaner alternative despite challenges in efficiency and cost. The assessment revealed that AWE has a significantly higher LCC than SMR, making AWE the more economically viable hydrogen production method in the long term. A sensitivity analysis was also conducted to determine the main cost factors affecting the LCC, providing insights into the long term viability of each technology from an operational and financial standpoint. AWE’s economic viability is mostly driven by the high electricity and feedstock costs, while SMR relies heavily on feedstock costs. However, Environmental Impact Analysis (EIA) indicates that AWE produces significantly higher carbon dioxide emissions than SMR, which emits approximately 9100 metric tons of carbon dioxide annually. Nevertheless, findings suggest that AWE remains the more sustainable option due to its higher LCC costs and compatibility with renewable energy, especially in regions with access to low-cost renewable electricity. Full article

Environmental Impact Assessment (EIA) is a required systematic process of identifying, predicting, and assessing the environmental effects of proposed actions and projects such as nuclear power stations, long-distance railways, motorways, express roads, waste disposal installations for hazardous waste, and dams of a certain capacity. After presenting the EIA evolution at the international level, its introduction into Romanian legislation in 1973 is discussed, considering criticism regarding the main problems arising from its widespread implementation. Although some studies have included state-of-the-art synthesis of the EIA effectiveness concept, there are no reported studies using bibliometric analysis to describe in detail the historical development of the EIA process. The aim of this study is to analyze the evolution of the EIA process in Romania in the context of sustainable development (SD). To achieve this objective, the data obtained from the implementation of PRISMA methodology and bibliometric analysis were considered. For this purpose, 125 publications on the EIA evolution were selected, obtained from a systematic review in the Elsevier, Scopus, and Springer databases for the period 2000–2024. The research results provide practical recommendations for decision-makers and practitioners in Romania, aiming to strengthen EIA legislation and practices with the purpose of ensuring the effective implementation of sustainable development principles. Full article

The present study examines the global ionospheric response to the “Mother’s Day Superstorm” (10–11 May 2024), one of the most intense geomagnetic storms since 1957, with a minimum SYM-H index of −436 nT. Constellation Observing System for Meteorology, Ionosphere, and Climate-2 (COSMIC-2) Radio Occultation (RO) data indicated an increase in the F2 layer maximum critical frequency (foF2) over midlatitude dayside regions, which was accompanied by a significant F-region uplift (hmF2 increase) on a global scale, even on the nightside during the main and recovery phases. At the same time, a decrease in foF2 was observed on the nightside. High southeastward and vertical drift velocities were observed in the nightside sector of the northern hemisphere with the dayside sector exhibiting upward and southwestward-to-northwestward drifts during the main and recovery phases of the storm. An intense upward drift (~170 m/s) in the southern hemisphere was registered with the poleward expansion of the Equatorial Ionization Anomaly (EIA) during the main phase. Swarm A data highlighted the EIA expansion from ~45°N to 60°S during the dayside main phase and from ~30°N to 40°S on the nightside during recovery. Full article