Search Results (4,068)

Background: Genital tract infections and dysbiosis-related conditions contribute substantially to women’s sexual and reproductive morbidity. In South America, evidence on clinically relevant genital microorganisms remains fragmented across countries, populations, and diagnostic approaches. This systematic review and meta-analysis synthesized the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Gardnerella vaginalis, and Candida spp. among women in South America. Methods: We searched PubMed/MEDLINE, Web of Science, Cochrane Library, and SciELO for studies published from 1 January 2014 to 29 February 2024. Eligible studies reported prevalence data for at least one target microorganism in female populations from South American countries. Two reviewers independently screened studies, extracted data, and assessed methodological quality using Joanna Briggs Institute criteria for prevalence studies. Crude prevalence and random-effects pooled prevalence estimates with 95% confidence intervals were calculated. The review protocol was registered in PROSPERO (CRD420261324060). Results: Of 629 records identified, 51 studies from eight South American countries and French Guiana met the eligibility criteria for the systematic review, and 46 contributed to the main pooled prevalence meta-analysis. Substantial between-study heterogeneity was observed across all pathogen-specific analyses. Pooled prevalence was highest for G. vaginalis (28%), followed by Candida spp. (12%), C. trachomatis (7%), T. vaginalis (6%), and N. gonorrhoeae (3.2%). Conclusions: This review highlights the heterogeneous burden of clinically relevant genital microorganisms among women in South America and supports standardized diagnostic approaches, clearer phenotypic definitions, and stronger surveillance across underrepresented regional settings. Full article

Unusual DS-1-like G3P[8] rotavirus strains have emerged and spread rapidly across several countries. In Africa, however, reports of these strains and available whole-genome data remain limited, and their evolutionary relationships across the continent are not yet fully understood. In this study, we sequenced and characterized the complete genome of a DS-1-like G3P[8] strain (RVA/Human-wt/KEN/KCH1748/2020/G3P[8]) detected in a child with acute gastroenteritis in Kenya. Strain KCH1748 possessed an unusual genotype constellation: G3-P[8]-I2-R2-C2-M2-A2-N2-T2-E2-H2. Phylogenetic analysis revealed that 10 of the 11 genomic segments of strain KCH1748 were closely related to those of other East African DS-1-like G3P[8] strains from Kenya and Tanzania within the globally circulating DS-1-like G3P[8] lineage, suggesting that it may be derived from this globally emerging lineage. In contrast, the VP1 gene of strain KCH1748 was closely related to those of Ghanaian G9P[4] strains, sharing a common branch with Beninese DS-1-like G3P[8] and G2P[4] strains, suggesting a VP1 intragenogroup reassortment event involving African RVA strains. This study provides the first comprehensive whole-genome evolutionary characterization of a DS-1-like G3P[8] strain identified in Kenya. Our findings contribute to understanding the evolutionary dynamics and genomic diversification of emerging DS-1-like G3P[8] strains in Africa. Full article

Background/Objectives: Docosahexaenoic acid (DHA) is an essential component of breast milk for infant neurocognitive and visual development. Because DHA depends largely on dietary intake, women with low seafood consumption are at increased risk of inadequate DHA contents in breast milk. This study aims to quantify the DHA content in breast milk and assess how recommended dietary supplementation during lactation affects these contents among lactating women in three Balkan countries. Methods: This cross-sectional multicenter study included 128 lactating women (18–35 years). Dietary intake of DHA was assessed using a modified Food Frequency Questionnaire. DHA in breast milk was measured by gas chromatography following standard protocols. Both the FFQ and breast milk samples were collected at two time points: 20–40 (visit 1—V1) and 80–100 days (visit2—V2) postpartum. Results: In lactating women, seafood intake was low (Visit 1: 37.5 (0.0–93.8) g/week), meeting about 28% of the recommended amount, with some variation between countries. Consequently, the mean dietary n-3 PUFA and DHA intake for the total sample was less than 50% and 5% of the recommended daily allowance, respectively. Correlation analysis indicates that DHA content in breast milk is related to dietary DHA intake (Visit 1: r = 0.258, p = 0.001; Visit 2: r = 0.238, p = 0.012). DHA contents failed to reach the 0.3% clinical threshold for optimal neurodevelopment, with average levels ranging from 0.149 to 0.165%. Furthermore, no significant differences were observed between supplemented and unsupplemented women at either time point, highlighting a persistent regional deficit regardless of supplementation status. Conclusions: Lactating women in the Balkan region have a low dietary intake of n-3 PUFA and DHA, which is reflected in the breast milk lipid profile, regardless of standard supplementation. These findings highlight the need for a targeted nutritional strategy both via nutrition and supplementation to improve DHA intake in lactating women, but more importantly in infants. Full article

Background/Objectives: Adults at high risk of type 2 diabetes frequently show concurrent dyslipidemia, insulin resistance, and central adiposity before overt diabetes develops. We evaluated cardiometabolic responses to standardized whole-grain staple replacement and examined grain-quality patterns in free-living and country-level settings. Methods: This secondary exploratory analysis included 144 participants (48 per group) from a 12-week, three-arm randomized dietary trial. Participants were analyzed according to their randomized assignments to 100 g/day, 50 g/day, or control. Lipid, anthropometric, body composition, and composite cardiometabolic phenotypes were evaluated. Longitudinal and time-weighted cumulative effects were estimated using linear mixed-effects and regression models, with Benjamini–Hochberg false discovery rate (FDR) correction applied within the corresponding multiplicity domains. Complementary analyses included 30,769 NHANES adults without diabetes, including 12,169 with prediabetes, and descriptive country-level data on whole-grain intake, high-FPG-attributable diabetes burden, and cereal supply. Results: Within the extended phenotype panel, HWG versus control time-weighted cumulative effects included triglycerides (β = −0.220, 95% CI −0.397 to −0.043; FDR-adjusted p = 0.047), the atherogenic index of plasma (β = −0.125, −0.191 to −0.060; FDR-adjusted p = 0.002), and the triglyceride–glucose index (β = −0.301, −0.429 to −0.173; FDR-adjusted p < 0.001). Conventional lipid components showed distinct temporal responses. In NHANES, higher whole-grain exposure and more favorable grain-quality ratios were associated with lower adiposity- and insulin resistance-related phenotypes, whereas refined-grain exposure generally showed the opposite pattern. Country-level analyses showed marked heterogeneity in whole-grain intake, diabetes burden, and cereal supply context. Conclusions: Standardized whole-grain staple replacement was associated with short-term changes across several cardiometabolic dimensions in adults at high risk of type 2 diabetes, with the clearest extended-phenotype signals involving triglyceride-related and glucose–triglyceride coupling measures. NHANES identified cross-sectional grain-quality associations in free-living adults; country-level analyses described heterogeneity in whole-grain intake, diabetes burden, and cereal supply context. Full article

Nepal is a small, landlocked country with marked elevational variation from the Terai plains to the Himalayas. Here, four indigenous goat populations (Chyangra, Sinhal, Khari, and Terai) are raised at different elevations. This study aimed to clarify the genetic structure of these populations and how they are formed and propagated across the Himalayan region. We analyzed 136 Nepalese goats using mitochondrial (mt) DNA D-loop and sex-determining region Y (SRY) 3′-untranslated region (UTR) sequences, as well as 50 K SNP array data. The mtDNA haplogroups D (0.162) and G (0.03) were detected only in Chyangra, whereas haplogroup B was predominant in Sinhal (0.42), followed by Khari (0.260). Regarding SRY haplotypes, Y2B was detected in all populations, whereas Y1AB (0.42) was found only in Chyangra. Genome-wide SNP analysis showed that Chyangra was genetically related to Tibetan and Central Asian goats, while Terai resembled South Asian goats. Interestingly, Sinhal formed a distinct cluster, whereas Khari exhibited an admixed genetic structure. These findings suggest that Nepalese goats originate from at least three ancestral lineages and that an additional migration route may have existed through the southern Himalayas. Full article

Geopolitical disruptions of natural gas supply have repeatedly forced importing countries to reorganize their electricity systems, yet it remains unclear whether such disruptions are followed by movement of structurally different economies toward comparable energy-security and sustainability outcomes. This study compares Germany, a high-income economy exposed to the 2022 curtailment of Russian pipeline gas, with Jordan, a developing import-dependent economy exposed to the repeated sabotage of the Arab Gas Pipeline after 2011, using harmonized generation-mix and carbon intensity data for Germany over 1985–2024 and Jordan over 2000–2022, supplemented by weekly German market data. The generation fuel mix concentration is measured with a Herfindahl-based Supply Concentration Index (SCI), structural change is estimated with segmented interrupted time series (ITS) regressions inferred through Newey–West heteroskedasticity- and autocorrelation-consistent standard errors, and the joint security–sustainability position of each country is summarized with a newly proposed Energy Vulnerability–Transition Index (EVTI) that combines diversification, renewable penetration, and carbon intensity performance. The results show that Jordan’s 2011 disruption was associated with a baseline estimated change in its carbon intensity trajectory from +3.32 to −12.63 gCO₂/kWh per year and with renewable growth of +2.39 percentage points per year from a near-zero base, while Germany’s 2022 disruption was associated with a temporary carbon intensity shock, visible in a coal reactivation index that peaked at 1.26 and a sixfold wholesale price increase, followed by a policy-supported return to the pre-existing decarbonization pathway. The Germany–Jordan EVTI ratio narrowed from 6.5× in 2014 to 1.8× in 2022, and this convergence is robust to alternative component weightings. The findings indicate that geopolitical gas disruptions, despite their high short-run costs, were followed in both contexts by measurable movement toward more diversified and lower-carbon electricity systems, with direct implications for Sustainable Development Goal (SDG) 7. Full article

Households have been reported to account for more than a third of food waste (FW) generated in the most developed and high-income countries. Despite this, there remains a limited understanding of the behavioural and sociodemographic factors driving household food waste (HFW) generation in most countries, including the Republic of Ireland (ROI). This study therefore examined how behavioural practices and sociodemographic characteristics independently and interactively influence HFW generation in the ROI. Data from a national online survey (n = 966 households; 3163 individuals) were analysed using hierarchical quantile regression. Households with children (Mixed households) reported the highest HFW (1177 g/household/week), and single-adult households recorded the highest per capita median waste (females = 596.0 g/cap/week and males = 496.5 g/cap/week). Behavioural factors were stronger predictors than sociodemographic characteristics. Reliance on date labels was the strongest predictor of HFW, associated with an additional 239 g/week. Each additional weekly shopping trip was associated with 140 g/week more waste, whereas using a shopping list was associated with 42 g/week less waste. Some effects were moderated by sociodemographic factors: reliance on date labels was more strongly associated with waste among adults aged 18–24, and shopping frequency more strongly associated with waste in middle-income households. The findings point to the value of reforming date labelling, supporting more planned shopping, and encouraging the active reuse of leftovers, with attention to differences across household groups. The findings also have direct implications for Ireland’s obligations under SDG 12.3 and the EU Waste Framework Directive. Full article

Legal definitions of human viability vary worldwide. Background/Objectives: The treatment of periviable newborns remains controversial and raises ethical concerns. However, currently, the World Health Organization (WHO) sets the lower limit of viability at 22 weeks of gestation or 500 g birth weight. The aim of our research was to determine the knowledge of healthcare practitioners in our country regarding this topic, as well as including a course after which we sought to evaluate whether their perceptions regarding the management of these cases changed. Methods: The recruitment of participants encompassed those who voluntarily took part in the survey, and 30 clinicians were included; they participated in a 30 h online course and completed a survey questionnaire before and after the course. Results: After Holm adjustment, we observed an improvement in participants’ perceptions regarding recommendations concerning a multidisciplinary approach, perinatal counseling (20.0% vs. 100.0%), ethical issues (16.7% vs. 93.3%), and awareness of national guidelines (36.7% vs. 100.0%). Moreover, they recognized the importance of including parental wishes in decision-making (Holm-adjusted p = 0.0469), but with clinicians having the final word in the decision. Other factors did not change, with practitioners having knowledge about the serious outcomes of newborns in such challenging situations. Conclusions: Ethically grounded strategies to guide the management of newborns at the limit of viability is of great importance, whereby gestational age is an insufficient parameter. A collaborative, multidisciplinary process is mandatory in order to ensure the best outcomes for the newborn. The value of continuing medical education should be acknowledged. Full article

Passenger Car Equivalent (PCE) factors are widely used to convert heterogeneous traffic streams into equivalent homogeneous flow rates for the design and analysis of roads and intersections. In developing countries, mixed traffic conditions differ substantially from those in developed contexts due to variations in vehicle composition, operating characteristics, roadway parameters, and environmental conditions. Consequently, PCE values are highly context-specific and require periodic updates to accurately represent prevailing traffic conditions. However, such updates are often infrequent because conventional PCE estimation relies on extensive field data collection through time-consuming and costly traffic surveys, as well as the availability of experienced experts to conduct and validate the analyses. In Sri Lanka, the currently adopted PCE factors are more than two decades old and no longer reflect existing traffic conditions. Although several recent studies have estimated PCE values for mid-block roadway sections of various facility types (e.g., four-lane roads, two-lane roads, and freeways), no study has comprehensively addressed intersections, which are critical for signal timing and geometric design. This study aims to develop a systematic methodology for estimating intersection-specific PCE factors using drone-based video data. Traffic data were collected at selected intersections using an unmanned aerial vehicle to obtain an accurate bird’s-eye view of vehicle movements. The methodology compares the area occupancy of different vehicle categories under varying traffic compositions with that of a passenger-car-only traffic stream operating at the same average speed. Using the extracted traffic parameters, the basic headway method was applied to establish a framework for calculating PCE factors. PCE values were estimated for ten vehicle categories, and the results reveal significant deviations, particularly for three-wheelers, motorcycles, and commercial vehicles, when compared with values currently in use. A high-level comparison with studies from other developing countries in the South Asian region indicates notable differences in vehicle impacts at signalized intersections in Sri Lanka. Furthermore, the proposed methodology provides a practical, economical, and less labour-intensive approach for estimating PCE factors, enabling more frequent updates without requiring extensive field surveys or specialized expertise. Because it relies on a straightforward headway-based framework and drone-derived traffic data, the methodology can be readily adapted to different roadway facilities, including highways, rural roads, and intersections, making it suitable for application across diverse geographical regions. Full article

The molecular epidemiology and antiretroviral (ARV) drug resistance of human immunodeficiency virus type 1 (HIV-1) remain incompletely outlined in the Middle East and North Africa (MENA). The aim of this retrospective molecular epidemiology study was to analyze MENA HIV-1 sequences for phylogenetic clustering and to delineate surveillance drug-resistance mutations (SDRMs) for nucleoside reverse-transcriptase inhibitors (NRTIs), non-nucleoside reverse-transcriptase inhibitors (NNRTIs), and protease inhibitors (PIs) across various periods, locations, and subtypes/circulating recombinant forms (CRFs). Viral sequences were retrieved from the Los Alamos HIV Sequence Database as of 15 April 2026. Analyses were done using multiple sub-gene regions (two env regions (n = 224 and n = 60) and PR (n = 2413) and RT (n = 2103) of the pol gene). Phylogeny construction was conducted using maximum-likelihood estimation, while ARV drug resistance analysis was conducted using the Stanford HIVdb algorithm. The HIV-1 MENA sequences showed a remarkable genetic diversity, with co-circulation of multiple subtypes/CRFs, including subtype B in the Maghreb, Levant, and Egypt sub-regions, subtypes A1, G, CRF01_AE, and CRF02_AG in the Gulf Cooperation Council (GCC) and Yemen sub-region, and subtypes C and D in the Horn of Africa and Sudan sub-region. The percentage of MENA HIV-1 sequences in clusters was 10.3% for env1, 8.3% for env2, 22.0% for PR and 37.2% for RT. Phylogenetic reconstruction hinted at a structured epidemic dominated by small transmission units, with most clusters comprising dyads (n = 260) or networks (n = 142) and a limited number of large clusters (n = 8) that were largely confined within national boundaries, with only occasional cross-border linkages (n = 8). Overall SDRM prevalence was 3.2% in the PR region and 14.9% in the RT region, with a higher percentage of NNRTI-associated mutations (10.0%) than NRTI-associated mutations (9.1%) and dual-class resistance observed in 4.1% of sequences. Phylogenetic clustering was not associated with the probability of harboring SDRMs; however, negative binomial models showed that non-clustered sequences had a greater burden of NRTI-associated mutations, whereas no such association was observed for NNRTI- or PI-associated mutations. The findings showed predominantly localized and fragmented MENA HIV-1 transmission dynamics. Heterogeneous ARV drug resistance dynamics indicated that resistance emergence might be shaped by broader epidemiologic and treatment-related factors rather than ongoing clustered transmission. There is a need for coordinated molecular surveillance and optimized ART strategies across the MENA countries. Full article

The present study examined how volatility in exchange rates shapes banking-sector financial stability across the G7 and six high-income European countries, consisting of 13 developed economies. The study analyses the time period from 2000 to 2023. To measure volatility, the present study employed the GARCH(1,1) conditional variance of monthly real effective exchange rates. Stability is measured through the following two supporting indicators: Bank Z-score (solvency) and Non-Performing Loan (NPL) ratio (credit quality). Our analysis combines the Fully Modified OLS and two-step System GMM for analysing long-run and dynamic effects. To assess distributional heterogeneity, Method of Moments Quantile Regression (MMQR) is employed, while Dumitrescu–Hurlin tests are used for examining causality. The results show that volatility in exchange rates significantly reduces bank solvency and elevates credit risk. These effects are highly uneven: the adverse impact falls on the most fragile banking systems—those in the lower quantiles of the Z-score distribution and the upper quantiles of the NPL distribution. Causality runs unidirectionally, moving from volatility to instability. Institutional quality, which is proxied by the rule of law and regulatory quality, is seen to significantly decrease the credit-risk channel but not the solvency channel. Our findings provide implications for developed economies and support targeted, fragility-sensitive macro-prudential policy. Full article

Recreational fisheries contribute significantly to global economies through tourism, employment, and ecosystem service valorization. However, a systematic understanding of their economic magnitude and regional disparities remains fragmented. This study conducts a systematic review of 112 peer-reviewed articles published between 1991 and 2024, synthesizing the economic evidence across three key domains: consumer behavior, resource management, and ecological interactions. Consistent with previous research, our systematic synthesis documents a pronounced imbalance in the existing evidence base: studies from high-income countries more frequently report established management frameworks (e.g., bag limits, catch-per-unit-effort monitoring) and robust economic valuation mechanisms (e.g., Willingness to Pay estimation), whereas low- and middle-income countries face significant barriers in infrastructure and resource quantification. We identify that non-market valuation methods, particularly the travel cost method and consumer surplus analysis, are critical for internalizing the environmental value of fisheries. Furthermore, while ecological restoration demonstrates clear positive feedback loops for local economies, the sector exhibits high vulnerability to external shocks, such as the COVID-19 pandemic. This review highlights the urgent need to bridge the data gap in developing regions and suggests that transferring successful adaptive management models from developed nations is essential for achieving equitable and sustainable growth in the global recreational fishery economy. Full article

Infectious diseases remain a major global public health concern, disproportionately causing morbidity and mortality in low- and middle-income countries. Sexually Transmitted Infections (STIs) heavily affect sexually active populations. Sex workers, encompassing female sex workers (FSWs), male sex workers (MSWs), and transgender/gender-diverse individuals, face heightened vulnerabilities due to occupational exposures, structural barriers, stigma, and criminalization. While substantial focus has historically centered on HIV, non-HIV STIs such as Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, and viral hepatitis present significant co-morbidity. Crucially, drug resistance across these pathogens presents distinct biological and epidemiological challenges: bacterial antimicrobial resistance (AMR) in N. gonorrhoeae and C. trachomatis, antiretroviral (ARV) resistance in HIV, and direct-acting antiviral (DAA) resistance in hepatitis B and C. This perspective article synthesizes the current epidemiological landscape, critiques the reliance on syndromic management over molecular diagnostics (e.g., NAATs, point-of-care, and genomic surveillance), highlights diagnostic stewardship, and outlines priority public health strategies aligned with the WHO 2022–2030 Global Health Sector Strategies. Full article

In the last twenty years, as global uncertainties increased, tourism demand has become more fragile and harder to predict. This study aims to examine the impact of global uncertainty on tourism demand in G20 countries from 2001 to 2023 and to compare the forecasting performance of machine learning algorithms with traditional econometric approaches. The analysis uses international tourist arrivals as the dependent variable; per capita income, the real effective exchange rate (REER), the Global Uncertainty Index (WUI), and lagged demand are included in the model. The dynamic panel (System GMM) estimation confirms strong habit persistence in tourism demand, with the coefficient on lagged arrivals being highly significant at 0.8672 ($p<0.01$) for the full G20 sample, 0.8812 ($p<0.01$) for advanced economies, and 0.8524 ($p<0.01$) for emerging markets. The negative and statistically significant WUI coefficient across the full sample ($-0.4568$, $p<0.01$), advanced economies ($-0.4683$, $p<0.01$), and emerging economies ($-0.4452$, $p<0.01$) demonstrates that global uncertainty systematically suppresses tourism demand. Furthermore, income elasticities ($\ln GDP$) exert a positive and statistically significant impact across both advanced ($0.2145$, $p<0.01$) and emerging nations ($0.3412$, $p<0.01$), whereas real exchange rate appreciation ($\ln REER$) significantly deters demand in emerging markets ($-0.1145$, $p<0.05$). The negative and significant WUI coefficient (−0.45 to −0.47) in both developed and developing countries indicates that uncertainty systematically suppresses tourism demand. Machine learning models, especially during periods of high volatility, produced more successful results; the hybrid model achieved an average MAPE of 3.98% for the 2016–2023 period, demonstrating high accuracy. The findings highlight the importance of flexible and data-driven approaches during periods of uncertainty; they suggest that policymakers should focus on reducing uncertainty shocks and increasing demand resilience. Full article

In industrialized countries, existing regulations generally require the use of renewable energy to the greatest feasible extent. A major difficulty with renewable sources is the inherent fluctuation in their power output due to the main source character. By now, one of the best technologies capable of providing rapid compensation for these fluctuations is hydroelectric power. Hydropower plants, those equipped with hydraulic turbines with fixed blades (e.g., Francis, propeller) are typically designed to operate close to their best efficiency point (BEP) with acceptable load limits in the vicinity due to vibrations and pressure pulsations. Usually, the swirling flow exiting the runner is tailored for peak overall efficiency, which minimizes energy losses in the draft tube cone. When operating away from the design point, draft tube cone losses increase abruptly, and pronounce flow instabilities arise (e.g., vortex rope). This study proposes a new method to control such instabilities that inject a radial-axial water jet into the draft tube cone. Compared with conventional axial water jet injection, the radial-axial jet requires a lower additional flow rate while still effectively suppressing hydraulic instabilities in the draft tube cone. The carried-out analysis was done numerically by using Ansys Fluent 2023 R2. The performed 3D unsteady numerical simulations were carried out to examine the internal flow behavior and evaluate the effect of the radial-axial water jet injection on the unsteady behavior of the flow unsteadiness. Finally, the paper quantifies the relationship between the draft tube pressure fluctuation amplitude and the auxiliary flow rate needed to mitigate these instabilities. Full article