Search Results (451)

Background/Objectives: Mobile healthcare units (MHUs) comprise flexible, ambulatory healthcare teams that deliver community care services, particularly in underserved or remote areas. In Greece, MHUs were pivotal in epidemiological surveillance during the COVID-19 pandemic and are now evolving into a sustainable and integrated service for much-needed community-based healthcare. To support this expanded role, targeted, competency-based training is essential; however, this can pose challenges, especially in coordinating synchronous learning across geographically dispersed teams and in ensuring engagement using an online format. Methods: A nationwide, online training program was developed to improve the knowledge of the personnel members of the Hellenic National Public Health Organization’s MHUs. This program was structured focusing on four core themes: (i) prevention–health promotion; (ii) provision of care; (iii) social welfare and solidarity initiatives; and (iv) digital health skill enhancement. The program was implemented by the University of Crete’s Center for Training and Lifelong Learning from 16 January to 24 February 2025. A multidisciplinary team of 64 experts delivered 250 h of live and on-demand educational content, including health screenings, vaccination protocols, biomarker monitoring, chronic disease management, treatment adherence, organ donation awareness, counseling on social violence, and eHealth applications. Knowledge acquisition was assessed through a pre- and post-training multiple-choice test related to the core themes. Trainees’ and trainers’ qualitative feedback was evaluated using a 0–10 numerical rating scale (Likert-type). Results: A total of 873 MHU members participated in the study, including both healthcare professionals and administrative staff. The attendance rate was consistently above 90% on a daily basis. The average assessment score increased from 52.8% (pre-training) to 69.8% (post-training), indicating 17% knowledge acquisition. The paired t-test analysis demonstrated that this improvement was statistically significant (t = −8.52, p < 0.001), confirming the program’s effectiveness in enhancing knowledge. As part of the evaluation of qualitative feedback, the program was positively evaluated, with 75–80% of trainees rating key components such as content, structure, and trainer effectiveness as “Very Good” or “Excellent.” In addition, using a 0–10 scale, trainers rated the program relative to organization (9.4/10), content (8.8), and trainee engagement (8.9), confirming the program’s strength and scalability in primary care education. Conclusions: This initiative highlights the effectiveness of a structured, online training program in enhancing MHU knowledge, ensuring standardized, high-quality education that supports current primary healthcare needs. Future studies evaluating whether the increase in knowledge acquisition may also result in an improvement in the personnel’s competencies, and clinical practice will further contribute to assessing whether additional training programs may be helpful. Full article

In the United States, the Clozapine Risk Evaluation and Mitigation Strategy (REMS) program was implemented to ensure safe prescription and monitoring; however, its administrative complexity has often resulted in unintended barriers to access. Clozapine remains the most effective antipsychotic for treatment-resistant schizophrenia (TRS), yet its use continues to be constrained by outdated regulatory frameworks, cultural inertia, and clinical hesitancy. This perspective article revisits the pharmacokinetic foundations of clozapine, re-examines its association with fatal outcomes, and critiques the persistence of obsolete monitoring systems such as the U.S. REMS program. Drawing on recent consensus publications endorsed by over 120 international clozapine experts, this article outlines the proposed changes to the U.S. prescription information and contextualizes them within broader global practices. This article argues that many barriers to clozapine use stem not from evidence, but from regulatory conservatism and the perpetuation of clinical myths. The dismantling of the REMS program in early 2025 represents a pivotal moment, yet further reforms are urgently needed to align regulatory guidance with contemporary science. Ultimately, this article is a call to rediscover the clinical value of clozapine and to translate decades of knowledge into regulatory and clinical action. Full article

This study explores the use of artificial intelligence (AI) in religious leadership in Germany, focusing on the interplay between technological innovation, theological principles, and human interaction. Drawing on qualitative methods, 23 Christian leaders and experts were interviewed to examine their perceptions, assessments, and potential applications of AI and related technologies in their work, alongside ethical and theological considerations. The findings reveal a prevailing ambivalence towards AI: while it is generally accepted as a tool for administrative tasks, its use in pastoral contexts encounters resistance due to ethical concerns and theological tensions. Despite predominantly neutral to positive attitudes, many leaders lack proactive engagement in exploring AI’s transformative potential—pointing to a marked lack of agency. Digital competence among leaders emerges as a significant factor influencing the openness to AI adoption. This study identifies key barriers to the integration of AI into religious practice and underscores the need for strategic education and planning. It advocates for a balanced approach to leveraging AI in ways that align with religious values while embracing innovation in a digitalizing society. Full article

Background/Objectives: The development of hypophosphatemia has been associated with intravenous iron products, with the rate of hypophosphatemia found to be higher with ferric carboxymaltose. This consensus statement provides clinical guidance on the risk of hypophosphatemia development with ferric carboxymaltose and the approaches for management. To develop consensus recommendations regarding the clinical implications of hypophosphatemia after the administration of ferric carboxymaltose, the assessment of patient risk profile, and recommended approaches for risk reduction. Methods: Consensus statements were developed from an in-person meeting of specialists with expertise in iron pathophysiology and iron therapy and further supplemented with literature review. The multidisciplinary expert panel comprised global iron specialists spanning anesthesiology, cardiology, gastroenterology, obstetrics/gynecology, hematology, nephrology, and iron molecular biology. Structured discussions were held in an in-person meeting to gather expert opinion on the evidence base regarding intravenous iron and hypophosphatemia. Consolidated summary opinions underwent further iterations of panel review to form consensus recommendation statements. Results: The expert panel developed the following consensus statements: (1) Routine serum phosphate level measurement is not recommended for low-risk patients before or after treatment with ferric carboxymaltose, as most cases of hypophosphatemia that occur following the administration of ferric carboxymaltose are asymptomatic and transient; (2) patients receiving ferric carboxymaltose should be assessed for the degree of risk for developing symptomatic or severe hypophosphatemia prior to administration; (3) monitoring serum phosphate is recommended for patients at an increased risk for developing low serum phosphate or who require repeated courses of ferric carboxymaltose treatment at higher doses; (4) prophylactic oral phosphorus after ferric carboxymaltose is unlikely to effectively elevate phosphate and is not recommended for routine clinical practice; and (5) hypophosphatemic osteomalacia is rare and the risk of development after the administration of ferric carboxymaltose, in particular single infusion, is low. Conclusions: Hypophosphatemia following ferric carboxymaltose is predominantly asymptomatic and transient. Individuals at higher risk for developing hypophosphatemia with ferric carboxymaltose treatment include those who receive multiple infusions, higher cumulative doses, or long-term iron treatment or who have underlying clinical risk factors. These consensus statements provide structured guidance on the risk of hypophosphatemia with ferric carboxymaltose and the approaches to clinical management. Full article

Cat owners are involved in their cats’ healthcare, including the prevention of parasitic diseases. However, a comprehensive understanding of their preferences for feline antiparasitics is lacking. This study addresses this gap through a multifaceted methodology comprising three phases. In Phase 1, the physical properties and usability aspects of seven topical antiparasitic formulations were assessed. Within Phase 2, an ease-of-use study was conducted to evaluate the cat owners’ application experience with deidentified products representing three topical antiparasitics. Phase 3 included the identification and validation of product attributes most valued by pet owners through interviews with cat owners and veterinary experts. The product attributes identified informed the subsequent quantitative discrete choice experiment (DCE), which involved 1040 cat owners from different countries (Australia/New Zealand, Canada, Greece/Spain, and the UK) and aimed to analyze their preferences based on choices among product profiles mirroring four topical antiparasitics: selamectin–sarolaner, moxidectin–fluralaner, moxidectin–imidacloprid, and eprinomectin–esafoxolaner–praziquantel. Phase 1 showed that the selamectin–sarolaner formulation exhibits minimal odor, less stickiness, and less drying time. The ease-of-use study (Phase 2) showed that the blinded product representing the selamectin–sarolaner formulation was characterized by seamless application, rapid dispensing, and a sense of control during application. The quantitative DCE study (Phase 3) indicated a preference for the product profile mirroring the selamectin–sarolaner formulation among a global sample of cat owners. Demographic characteristics such as gender, age, and insurance status influenced their preferences. Key predictors for preferring the selamectin–sarolaner formulation over at least one comparator treatment included the ability to confirm successful administration, age restrictions, ease of application, and the time before the cat could sit on furniture following administration. These findings suggest that cat owners prioritize ease of use, safety, and overall user experience, providing valuable guidance for veterinary practitioners to make informed treatment recommendations. Full article

This study explores the fundamental components and specificities of agroforestry policies in France and Quebec, with a particular focus on the regions of Brittany and Montérégie. It uses a mixed-methods approach, combining an in-depth literature review and 14 semi-structured interviews with various stakeholders, including research institutions, agricultural advisory organizations, independent experts, and regional public agencies engaged in agroforestry and environmental initiatives. The collected data were qualitatively analyzed using word frequency and co-occurrence techniques, based on Elinor Ostrom’s Institutional Analysis and Development (IAD) framework. The results reveal that in France, agroforestry benefits from a well-structured policy environment, centered on the Common Agricultural Policy (CAP) and the Agroforestry Development Plan (PDA). The Breizh Bocage initiative is making a positive contribution to this, with more than 5000 km of hedges planted thanks to its localized governance model and direct community funding. In Quebec, agroforestry is also supported by various policies and programs such as Prime-Vert, with more than 2370 hedge planting projects completed. Despite its strengths, the French case, particularly the Breizh Bocage program, is limited by cumbersome administrative procedures. In both contexts, stakeholders emphasize the need to improve the transparency and efficiency of the program by simplifying administrative processes and harmonizing financial support mechanisms. Full article

This study presents the first comprehensive nationwide assessment of mangrove ecosystems in the Maldives. Surveys were conducted across 162 islands in 20 administrative atolls, integrating field data, the literature, and secondary sources to map mangrove distribution, confirm species presence, and classify habitat types. Twelve true mangrove species were identified, with Bruguiera cylindrica, Rhizophora mucronata, and Lumnitzera racemosa emerging as dominant. Species diversity was evaluated using Shannon (H′), Margalef (d′), Pielou’s evenness (J′), and Simpson’s dominance (λ′) indices. Atolls within the northern and southern regions, particularly Laamu, Noonu, and Shaviyani, exhibited the highest diversity and evenness, while central atolls such as Ari and Faafu supported mono-specific or degraded stands. Mangrove habitats were classified into four geomorphological types: marsh based, pond based, embayment, and fringing systems. Field sampling was conducted using standardized belt transects and quadrats, with species verified using photographic documentation and expert validation. Species distributions showed strong habitat associations, with B. cylindrica dominant in marshes, R. mucronata and B. gymnorrhiza in ponds, and Ceriops tagal and L. racemosa in embayments. Rare species like Bruguiera hainesii and Heritiera littoralis were confined to stable hydrological niches. This study establishes a critical, island-level baseline for mangrove conservation and ecosystem-based planning in the Maldives, providing a reference point for tracking future responses to climate change, sea-level rise, and hydrological disturbances, emphasizing the need for habitat-specific strategies to protect biodiversity. Full article

In this research, we have compiled and analysed the organisations and studies that jointly address the issue of land administration, fundamentally in the cartographic aspects related to the cadastre and land registry, in the international environment, and at the Ibero-American level. Through qualitative social research, interviews were conducted with internationally recognised experts on issues of general cartography, cartography and legal security, and related to cadastral valuation, obtaining conclusions that allow a general diagnosis of the situation of the Land Administration System in Ibero-America. In this environment, problems such as the heterogeneity of systems, overlapping of competencies, instability, lack of sustainability, need for standards, lack of transparency, etc., should be highlighted, among others. Finally, based on the compilation of existing data from the Cadastre Data survey conducted in 2011 by the Permanent Committee of Cadastre in Ibero-America, and with information from its members and member organisations of the Pan-American Association of Professional Surveyors, the geoportal Diagnosis of the Situation of the Land Administration System in Ibero-America has been created. This geoportal allows the initial identification of the different organisations and general regional data. Full article

Background/Objectives: Renal cell carcinoma (RCC) is a malignant disease that requires rapid and reliable diagnosis to determine the correct treatment protocol and to manage the disease effectively. However, the fact that the textural and morphological features obtained from medical images do not differ even among different tumor types poses a significant diagnostic challenge for radiologists. In addition, the subjective nature of visual assessments made by experts and interobserver variability may cause uncertainties in the diagnostic process. Methods: In this study, a deep learning-based hybrid model using multiphase magnetic resonance imaging (MRI) data is proposed to provide accurate classification of RCC subtypes and to provide a decision support mechanism to radiologists. The proposed model performs a more comprehensive analysis by combining the T2 phase obtained before the administration of contrast material with the arterial (A) and venous (V) phases recorded after the injection of contrast material. Results: The model performs RCC subtype classification at the end of a five-step process. These are regions of interest (ROI), preprocessing, augmentation, feature extraction, and classification. A total of 1275 MRI images from different phases were classified with SVM, and 90% accuracy was achieved. Conclusions: The findings reveal that the integration of multiphase MRI data and deep learning-based models can provide a significant improvement in RCC subtype classification and contribute to clinical decision support processes. Full article

This paper aims to explore the challenges of maintaining and modernizing legacy systems, particularly COBOL-based platforms, the backbone of many financial and administrative systems. By exploring the DOGE team’s initiative to modernize government IT systems on a relevant case study, the author analyzes the pros and cons of AI and Agile methodologies in addressing the limitations of static and highly resilient legacy architectures. A systematic literature review was conducted to assess the state of the art about legacy system modernization, AI integration, and Agile methodologies. Then, the gray literature was analyzed to provide practical insights into how government agencies can modernize their IT infrastructures while addressing the growing shortage of COBOL experts. Findings suggest that AI may support interoperability, automation, and knowledge abstraction, but also introduce new risks related to cybersecurity, workforce disruption, and knowledge retention. Furthermore, the transition from Waterfall to Agile approaches poses significant epistemological and operational challenges. The results highlight the importance of adopting a hybrid human–AI model and structured governance strategies to ensure sustainable and secure system evolution. This study offers valuable insights for organizations that are facing the challenge of balancing the desire for modernization with the need to ensure their systems remain functional and manage tacit knowledge transfer. Full article

Background: Economic logistics in fire and rescue services is a critical determinant of operational readiness, fiscal sustainability, and resilience to large-scale emergencies. Despite its strategic importance, logistics remains under-researched in Central and Eastern European contexts, where legacy governance structures and EU-funded modernization coexist with systemic inefficiencies. This study focuses on the Slovak Fire and Rescue Service (HaZZ) as a case to explore how economic logistics systems can be restructured for greater performance and value. Objective: The objective of this paper was to evaluate the structure, performance, and reform potential of the logistics system supporting HaZZ, with a focus on procurement efficiency, lifecycle costing, digital integration, and alignment with EU civil protection standards. Methods: A mixed-methods design was applied, comprising the following: (1) Institutional analysis of governance, budgeting, and legal mandates based on semi-structured expert interviews with HaZZ and the Ministry of Interior officers (n = 12); (2) comparative benchmarking with Germany, Austria, the Czech Republic, and the Netherlands; (3) financial analysis of national logistics expenditures (2019–2023) using Total Cost of Ownership (TCO) principles, completed with the visualization of cost trends and procurement price variance through original heat maps and time-series graphs. Results: The key findings are as follows: (1) HaZZ operates a formally centralized but practically fragmented logistics model across 51 district units, lacking national coordination mechanisms and digital infrastructure; (2) Maintenance costs have risen by 42% between 2019 and 2023 despite increasing capital investment due to insufficient lifecycle planning and asset heterogeneity; (3) Price variance for identical equipment categories across regions exceeds 30%, highlighting the inefficiencies in decentralized procurement; (4) Slovakia lacks a national Logistics Information System (LIS), unlike peer countries which have deployed integrated digital platforms (e.g., CELIS in the Czech Republic); (5) Benchmarking reveals high-impact practices in centralized procurement, lifecycle-based contracting, regional logistics hubs, and performance accountability—particularly in Austria and the Netherlands. Impacts: Four high-impact, feasible reforms were proposed: (1) Establishment of a centralized procurement framework; (2) national LIS deployment to unify inventory and asset tracking; (3) adoption of lifecycle-based and performance-based contracting models; (4) development of regional logistics hubs using underutilized infrastructure. This study is among the first to provide an integrated economic and institutional analysis of the Fire and Rescue Service logistics in a post-socialist EU member state. It offers a structured, transferable reform roadmap grounded in comparative evidence and adapted to Slovakia’s hybrid governance model. The research bridges gaps between modernization policy, procurement law, and digital public administration in the context of emergency services. Full article

Background/Objectives: Accurate prehospital assessment of total body surface area burned (TBSA-B) is crucial for pediatric burn management, guiding resuscitation, fluid therapy, and transfer decisions. This study evaluates the accuracy of prehospital TBSA-B estimations compared to in-hospital expert assessment and examines their impact on prehospital management. Methods: This retrospective study analyzed 104 pediatric burn cases (median 17 months; 5 days–14 years) from 2017 to 2021. The primary endpoint was the difference between prehospital TBSA-B estimation and clinical measurement, with a clinically significant discrepancy defined as >5%. Secondary endpoints included the relationship between TBSA-B estimation and fluid therapy, analgesia, and hospital stay duration. Results: Prehospital TBSA-B estimations ranged from 2% to 40% (mean: 13.9%, SD = 4.4%) with scalds being the most common burn type (90.4%). Bland–Altman analysis showed a mean TBSA-B overestimation (bias) of 6.35%, with limits of agreement ranging from −6.97% (CI: −9.42 to −4.51) to 19.67% (CI: 17.21 to 22.12). No significant patterns in overestimation were associated with age, gender, or burn location. Fluid therapy volumes were independent of prehospital TBSA-B estimates, and analgesic administration varied by gender, with girls receiving less analgesia than boys, but showed no association with burn extent or severity. Hospital stay duration correlated proportionally with in-hospital assessed TBSA-B. Conclusions: Prehospital TBSA-B estimation was systematically overestimated, yet it did not influence fluid therapy decisions. Gender differences were observed in analgesic administration, while hospital stay duration was directly related to burn extent. These findings highlight the need for improved training and standardized tools to enhance prehospital burn assessment in pediatric patients. Full article

Although they show great promise in the medical field, the safety of fullerenes—discovered forty years ago—is still uncertain, according to regulatory experts at the European Scientific Committee on Consumer Safety. This is a major obstacle to progress in the field. Meanwhile, oily solutions of fullerenes intended for human and pet consumption can be purchased online, without any marketing authorization. Therefore, to avoid any potential public health issues, regulatory-compliant preclinical studies on fullerene oily solutions are urgently needed. We present the first in vivo genotoxicity study of a C60/C70 fullerene mixture (4.1/1, w/w) dissolved in extra virgin olive oil (0.8 mg/mL). The study was conducted using the Mammalian Micronucleus Test (MMT) in an independent GLP-laboratory, in compliance with the OECD and EPA guidelines. The MMT was performed on NMRI mice following the oral administration of fullerenes at doses of up to 3.6 mg/kg. This dose is almost the maximum dose that can be administered to rodents. The data obtained clearly show that fullerene oily solutions have no genotoxic activity under these conditions. This should pave the way for further regulatory investigations of fullerene oily solutions. Full article

Mitochondria, the energy factories of human organisms, can be the cause of a variety of genetic disorders called mitochondrial myopathies. Mitochondrial diseases arise from genetic alterations in either mitochondrial DNA (mtDNA) or nuclear DNA (nDNA) and can manifest with great heterogeneity, leading to multiorgan dysfunction. The purpose of this article is to concisely review the pathophysiology, genetics and main clinical features of mitochondrial myopathies, focusing mainly on the treatment and management of these disorders. Currently, a particular treatment for mitochondrial myopathies does not exist, while the available guidelines concerning management are based on experts’ opinions. The therapeutic options currently applied largely aim at symptom relief and amelioration of patients’ quality of life. The most commonly used regimens involve the administration of vitamins and cofactors, although hard evidence regarding their true benefit for patients is still lacking. Recent studies have demonstrated promising results for elamipretide; however, phase III clinical trials are still ongoing. Regarding patient management, a multidisciplinary approach with the collaboration of different specialties is required. Further clinical trials for the already applied treatment options, as well as on novel experimental therapies, are of utmost importance in order to improve patients’ outcomes. Full article

This study integrated the strengths of ensemble learning and soft computing to develop a future regional rainfall model for evaluating the complex characteristics of island precipitation. Soft computing uses the well-developed adaptive neuro-fuzzy inference system, which has been successfully applied in atmospheric hydrology and combines the features of neural networks and fuzzy logic. This combination enables artificial intelligence (AI) to effectively represent reasoning derived from complex data and expert experience. Due to the multiple atmospheric and hydrological factors that influence rainfall, the nonlinear interrelations among them are highly intricate. Nonlinear principal component analysis can extract nonlinear features from the data, reduce dimensionality, and minimize the adverse effects of data noise and excessive input factors on soft computing, which may otherwise result in poor model performance. Ultimately, ensemble learning enhances prediction accuracy and reduces uncertainty. This study used Tamsui and Kaohsiung in Taiwan as case study locations. Historical monthly rainfall data (January 1950 to December 2005) from Tamsui Station and Kaohsiung Station of the Central Weather Administration, along with historical and varied emission scenario data (RCP 4.5 and RCP 8.5) from three AR5 GCM models (ACCESS 1.0, CSIRO-MK3.6.0, MRI-CGCM3), were used to evaluate future regional rainfall trends and uncertainties through the method proposed in this study. The research findings indicate the following: (1) Ensemble learning results demonstrate that all examined general circulation models effectively simulate historical rainfall trends. (2) The average rainfall trends under the RCP 4.5 emission scenario are generally consistent with historical rainfall trends. (3) The exceedance probabilities of future rainfall during the mid-term (2061–2080) and long-term (2081–2100) suggest that Kaohsiung may experience precipitation events with higher rainfall than historical data during dry seasons (October to April of next year), while Tamsui Station may exhibit greater variability in terms of exceedance probabilities. (4) Under both the RCP 4.5 and RCP 8.5 emission scenarios, the percentage changes in future rainfall variability at Kaohsiung Station during dry seasons are higher than those during wet seasons (May to September), indicating an increased risk of extreme precipitation events during dry seasons. Full article