Search Results (14,400)

Background: Biliary tract cancers (BTCs), encompassing cholangiocarcinoma and gallbladder carcinoma, are aggressive malignancies with poor prognosis and increasing incidence in selected regions worldwide. Advances in imaging, biomarker profiling, immunotherapy, and targeted therapies have improved treatment options but have also increased the economic pressure on health systems. Understanding the economic evidence on BTC is therefore important for resource allocation and health technology assessment. Methods: We systematically searched PubMed/MEDLINE, Embase, Scopus, and Web of Science for peer-reviewed economic studies of BTC published from January 2010 to March 2025. Eligible studies included cost-effectiveness, cost–utility, cost–benefit, cost-of-illness, and resource-use analyses. The review followed PRISMA reporting principles. Reporting completeness was assessed using CHEERS 2022, and methodological credibility was appraised using the Drummond framework. Results: Twenty studies were included: 13 cost-effectiveness or cost–utility analyses and seven cost-of-illness or resource-use studies. Conventional chemotherapy strategies, including gemcitabine plus cisplatin in some settings and other cytotoxic combinations in selected jurisdictions, generally produced more favorable economic results than newer systemic therapies, although findings varied by country, threshold, comparator, and price assumptions. First-line immunotherapy combinations and biomarker-directed targeted therapies frequently produced ICERs above jurisdiction-specific willingness-to-pay thresholds at current prices, often requiring substantial price reductions to approach cost-effectiveness. Real-world studies showed high resource use and costs, particularly with hospitalizations and later treatment lines. Evidence on screening and prevention was limited, with one study suggesting that ultrasound surveillance may be cost-effective in a liver fluke-endemic region of Thailand. Discussion: The available economic evidence suggests that affordability and jurisdiction-specific value assessment are central to BTC policy decisions. Current prices for several immunotherapy and targeted agents limit cost-effectiveness in published models, while evidence on prevention, early detection, and care-pathway interventions remains sparse and context-specific. Full article

Vehicle restrictions on urban expressways are widely used to relieve traffic congestion and reduce traffic emissions. However, the effects of such restrictions should be assessed over the wider urban road network rather than on expressways alone, and over both short-run and longer-run periods. This study empirically investigates the impacts of vehicle restriction policies on network-level emissions in Shanghai. The network-level vehicle emissions are dynamically estimated using a carbon-emissions macroscopic fundamental diagram (CE-MFD) model based on taxi trajectory data and loop detector data. The effects are then identified using a spatial difference-in-differences (SDID) framework, while geographically weighted regression (GWR) is used to examine spatial heterogeneity in the associated factors. The results show that extending the restriction periods reduced carbon emissions across the urban road network by 9.96% after one month and by 17.93% after one year. The effects are spatially heterogeneous and are associated with population, road-network characteristics, parking supply, and ramp configuration. These findings suggest that the sustainability impacts depend not only on the restrictions themselves, but also on traffic redistribution and local network conditions. Findings provide empirical evidence for designing sustainability-oriented traffic strategies, underscoring the importance of evaluating emissions outcomes across the urban road network over both short-run and longer-run horizons. Full article

Tourism plays an increasingly important role in promoting economic growth and rural revitalization in ecologically fragile regions. However, tourism systems in Tibet–related areas of Sichuan, China, are highly vulnerable to natural disasters, ecological degradation, and regional development imbalances, posing challenges to sustainable tourism development. This study aims to evaluate tourism system resilience and identify its key influencing factors from a sustainability perspective. Based on the regional characteristics of Tibet-related areas in Sichuan, a comprehensive evaluation framework is constructed covering four subsystems: tourism infrastructure and scale, economy, society, and ecology. An integrated entropy weight–analytic hierarchy process (AHP) model, coupling coordination model, and obstacle degree model are employed to assess tourism system resilience and examine subsystem interactions using panel data from 2011 to 2020. The results indicate that: (1) the resilience levels of tourism subsystems show no clear spatial or temporal regularity across the study areas; (2) ecological resilience remains significantly lower than tourism, economic, and social resilience, representing the weakest component of the tourism system; (3) the coupling coordination among subsystems remains at a low level, suggesting insufficient synergy for sustainable regional development; and (4) ecological constraints are the primary limiting factors affecting overall tourism system resilience. This study contributes to sustainable tourism research by revealing the critical role of ecological governance and subsystem coordination in enhancing tourism resilience in ecologically sensitive regions. Policy implications include strengthening ecological protection, improving tourism infrastructure, promoting digital tourism marketing, and advancing rural revitalization to achieve long-term sustainable development. However, this study is limited by data availability and the spatial scope of the selected case-study areas, which may affect the generalizability of the findings. Full article

[d=LE]Transitions of control between automated driving systems and human drivers remain safety-relevant and cognitively demanding moments in human–automation interaction. Recent studies show that transition performance depends not only on takeover timing or response speed but also on traffic complexity, driver readiness, automation limitations, trust calibration, and situational-awareness recovery. As in-vehicle interaction evolves toward conversational and agentic AI assistance, takeover support also becomes a problem of governing how natural-language AI systems communicate with the driver under uncertainty.Transitions of control between automated driving systems and human drivers remain safety-relevant and cognitively demanding moments in human-automation interaction. Recent studies suggest that transition performance should not be assessed only through takeover timing or response speed since control resumption quality also depends on traffic complexity, driver readiness, automation limitations, and situational awareness recovery. [d=LE]This paper proposes a digital-twin-mediated framework for human-aware takeover support in automated driving. In this framework, the companion AI is treated as an assumed LLM-based in-vehicle conversational or agentic assistant used as an advisory interaction component. The contribution is defined at the architectural level: human, vehicle, and context/road digital twins provide structured semantic state abstractions through a semantic state interface exposing confidence, freshness, provenance, and consistency metadata, while a trustworthy companion AI (TCAI) layer grounds, constrains, validates, and governs companion AI output proposals before HMI delivery.This paper motivates and defines a trustworthy companion AI (TCAI) layer for human-aware transition support in automated driving. The TCAI is conceived as a bounded, supervised, and explainable advisory agent that supports the driver without entering the safety-critical vehicle-control loop. It reasons over structured semantic state abstractions derived from a human digital twin, a vehicle digital twin, and a context/road digital twin, exposing driver readiness, automation capability, and contextual urgency in a form that supports traceable, uncertainty-aware, and degradation-aware assistance. [d=LE]Building on the research on driver-state monitoring, adaptive HMI, trust calibration, explainability, conversational assistance, and human assistance systems (HASs), the framework coordinates advisory interaction across vigilance support, contextual explanation, trust-calibrating communication, and directive handover guidance. The TCAI layer combines bounded reasoning, human-factor-derived guardrails, state-consistency management, dynamic explanation-depth control, trust-dynamics modeling, graded watchdog veto handling, mandatory access-control assumptions, and deterministic fallback. Safety-critical vehicle-control and minimum risk condition (MRC) functions remain assigned to the deterministic vehicle-control stack, while the authorized output path of the TCAI layer is validated HMI delivery.Building on the research on driver-state monitoring, adaptive HMI, trust calibration, explainability, and conversational assistance, we propose a conceptual architecture in which the TCAI coordinates multimodal assistance across different interaction conditions, including vigilance support, contextual explanation, trust-calibrating communication, and directive handover guidance. The companion does not actuate the vehicle; its outputs are constrained by runtime governance, policy enforcement, and deterministic fallback mechanisms. [d=LE]The paper concludes with a validation agenda and technical roadmap covering planned transitions, urgent handovers, degraded or adversarial conditions, temporal fusion of driver-state evidence, phase-sensitive HMI policies, trust-calibration trajectories, driver veto and partial-disabling mechanisms, and staged simulator-to-vehicle evaluation. Although motivated by SAE Level 3 automation, the framework may also inform fallback-related Level 4 scenarios in which human and automated agency must be managed under uncertainty.The paper concludes with a research roadmap for validating the proposed architecture under planned transitions, urgent handovers, and degraded or adversarial conditions. Although motivated by SAE Level 3 automation, the approach may also inform fallback-related Level 4 scenarios. Full article

Background/Objectives: Foods and beverages consumed during school lunch periods contribute substantially to children’s dietary intake; however, Canadian evidence of their nutritional contribution and quality remains limited. This study assessed nutrient content, nutrient density, and contributions to dietary recommendations among Saskatchewan elementary students. Methods: A descriptive quantitative study was conducted among 379 students aged 5–13. Dietary intake during school lunch periods was assessed using a photography-assisted plate waste method. Nutrient content was estimated using standard nutrient databases, nutrient density was evaluated using the Nutrient-Rich Food (NRF) 9.3 Index, and contributions to dietary recommendations were examined. Results: Median lunch energy was 411.4 kcal (IQR: 296.7), and the mean NRF 9.3 score was 292.6 (SD: 130.7). Compared with home-packed and mixed lunches, school-provided lunches contained less energy, carbohydrate, fat, and sugar, while protein was similar across lunch types. Overall, lunches contributed <25% of daily requirements for key nutrients, including fibre, vitamin D, calcium, and potassium. Older students had lower proportional nutrient contributions relative to their higher nutritional requirements. Nutrient density differed by lunch provenance, but not by age or reported gender, with school-provided lunches achieving the highest NRF 9.3 scores. Conclusions: Lunches contributed modestly to daily nutrient requirements, particularly among older students. In this sample, school-provided lunches were associated with higher nutrient density than home-packed lunches, although their absolute contributions to several nutrients remained limited. These findings provide baseline evidence on lunches consumed during school lunch periods among Saskatchewan elementary students and may inform future evaluations of school food systems and policies. Full article

As part of the development of sustainable forest management, it is important to identify the risk of reduced availability of commercial forests, assess the adaptation of companies to new conditions, and analyze measures that allow them to adapt to the changing market situation. The aim of this research was to confirm or refute the hypothesis that forest service plants in Poland are at an increased risk of operating under the planned exclusion of 20% of State Forests’ area from commercial use. A direct survey method was used for the study. The results of the study indicated that most companies (65%) plan to reduce employment due to restrictions on forest area, which is a result of difficulties in the labor market in the forestry sector. A significant proportion of respondents (82%) perceive the exclusion of part of the forests from commercial use as a threat to their business, with as many as 41% assessing this threat as very high. A total of 31% of companies assess their ability to adapt to change as poor or very poor, which raises concerns about the future of their business. A significant proportion of respondents (77%) indicated that the uncertainty surrounding the rules for excluding forest land could negatively affect their investment decisions. The study results showed that changes in business risk, responsiveness to change, and adaptability associated with the planned forest exclusion policy were independent of company size, the form of inter-company cooperation, or employment levels. A wide range of issues that must be addressed to maintain sustainable forest management were identified, including concerns related to the perceived or anticipated reduction in employment under a planned exclusion scenario. Full article

Indian metropolitan cities such as Mumbai grapple with rapid urbanisation, extreme urban density, high built-up areas, loss of green cover, and shrinking open spaces, resulting in increased impermeable surfaces, urban heat island effects, and frequent flooding occurrences. Modern stormwater management has increasingly been characterised by integrated grey-green approaches; however, cities in the Global North benefit from established policies, technical expertise, and financial resources that enable the systematic and large-scale integration of Blue-Green Infrastructure (BGI) through district-wide geospatial assessment frameworks, unlike many cities in the Global South. Despite growing interest in nature-based stormwater solutions, there remains a dearth of geospatial empirical research from India examining the placement, distribution, performance, and functionality of BGI integrated with existing stormwater management systems in cities such as Mumbai. Furthermore, hydrological modelling using tools such as the Storm Water Management Model (SWMM) for the design, planning, and implementation of BGI in Indian cities remains largely unexplored. This study explores the role of BGI strategies in improving urban stormwater management within high-density Indian cities under a 25-year return period extreme rainfall scenario. Using an integrated approach that combines QGIS-based spatial analysis with EPA-SWMM hydrologic-hydraulic modelling, the research examines runoff behaviour, identifies flooding hotspots, and evaluates the effectiveness of Low Impact Development (LID)-based BGI measures such as permeable pavements, infiltration trenches, and green roofs applied at the ward level in Mumbai’s F/North and G/North Wards. Detailed land use classification, spatial mapping, and rainfall simulation corresponding specifically to a 25-year return period rainfall event was used to assess pre- and post-intervention conditions. The findings indicate that the applied BGI measures led to a 12.6% reduction in peak runoff (137.6 m³/s to 120.2 m³/s) and a 5.5% decrease in total runoff volume (783,510 m³ to 740,410 m³). More importantly, the peak flooding flow rate decreased by 45% (94.1 m³/s to 51.7 m³/s), demonstrating that BGI measures can efficiently reduce peak flooding flows by extending runoff hydrographs during extreme rainfall events. These findings are specifically applicable to the simulated 25-year return period extreme rainfall scenario and may vary under different rainfall intensities or return periods. Less extreme events could potentially experience even greater relative reductions or prevent flooding altogether, while also easing downstream hydraulic loads. Overall, strategically placed BGI interventions can significantly reduce surface runoff and peak flow, thereby enhancing stormwater resilience within spatially constrained urban environments. This study provides a replicable, data-driven framework for catchment-scale stormwater planning in dense Indian cities under extreme rainfall conditions, offering practical insights into methods, local contextual considerations, and spatial planning strategies for policymakers and urban planners seeking to retrofit and adapt existing infrastructure under increasing hydrologic stress and climate variability. Full article

Background: Childhood oral hygiene behaviors are crucial to preventing oral diseases and can influence the development and progression of malocclusions. The World Health Organization (WHO) Oral Health Questionnaire is a standardized tool for assessing oral hygiene behaviors, oral health-related behaviors, and preventive dental awareness in children. Aim: This study aimed to assess oral hygiene behaviours and examine associations between WHO Oral Health Questionnaire variables and Angle malocclusion classes among children aged 6–9 years. Materials and Methods: This cross-sectional study included 90 children aged 6–9 years from the Pristina region, Kosovo. Data were collected using the WHO Oral Health Questionnaire for Children, which assessed oral hygiene habits, toothbrushing frequency, fluoride awareness, dental attendance, dietary behaviors, oral symptoms, and oral-health-related quality of life. Malocclusion was classified according to Angle classification into Class I, II, and III malocclusions with 3D intraoral scanners, Aerolscan 3. Descriptive statistical analysis, Chi-square (χ²) test, Spearman correlation analysis, and reliability analysis using Cronbach’s Alpha were performed using SPSS Statistics 23.0 (IBM Corp., Armonk, NY, USA) and Statistica 7.1 (StatSoft Inc., Tusla, OK, USA). Results: Most participants reported regular oral hygiene practices, with 46.7% brushing their teeth two or more times daily. However, limited awareness regarding fluoride-containing toothpaste was observed, as most children answered “don’t know” regarding fluoride use. Occasional toothache or oral discomfort was reported by 33.3% of participants, while 23.3% reported dissatisfaction with dental appearance. Difficulty biting hard foods was present in 34.4% of children. Reliability analysis of the Q10 section demonstrated moderate internal consistency (Cronbach’s Alpha = 0.500). Chi-square analysis demonstrated no statistically significant association between Angle malocclusion classes and WHO questionnaire variables (p > 0.05). The highest χ² value was observed for tooth-cleaning frequency (Q7) (χ² = 11.97; p = 0.152), although the association remained statistically non-significant. Psychosocial impact questions and oral health-related quality of life questions also demonstrated no statistically significant association with malocclusion classes. Conclusions: oral hygiene practices, preventative oral health practices, and oral health-related experiences were comparatively similar among children in different Angle malocclusion classes. Although there were no statistically significant correlations found between malocclusion classes and WHO questionnaire variables, the results show that some children have psychosocial concerns about their dental appearance and insufficient awareness of preventive oral health. The WHO Oral Health Questionnaire is a useful epidemiological tool for evaluating pediatric oral health behaviors and may help build youth orthodontic and preventive oral health policies. Full article

Vegetated coastal wetlands, especially mangroves, seagrass beds, and salt marshes, are biodiversity-rich ecosystems whose blue carbon outcomes depend on living communities, sediment dynamics, hydrological connectivity, and landscape context. Biodiversity conservation and blue carbon management are often assessed through separate scientific, monitoring, and policy frameworks. This review uses a staged literature search and thematic synthesis to examine biodiversity–blue carbon linkages across the three major vegetated coastal wetland types. It considers how taxonomic, genetic, functional, and habitat diversity influence productivity, sediment stabilization, trophic exchange, carbon stocks, carbon burial, and carbon retention. It also evaluates how climate change, habitat fragmentation, hydrological alteration, pollution, and anthropogenic disturbance weaken these linkages. The synthesis compares representative carbon-stock and burial-rate baselines, examines conservation and restoration synergies and trade-offs, and expands the discussion of seagrass regime shifts. Field surveys, remote sensing, unmanned aerial vehicles, environmental DNA, and AI-enabled data integration are placed within a tiered monitoring framework. The review further develops an operational decision pathway for biodiversity-centered blue carbon management. Persistent blue carbon benefits arise where conservation and restoration maintain native communities, hydrological exchange, sediment stability, habitat complexity, migration space, and long-term stewardship capacity. Full article

Climate change is reshaping agricultural systems by altering temperature and rainfall regimes, increasing the frequency of extreme events, and intensifying risks to crop productivity, water use, and farm decision-making. As climate–agriculture research expands rapidly, it becomes increasingly difficult to identify consolidated knowledge domains, emerging priorities, and evidence gaps. This study maps the structure and evolution of this literature using 219,261 Scopus-indexed documents selected from 290,560 records published between 1990 and 2025. A text-mining workflow combined BERTopic-based semantic modeling with supervised thematic classification into 18 macro-themes, while annual shares, z-scores, and document-level primary–secondary co-framing were used to assess temporal salience and cross-theme coupling. The results show sustained growth in research output, with 53.67% of publications produced between 2016 and 2025, and strong geographical concentration in the United States and China, which together account for 41.98% of the corpus. Hydrology and water management, crop production, impact assessment, and atmospheric processes remain central pillars, while socio-economic vulnerability, food security, sustainability, biotechnology, and greenhouse gas mitigation have gained prominence. The resulting evidence map provides a reproducible overview of the climate–agriculture knowledge landscape and can support research prioritization and policy design for climate-resilient agrifood systems. Full article

This study examines how two forms of financial literacy—objective financial literacy (OFL; demonstrated knowledge of interest rates, inflation, and diversification) and perceived financial literacy (PFL; self-assessed confidence in financial matters)—relate to financial wellbeing through distinct capability pathways, and whether self-regulation conditions these links. We use three nationally representative cross-sections from Portugal (2015, 2020, 2023; N = 3648), a European setting marked by declining objective literacy and constrained market participation. Guided by capability theory, we propose a dual-lane model in which OFL operates through behavioural capability (BC; enacted saving, investing, and planning behaviours) to shape objective financial wellbeing (OFW; resilience, assets, and saving), while PFL operates through perceived capability (PC; financial self-efficacy and perceived control) to shape subjective financial wellbeing (SFW; perceived security, satisfaction, and freedom from financial stress). We also test whether non-impulsive, future-oriented behaviour (NIB) strengthens the associations along the objective lane. Structural equation models provide partial support for the dual-lane model, revealing three asymmetries with implications for European policy: (1) the link between behavioural capability and objective financial wellbeing weakens in 2023, suggesting that macroeconomic conditions can undercut even prudent financial behaviour; (2) perceived financial literacy directly predicts subjective financial wellbeing, but perceived capability does not mediate this association, indicating that financial confidence shapes wellbeing independently of self-efficacy; and (3) non-impulsive, future-oriented behaviour amplifies the association between objective literacy and objective wellbeing in 2015 and 2023 but not in 2020, showing that the benefits of self-regulation are context-dependent. The findings inform financial education and policy across Europe by distinguishing intervention levers for objective versus subjective outcomes and identifying conditions under which behavioural interventions are most effective. Full article

Background/Objectives: Prehospital advanced airway management significantly affects patient outcomes. The King Laryngeal Tube (King LT) has been a standard method for managing compromised airways in various emergency medical services (EMSs). However, in-depth analyses of first-attempt success and influencing factors are limited. This study explores the use of the King LT in Saudi Arabia to assess the first-attempt success rate and predictors of successful management. Methods: This retrospective cross-sectional study was conducted to analyze cases requiring the King LT in the main EMS provider in Saudi Arabia between October 2021 and September 2022. A descriptive analysis was employed for categorical data, and Chi-square test, Fisher’s exact test, and a regression analysis were applied to assess the significance of the association. Results: Of the 239 analyzed cases, adults (58.6%) and males (70.7%) were predominant. The highest proportions of cases were medical cases (36.8%) and indoor incidents (69.9%), with a significant association of indoor incidents with female and elderly patients (p = 0.001). The first-attempt success rate reached 82.4%, with significant success likelihood in afternoon incidents (adjusted odds ratio [OR] = 2.92, 95% confidence interval [CI] [0.53–3.57]; p = 0.03). Conclusions: This first nationwide study of King LT outlines advanced airway management characteristics in Saudi Arabia. The high use rates in adults, males, medical cases, and indoor incidents could suggest tailored training strategies. Noted temporal variations may provide insights for policy improvements. While first-attempt success rates are high, reflecting literature findings; performance could improve with further training. Full article

Cities face the need to implement urban planning solutions that support sustainable development; however, this is not fully possible due to inadequate legal regulations. This development can be understood as increasing the environmental and economic resilience of urban areas and improving the quality of life for city residents. A noticeable trend in urban development plans is the implementation of the “15 min city”, “20 min city”, or similar concepts, which aim to enhance walkability by ensuring access to basic urban services and functions within walking distance. The aim of this article is to evaluate accessibility to green areas and selected educational services in cities (named in the article as MSAS–Municipal Standards for Accessibility of Social Infrastructure), and then to compare the results with proposed legal regulations in Poland that set minimum distances between social infrastructure zones and residential areas. The study will be conducted using selected urban centers: in Poland as a case study and in Belgium as verification. The use of spatial analysis methods (GIS) and a method transferability test enables the assessment of accessibility zones, as well as the identification of potential discrepancies between legal standards and actual accessibility conditions. In this context, this article addresses the question of whether accessibility standards for elementary schools and public green spaces can affect the future directions of residential development and urban spatial policy. The conclusions indicate that, although MSAS are not perfect solutions for a variety of reasons, they represent a step toward sustainable development. Full article

Background: HIV/AIDS remains a major global public health challenge, with persistent regional disparities in burden and progress toward the UNAIDS 95–95–95 targets. This study assessed temporal trends in the HIV/AIDS burden in Kazakhstan, compared them with Central Asia and global patterns, and projected trends through 2030. Methods: We conducted a population-level analysis using Global Burden of Disease 2023 data, examining age-standardized rates (per 100,000) of incidence, prevalence, mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) from 2010 to 2023. Trends were quantified using percent change and average annual percentage change, with projections based on log-linear models. Results: Between 2010 and 2023, prevalence in Kazakhstan increased by 332.1% and incidence by 111.0%, contrasting with the decline in global incidence (−24.7%). Mortality decreased (−32.7%), along with DALYs (−28.8%) and YLLs (−37.1%), while YLDs increased by 135.5%, indicating a shift toward a chronic disease burden. In 2023, Kazakhstan had a lower overall burden than global estimates but showed steeper increases in incidence and prevalence. Age-specific analyses indicated the largest increases among adults aged 30–69 years. Under current trend assumptions, projections suggest continued growth in prevalence and incidence, with modest mortality declines through 2030, though these trajectories do not account for future changes in prevention coverage, treatment access, or policy. Conclusions: Kazakhstan is undergoing a transition toward a chronic HIV epidemic, underscoring the need to strengthen prevention, expand PrEP and testing coverage, and address structural barriers to achieve epidemic control. Full article

The urban landscape is a constant presence in the daily lives of urban residents, and its quality is closely linked to their overall quality of life. Therefore, it is essential to provide municipalities with effective tools to assess urban landscape quality. The identification of evaluation criteria, validated by an expert panel, contributes to the development of urban landscape assessment policies and supports the construction of a multi-criteria evaluation model. This study acknowledges the multidimensional nature of the urban landscape and is grounded in the definition of “landscape” established by the European Landscape Convention. It proposes a methodology for assessing urban landscape quality through the identification of evaluation criteria using the Delphi method, based on a panel of 24 experts. The process resulted in the identification of five key criteria: Human Dimension, Functional Diversity, Natural Elements, Identity, and Maintenance. Full article