Search Results (99)

The legalization of euthanasia in Spain through Organic Law 3/2021 has intensified debates concerning the relationship between patients’ autonomy, the protection of life, and the freedom of conscience of healthcare professionals. In a context marked by increasing moral and religious pluralism, conscientious objection has emerged as a particularly sensitive issue in the practical implementation of assisted dying. This article adopts a legal and socio-religious approach to analyze the role of conscientious objection in the Spanish euthanasia framework. First, it examines the constitutional foundations of freedom of conscience and its specific regulation under Organic Law 3/2021, with particular attention to the guarantees and limits established for healthcare professionals. Second, it analyses the official positions of the main religious traditions present in Spain regarding euthanasia, assisted suicide, and end-of-life care, identifying both points of convergence and doctrinal diversity. Finally, the article assesses the practical impact of religious and moral convictions on the exercise of conscientious objection, drawing on the limited empirical evidence currently available. The analysis shows that, although most religious traditions oppose active euthanasia while accepting palliative care and the withdrawal of futile treatments, analysis of available empirical evidence suggests that objections are more often grounded in secular ethical or professional reasons than explicitly religious ones. The article concludes that conscientious objection should be understood as a structural feature of pluralist healthcare systems, requiring legal and organizational arrangements capable of safeguarding both freedom of conscience and effective access to legally recognized rights. Full article

Background/Objectives: Epidemiological studies over the first decades of the 21st century have reported a decrease in cardiovascular disease (CVD) morbidity and mortality. Changes in coronary care for acute myocardial infarction (AMI) over these years, including the COVID-19 pandemic period, have been less studied in Eastern and Central Europe. The study aimed to assess changes in coronary care—the time of medical assistance and treatment—for AMI patients over 2000–2023 in urban Kaunas residents aged 25–64. Methods: The data source was study cases from the Kaunas Ischemic Heart Disease Registry (Registry)—Kaunas city residents aged 25–64 years included in the Registry according to MONICA project protocol evaluation methodologies. Data were analyzed by sex and age group (25–54 and 55–64 years). Descriptive statistics (chi-square and z-score values) were used to evaluate the data; the significance level was p < 0.05. A logistic regression analysis was performed to assess the odds ratios of death within 28 days across six time periods. Results: The proportion of AMI patients hospitalized up to 2 h from the onset of pain accounted for about one-fifth of all hospitalized patients in 2000–2016, while in 2017–2023, it significantly decreased. In 2017–2023, compared with 2000–2004 and 2009–2016, significantly fewer men who developed AMI were hospitalized within the first 2 h of emergency presentation (p < 0.05). Over the whole study period, fewer women with AMI were hospitalized within the first 2 h of pain as compared to men (p < 0.05). There were no significant differences in time from pain onset to hospitalization between the age groups. At the same time, from 2009 to 2012, more young AMI patients were hospitalized within the first 2 h (p < 0.05). Percutaneous coronary angioplasty (PTCA) with stenting (PCI) increased 30 times from 2000–2004 to 2020–2023. PCI has been the most available treatment for men with AMI since 2009 and stayed stable from 2013 (66.0%) until 2023 (72.1%). Women with AMI tended to get less PCI, PTCA, and coronary artery bypass grafting (CABG) than men. The pre-pandemic and COVID-19 periods did not differ in the proportions of reperfusion treatment methods used in both men and women. Thrombolysis was very rare, and since 2017, it has not been used in Kaunas because PCI has become more accessible. PCI (2000–2016) and CABG (2009–2016) were more prevalent among the 25–54-year-old AMI patients (p < 0.05). From 2017 to 2023, there were no differences between age groups in the reperfusion procedures used, nor were there differences in treatment between these groups during the pre-pandemic (2017–2019) and peri-COVID-19 pandemic (2020–2023) periods. Conclusions: In Kaunas, the treatment of patients with AMI has improved significantly over the past 20 years. The use of PCI has increased greatly, and the rate of CABG surgery stayed stable, while only every fifth patient has been admitted to the hospital in a timely manner. Men were more likely to receive PCI, and older patients were more likely to undergo CABG. Compared to the period of 2000–2004, the chance of dying within 28 days after AMI was significantly lower in 2017. Full article

Tomato leaf diseases seriously affect tomato production, and early image-based screening is important for assisted diagnosis under greenhouse or semi-controlled cultivation conditions. Traditional manual inspection methods are often inefficient and highly subjective. To address these limitations, this study proposes a lightweight tomato leaf disease detection model named HDR-YOLO, which integrates high-level semantic guidance and dynamic upsampling. First, a High-level Semantic Feature Pyramid Network (HSFPN) is introduced to reconstruct the feature fusion neck. This modification significantly reduces the parameter count while enhancing the fusion of semantic features. Second, a dynamic upsampling operator (DySample) replaces traditional upsampling techniques to minimize information loss during feature map expansion. Finally, Receptive Field Coordinate Attention Convolution (RFCAConv) is incorporated into the critical feature fusion path. This enhances spatial coordinate perception, thereby improving the recognition accuracy for diseases with complex textures, such as early blight. Experimental results demonstrate that HDR-YOLO achieves a mean average precision at an Intersection over Union of 0.5 (mAP(0.5%)) of 79.5% on the test dataset. Compared to the baseline YOLOv12n model, the proposed method increases mAP(0.5%) by 2.2% while reducing the number of parameters by approximately 29.5% and computational complexity by approximately 14.3%. HDR-YOLO achieves efficient and accurate detection, providing a lightweight image-based framework for tomato leaf disease screening and assisted diagnosis under greenhouse or semi-controlled cultivation conditions. Full article

Background: Birth asphyxia is a leading cause of neonatal mortality. More than half of these deaths are due to low-quality care. Objectives: To describe the frequency, sequence, timing, and duration of interventions after birth and newborn outcomes. Methods: This prospective observational study in rural Tanzania included newborns ≥28 weeks gestation. Trained research assistants observed and recorded all deliveries and resuscitations 24 h a day, 7 days a week, logging interventions in real time using the Liveborn Observation app. Results: Of 2564 newborns born, 2431 (94.9%) were enrolled in the study. Macerated stillbirth (n = 52), newborns with no parental consent (n = 67) or incomplete Liveborn data (n = 14) were excluded. Additionally, 2193/2431 (90.2%) newborns did not receive bag-mask ventilation (BMV), and 1755/2431 (72.2%) started breathing before 30 s from birth at median (quartiles) 6 (3, 13) s, 438/2431 (18.0%) started breathing beyond 30 s at 49 (38, 67) s. Moreover, 238/2431 (9.8%) received BMV at 82 (54, 120) s after birth, 1/3 within the first min. Finally, 159/238 (66.8%) were suctioned for 26 (17, 40) s. The first suction sequence was initiated at 44 (24, 78) s after birth. In 24/238 (10.1%) newborns, BMV continued for more than 10 min, with an increased risk of dying within 24 h (RR = 4.26, 95% CI; 1.3–10.0, p = 0.016) and seven days (RR = 8.14, 95% CI; 3.5–17.6, p < 0.001) compared to those ventilated for less than 10 min. Conclusions: Almost 10% of newborns received BMV at birth, but only one-third were ventilated within the first recommended minute. Excessive use of suctioning likely delayed the start of BMV, and prolonged ventilation beyond 10 min was associated with higher mortality. Full article

Traditional chemical hair dyes are associated with potential health risks, while botanical alternatives are often hampered by poor stability and limited color longevity. In this study, discarded squid ink was used to prepare bionic hair colorants of high performance. By synergizing ultrasound disruption with enzymatic hydrolysis, the crude ink aggregates were transformed into highly uniform squid ink melanin nanoparticles (SIMNPs) with size and zeta potential of ~174 nm and −37.5 mV, respectively. This effectively improved the solubility but reduced the steric limitation of natural melanin. To overcome the weak affinity between melanin and human hair, a biomimetic interface where Fe(III) ions act as supramolecular bridges was further engineered to stably bind the SIMNPs to hair keratin. Under optimized conditions (pH 8.0, 45 °C, and 80 min), the dyed hair achieved a natural deep black with a total color difference (ΔE*) of 68.79 ± 0.29, which was maintained at 63.19 ± 0.27 even after 13 consecutive water washing cycles. Unlike destructive oxidative dyes, this SIMNP dyeing system assisted by coordination-driven assembly preserved the native α-helical architecture and disulfide bond networks of hair keratin. Furthermore, the deposited SIMNP layer effectively protected hair fibers from ultraviolet (UV) damage due to its powerful UV-shielding capacity. Crucially, in vitro and in vivo evaluations confirmed the exceptional biosafety of this formulation, demonstrating robust cellular tolerance and absence of murine skin irritation. The work demonstrates a green, low-damage paradigm for the development of bio-based hair colorants of high performance and presents a promising pathway for the high-value utilization of marine by-products. Full article

Background: Medical Assistance in Dying (MAiD) was first legalized in Canada in 2016, with legislation expanding from foreseeable to non-foreseeable natural deaths. A sole underlying medical condition of mental illness is expected to be added in 2027. Although legislation and reporting requirements are federally mandated, the implementation and delivery of MAiD are the responsibility of individual provinces and territories. Objectives: The aim of this study is to compare the organization, delivery, and oversight of MAiD programs across provinces and territories in consideration of access, equity, and safeguards. Methods: This study used a mixed methods approach to collect data. A comprehensive and systematic search for published peer reviewed literature on MAiD programs in Canada was conducted along with qualitative interviews with key informants using purposive and snowball sampling. A qualitative descriptive design was used for qualitative data, including content analysis. To facilitate a detailed comparative analysis of MAiD across jurisdictions, separate tables were created for each component or element, organizing the results of the literature review and qualitative analysis by jurisdiction. Patterns within these tables were identified through qualitative interpretation. The findings were then summarized in a narrative format. Results: A total of 113 interviews were conducted, representing all provinces and territories but Nunavut. Findings showed varied practices throughout the MAiD process between jurisdictions. Conclusions: The main findings of this study are that the organization of MAiD programs, oversight, reporting methods to Health Canada, intake, preliminary assessments, assessments, provision, and bereavement support vary. In addition, specific policies related to potentially vulnerable populations are lacking and jurisdictional practices also vary. Centralized, multidisciplinary MAiD programs with strong oversight mechanisms may strengthen issues related to access, equity, and safeguards. Full article

In this study, the dyeing kinetics of polyamide fabrics with acid dyes, such as Telon Blue M2R, under both conventional and microwave-assisted heating conditions were comprehensively investigated. While the conventional dyeing reaction was completed in 30 min, microwave-assisted dyeing was performed in the microwave device for 10 min. Dyeing kinetics were investigated as a function of reaction time, reaction concentration and dyeing temperatures. The K/S values (color depth) of the dyed fabrics were correlated with the concentration. A significant reduction in the dyeing process time for polyamide fabric was observed with microwave heating compared to the conventional method. Kinetic analysis revealed that the Pseudo-Second-Order (PSO) kinetic model provides a better fit to the experimental data on the diffusion process of acid dye in polyamide fabrics, as evidenced by higher correlation coefficients (R²) compared to the Pseudo-First-Order (PFO) model. The activation energy of the reaction in dyeing was found to be 63.27 kJ/mol, and the Arrhenius constant was determined as 7.20 × 10¹⁰ L/g·min in conventional media and 18.70 × 10¹⁰ L/g·min in microwave media. The Arrhenius factor in the microwave medium was more than two times higher than in the conventional media. Full article

The reliability of photovoltaic (PV) equipment is vital for ensuring the safe and stable operation of power systems. While multimodal large language models (MLLMs) open up promising avenues for intelligent fault diagnosis, they often falter when confronted with the heterogeneity of PV data—where visual observations come from different sensor modalities (e.g., visible, infrared, and thermal) and display strong domain-dependent variations. Conventional Low-Rank Adaptation (LoRA) is not expressive enough to model such modality-aware differences, which can result in insufficient exploitation of informative patterns. To overcome this limitation, we propose PV-FaultExpert, a domain-adaptive MLLM designed specifically for PV equipment fault analysis. PV-FaultExpert is built upon DyLoRA (Dynamic Expert Routing with LoRA), a dynamic routing strategy that reformulates standard LoRA into a shared low-rank component coupled with multiple expert-specific adapters. A routing module then selects expert paths according to input characteristics, allowing the model to adapt to diverse modalities while maintaining parameter efficiency. Moreover, we construct a PVfault diagnosis dataset via ChatGPT-4o-assisted chain-of-thought reasoning and subsequent expert verification, which both supports model training and enables rigorous evaluation of our method. Extensive experiments demonstrate that PV-FaultExpert consistently surpasses strong baselines, including GPT-4 and Claude-3, across multiple evaluation criteria, producing fault analysis reports that are accurate, interpretable, and aligned with safety-critical requirements. Full article

Natural plant-based resources are rich in bioactive compounds that offer promising alternatives for developing sustainable, functional textiles. This study focuses on the extraction and application of natural dyes from Gardenia jasminoides as an eco-friendly substitute for conventional synthetic dyes. The dye was extracted using methanol–water (50:50) and ethanol–water (50:50) solvent systems, alongside conventional aqueous extraction, followed by characterization through column chromatography. The characterization of the extracted powders confirmed the presence of gardenia yellow pigments with strong coloration potential. Among the tested extraction methods, ultrasonic-assisted methanol–water extraction (M.W.U.) exhibited the highest dye yield of 29.5%, followed by ethanol–water ultra-sound extraction (E.W.U.) at 24.9%, water ultrasound extraction (W.U.) at 18.35%, and the lowest yield obtained from the water-heater method (W.H.) at 18.25%. The dyed cotton fabrics were tested for color strength (K/S), CIELAB, colorfastness (washing, light, rubbing), and functional properties (antibacterial and vector protection) according to standard operating procedures. The results revealed that an optimal mordant concentration produced the maximum color strength (K/S = 1.7730), with good rubbing (4–5), washing (4–5), and light fastness (5). The dyed fabrics also exhibited excellent antibacterial activity against both Staphylococcus aureus and Escherichia coli, as evaluated by the AATCC 100 test method. For instance, the vector protection property of the cotton dyed fabrics was also excellent, as confirmed by the cage test. Overall, the use of Gardenia jasminoides seed-based natural dye demonstrates not only desirable coloration and functional performance but also significant ecological advantages, reducing chemical pollution and supporting the transition toward environmentally sustainable textile processing. Full article

Carotenoid content is a key trait that defines the unique characteristics of foxtail millet varieties. Varieties with different levels of carotenoids often show distinct genetic features and nutritional profiles. However, the genetic basis of carotenoid content in foxtail millet remains mostly unknown. In this study, we explored the genetic basis of carotenoid content using a recombinant inbred line (RIL) population of 305 lines derived from two parental accessions, JG21 (high-carotenoid, 16.75 mg·kg⁻¹) and JG25 (low-carotenoid, 0.93 mg·kg⁻¹). The results showed that the RIL population exhibited continuous phenotypic variation and significant transgressive segregation for carotenoid components (lutein, zeaxanthin, β-cryptoxanthin) and kernel color (measured by b* value), with zeaxanthin reaching 8.47 mg·kg⁻¹, significantly surpassing the higher parent (3.44 mg·kg⁻¹) in 24DY. To ensure that enhancing this nutritional trait does not compromise grain yield, we analyzed its relationship with key agronomic traits, testing for pleiotropic trade-offs. Notably, carotenoid content showed no significant correlation with any of the 8 key agronomic traits (r ranged from −0.11 to 0.08, all p > 0.05), suggesting no apparent trade-off, although fine-mapping is needed to separate pleiotropy from tight linkage for concurrent improvement. Genetic modeling analysis revealed that carotenoid content is stably controlled by three major-gene pairs plus polygenes (MX3-AI-A model), with major-gene heritability of 96.65% and polygene heritability of 3.35%. Based on this framework, three elite RILs with >23% higher carotenoid and superior agronomic performance were identified and advanced to marker-assisted backcrossing. These results provide a clear genetic framework and immediate breeding resources for marker-assisted selection, enabling the development of high-yielding, carotenoid-enriched foxtail millet varieties without compromising agronomic value. Full article

This paper explores recent advancements in end-of-life (EOL) care in Canada, focusing on palliative care (PC) in oncology, advance care planning (ACP), and medical assistance in dying (MAiD). Despite improvements in cancer treatment, cancer remains a leading cause of death in Canada, with patients facing significant physical, psychosocial, and emotional challenges throughout the illness trajectory. Over the past few decades, PC has evolved to address serious illness from diagnosis onward, enhancing symptom management, quality of life, and patient satisfaction, while reducing hospital admissions and unnecessary treatments. However, barriers such as misconceptions about PC, late PC referrals, and limited access to PC, particularly in rural and remote areas, still exist. This perspective paper draws on the authors’ collective clinical and research experience in oncology and PC, complemented by a focused review of key literature. Ongoing education for oncology nurses on EOL care, including on PC, ACP, and MAiD, as well as continued efforts to expand access to PC for all Canadians, are imperative in order to improve the EOL experience for people affected by cancer nationwide. Full article

Background and Clinical Significance: Anaplastic thyroid cancer (ATC) is a rare and aggressive malignancy with a poor prognosis, where median survival typically ranges from 4 to 10 months. Advances in genetic profiling, particularly the identification of BRAF mutations, offer new opportunities for targeted therapy. Case Presentation: This case report details the journey of a woman in her late 50s diagnosed with symptomatic ATC. Initial immunohistochemistry (IHC) testing for BRAF mutations returned negative results, leaving the patient with limited treatment options and prompting her to pursue medical assistance in dying (MAiD). However, next-generation sequencing (NGS) confirmed a ^V600EBRAF mutation, and a basis for targeted therapy. The patient began treatment with dabrafenib-trametinib, followed by pembrolizumab as second-line therapy, ultimately extending her life by nearly seven months. Conclusions: This case underscores the importance of rapid and comprehensive diagnostic approaches, particularly the higher sensitivity of NGS over IHC for detecting BRAF mutations. The complexities of accessing newer therapies in Canada’s single-payer healthcare system are also emphasized. The utilization of newer rapid diagnostic technologies can have a direct impact on directing treatment for ATC and other aggressive malignancies. Full article

A novel Z-scheme Dy₂TmSbO₇/BiHoO₃ heterostructure photocatalyst was synthesized with the ultrasound-assisted solvothermal method. The Dy₂TmSbO₇/BiHoO₃ heterojunction photocatalyst (DBHP) reflected wonderful separation efficiency of photogenerated electrons and photogenerated holes owing to the efficient direct Z-scheme heterojunction structure characteristic. The lattice parameter and the bandgap energy of the Dy₂TmSbO₇ were 10.52419 Å and 2.58 eV, simultaneously, the lattice parameter and the bandgap energy of the BiHoO₃ were 5.42365 Å and 2.25 eV, additionally, the bandgap energy of the DBHP was 2.32 eV. Above results indicated that DBHP, Dy₂TmSbO₇ or BiHoO₃ possessed an excellent ability for absorbing visible light energy, therefore, DBHP, Dy₂TmSbO₇ or BiHoO₃ owned superior photocatalytic activity for degrading the sulphamethoxypyridazine (SMP) under visible light irradiation. The removal rate of the SMP after visible light irradiation of 135 min with the DBHP was 99.47% for degrading the SMP during the photocatalytic degradation (PADA) process, correspondingly, the removal rate of the total organic carbon (TOC) concentration after visible light irradiation of 135 min with the DBHP was 98.02% for degrading the SMP during the PADA process. The removal rate of the SMP after visible light irradiation of 135 min with the DBHP was 1.15 times, 1.29 times or 2.60 times that with Dy₂TmSbO₇, BiHoO₃ or nitrogen-doped TiO₂ (N-T). Therefore, the DBHP displayed higher photocatalytic activity for degrading the SMP under visible light irradiation compared with Dy₂TmSbO₇, BiHoO₃ or N-T. Specifically, the mineralization rate for removing the TOC concentration during the PADA process of the SMP with the DBHP was 1.18 times, 1.32 times or 2.79 times that with Dy₂TmSbO₇, BiHoO₃ or N-T. In addition, the stability and reusability of the DBHP were systematically evaluated, confirming that the DBHP owned potential applicability for degrading the antibiotic pollutant, which derived from the practical industrial wastewater. Trapping radicals experiments and the electron paramagnetic resonance measurement experiments were conducted for identifying the reactive radicals, such as the hydroxyl radicals (•OH), the superoxide anions (•O₂⁻) and the photogenerated holes (h⁺), which were generated with the DBHP for degrading the SMP during the PADA process under visible light irradiation, as a result, the •O₂⁻ possessed the maximal oxidative capability compared with the •OH or the h⁺. Above results indicated the degradation mechanism and the degradation pathways which were related to the SMP. In conclusion, this study makes a significant contribution for the development of the efficient Z-scheme heterostructure photocatalysts and provides a key opinion to the development of the sustainable remediation method with the view of mitigating the antibiotic pollution. Full article

Background/Objectives: Assisted suicide and suicide prevention remain subjects of intense societal, political, and professional-ethical debate in Germany. Nurses working in residential and home-based long-term care (LTC) play a pivotal role in responding to requests for assisted suicide and in supporting suicide prevention. While international research has explored diverse ethical perspectives and challenges related to these issues, little is known about how LTC nurses in Germany experience and navigate them. This study examines German LTC nurses’ ethical perspectives on assisted suicide and suicide prevention and explores the associated ethical challenges. Methods: A qualitative design employing both in-person and online focus groups was used. Data were analyzed following Mayring’s qualitative content analysis. Results: Twelve focus groups with a total of 96 nurses working in residential and home-based LTC were conducted between February and September 2025. Findings show that nurses perceive assisted suicide and suicide prevention as ethically complex and emotionally demanding. Three overarching themes emerged: (1) Intuitive and Emotional Reactions, (2) Ethical Perception and Ethical Reflection, and (3) Ethical Challenges. Conclusions: This study offers new insights into the diverse ethical perspectives of German LTC nurses on assisted suicide and suicide prevention. It extends existing knowledge through its explicit focus on the ethical issues and implications involved, both in residential and home-based LTC. The ethical challenges identified may enhance understanding of the factors underlying the development of moral distress in Germany and other countries where assisted suicide is a legal option. To help nurses navigate these ethically demanding situations, strategies at multiple levels are required. These include continuous ethics education, an open ethical culture, role definitions and clear professional guidance, alongside societal support for equitable access to general healthcare and suicide prevention services. Full article

In this segment of the Palliative Care Unit case series, we introduce a patient with a long history of oncological treatments for recurrent breast cancer. After active treatments and a global control of the neoplasm, disease progression made the patient access different lines of chemotherapies, even asking for them in anticipation of a few advantages in the balance between benefits and risks. When the patient decided to permanently discontinue chemotherapy, she felt she had disrupted her values. Also, as a reaction to breaking bad news without estimating alternative paths, she considered her deteriorating condition as the sole criterion for assisted dying in another country. Could this be a self-consistent choice for this patient, so determined to find and pursue possibilities in treatment previously? Should this clue respond precisely to the patient’s needs? This contribution’s objective is to debate possibilities of patient self-determination and dignity at the end of life by integrating psychological support, palliative care, and legal–ethical awareness. This case study presents multidisciplinary team work through some key turning points. This team work was carried out in a national context that is currently inconclusive regarding assisted suicide, since active euthanasia is illegal. At the same time, the national Constitutional Court (242/2019) recently opened the possibility of eventual medically assisted suicide under certain circumstances. In this case, health professionals considered this context and tried to delve deeply into respecting the patient’s identity in order to determine when and if the exceptional circumstances were met. This case highlights the ethical sense of end-of-life accompaniment, which when conducted by physicians, nurses, and psychologists together can lead to effective support and allow patients to maintain their identity and to express themselves respecting not only their fears but also their vision of themselves as human beings. A first key turning point was, for instance, taking into account the patient’s history and values, and a subsequent one was supporting the patient in exploring healthcare services and related end-of-life support. In a further key turning point, the patient was helped in engaging with physicians in order to understand types of continuous care, as well as the timing and expected results of sedation. Finally, she chose a healthcare service where she could spend the end of her life in fulfillment of her values. Overall, this case report illustrates how integrating psychological support, palliative care, and legal–ethical awareness can promote patient self-determination and dignity at the end of life. Full article