Search Results (3,615)

Background/Objectives: Antibiotics are among the most commonly prescribed medicines in the Pediatric Emergency Department (PED). The overuse of antibiotics is directly linked to the emergence of resistance. Recent clinical trials have emerged in children in which short courses have proven to be as effective as longer courses. The aim of this study was to analyze the duration of antibiotic treatment prescribed in our PED for the most important and common infections in children and to compare with the best available evidence. Methods: A single-center retrospective study was conducted in the PED of a tertiary hospital. We evaluated outpatients from birth to 16 years who were discharged with antibiotic therapy during a 1-year period (2022) to classify duration of therapy as appropriate or inappropriate. Results: 1972 antibiotic prescriptions were analyzed. 28.3% (560/1972) of the prescriptions were classified as inappropriate according to duration of therapy; 551 (98.3%) were due to longer-than-recommended duration. The condition associated with the highest number of inappropriate prescriptions was Uncomplicated Community-acquired Pneumonia (CAP) (427/560; 76.2%). When focusing on each infectious syndrome, Uncomplicated CAP had also the highest percentage of inappropriate duration (92.6%) comparing with appropriate prescription. Regarding specific types of antibiotics, amoxicillin accounted for the highest number of inappropriate prescriptions (422/560; 75.4%). Conclusions: A longer-than-recommended prescription of antibiotics is frequent in the Pediatric Emergency Department. Uncomplicated CAP is the condition associated with the highest number of inappropriate duration of antibiotics in our setting. Full article

This study presents a sustainable valorization strategy for wastewater treatment plant (WWTP) residual sands through their hydrothermal conversion into a dual-phase FAU/LTA zeolite and evaluates its adsorption performance toward methylene blue (MB) as a model cationic contaminant. The synthesized material (ZEO-RS) exhibited a low Si/Al ratio (~1.7), well-developed FAU supercages with minor LTA domains, and high structural integrity, as confirmed by XRD, FTIR, XRF, SEM and PZC analyses. ZEO-RS demonstrated rapid adsorption kinetics, reaching approximately 92% of equilibrium uptake within 30 min and following a pseudo-second-order kinetic model (k₂= 2.73 g·mg⁻¹·h⁻¹). Equilibrium data were best described by the Langmuir isotherm, yielding a maximum adsorption capacity of 34.2 mg·g⁻¹ at 20 °C, with favorable separation factors (0 < r_L < 1), while Freundlich fitting indicated moderate surface heterogeneity. Thermodynamic analysis revealed that MB adsorption is spontaneous (ΔG° = −11.98 to −12.56 kJ·mol⁻¹), mildly endothermic (ΔH° = +5.26 kJ·mol⁻¹), and entropy-driven (ΔS° = +0.059 kJ·mol⁻¹·K⁻¹). FTIR evidence, combined with pH-dependent behavior, indicates that adsorption proceeds via synergistic electrostatic attraction, pore confinement within FAU domains, and partial ion-exchange interactions. Desorption efficiencies conducted under mild acidic, neutral, and alkaline conditions resulted in low MB release (1–8%), indicating strong dye retention and high framework stability. Overall, the results demonstrate that WWTP residual sands are an effective and scalable low-cost precursor for producing zeolitic adsorbents, supporting their potential application in sustainable water purification and circular-economy-based wastewater treatment strategies. Full article

Chronic pain is inherently multifactorial, with biological, psychological, and social factors contributing to neuropathic pain (NP) and central sensitization (CS) syndromes. Comorbidity between functional disorders and the lack of clinical biomarkers adds to the challenge of diagnosis and treatment, leading to frustration for healthcare professionals and patients. Available treatments are limited, increasing patient suffering with personal and financial costs. This systematic review examined multisensory processing alterations in chronic pain and reviewed current pharmacological and non-pharmacological interventions. A structured search was conducted on the PubMed database using the keywords Central Sensitization, Fibromyalgia, Complex Regional Pain Syndrome, and Neuropathic Pain, combined with the keywords Vision, Audition, Olfaction, Touch, Taste, and Proprioception. Papers were then filtered to discuss current treatment approaches. Articles within the last five years, from 2018 to 2023, have been included. Papers were excluded if they were animal studies; investigated tissue damage, disease processes, or addiction; or were conference proceedings or non-English. Results were summarized in table form to allow synthesis of evidence. As this study is a systematic review of previously published research rather than a clinical trial or experimental investigation, the risk of bias was assessed independently by at least two reviewers. 138 studies were identified and analyzed. Of these, 96 focused primarily on treatment options for chronic pain and were analyzed for this systematic review. There were a few emerging themes. No one therapy is effective, so a multidisciplinary approach to diagnosis, including pharmacological, somatic, and psychological treatment, is generally predicted to achieve the best outcomes. Cranial neurovascular compromise, especially of the trigeminal, glossopharyngeal, and potentially the vestibulocochlear nerve, is being increasingly revealed with the advancement of neuroimaging. Cortical and deep brain stimulation to evoke neuroplasticity is an emerging and promising therapy and warrants further investigation. Finally, including patients in their treatment plan allows them control and offers the ability to self-manage their pain. Risk of bias limits the ability to judge the quality of evidence. Full article

Purpose: A growing body of evidence has emerged on the role of diet for health outcomes in cancer survivors. Patients transitioning to post-treatment care may seek guidance on dietary changes, and summaries of the evidence for dietary patterns recommended by guidelines can support providers in effectively answering questions. Increasing evidence suggests that food choices impact planetary health. Plant-based diets are one eating pattern that may improve patient outcomes and planetary health. Methods: We performed a literature review and used narrative reporting to summarize evidence for plant-based diets and offer specific guidance for breast, colorectal, and prostate cancer patients who are post-diagnosis. Specifically, we reviewed impacts on recurrence, all-cause, and cancer-specific mortality. Results: Increased fibre intake by consuming foods like fruits, vegetables, and whole grains is associated with a decreased risk of breast cancer-specific and all-cause mortality, as well as reduced colon cancer-specific mortality. Replacing refined grains with whole grains is associated with improved disease-free survival for colon cancer survivors. Higher tree nut consumption is associated with improved disease-free survival for breast, colorectal, and prostate cancer survivors. Soy is safe to consume for breast cancer survivors and is associated with a reduced risk of recurrence. Conversely, more Western dietary patterns high in processed meat intake are associated with an increased risk of colon cancer recurrence and prostate cancer mortality. There are also environmental benefits of a shift towards plant-based diets to address the adverse health outcomes associated with climate change and its potential impact on cancer care delivery as previously outlined in a 2024 ASCO policy statement. Conclusions: Based on the best existing evidence, providers can suggest that patients consider plant-based dietary patterns in the post-treatment phase of their cancer care to support health outcomes and planetary health. Full article

This study proposes a circular economy strategy to recover phenolic compounds by valorizing shrimp shell waste into a chitosan biosorbent (CH-B). Its adsorption efficiency was evaluated compared to commercial activated carbon (AC) and synthetic XAD-4 resin. Kinetic analysis revealed that while both pseudo-first-order (PFO) and pseudo-second-order (PSO) models exhibited high correlations (R²$\ge$ 0.96), both CH-B and XAD-4 resin were best described by the PFO model. This aligns with diffusion-controlled processes consistent with the porous and physical nature of these adsorbents. In contrast, AC followed the PSO model. Isotherm modeling indicated that CH-B and AC fit the Temkin model, reflecting heterogeneous surfaces, whereas XAD-4 followed the Langmuir model (monolayer adsorption). Notably, CH-B exhibited a maximum adsorption capacity (q_m) of 229.2 mg/g, significantly outperforming XAD-4 (104.8 mg/g) and AC (90.2 mg/g). Thermodynamic and kinetic modeling confirmed that the adsorption mechanism was governed by a combination of electrostatic interactions, π–π stacking, and hydrogen bonding between the hydroxyl/amine groups of chitosan and phenolic compounds. Optimization using Box–Behnken design for CH-B showed optimal acidic pH and moderate temperature but non-significant effect of CH-B dose in the experimental domain. Optimisation results showed unexpected high removal efficiency at low CH-B dosages. A tentative explanation may be adsorbent aggre-gation, which needs to be confirmed by further experimental evidence. Full article

The increasing complexity of contemporary urban systems necessitates decision-making frameworks capable of systematically integrating multidimensional sustainability considerations into policy evaluation processes. While existing urban sustainability assessment approaches predominantly focus on isolated environmental or socio-economic indicators, they often lack methodological coherence and direct applicability to operational decision-making. This study proposes a multi-layer sustainability indicator framework explicitly designed to support evidence-based urban decision-making under conditions of uncertainty, institutional constraints, and competing policy objectives. The framework integrates environmental, economic, social, and institutional dimensions of sustainability into a structured decision-support architecture. Methodologically, the study employs a two-stage approach combining expert-based weighting techniques (Analytic Hierarchy Process and Best–Worst Method) with multi-criteria decision-making methods (TOPSIS and VIKOR) to evaluate and rank alternative urban policy scenarios. The proposed framework is empirically validated through an urban case study, demonstrating its capacity to translate abstract sustainability indicators into comparable decision outcomes and policy priorities. The results indicate that the integration of multi-layer indicator systems with formal decision-analysis tools enhances transparency, internal consistency, and strategic coherence in urban governance processes. By bridging the gap between sustainability measurement and decision implementation, the study contributes to the advancement of urban governance scholarship and provides a replicable analytical model applicable to cities facing complex sustainability trade-offs. Full article

The rapid advancement of Artificial Intelligence (AI) technologies has significantly transformed teaching, learning, and research practices within higher education institutions (HEIs). Although a growing body of literature has examined the application of AI in higher education, existing studies remain fragmented, often focusing on isolated tools or outcomes, with limited synthesis of best practices, core functionalities, and implementation challenges across diverse contexts. To address this gap, this systematic review aims to comprehensively examine the best practices, functionalities, and challenges associated with the integration of AI in HEIs. A comprehensive literature search was conducted across major academic databases, including Google Scholar, Scopus, Taylor & Francis, and Web of Science, resulting in the inclusion of 35 peer-reviewed studies published between 2014 and 2024. The findings suggest that effective AI integration is supported by best practices, including promoting student engagement and interaction, providing language support, facilitating collaborative projects, and fostering creativity and idea generation. Key AI functionalities identified include adaptive learning systems that personalize educational experiences, predictive analytics for identifying at-risk students, and automated grading tools that improve assessment efficiency and accuracy. Despite these benefits, significant challenges persist, including limited knowledge and skills, ethical concerns, inadequate infrastructure, insufficient institutional and management support, data privacy risks, inequitable access to technology, and the absence of standardized evaluation metrics. This review provides evidence-based insights to inform educators, institutional leaders, and policymakers on strategies for leveraging AI to enhance teaching, learning, and research in higher education. Full article

This structured narrative review compared the efficacy, durability, and safety of anti-vascular endothelial growth factor (anti-VEGF) agents and intravitreal corticosteroids for the treatment of diabetic macular edema (DME), with the aim of identifying patient- and disease-specific factors to guide individualize therapy. A comprehensive search of PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov was conducted for studies published between January 2009 and November 2025, including randomized controlled trials, meta-analyses, and large observational cohorts with at least six months of follow-up. Visual acuity, anatomical outcomes, treatment burden, durability, and safety were extracted, and evidence quality was assessed using the GRADE framework. Eleven studies encompassing 1341 eyes were included. Anti-VEGF therapy consistently produced greater improvements in best-corrected visual acuity, particularly in treatment-naïve eyes and in patients with worse baseline vision, whereas corticosteroids achieved larger reductions in central macular thickness and significantly reduced injection burden because of longer durability. However, corticosteroid therapy was associated with higher rates of intraocular pressure elevation and cataract progression. In pseudophakic patients and in chronic or refractory DME, functional and anatomical outcomes were generally comparable between the two therapeutic classes. Combination therapy resulted in the greatest anatomical improvement but at the cost of increased ocular adverse events. Overall, anti-VEGF agents remain the preferred first-line treatment for most patients with DME owing to superior visual outcomes and a more favorable safety profile, while corticosteroids represent valuable alternatives in pseudophakic eyes, chronic or anti-VEGF–refractory DME, and cases with prominent inflammatory features, provided that careful monitoring for ocular adverse events is maintained. Full article

Tourism is increasingly acknowledged as a major driver of global greenhouse gas emissions. However, efforts to accurately assess its carbon footprint remain hindered by methodological inconsistencies and a reliance on fragmented case studies. This study undertakes a systematic review of 166 peer-reviewed research papers to critically evaluate prevailing approaches for quantifying tourism-related carbon emissions. Leveraging a structured framework encompassing four analytical dimensions and fourteen parameters, the analysis reveals that energy consumption and emission factors constitute the core elements of prevailing models. Nevertheless, only half of the papers account for indirect emissions, and the majority of studies are confined to national or subnational scales, offering limited insight into destination-specific impacts. This methodological heterogeneity undermines the comparability of results and constrains their utility in formulating coherent, evidence-based climate policies. By synthesising these diverse approaches, this review identifies critical methodological gaps, advocates for the harmonisation of best practices, and delineates a roadmap for more robust and context-sensitive carbon accounting within the tourism industry. The insights gained are practical for researchers and policymakers seeking to align tourism development with climate mitigation objectives, thereby fostering greater transparency and efficacy in carbon governance within the sector. Ultimately, such initiatives aim to fortify the sector’s contribution to global decarbonisation efforts. Full article

The Netherlands is widely recognised as the global leader in water management, with its flood risk management (FRM) infrastructure lauded as being of the best in the world. This status notwithstanding, Dutch FRM primarily maintains established infrastructural practices and experimental applications of NBSs remain less frequent than established structural projects. This paper details and examines the challenges associated with the prevailing ‘business-as-usual’ approach to FRM in The Netherlands, in which traditional ‘grey’ infrastructural techniques are prioritised over innovative ‘green’ nature-based solutions (NBSs). In line with emerging international trends, such as the EU Water Resilience Strategy, NBSs are increasingly advocated as a strategic, complementary layer to enhance the resilience of existing safety frameworks rather than a self-evident replacement for them. Contrary to grey infrastructure, NBSs provide a number of environmental and social co-benefits extending beyond their flood and drought protection utility. The literature on NBSs details the design, effectiveness, and positive socio-economic impact of the operationalisation of such projects for FRM. This notwithstanding, the uptake and practical implementation of NBSs have been slow in The Netherlands. From a legal and policy perspective, this has been attributed to a lack of political will and the corresponding failure to include NBSs in long term FRM planning. Given the long planning horizons associated with FRM (50–100 years), the failure to incorporate NBSs can lead to policy lock-in that blocks future adaptations. Against this backdrop, this paper employs a semi-systematic literature review to clarify the obstacles to implementing NBSs in Dutch FRM and sets a research agenda that charts a course to mainstreaming NBSs in Dutch FRM. Seven core focus areas for future research are identified. The paper concludes by drawing on these identified focus areas to construct a research agenda aimed at systematically addressing each barrier to the practical operationalisation of NBSs in Dutch FRM, emphasising a hybrid green–grey approach which may serve to inspire similar research in other jurisdictions. Full article

Background: Feigned restriction of shoulder joint movement for secondary gain is clinically relevant and may misdirect care, distort disability determinations, and inflate system costs. Distinguishing feigning from structural pathology and from functional or psychosocial presentations is difficult because pain is subjective, performance varies, and no single sign or test is definitive. This comprehensive review hypothesizes that the systematic integration of clinical examination, objective biomechanical and neurophysiological testing, and emerging technologies can substantially improve detection accuracy and provide defensible medicolegal documentation. Methods: PubMed and reference lists were searched within a prespecified time frame (primarily 2015–2025, with foundational earlier works included when conceptually essential) using terms related to shoulder movement restriction, malingering/feigning, symptom validity, effort testing, functional assessment, and secondary gain. Evidence was synthesized narratively, emphasizing objective or semi-objective quantification of motion and effort (goniometry, dynamometry, electrodiagnostics, kinematic sensing, and imaging). Results: Detection is best approached as a stepwise, multidimensional evaluation. First-line clinical assessment focuses on reproducible incongruence: non-anatomic patterns, internal inconsistencies, distraction-related improvement, and mismatch between claimed disability and observed function. Repeated examinations and documentation strengthen inference. Instrumented strength testing improves quantification beyond manual testing but remains effort-dependent; repeat-trial variability and atypical agonist–antagonist co-activation can indicate submaximal performance without proving intent. Imaging primarily tests plausibility by confirming lesions or highlighting discordance between claimed limitation and minimal pathology, while recognizing that normal imaging does not exclude pain. Diagnostic anesthetic injections and electrodiagnostics can clarify pain-mediated restriction or exclude neuropathic weakness but require cautious interpretation. Motion capture and inertial sensors can document compensatory strategies and context-dependent normalization, yet validated standalone thresholds are limited. Conclusions: Feigned shoulder impairment cannot be confirmed by any single test. The desirable strategy combines structured assessment of inconsistencies with objective biomechanical and neurophysiologic measurements, interpreted within the whole clinical context and rigorously documented; however, prospective validation is still needed before routine implementation. Full article

Arbuscular mycorrhizal fungi (AMF) form symbiotic interactions with most terrestrial plants, enhancing nutrient uptake and stress resilience. Organic amendments like biochar, compost, and manure are advocated to improve soil health and promote AMF symbiosis. However, empirical evidence of their effects on root AMF colonization is inconsistent, and a systematic understanding of the governing factors is lacking. Here, we synthesized the responses of root AMF colonization in agricultural systems to biochar, compost, and manure input from 85 studies (663 pairs of observations) globally based on a meta-analysis. Overall, biochar and compost/manure significantly increased root AMF colonization. However, these effects were highly context-dependent. Biochar most strongly promoted colonization in coarse-textured soils with low total potassium (TK ≤ 25 g kg⁻¹) and high total carbon (TC ≥ 11 g kg⁻¹), particularly for fruit and tuber crops. In contrast, compost/manure were most effective in fine-textured soils with high TK (≥25 g kg⁻¹) and low bulk density (BD ≤ 1.3 g cm⁻³). Notably, compost/manure suppressed colonization in neutral pH (6.5 < pH < 7.5) and high BD soils (>1.3 g cm⁻³). Key amendment properties drove these responses: biochar with low electrical conductivity (EC < 5 dS m⁻¹), high sodium and low macronutrient content was most beneficial, whereas compost/manure with high total nitrogen (TN > 9 g kg⁻¹) and low organic carbon (OC ≤ 500 g kg⁻¹) performed best. The efficacy of organic amendments in enhancing AMF symbiosis is not universal but dictated by a complex interplay of soil properties and amendment characteristics. Our findings provide a robust, quantitative framework for tailoring amendment strategies to specific agro-ecological contexts, enabling farmers and land managers to selectively use biochar or compost/manure to harness AMF benefits for sustainable crop production. Full article

Sjögren’s syndrome is a chronic autoimmune disease marked by lymphocytic infiltration of the exocrine glands and the development of sicca symptoms, yet some patients also develop extraglandular involvement. Imaging has become relevant for describing these systemic features and supporting clinical assessment. This review discusses the roles of ultrasonography, elastography, computed tomography, and magnetic resonance imaging in evaluating multisystem disease associated with Sjögren’s syndrome. Ultrasonography and elastography help assess muscular involvement by showing changes in echogenicity and stiffness that reflect inflammation and later tissue remodeling. In joints, ultrasound can detect synovitis, tenosynovitis, and early erosive changes, including abnormalities not yet evident on examination. Pulmonary disease, most often with interstitial lung involvement, is best evaluated with high-resolution computed tomography, which remains the most reliable imaging modality for distinguishing interstitial patterns. Magnetic resonance imaging is valuable in assessing neurological complications. It can reveal ischemic and demyelinating lesions, neuromyelitis optica spectrum features, or pseudotumoral appearances. Imaging is also essential for detecting lymphoproliferative complications, for which ultrasound and magnetic resonance imaging can reveal characteristic structural and diffusion-weighted imaging findings. When combined with clinical and laboratory information, these imaging methods improve early recognition of systemic involvement and support accurate monitoring of disease progression in Sjögren’s syndrome. Full article

Reading speed is hypothesized to have distinct neural signatures across orthographically diverse languages, yet cross-linguistic evidence remains limited. We investigated this by classifying speed readers versus regular readers among Sinhalese and Japanese adults ($n=142$) using task-based fMRI and 35 supervised machine learning classifiers. Functional activation was extracted from 12 reading-related cortical regions. We introduced Fuzzy C-Means (FCM) clustering for data augmentation and Shapley additive explanations (SHAP) for model interpretability, enabling evaluation of region-wise contributions to reading speed classification. The best model, an FT-TABPFN network with FCM augmentation, achieved 81.1% test accuracy in the Combined cohort. In the Japanese-only cohort, Quadratic SVM and Subspace KNN each reached 85.7% accuracy. SHAP analysis revealed that the angular gyrus (AG) and inferior frontal gyrus (triangularis) were the strongest contributors across cohorts. Additionally, the anterior supra marginal gyrus (ASMG) appeared as a higher contributor in the Japanese-only cohort, while the posterior superior temporal gyrus (PSTG) contributed strongly to both cohorts separately. However, the posterior middle temporal gyrus (PMTG) showed less or no contribution to the model classification in each cohort. These findings demonstrate the effectiveness of interpretable machine learning for decoding reading speed, highlighting both universal neural predictors and language-specific differences. Our study provides a novel, generalizable framework for cross-linguistic neuroimaging analysis of reading proficiency. Full article

Background: Evidence guiding secondary repair of persistent full-thickness macular holes (FTMHs) remains limited and heterogeneous. Temporal arcuate relaxing retinotomy has been described as a salvage maneuver intended to increase temporal retinal compliance, yet functional safety data are scarce. We report consecutive real-world outcomes of temporal arcuate relaxing retinotomy for persistent FTMHs after failed standard repair(s). Methods: Retrospective consecutive case series of patients with persistent FTMH after ≥1 pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling, treated with repeat PPV and temporal arcuate relaxing retinotomy. Outcomes included OCT (Optical Coherence Tomography)-confirmed closure after gas absorption and best-corrected visual acuity (BCVA, logMAR), ellipsoid zone (EZ) status, retinotomy-site morphology on OCT/fundus autofluorescence (FAF), and safety/functional outcomes (systematic scotoma symptom inquiry; Humphrey visual field testing when feasible). Exact binomial 95% confidence intervals (CI) were calculated for proportions. Results: Nine eyes (median age 70 years; range 55–76) underwent temporal arcuate relaxing retinotomy for persistent FTMH. Minimum linear diameter ranged 412–1037 µm (median 613 µm). OCT-confirmed closure was achieved in 7/9 eyes (77.8%; 95% CI 40.0–97.2) at a mean follow-up of 5.9 months (range 2–12). BCVA improved in 8/9 eyes (88.9%; 95% CI 51.8–99.7); mean BCVA improved from 1.26 ± 0.51 logMAR pre-operatively to 0.61 ± 0.18 logMAR at last follow-up (mean change −0.64 logMAR; Wilcoxon signed-rank test p = 0.011). As a sensitivity analysis, the paired t-test yielded p = 0.008. Humphrey visual fields were obtained in 6/9 eyes; one patient reported a new paracentral nasal scotoma, which was subjectively well tolerated. Conclusions: In this small consecutive series, temporal arcuate relaxing retinotomy was associated with a 78% closure rate and mean BCVA improvement in eyes with persistent FTMH after failed standard repair(s), with limited symptomatic scotoma reporting in those assessed. Given the retrospective design, small cohort, and incomplete standardized functional testing, larger comparative studies with uniform functional endpoints (microperimetry, RNFL/GCL metrics, and systematic perimetry) are needed to define patient selection, reproducibility, and relative performance versus contemporary salvage options. Full article