Search Results (257)

Sustainable agricultural development requires ensuring food security while preserving essential ecological conditions. This study incorporated ecosystem service value and carbon emissions as the positive and negative ecological outputs of agriculture, respectively, to account for the AGEE of 31 Chinese provinces from 2012 to 2021 and to analyse its spatiotemporal characteristics. The Malmquist Index was employed to calculate the green total factor productivity (GTP) as a quantitative indicator of AGEE dynamics, providing further insights into the sources and equilibrium of AGEE growth, as well as provincial-level improvement paths. Furthermore, the Spatial Durbin Model was applied to systematically analyse the influencing factors and their associated spatial spillover effects. The results show the following: (1) AGEE demonstrated steady improvement, with a mean value of 0.576, and was spatially concentrated along a northeast–southwest axis, exhibiting regional disparities and polarisation. (2) GTP consistently exceeded 1, indicating overall AGEE growth, primarily driven by technological scale expansion. Regional imbalances in AGEE growth had emerged, with heterogeneous causes across economic regions. Three identified AGEE improvement paths—technological catch-up, green innovation, and technological progress—varied by province, with green innovation being the most common priority. (3) AGEE exhibited spatial autocorrelation, with rural income, adequate irrigation, and cropping structure promoting AGEE. Effective irrigation also exhibited a positive spatial spillover effect, whereas industrial structure hindered AGEE. These findings provide valuable insights for advancing green agricultural practices and sustainable regional development. Full article

Background: Small for gestational age neonates represent a population at risk of growth failure or deviant growth patterns and long-term metabolic complications. Breastfeeding has been identified as a critical factor in promoting healthier growth and long-term metabolic health in both full-term and preterm appropriate for gestational age infants, but similar studies in small for gestational age infants are limited. The aim of this narrative review is to assess the impact of breastfeeding on growth and body composition in small for gestational age neonates. Methods: The PubMed and Google Scholar databases were screened for the relevant literature. The following terms, were used: “low birth weight”, “in utero growth restriction”, “small for gestational age”, “human milk”, and “growth”. The initial screening identified 57 relevant studies. Thirteen of them fulfilled the eligibility criteria and were included in this narrative review. Results: In preterm small for gestational age neonates, human milk nutrition was associated with healthier catch-up growth without excessive fat accumulation. Fortification strategies were associated with enhanced growth outcomes without increased incidence of neonatal morbidities. In the context of full-term, small for gestational age neonates, exclusive breastfeeding has been demonstrated to be associated with healthy catch-up growth. Furthermore, human milk nutrition has been shown to mitigate the predisposition of these children to obesity and cardiometabolic complications. Conclusions: According to the limited extant literature, human milk feeding has been identified as a potentially protective factor for small for gestational age neonates, promoting healthier growth patterns and long-term cardiometabolic health. However, larger prospective studies are needed to evaluate human milk feeding and human milk fortification in association with growth and long-term outcomes in small for gestational age infants. Full article

Artificial intelligence (AI) is a key driver of the energy transition and sustainable economic development. However, the specific mechanisms through which AI adoption impacts renewable energy production versus consumption remain poorly understood. This study addresses this research gap by empirically analyzing how three AI dimensions (investments, readiness, and projects) differently influenced renewable energy production and consumption across 30 countries (EU-27, USA, China, and UK) during 2020–2023. Additionally, the AI–energy transition nexus is analyzed in relation to economic development (GDP per capita) and carbon emissions (CO₂). Employing robust regression, Gaussian graphical modeling, and cluster analysis, the study provides robust multidimensional validation. Empirical findings reveal that AI investments predominantly stimulate renewable energy production, while AI readiness and institutional ecosystems primarily drive renewable energy consumption. The following two country clusters emerge: advanced economies (USA, China, Germany, UK, and France) characterized by higher AI readiness and superior green-energy integration, and developing economies with significant catch-up potential. The study demonstrates AI’s dual role as both direct determinant and systemic mediator in the energy transition. Moreover, CO₂ emissions show an asymmetric role, being positively correlated with renewable energy production but negatively linked with renewable energy consumption. These insights highlight the need for targeted policies that bridge economic and technological divides, thereby accelerating the renewable energy transition and enriching academic debates on technology-driven sustainability. Full article

Background/Objectives: Patients with inflammatory bowel disease (IBD) are at increased risk of severe infections, particularly when undergoing immunosuppressive therapy. Vaccination is a key preventive strategy, but coverage in this group is often suboptimal. This study evaluated vaccination coverage among IBD patients at diagnosis/referral and after admission to a structured hospital-based vaccination pathway. Methods: We conducted an observational study (February 2022–February 2025) at the Vaccination Center (VC) of the University Hospital “G. Martino” in Messina, Italy. Adult IBD patients referred by gastroenterologists were assessed for vaccination status using hospital and regional registries, and personalized schedules were developed based on Italian National Vaccine Prevention Plan guidelines. Descriptive statistics were applied to assess baseline and post-intervention vaccination coverage. Results: Of 154 participants (mean age 64 years; 51.9% male), 55.4% were on immunosuppressive therapy. Baseline coverage was heterogeneous: influenza, 6.5%; PCV13, 25.5%; PPV23, 26.6%; herpes zoster, 62.3%; and COVID-19 primary cycle, 79.6%. After enrollment, substantial improvements were observed: influenza, 89.2%; PCV13, 74.5%; PPV23, 67.0%; herpes zoster, 75.4%; and COVID-19 primary cycle, 96.8%. Coverage for catch-up vaccines also improved (e.g., HBV went from 1.9% to 44.2%). However, uptake of COVID-19 booster doses during the study period remained low (15.6%). No significant differences emerged by sex or treatment subgroup. Conclusions: A structured, collaborative care pathway between gastroenterologists and public health specialists significantly improved vaccination coverage among IBD patients. Despite gains, gaps persist in COVID-19 booster uptake and catch-up vaccinations. Integration of vaccination services into routine IBD management is essential to enhance protection in this high-risk population. Full article

Malnutrition afflicts millions of the world’s children and predisposes to death from diarrhea and infectious diseases. Children with severe acute malnutrition (SAM) are at highest risk. Our review of the endocrinology and metabolomics of SAM implicates critical roles for white adipose tissue and its regulatory hormones and growth factors in the adaptation to nutritional deprivation and the restoration of metabolic homeostasis: white adipose provides substrates and energy for hepatic glucose production and cardiopulmonary and central nervous system function, and products of fat metabolism inhibit muscle glucose uptake and utilization and spare muscle protein. Collectively, these effects maintain glucose availability for the brain, red blood cells, and renal medulla and conserve muscle mass. White adipose tissue also secretes leptin, which facilitates the immune response and may protect against mortality from infection. Euglycemia and survival in SAM are thereby prioritized over linear growth, which is suppressed owing to inhibition of insulin-like growth factor 1 production and action. Diversion of energy from growth serves to maintain essential bodily functions in critically ill malnourished children, who have limited energy reserves. Thus, short-term reductions in growth rate have adaptive benefits in SAM. Under favorable conditions, clinical and metabolic recovery are accompanied by catch-up growth, which can mitigate, and in many cases reverse, the stunting of growth in childhood. Nevertheless, clinical recovery can be complicated by preferential accrual of central fat and a relative deficiency of lean/skeletal mass, with potential long-term complications including insulin resistance, glucose intolerance, and metabolic syndrome. Full article

This study examines the effects of supply chain pressure, smart AI, and socio-economic fairness on long-term economic sustainability. To this end, this study uses quarterly data from 1999 Q1 through 2024 Q4 for the United States and employs the recently introduced Wavelet Cross-Quantile Regression (WCQR) to analyze this relationship. This study finds that smart AI, supply chain pressure (SC), and renewable energy consumption (REC) significantly drive U.S. economic growth, with the strongest short-term effects appearing when adoption and output are in the lower quantiles, reflecting threshold and diffusion dynamics. SC enhances growth once supply chain networks reach a critical level of connectivity, while REC generates substantial gains at low penetration levels, illustrating a “catch-up” effect. In contrast, economic inequality (EI) generally dampens growth, especially at moderate to high inequality levels; however, long-term reductions in EI yield positive returns in high-growth states by improving social cohesion and workforce productivity. Based on these findings, this study proposes funding low-adoption AI now, scaling to mid-adoption users mid-term, and entrenching long-term gains through economy-wide upskilling. Full article

Background/Objectives: In India, according to the National Family Health Survey (NFHS-5), 36% of children under five years old are stunted, 19% are wasted, and 32% are underweight, indicating widespread undernutrition. Methods: A randomized controlled trial was conducted between August 2023 and May 2024 (CTRI/2023/04/051566), enrolling 223 undernourished Indian children, randomly assigned to the oral nutritional supplement (ONS) + dietary counseling (DC) (n = 111) arm or the dietary counseling (DC) arm (n = 112). This study recruited both male and female subjects with picky eating habits and with height-for-age (HAP) and weight-for-height percentiles (WHP) below the 25th percentile according to the WHO Growth Standards and Growth Reference. Outcomes assessed were anthropometric indices, dietary intake, sick days, and nutrient adequacy. Data were analyzed using ANCOVA, with statistical significance at p < 0.05. Results: At 6 months, the ONS + DC group showed significant improvements compared to DC in HAP (12.1 vs. −0.4, LS Mean difference [95% CI], 13.3 [11.13, 15.48], p < 0.0001), and WAP (9.7 vs. 2.3, LS Mean difference [95% CI] 7.9 [5.07, 10.78], p < 0.0001). MUACP significantly increased in the ONS + DC group (11.1 vs. −1.0 in DC, LS Mean difference [95% CI], 11.1 [5.28, 16.99], p < 0.0001). Dietary intake of carbohydrates, proteins, and energy was significantly higher in the ONS + DC group at 3 months, with sustained improvements at 6 months. By 6 months, the ONS + DC group showed a significantly higher protein-to-energy intake ratio compared to the DC group (0.0027 vs. −0.0003, LS Mean difference [95% CI] 0.00224 [0.00025, 0.00423], p = 0.0204). Conclusions: The addition of ONS + DC significantly improved linear catch-up growth outcomes in children at risk of undernutrition as a result of improved energy and nutrient intake and a higher protein-to-energy ratio. Full article

Background: Sirolimus is an effective treatment for kaposiform hemangioendothelioma (KHE), a rare vascular tumor in children. However, its immunosuppressive properties raise concerns regarding the safety and efficacy of vaccinations during treatment. This study aims to evaluate the safety and immunogenicity of inactivated and live-attenuated vaccines administered to pediatric KHE patients undergoing sirolimus therapy. Methods: We conducted a prospective study involving 56 KHE children receiving sirolimus who were vaccinated during treatment. Data on vaccine-related adverse events were collected to assess safety. Immunogenicity was evaluated by measuring seroconversion or protective antibody titers against vaccines, including Hepatitis B, DTaP, and MMR. Results: Among 56 catch-up vaccinated children, no serious adverse events related to vaccination were observed. Mild local or systemic reactions occurred in a minority of patients. Serological analysis demonstrated that children with kaposiform hemangioendothelioma (KHE) receiving sirolimus therapy were able to generate and sustain robust protective antibody responses following vaccination. High seroconversion rates and antibody titers were observed for both inactivated vaccines (e.g., hepatitis B and DTaP) and live-attenuated vaccines (e.g., MMR). Protective antibody levels were maintained both within 3 months and beyond 6 months post-vaccination, indicating durable immunogenicity under sirolimus treatment. Conclusions: Vaccination during sirolimus therapy appears to be safe and immunogenic in children with KHE. These findings support the administration of both inactivated and live-attenuated vaccines under appropriate clinical monitoring in this rare patient population. Full article

In the era of digital–real integration, open-source collaboration has become a strategic pathway for accelerating the innovation catch-up of China’s industrial software. This study employs an exploratory multi-case design, focusing on the China Automotive Operating System open-source project and the FastCAE open-source domestic CAE software integrated development platform to examine how open-source strategies shape collaborative mechanisms and innovation outcomes. The analysis reveals that firms adopt both formal (behavioral and outcome coordination) and informal (relationship and empowerment coordination) strategies, fostering high-level complementary collaboration in data, technology, institution, and human resources. These mechanisms significantly enhance R&D efficiency and quality, drive technological innovation, and create new market innovation, thereby improving collaborative performance. The study contributes to theory by linking open-source-driven digital–real integration with industrial software innovation catch-up and offers practical governance recommendations for strengthening China’s industrial software autonomy and ecosystem sustainability. Full article

Background/Objectives: Booster vaccination coverage in the adult population in Poland remains insufficient. The objective of this study was to utilize the opportunity of a visit to the Regional Blood Transfusion Center in Wroclaw—associated with blood donation—as a means to remind individuals about the need for tetanus booster vaccination and to assess tetanus immunity in healthy adults (30–40 years after their last mandatory dose) who had not received booster immunizations. Materials and Methods: A total of 97 blood donors aged 50 to 64 years (median age: 54 years) were enrolled, of whom 78% were male. 1. Tetanus immunity was assessed by a single measurement of serum anti-tetanus IgG antibody concentration. 2. A questionnaire was used to collect data relevant to tetanus immune status. 3. Individuals with insufficient protection received a booster dose of the tetanus vaccine, and the post-vaccination serologic response was evaluated. Results: 1. In the study group, 10.3% of participants had no protective immunity against Clostridium tetani, while 5.2% exhibited uncertain protection. An additional 32% demonstrated antibody levels conferring only short-term protection. Satisfactory protection—defined as immunity lasting at least 3 years—or long-term protection (at least 5 years) was identified in 52.5% of patients. Although 72% of donors reported receiving mandatory childhood immunizations, only 5% could provide medical documentation. In this subgroup, a significantly higher geometric mean antibody concentration was observed (0.69 vs. 0.52 IU/mL; p = 0.04), and significantly fewer participants required immediate post-exposure prophylaxis (1/39 vs. 14/54; p = 0.003). 2. Among the 46 individuals eligible for a booster dose, 17 (37%) returned for vaccination. Of these, 16 (94%) achieved antibody titers consistent with long-term protection following a single vaccine dose. Conclusions: Tetanus immunity among adults is heterogeneous and difficult to predict due to the frequent lack of vaccination records and unreliable self-reported histories. A history of injury and associated surgical wound care involving injection often serves as the only indication of prior vaccination. A single booster dose is highly effective in eliciting a robust immune response in individuals vaccinated during childhood but lacking recent boosters. Rising vaccine hesitancy toward both mandatory and recommended immunizations in Poland negatively influences adult decisions regarding tetanus vaccination. Participation in voluntary blood donation programs presents a valuable opportunity for immunization education, immune status screening, and the implementation of effective catch-up vaccination strategies. Full article

Significance: Hepatic encephalopathy (HE) occurs in 20–80% of patients with liver cirrhosis, impacting attention, memory, processing speed, and visuospatial skills. HE standard-of-care psychometric assessments are time-consuming and require staff training. Oculometrics may provide a fast, non-invasive brain health assessment that can be self-administered in a medical environment. Purpose: We investigated whether an oculometric assessment could measure the severity of HE as accurately as standard-of-care psychometric methods. Methods: Forty-eight participants (19 with decompensated cirrhosis, 10 with compensated cirrhosis, 19 controls) completed a previously validated five-minute oculometric test and the standard-of-care psychometric hepatic encephalopathy (PHE) battery. The oculometric test consists of following a dot as it moves across a computer screen and generates 10 metrics including a summary score called nFit. The PHE battery entails five standard cognitive tests, generating seven metrics including a PHE composite score (PHES). Results: The oculometric summary score, nFit, correlated with the current diagnostic standard, the PHES (r = 0.51, p < 0.001), the presence or absence of HE as determined by PHES composite (r = −0.44, p < 0.001), as well as the severity of cirrhosis (r = −0.59, p < 0.001). Additionally, performance on both nFit and PHES distinguished compensated (ROC: nFit: 0.71, PHES: 0.68) and decompensated (ROC: nFit: 0.88, PHES: 0.85) patient groups from control participants comparably. Finally, compared to participants with decompensated cirrhosis, control participants had better scores for almost all oculometrics: acceleration, catch-up saccade amplitude, proportion smooth, direction noise, and speed noise. Conclusions: Patients with liver disease showed impairment on multiple aspects of visual processing compared to a control group. These functional visual processing impairments correlate with the presence or absence of HE, showing significant sensitivity in distinguishing people with HE from controls. Oculometric tests provide a quick, non-invasive functional assessment of brain health in patients with liver disease, with sensitivity indistinguishable from standard-of-case psychometric tests. Full article

Background and Objectives: Romania has experienced the highest measles incidence rate in the European Union since late 2023, driven by suboptimal measles–mumps–rubella (MMR) uptake. Contemporary data on bedside predictors of clinical deterioration are scarce. The objective was to characterise demographic, clinical and laboratory differences between severe and non-severe measles and derive a multivariable model for intensive-care-unit (ICU) admission. Methods: We undertook a retrospective cohort study at the “Victor Babeș” University Hospital for Infectious Diseases, Timișoara. All admissions from 1 November 2023 to 15 May 2025 with serological or RT-PCR confirmation and a complete baseline laboratory panel were included. Descriptive statistics compared ward-managed versus ICU-managed patients; independent predictors of ICU transfer were identified through logistic regression that incorporated age, vaccination status, leukocyte count, C-reactive protein (CRP) and interleukin-6 (IL-6). Results: Among 455 patients (median age 3.0 y, interquartile range [IQR] 1.0–7.0), 17 (3.7%) required ICU care. Vaccine coverage was 18.0% overall and 0% among ICU cases. Compared with ward peers, ICU patients exhibited higher leukocyte counts (8.1 × 10⁹ L vs. 6.0 × 10⁹ L; p = 0.003) and a near-five-fold elevation in IL-6 (18 pg mL vs. 4 pg mL; p < 0.001), while CRP, procalcitonin and fibrinogen were similar. ICU admission prolonged median length of stay from 5 days (IQR 4–7) to 8 days (5–12; p = 0.004). In multivariable modelling, IL-6 remained the sole independent predictor (odds ratio [OR] 1.07 per pg mL; 95% confidence interval [CI] 1.03–1.12; p = 0.001); the model’s AUC was 0.83, indicating good discrimination. Complete separation precluded reliable estimation of the protective effect of vaccination, but no vaccinated child required ICU care. Conclusions: A simple admission panel centred on IL-6 accurately identified Romanian measles patients at risk of critical deterioration, whereas traditional markers such as CRP and leukocyte count added little incremental value. Even a single documented MMR dose was associated with the complete absence of ICU transfers, underscoring the urgent need for catch-up immunisation campaigns. Integrating IL-6-guided triage with intensified vaccination outreach could substantially reduce measles-related morbidity and health-system strain in low-coverage EU settings. Full article

Background: The 2022 conflict in Ukraine triggered mass migration, leading to a significant influx of Ukrainian refugee children into Poland. This situation raises concerns about hepatitis B virus immunity, as Ukraine’s hepatitis B vaccination coverage has been inconsistent compared to Poland’s high vaccination rates. Objective: To evaluate hepatitis B immunity and infection prevalence among Ukrainian refugee children residing in Southern Poland and to assess implications for vaccination strategies in the host country. Methods: A prospective cross-sectional study was conducted on 1322 Ukrainian refugee children (0–18 years) presenting to a pediatric infectious diseases department in Southern Poland between February 2022 and March 2024. Data on vaccination history, demographic characteristics, and selected laboratory parameters, including hepatitis B surface antigen and anti-HBs antibody levels, were collected. Protective immunity was defined as anti-HBs antibody levels ≥10 IU/L. Results: Among the participants (mean age 9.9 years; 50.2% female), 83.2% were reported as vaccinated according to national immunization programs, but only 64.9% demonstrated protective anti-HBs antibody levels. Protective antibody prevalence declined significantly with age, with less than half of adolescents aged 15–18 years showing immunity. Five children (0.4%) were diagnosed with chronic hepatitis B, four of whom were unvaccinated. Conclusions: This study identifies a significant gap in hepatitis B immunity among Ukrainian adolescent refugees residing in Southern Poland, with less than half possessing protective anti-HBs antibody levels. This immunity gap and the high risk of sexual transmission of the hepatitis B virus in adolescents highlight the urgent need for comprehensive surveillance, screening, and catch-up vaccination programs. Full article

With the digital economy continuing to integrate deeply into the agricultural sector, agricultural digital transformation has emerged as a pivotal driver of rural revitalization and the development of a robust agricultural economy. Although existing studies have affirmed the positive role of agricultural digital transformation in promoting rural development and enhancing agricultural efficiency, its spatiotemporal evolution patterns, regional disparities, and underlying driving factors have not yet been systematically and thoroughly investigated. This study seeks to fill that gap. Based on provincial panel data from China spanning 2011 to 2023, this study employs the Theil index, kernel density estimation, Moran’s index, and quantile regression to systematically assess the spatiotemporal dynamics and driving factors of agricultural digital transformation at both national and regional levels. The results reveal a steady overall improvement in agricultural digital transformation, yet regional development imbalances remain prominent, with a shift from inter-regional disparities to intra-regional disparities over time. The four major regions exhibit a stratified evolutionary trajectory marked by internal differentiation: the eastern region retains its lead, while central and western regions show potential for catch-up, and the northeastern region faces a “balance trap.” Economic development foundation, human capital quality, and policy environment support are identified as the core driving forces of transformation, while other factors demonstrate pronounced regional and phase-specific variability. This study not only deepens theoretical understanding of the uneven development and driving logic of agricultural digital transformation but also provides empirical evidence to support policy optimization and promote more balanced and sustainable development in the agricultural sector. Full article

Cervical cancer remains a significant global public health challenge, with human papillomavirus (HPV) as its primary cause. In response, the World Health Organization (WHO) launched a global strategy to eliminate cervical cancer by 2030 and, in its 2022 position paper, recommended a single-dose vaccination schedule. The objective of this review is to critically examine the current HPV vaccination landscape in China, including vaccination policies, immunization schedules, supply–demand dynamics, and the feasibility of transitioning to a single-dose regimen. By synthesizing recent developments in HPV virology, epidemiology, vaccine types, and immunization strategies, we identify both opportunities and barriers unique to the Chinese context. Results indicate that China primarily adheres to a three-dose vaccination schedule, with an optional two-dose schedule for girls aged 9–14, leaving a notable gap compared to the most recent WHO recommendation. The high prevalence of HPV types 52 and 58 contributes to a distinct regional infection pattern, underscoring the specific need for nine-valent vaccines tailored to China’s epidemiological profile. Despite the growing demand, vaccine supply remains inadequate, with an estimated annual shortfall of more than 15 million doses. This issue is further complicated by strong public preference for the nine-valent vaccine and the relatively high cost of vaccination. Emerging evidence supports the comparable efficacy and durable protection of a single-dose schedule, which could substantially reduce financial and logistical burdens while expanding coverage. This review advocates for the adoption of a simplified single-dose regimen, supported by catch-up strategies for older cohorts and the integration of HPV vaccination into China’s National Immunization Program (NIP). Sustained investment in domestic vaccine development and centralized procurement of imported vaccines may also possibly alleviate supply shortage. These coordinated efforts are critical for strengthening HPV-related disease prevention and accelerating China’s progress toward the WHO’s cervical cancer elimination targets. Full article