Search Results (5,107)

Background/Objectives: Home Enteral Nutrition Therapy (HENT) is widely used for patients with preserved gastrointestinal function who cannot maintain adequate oral intake. It can be administered through commercial formulas (CF) or artisanal preparation (AP). Methods: This was a cross-sectional, descriptive, observational study with a quantitative and qualitative approach, conducted through semi-structured interviews by the researcher herself. Patients using HENT were evaluated for nutritional status using a 24 h dietary recall, and their quality of life was assessed using a questionnaire administered during an interview with the patient and/or caregiver. Microbial characteristics of the diets were evaluated by collecting samples and performing microbiological analyses according to standard methods. Results: 22 patients participated, mostly elderly, bedridden, and dependent, with gastrostomy as the primary method of administration (72.7%) and CF as the most commonly used (54.5%). AP consisted of cooked vegetables, legumes, milk, oil, and salt, and showed low nutritional diversity and a high risk of microbiological contamination due to manual handling. Frequent complications included diarrhea (72.7%) and mechanical complications (77.7%). Despite these issues, 91% of participants rated their quality of life as acceptable. Conclusions: HENT posed significant challenges to nutritional adequacy and microbiological safety, particularly among patients using artisanal preparations. These findings highlight the need for systematic monitoring and individualized adjustments by a multidisciplinary team, along with structured caregiver training, to optimize intake, reduce complications, and improve the quality and safety of home-based enteral therapy. Full article

Biofilms are microbial communities embedded in an extracellular matrix that facilitates their attachment to surfaces. This lifestyle provides advantages to pathogenic bacteria, including increased survival in the presence of antibiotics and an enhanced capacity to develop resistance. Once a biofilm is established, infections get difficult to eradicate and frequently become chronic. There is, therefore, an urgent need to develop novel strategies to counteract biofilm-associated antibiotic resistance. Here, we developed a method to monitor the evolution of antimicrobial resistance, aiming to evaluate novel drugs against bacterial resistance to antibiotics. We validated this methodology using an RNase chimera with antibiofilm activity and a reported ability to hinder colistin resistance in planktonic cultures of Acinetobacter baumannii (A. baumannii). We assessed the emergence of resistance in A. baumannii biofilms by repeated cycles of colistin exposure. This method not only preserves biofilm structure throughout treatment but also enables controlled induction of resistance acquisition while monitoring antimicrobial efficacy. Although the RNase enhanced the antibiotic’s activity against biofilms by reducing by 50% the effective dose, it did not prevent the emergence of colistin resistance, indicating that the protein may use distinct mechanisms against planktonic and biofilm communities. Nonetheless, our findings highlight the potential of this methodology for evaluating antibiotic-adjuvant candidates to combat antibiotic resistance in biofilms. Full article

Reliable environmental monitoring in remote or sparsely instrumented regions is hindered by the cost, maintenance demands, and inaccessibility of dense physical sensor deployments. To address these challenges, this study introduces VSG-SGL, a unified virtual sensor generation framework that integrates Sparse Gaussian Process Regression (SGPR) and Bayesian Ridge Regression (BRR) with deep generative learning via Variational Autoencoders (VAE) and Conditional Tabular GANs (CTGAN). Real meteorological datasets from multiple South Korean cities were preprocessed using thresholding and Isolation Forest anomaly detection and evaluated using distributional alignment (KDE) and sequence-learning validation with BiLSTM and BiGRU models. Experimental findings demonstrate that VAE-augmented virtual sensors provide the most stable and reliable performance. For temperature, VAE maintains predictive errors close to those of BRR and SGPR, reflecting the already well-modeled dynamics of this variable. In contrast, humidity and wind-related variables exhibit measurable gains with VAE; for example, SGPR-based wind speed MAE improves from 0.1848 to 0.1604, while BRR-based wind direction RMSE decreases from 0.1842 to 0.1726. CTGAN augmentation, however, frequently increases error, particularly for humidity and wind speed. Overall, the results establish VAE-enhanced VSG-SGL virtual sensors as a cost-effective and accurate alternative in scenarios where physical sensing is limited or impractical. Full article

Continuous vegetation monitoring is essential for predicting crop varieties and yields; however, optical satellite data are frequently unavailable due to cloud cover. To overcome this limitation, this study proposes a method for generating pseudo-NDVI (Normalized Difference Vegetation Index) imagery from RVI (Radar Vegetation Index) derived from Synthetic Aperture Radar (SAR) data using Generative Adversarial Networks (GANs). Two architectures—pix2pixHD (supervised) and CycleGAN (unsupervised)—were evaluated using Sentinel-1 and Sentinel-2 data under identical conditions. By introducing RVI as an intermediate feature instead of directly converting SAR backscatter to NDVI, the proposed method enhanced physical interpretability and improved correlation with NDVI. Quantitative results show that pix2pix achieved higher accuracy (SSIM = 0.5667, PSNR = 22.24 dB, RMSE = 20.54) than CycleGAN (SSIM = 0.5240, PSNR = 19.54 dB, RMSE = 28.02), with further improvement when combining VV and VH polarization data. Although the absolute accuracy remains moderate, this approach enables continuous annual NDVI time series reconstruction for crop monitoring under persistent cloud conditions, demonstrating clear advantages over conventional direct SAR-to-NDVI conversion methods. Full article

Background/Objectives: Dalbavancin is approved for pediatric acute bacterial skin and skin structure infections (ABSSSIs), yet real-world practice frequently necessitates off-label use for deep-seated infections requiring prolonged suppression. While adult data support therapeutic drug monitoring (TDM)-guided maintenance, the pediatric evidence for repeated-dose pharmacokinetics (PK) is limited. We evaluated the efficacy, safety, multi-dose PK, and pharmacoeconomic impact of dalbavancin in a complex pediatric cohort. Methods: A retrospective study (2023–2025) of enrolled patients < 18 years treated with dalbavancin. A subgroup receiving ≥3 doses underwent PK analysis to assess concentration decay against conservative efficacy targets (4 and 8 mg/L). A pharmacoeconomic analysis compared resource utilization against the standard of care. Results: Sixteen patients (median age 12) were included, primarily treated for Staphylococcus aureus (S. aureus) osteoarticular infections (75%), and frequently device-associated (66.7%). Clinical success was 93.8% (15/16) with no adverse events. A PK analysis (n = 9; 78 samples) ruled out dangerous accumulation but revealed a significant concentration drop at week 4 (mean 6.06 mg/L; p = 0.005). Logistic regression identified the time since the previous dose as the sole predictor of sub-therapeutic levels, with >50% of the patients dropping below 8 mg/L by the fourth week. An analysis showed median net savings of EUR 3215.84 per patient (p = 0.004). Conclusions: Dalbavancin is effective and cost-saving for complex pediatric infections. However, due to distinct pediatric PK, dosing regimens extrapolated from adults may result in sub-therapeutic concentrations by week 4. We recommend TDM around week 3 to tailor dosing or limiting maintenance intervals to a maximum of 4 weeks. Full article

Studying bird, insect, and other wildlife interactions with photovoltaic (PV) solar energy facilities is difficult due to limited multi-season, multi-site data. Researchers can address such data gaps by combining passive monitoring and artificial intelligence (AI). As a part of the development of AI-enabled avian–solar monitoring software, we collected over 19,000 h of daytime videos at five PV sites across three U.S. regions between 2019 and 2024. We applied a moving object detection and tracking (MODT Version 1) AI model we developed earlier to 4373 h of the footage to extract moving objects in video frames, and human reviewers interpreted the model output and identified 68,646 bird, 25,968 insect, and 169 other wildlife instances to generate the training/validation dataset. We analyzed the data by site, region, and season, considering ground cover and landscapes. Songbirds were most common, with raptors as the next most frequent group. Most notably, no bird collisions were confirmed in our observations collected from the videos. Birds most often flew over or near panels, with the highest observations in the Midwest and Northeast (approximately 30 observations per hour on average) and fewer in the desert Southwest. Other behaviors included perching, foraging, and nesting. Bird abundance peaked during breeding and migration seasons. AI-assisted video monitoring proved effective for non-invasively studying flying wildlife at solar facilities to inform ecologically mindful energy development. Full article

Urban markets are key nodes for the persistence and adaptation of traditional edible plant knowledge, linking rural production with urban consumption. This study was based on monthly market surveys conducted throughout 2025 in an urban market in Baise City, Guangxi, China. A total of 54 edible plant taxa were recorded, including both native and introduced species, with herbaceous plants predominating alongside climbers, trees, and grasses. Ethnobotanical data were obtained through semi-structured interviews with 40 local informants (20 men and 20 women, aged 25–65 years) selected using purposive sampling, focusing on individuals actively involved in purchasing and preparing edible plants. High Cultural Food Significance Index (CFSI) values highlighted culturally central taxa, including Allium ascalonicum L., × Brassarda juncea (L.) Su Liu & Z.H. Feng, and Houttuynia cordata Thunb., reflecting frequent use and culinary–medicinal integration. Fidelity Level (FL) analyses identified species with strong consensus for specific therapeutic applications, such as × B. juncea, Alpinia galanga (L.) Willd., and Nelumbo nucifera Gaertn., while Informant Consensus Factor (FIC) values indicated moderate to high agreement across gastrointestinal, respiratory, inflammatory, and other health categories. These results underscore the persistence of the “food as medicine” concept, showing that edible plants function simultaneously as nutritional and preventive healthcare resources. The overlap of culinary and medicinal roles demonstrates dynamic food–medicine integration, with urban markets acting as cultural hubs that maintain dietary diversity, household food security, and ethnobotanical knowledge. Future studies should incorporate ethnozoological resources and longitudinal monitoring to capture the full scope of urban food–medicine systems. Full article

Background: Healthcare workers (HCWs) have experienced sustained occupational exposure to SARS-CoV-2 throughout the COVID-19 pandemic. While infection prevention and control (IPC) practices have been widely implemented, limited prospective data exist on how occupational exposure risk and adherence to protective practices evolve over time, particularly beyond the acute phases of the pandemic. This study aimed to prospectively assess occupational and community exposure risk to COVID-19 among HCWs and to evaluate temporal changes in adherence to IPC practices during routine care and aerosol-generating procedures. Methods: A prospective observational study was conducted among HCWs from four public hospitals in the region of Thessaly, Greece. Eligible participants were HCWs who reported contact with suspected or confirmed COVID-19 cases. The data were collected at baseline (January–March 2022) and at a six-month follow-up using the World Health Organization’s “Risk Assessment and Management of Exposure of Health Care Workers in the Context of COVID-19” questionnaire. The instrument captured demographic characteristics, professional roles, occupational and community exposure, and adherence to IPC practices. Results: A total of 203 HCWs participated in the study. The overall proportion of HCWs reporting occupational exposure was 72.9% in both assessments. Among HCWs with occupational exposure (n = 148), the proportion classified as high-risk showed a statistically significant increase from 76% (95% CI: 0.6951–0.8320) at baseline to 88% (95% CI: 0.8258–0.9310) at follow-up (p = 0.010). This shift reflects a substantial effect size, with the odds of high-risk classification being more than double at follow-up (OR = 2.24). Nurses consistently demonstrated higher risk compared with physicians. The overall use of personal protective equipment remained high. However, adherence to several IPC practices declined over time, including removal and replacement of PPE according to protocol and frequent decontamination of high-touch surfaces. Conclusions: Occupational exposure risk among HCWs remained substantial and increased over time despite stable occupational exposure estimates. The observed decline in adherence to key IPC measures highlights the need for continuous monitoring and reinforcement of protective practices in healthcare settings. Full article

Pesticide contamination poses significant threats to both humans and the environment, with residues frequently detected in surface waters worldwide. This study compares the effectiveness of passive samplers (POCIS and Chemcatcher) and grab sampling coupled with Stir-Bar Sorptive Extraction (SBSE) and Solid-Phase Extraction (SPE) for monitoring pesticides in surface waters. The comparative study was conducted at three sites in Victoria, Australia, representing different land uses. A total of 230 pesticides were screened, with 79 different pesticides detected overall. SBSE extracted the highest number of pesticides from grab samples, followed by SPE and passive samplers. The study highlights the complementarity of different sampling and extraction techniques in detecting a wide range of pesticides. The study also explores the suitability of these techniques for citizen science applications, emphasizing the importance of selecting appropriate methods based on specific research objectives and available resources. The findings underscore the need for a tiered approach, combining passive samplers for initial screening and grab sampling for quantitative analysis, to develop a robust monitoring strategy for protecting water quality. Full article

Background/Objectives: Intraductal papillary mucinous neoplasms (IPMN) are the most common pancreatic cystic lesions and are established precancerous entities. Side-branch IPMN (SB-IPMN) is the most prevalent subtype and generally carries a low risk of malignant transformation. The revised 2024 Kyoto guidelines define management and surveillance strategies based on high-risk stigmata and worrisome features; however, real-life adherence to these recommendations remains variable. To compare real-world management of SB-IPMN at a tertiary medical center with Kyoto guideline-based recommendations using an AIgo-based decision-support tool. Methods: SB-IPMN cases were retrospectively analyzed. An algorithm implementing the Kyoto guidelines was used to generate recommended management strategies based on imaging, clinical, and laboratory data, and these recommendations were compared with actual clinical decisions. Long-term clinical and radiological follow-up data were collected, including development of pancreatic ductal adenocarcinoma (PDAC). Results: A total of 368 patients (69% male; median age 69.5 years) were followed for a median of 48.5 months radiologically and 64 months clinically. Median cyst size at presentation was 10 (6–14) mm. Only 58 patients (15.8%) were managed in accordance with the Kyoto guidelines; most underwent more intensive surveillance (60.3%), while 23.9% received less intensive monitoring (p = 0.04). Larger cyst size (>2 cm) was associated with higher concordance with current guidelines. Younger patients, including all patients under 50 years of age, were more frequently over-surveilled. Over-surveillance resulted in an excess of 0.42 MRI/MRCP examinations per patient-year. Only one PDAC case occurred, arising after more than five years of cyst stability. Conclusions: Fewer than 20% of patients with SB-IPMN were managed according to Kyoto guidelines. Over-surveillance was common, particularly in younger patients, without apparent oncologic benefit. AIgo-based decision-support tools may help standardize care and optimize resource utilization. Full article

Background: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder and most frequently involves the posterior semicircular canal (PSC). Atypical apogeotropic variants of PSC-BPPV may present with pure down-beating positional nystagmus, mimicking contralateral anterior semicircular canal involvement and resulting in diagnostic and therapeutic uncertainty. Objective: To assess the effectiveness of the Bascule/Pendular maneuver in managing patients with pure down-beating positional nystagmus and suspected apogeotropic PSC-BPPV. Methods: A total of 178 patients presenting with pure down-beating positional nystagmus without a torsional component were evaluated using a standardized diagnostic protocol under video-Frenzel goggle monitoring. All patients underwent the Bascule/Pendular maneuver, a modification of the classical Semont maneuver designed to mobilize otoconial debris along the vertical canal planes (Left Anterior–Right Posterior and Right Anterior–Left Posterior), regardless of precise lateralization. Conversion of nystagmus from the apogeotropic to the geotropic variant was considered the primary outcome. Results: The maneuver was well tolerated, with no procedural interruptions or complications. Immediate conversion to the geotropic variant was achieved in 86 patients (48.3%) after a single maneuver. In the remaining patients, successful conversion was obtained after additional maneuvers, most commonly following a second application on the contralateral plane. Once geotropization was achieved, all patients were successfully treated using a standard posterior canal repositioning maneuver. Conclusions: The Bascule/Pendular maneuver is a practical and effective approach for patients presenting with pure down-beating positional nystagmus and suspected apogeotropic PSC-BPPV. By facilitating conversion to the geotropic form, it allows prompt treatment with conventional repositioning maneuvers and may represent a useful first-line strategy in atypical BPPV presentations. Full article

Background: Comparative real-world data on the pharmacokinetics of once-daily tacrolimus formulations in de novo kidney transplantation remain limited. We compared tacrolimus exposure and dosing requirements with Envarsus and Advagraf during the early post-transplant period. Methods: We conducted a prospective, observational, single-center study including adult de novo kidney transplant recipients treated with once-daily tacrolimus as either Envarsus or Advagraf. The immunosuppressive protocol was based on thymoglobulin induction, with delayed initiation of tacrolimus at an initial dose of 0.15 mg/kg/day, prednisone, and sirolimus as the third immunosuppressive agent. Trough concentrations (C0), daily dose, and dose-normalized trough exposure (C0/D) were assessed at 48 h and over 3 months (days 7, 14, 30, 60, and 90). Dose adjustments were guided by therapeutic drug monitoring and Bayesian individualization to achieve target trough ranges (6–10 ng/mL during month 1; 5–7 ng/mL thereafter). Clinical effectiveness and safety outcomes were evaluated through month 3. Results: Ninety recipients were included (Advagraf n = 43; Envarsus n = 47). At 48 h, Envarsus achieved higher trough concentrations and higher C0/D than Advagraf (C0: 10.7 vs. 7.7 ng/mL; C0/D: 1.30 vs. 0.75 (ng/mL)/mg; both p < 0.001). From week 1 to month 3, trough concentrations were similar between groups (week 1: 8.5 vs. 8.5 ng/mL, p = 0.968; month 3: 5.7 vs. 5.1 ng/mL, p = 0.234), but Envarsus required lower daily doses (week 1: 6.4 vs. 9.9 mg/day, p = 0.001; month 3: 3.2 vs. 4.1 mg/day, p = 0.021) and maintained higher C0/D (week 1: 1.53 vs. 1.00, p = 0.001; month 3: 1.94 vs. 1.57 (ng/mL)/mg, p = 0.012). At 48 h, infra-therapeutic troughs were less frequent with Envarsus (6.7% vs. 40.5%, p = 0.0001), while supra-therapeutic levels were more frequent (57.8% vs. 18.9%), and tacrolimus discontinuation due to high troughs occurred more often (23.4% vs. 7.0%, p = 0.032). Over 3 months, the proportion of measurements within the therapeutic range was similar (57.6% vs. 64.5%, p = 0.705). Efficacy and safety were similar between groups. Conclusions: In de novo kidney transplant recipients, Envarsus provides higher early tacrolimus exposure and consistently higher dose-normalized trough exposure than Advagraf, enabling lower maintenance doses while maintaining similar short-term effectiveness and safety. However, early overexposure was more frequent with Envarsus at 0.15 mg/kg/day, supporting careful early monitoring and consideration of lower starting doses. Full article

Groundwater heavy metal contamination (GHMC) has drawn significant attention in China over recent decades due to industrialization. However, effective monitoring and early warning remain global challenges because of the limited understanding of heavy metal behavior in groundwater. This study conducts a detailed comparative analysis of heavy metals and conventional indicators using a long-term, high-frequency online monitoring program. Groundwater online monitoring is an automated system for real-time, continuous collection, and transmission of indicators via sensors and IoT platforms. Conventional indicators refer to the priority parameters used to assess basic water quality, hydrological characteristics and health risks in routine monitoring. Nineteen heavy metals and ten conventional indicators were monitored simultaneously, generating approximately 1.6 million data points over three years. The time series data show that online monitoring effectively captures abnormal changes in heavy metal levels. Abnormal heavy metal fluctuations appear as sharp, isolated spikes lasting at least several hours, while conventional indicators exhibit high-amplitude variations lasting over 30 h—indicating that heavy metal changes are harder to detect in a timely manner. Long-term comparisons also reveal low consistency between heavy metals and conventional indicators, supporting the need for independent heavy metal monitoring. In contrast, strong consistency among heavy metals suggests opportunities to streamline monitoring by selecting representative elements. Monitoring frequency optimization shows that daily measurement is sufficient for heavy metals, which is slightly more frequent than the typical three-day interval for most conventional indicators. Long-term data enable reliable early warnings for both indicator types, with predictions closely matching field observations. However, heavy metal alerts are shorter and less frequent than those for conventional indicators. Integrating both types into a unified early warning system enhances its comprehensiveness, accuracy and timeliness. This study provides a solid scientific foundation for efficient GHMC monitoring and early warning in groundwater in areas under the influence of industrial activities. Full article

Background/Objectives: Safe delivery and correct identification of newborns are critical aspects of healthcare systems globally. The accreditation of healthcare and standards regulation significantly promotes the adoption of modern technologies to address risks related to infant abduction and misidentification. The effectiveness and extent of these mandates vary across settings and countries. Therefore, this study aims to map and explore modern technologies used for safe newborn delivery and correct identification aligned with healthcare accreditation and regulatory frameworks. Methods: This review adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews (PRISMA-ScR) guidelines. The Problem, Intervention, Comparison, and Outcome (PICO) framework was employed to facilitate the development of the research question. This study examined studies reporting technologies such as radio frequency identification (RFID), biometric identification, and real-time monitoring across healthcare settings for infant protection through the Normalization Process Theory (NPT). Among three databases and search engines (PubMed, Google Scholar, and Web of Science). The risk of bias for each study was assessed using the AACODS Checklist, SQUIRE 2.0 Checklist, TIDieR Checklist, and JBI tools. Results: Out of 8753 records, only 27 reports were eligible to be included in this review. The most frequently reported technologies were RFID systems (11 studies, 37.9%) and biometric systems such as footprint and facial recognition (6 studies, 20.7%). Despite strong technological potential, many healthcare institutions struggled with the adoption of infant protection technologies. Accreditation systems among the high-resource settings actively mandate advanced technologies and support the integration of staff training and simulation drills. Comparably, middle- and low-income regions usually face challenges related to regulatory enforcement, infrastructure, staff readiness, and limited adoption of modern technologies. Conclusions: Accreditation and standards development are critical catalysts for the adoption of modern infant protection technology. Standards must be comprehensible, adaptable, and supported by investment in human resources and infrastructure. Future regulation must focus on strengthening enforcement, continuous quality improvement, and capacity building to achieve sustainable protection across the world. Full article

Background: The progressive aging of the population has led to an increased prevalence of chronic diseases and polypharmacy, with arterial hypertension representing one of the most frequent conditions. Consequently, the management of vital signs during dental interventions, such as tooth extractions, has acquired particular clinical relevance. The present study aimed to analyze the hemodynamic impact of vasoconstrictors (VAs) used in local anesthesia (LA) at different procedural stages in patients with pharmacologically controlled hypertension, as well as to compare these effects with those observed in normotensive individuals. Additionally, the study evaluated the influence of antihypertensive medication on hemodynamic responses during dental extraction. Methods: A case–control study was conducted at Dr. Peset University Hospital (Valencia, Spain), including 254 patients—148 hypertensive (controlled with type 1 and 2 antihypertensive therapy) and 106 normotensive controls. Hemodynamic parameters—systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and oxygen saturation (SO₂)—were recorded at four time points: baseline (T1), five minutes post anesthesia with 4% articaine and epinephrine (T2), upon completion of extraction (T3), and one week postoperatively (T4). Results: The SBP remained more stable in normotensive patients, while both groups exhibited a slight DBP decrease at T2, with recovery by T3. In hypertensive patients treated with angiotensin receptor blockers (ARBs), DBP decreased further. Tooth extraction under controlled hypertension conditions caused a mild, clinically insignificant increase in HR. Conclusions: Significant fluctuations in SBP, DBP, and SO₂ occurred during dental extraction, underscoring the necessity for vigilant intraoperative monitoring and individualized management of hypertensive patients. Full article