Search Results (7,913)

Background: Total hip arthroplasty (THA) for the late sequelae of childhood septic hip arthritis is technically demanding, and infection-related risk remains incompletely defined. This systematic review and meta-analysis address the research question: “In adults undergoing THA after childhood septic arthritis of the hip, what is the incidence of post-THA infection, revision, and mechanical/neurologic complications?” We systematically reviewed and meta-analyzed outcomes after THA in patients with septic hip arthritis diagnosed at ≤18 years. Methods: PubMed, Web of Science, Scopus, and the Cochrane Library were searched from inception to 31 December 2025 (PRISMA). Eligible studies reported THA outcomes after childhood septic arthritis and met a Methodological Index for Non-Randomized Studies (MINORS) threshold (≥9). A random-effects meta-analysis of events per hip was performed. Results: Nine studies were included; eight contributed to the quantitative synthesis (343 hips). The pooled incidence of any post-THA infection was 1.55% (95% CI 0.38–3.48; I² = 23.8%; 5/343); when microbiology was available, no relapse due to the index organism was reported and events were classified as new infections. The pooled incidence of revision for any cause was 4.99% (95% CI 2.27–8.70; I² = 43.4%; 15/334). Non-infectious complications were clinically relevant, including intraoperative fracture (6.95%) and nerve palsy (4.84%). Evidence was limited by retrospective designs and heterogeneous reporting. Conclusions: THA after childhood septic hip arthritis demonstrates a low risk of postoperative infection, with relapse of the original pathogen appearing rare in carefully selected quiescent cases, but a clinically meaningful burden of mechanical and neurologic complications. These findings underscore the importance of careful preoperative assessment, meticulous surgical technique, and highlight the limitations of the current evidence. The protocol was registered in PROSPERO (ID: CRD420261298181). No external funding was received. Full article

Objective: Influenza and pertussis vaccines are recommended during pregnancy; however, uptake remains insufficient in many European countries, increasing the risk of preventable infections. Recent recommendations for maternal respiratory syncytial virus vaccination have been endorsed by scientific societies. This study evaluated maternal vaccination coverage, knowledge, attitudes, and factors influencing vaccine uptake among Lithuanian women. Methods: A retrospective cross-sectional online survey was conducted between 4 and 14 November 2025 in Lithuania among women aged 18–55 years with at least one previous pregnancy. The questionnaire contained 29 questions on sociodemographic characteristics, obstetric history, vaccination history, attitudes, and informational sources influencing decisions. Internal reliability was confirmed (Cronbach’s α = 0.83). Descriptive statistics were used to summarize the data. Associations between categorical variables were assessed using the Chi-square test or exact tests (Fisher’s exact or Fisher–Freeman–Halton). Binary and multivariable logistic regression analyses were performed to evaluate factors associated with self-reported vaccination uptake and the relationship between influenza and pertussis vaccination. Odds ratios with 95% confidence intervals were calculated. Statistical significance was set at p < 0.05. Results: A total of 241 women participated. Self-reported vaccination coverage during pregnancy was 28.7% for influenza, 43.8% for tetanus–diphtheria–pertussis, and 4.2% for respiratory syncytial virus. Physician’s recommendation was the strongest predictor: women advised to vaccinate were 17.0 times more likely to receive influenza, 16.5 times more likely to receive pertussis, while RSV vaccination occurred almost exclusively among women who reported receiving a physician’s recommendation. Higher uptake was associated with younger maternal age and university education. Reasons for declining vaccination were avoidance of medical interventions and concerns about safety or side effects. Conclusions: Maternal vaccination coverage in Lithuania remains low despite public funding and national recommendations. Strengthening provider communication, improving information strategies, and integrating vaccination counseling into routine antenatal care may increase uptake and enhance maternal and neonatal protection. Full article

Neglected tropical diseases (NTDs) such as soil-transmitted helminthiasis, lymphatic filariasis, schistosomiasis, leprosy, rabies, and food-borne trematodiasis are endemic in the Philippines. Despite global and national elimination efforts, these six NTDs remain a persistent burden to the poor, those living in Geographically Isolated and Disadvantaged Areas (GIDAs), and other vulnerable groups. This narrative review synthesized data from Field Health Services Information System (FHSIS) reports of the Philippine Department of Health (DOH) from 2020 to 2024, the available literature from electronic databases, and DOH and WHO reports focusing on the challenges, barriers, and gaps in NTD control and elimination in the country. Core challenges include complex epidemiological landscapes, lapses in disease surveillance, infrastructure, and fragmented health care systems. Gaps include access to diagnostics, insufficient funding and human resource training, and scarcity of local studies focusing on endemic NTDs. With these challenges and gaps, this review highlights the need for a real-time feedback loop system in surveillance strategy, community-based interventions, full integration of NTDs in primary health care, and collaboration between government, NGOs and private entities. Addressing these challenges and gaps is key to shifting from control to elimination. Full article

Open Educational Resources (OER) are widely promoted as mechanisms for expanding access to knowledge and supporting sustainability in higher education. Yet their long-term viability remains constrained by fragmented governance, unstable funding arrangements, weak faculty incentives, policy gaps, and uneven digital infrastructure. This article develops a conceptual and policy-oriented framework that reconceptualizes OER as sustainable knowledge commons embedded within higher education systems rather than merely repositories of open content. Using an integrative review and thematic synthesis of global scholarship on OER sustainability, commons governance, and higher education policy, the study identifies four interrelated governance dimensions: institutional embedding, participatory stewardship, equitable access and inclusion, and long-term resource sustainability. The analysis shows that sustainable OER ecosystems depend not only on open licensing and technological platforms but also on coherent policy design, institutional alignment, academic recognition structures, and collaborative governance arrangements. Each dimension is associated with indicative governance mechanisms and policy indicators such as institutional OER strategies, faculty incentive programs, and shared digital infrastructure. The framework also recognizes institutional diversity, emphasizing that governance models must be adapted to different policy environments, academic cultures, and stages of OER adoption across higher education systems. By conceptualizing OER as governable knowledge commons, the article clarifies how open knowledge initiatives can con-tribute to social equity, educational resilience, and sustainable transformation in higher education. Full article

This study developed internally consistent scenarios for tourism village development to strengthen destination competitiveness and support the local economy. Using an exploratory–constructive design and the Cross-Impact Balance method, the study structured the relationships among development elements, competitiveness, and local economic development into 13 descriptors with 52 states. Expert judgment was used to construct a cross-impact matrix, and ScenarioWizard identified 18 consistent scenarios and their Total Impact Scores. Four scenarios showed positive consistency scores, with one high-road scenario emerging as the most consistent pathway toward very high competitiveness and a stronger role for tourism villages in the local economy. This scenario was characterized by a clear value proposition, full integration of local MSMEs and products, diversified revenue sources, equitable benefit distribution, strong managerial and digital capacity, transparent governance, multi-stakeholder partnerships, strategic use of public funds, and a structured digital marketing and booking system. These findings suggest that policy efforts should prioritize coordinated improvements in value proposition, MSME integration, revenue diversification, governance, partnerships, and digital management to move tourism villages toward the high-road scenario. Full article

Building the capacity of health and social care professionals in health and migration is essential for the East and Horn of Africa region, which, according to UNHCR, hosted 23.6 million forcibly displaced people who have fled conflicts and climate change-related floods and droughts by the end of 2024. There is a high demand to build a critical mass of expertise and experts on health and migration that can engage in policy, programme and practice development. To contribute to the building of a community of experts, an online course on health and migration was developed and five courses were implemented from 2021 to 2024 with the participation of international experts in migration and health, universities and international institutions (WHO; UNAIDS, IGAD), in collaboration with the UN International Organisation for Migration (IOM), the Makerere University, Uganda, and the Center for Health and Migration Vienna, Austria (CHM), and with funding from the Austrian Federal Ministry of the Interior. The courses lasted nine weeks each, offering two three-hour sessions per week, and were complimented by discussion forums and webinars on topics of special interest, e.g., climate change. Participants were working in policy development, programme coordination, research, and service delivery in health and social care in communities affected by migration, cross-border settings, refugee and IDP settlements in the East and Horn of Africa geographic region. The importance of the course for capacity building in the respective countries as well as for personal development is underlined by continuous high numbers of applications from highly qualified people and highly positive evaluations from participants, and the demonstrated impact on the practice of service provision for refugees and IDPs. Future considerations should concentrate on developing sustainable frameworks for courses, including intergovernmental collaboration and community development. Full article

Skin aging is a multifactorial process that is dependent on mechanisms linked to age and hormonal changes and on external factors, primarily chronic exposure to ultraviolet radiation. One of the key elements of this process is the quantitative and qualitative changes in collagen. In recent years, there has been particular interest in oral supplementation with hydrolyzed collagen (HC), which is promoted as one of the tools to support anti-aging treatments. The purpose of this narrative review is to synthesize the importance of collagen in skin structure and function, discuss changes occurring during aging, and analyze current data on oral collagen supplementation. The following sections discuss the structure and function of collagen, its importance for skin integrity, the main mechanisms of collagen aging, available sources and forms of supplementation, as well as the clinical efficacy, safety, and interpretive limitations of the current literature. Oral supplementation with hydrolyzed collagen at doses of 2.5–10 g/day for at least 8–12 weeks is associated with improved skin hydration and elasticity, as well as a reduction in wrinkle depth, although study results are inconsistent, and the effect may be weaker in studies of the highest methodological quality and those free from industry funding. In clinical trials, hydrolyzed collagen preparations are typically highly purified (>90–97%) with minimal additives, enabling the isolated effect of the peptides to be evaluated. Future research should focus on independent, long-term randomized controlled trials, direct comparisons of commercial versus purified collagen peptides, and the contribution of synergistic additives to bioavailability and clinical efficacy. Such studies are essential to refine dosing recommendations and strengthen evidence-based use in both cosmetic and clinical settings. Full article

Though the European Commission has repeatedly stated that the necessary energy transition in Europe should leave “no one behind”, this paper describes a building refurbishment case that has entailed economic hardships for the low-income families involved. The project is located in the area of P. D. Orcasitas in southern Madrid, led by a grassroots neighbours’ movement, comprising one hundred and seven housing blocks, containing more than 2000 dwellings. The main source of funding for the operation consists of subsidies granted by the Madrid City Council; however, Spanish legislation requires the state Agency of Tax Administration to classify these subsidies as capital gains derived from lucrative transfers. Based on the tax data of vulnerable beneficiaries, the conclusion is that the recipients have ended up returning part of the subsidies to the State through their Income Tax Return. In addition, the Spanish Social Security Institute requires the return of social benefits associated with non-contributory retirement pensions and the Minimum Living Income. Apart from tax accounting, regulations are revised to draw conclusions. Unlike most actuations of this kind, in this case the negative effects are obvious. Although intended to alleviate fuel poverty, the initiative has exacerbated vulnerability due to the impact of the imposed penalties on household income. In conclusion, unless preventive measures are implemented, the mandatory refurbishment of inefficient buildings may place an undue burden on vulnerable low-income occupants and hinder the effective implementation of energy-efficiency regulations. Full article

Background: Upper-limb impairment is a major contributor to chronic disability after stroke. Conventional recovery protocols frequently suffer from poor adherence, limited accessibility, and insufficient intensity for prolonged rehabilitation. Methods: We performed a systematic analysis of randomized controlled trials (RCTs) and non-randomized designs published between 2019 and 2024, assessing virtual reality (VR) interventions for upper-limb stroke rehabilitation. Participant characteristics, VR intervention details, primary and secondary outcomes, and adherence rates were analyzed in accordance with PRISMA guidelines. The review is registered in PROSPERO (CRD420251150877). We searched PubMed, Embase, Wiley, Scopus, and Cochrane databases. Study quality was assessed using the RoB 2 and ROBINS-I tools. This review received no funding. Results: Forty-one trials met the inclusion criteria. High variability in study methodology, VR devices, intervention protocols, and outcome measures limited direct comparability. Dropout rates were low and were frequently attributed to factors unrelated to the VR intervention. Adverse events were uncommon, supporting the feasibility and safety of VR-based rehabilitation. Conclusions: While VR is a safe and feasible modality, large-scale, multicenter clinical trials with standardized protocols and long-term follow-up are essential to define the role of VR in routine stroke care. Full article

The date palm (Phoenix dactylifera L.) is a significant perennial crop in arid and semi-arid regions. Understanding the evolution of research on this crop is vital for identifying major research trends, current challenges, and emerging areas for future agricultural innovation and sustainable crop management strategies. This study conducts a comprehensive scientometric analysis of 9062 scientific publications indexed in the Scopus database between 1837 and 2025, spanning nearly two centuries of research on date palm. Using bibliometric tools such as Bibliometrix and ScientoPy, the study examines patterns of scientific production, collaboration networks, institutional participation, thematic evolution, and emerging research trends. The results indicate a marked increase in scientific publications, especially after 2007, with Saudi Arabia, Egypt, and Iran among the most productive countries. The thematic structure of the literature shows a shift from early studies on diseases and oasis cultivation to recent research focusing on biomass valorization, activated carbon production, antioxidant properties, pest management with special emphasis on the red palm weevil (Rhynchophorus ferrugineus), mechanical properties of date palm fibers, and plant biotechnology on methods like micropropagation and somatic embryogenesis. Geographically, research activity is concentrated in the Middle East and North Africa, the primary palm-producing region, with Saudi Arabia leading in institutions, researchers, funding, and international collaborations in date palm research. Emerging trends indicate a rising interest in digital tools, particularly artificial intelligence and advanced analytical tools, which are increasingly being explored to improve crop management. Overall, these findings provide a structured overview of the historical development of date palm research and contribute to a deeper understanding of the evolution and organization of scientific knowledge in this field. Additionally, the identification of key research pathways and emerging trends offers valuable insights for guiding future agronomic innovation, supporting evidence-based crop management strategies, and promoting the sustainable development of date palm production systems. Full article

Despite being a biodiversity hotspot, the Republic of Seychelles faces a critical challenge with an estimated 90% of its food imported. This dependency exposes the country to global supply disruptions and climate-related risks, while pressure on protected ecosystems continues to rise. In response, the Erasmus+ Capacity Building Higher Education GreenTraINT project (Green Training INTernational Program for agriculture, livestock farming, and conservation), co-funded by the European Union (2024–2026), aims to strengthen local expertise in sustainable agriculture, livestock farming, and biodiversity conservation. Through a transnational partnership involving European and Seychellois universities and institutions, GreenTraINT is co-designing innovative higher education modules tailored to the island’s priorities in agriculture, livestock, and biodiversity conservation. This paper focuses on a detailed needs analysis conducted in early 2025 across a diverse group of 84 stakeholders, including students, educators, NGOs, and professionals. The findings reveal a strong demand for applied training in sustainable food systems and biodiversity conservation, blended teaching methods, and programs that bridge theory with hands-on skills. Inspired by other Erasmus+ projects such as NETCHEM and SPARKLE, GreenTraINT adopts a multi-stakeholder, needs-driven approach that aligns international academic expertise with local development goals. As a key milestone, a Summer School in 2026 will pilot the newly developed modules. In the long term, GreenTraINT seeks to leave a lasting legacy by integrating its curriculum into national education pathways, thereby contributing to food security and environmental resilience. With less than four years remaining to achieve the 2030 Agenda targets, the project positions higher education reform as a strategic accelerator for SDG implementation in small island developing states (SIDS). By linking curriculum innovation to measurable sustainability priorities, GreenTraINT helps narrow the SDG implementation gap in vulnerable island contexts. The project offers a model for international collaboration in higher education for sustainability in SIDS. Full article

This paper describes two front-end architectures developed in a 28 nm CMOS process for the readout of pixel detectors in future high-energy physics (HEP) colliders and advanced X-ray imaging instrumentation. The front-end channels have been developed in the framework of the PiHEX project, funded by the Italian Ministry of University and Research. PiHEX aims to improve the state of the art of pixel readout chip technology in high-luminosity colliders and X-ray imagers in the next generation of free electron lasers (FELs) by developing, in 28 nm CMOS technology, the fundamental microelectronic building blocks for pixel readout chips. Such blocks, also implementing innovative circuit ideas, will enable, in future applications, the integration of large-scale readout chips, meeting a set of challenging requirements, such as high spatial resolution, high signal-to-noise ratio, very wide dynamic range and the capability to withstand unprecedented radiation levels. Two different front-end channels were designed, integrated into two prototype chips, and tested. One architecture, featuring a pixel size of 25 µm × 100 µm, was optimized for tracking applications in high-energy physics experiments, like the ones that take place at CERN in the high-luminosity upgrade of the Large Hadron Collider (LHC), while the second one, featuring a pixel size of 110 µm × 55 µm, was devised for X-ray imaging applications in FELs. Full article

This research enhances the literature on bank capital structure by combining financial intermediation theory with technological innovation to analyse the impact of FinTech adoption and liquidity management on leverage choices in South African banks. Utilising panel data spanning 2015 to 2024 and applying the Generalised Method of Moments (GMM) to tackle endogeneity and dynamic persistence, the research presents new findings from an overlooked emerging market setting. The results show a diverse effect of technology on leverage. Conventional banking systems, represented by automated teller machines (ATMs), show a positive relationship with the total debt ratio (TDR), suggesting a capital-intensive nature of tangible assets. Conversely, digital technologies such as mobile banking and a composite FinTech Index display a notable negative correlation with leverage, indicating that digital transformation improves efficiency, strengthens internal funding capacity, and reduces dependence on external debt. Moreover, increased liquidity levels are negatively correlated with leverage, suggesting that well-capitalised banks with robust liquidity rely less on debt funding. By examining FinTech and liquidity dynamics, the research contributes to both theory and practice, emphasising digital innovation as an alternative to external funding and stressing the importance of sound liquidity management amid evolving regulatory environments such as Basel III. Full article

This study analyzes the relationship between stock market returns and investment flows in investment funds in Spain. Through a quantitative analysis covering the period from December 2001 to June 2025, it examines not only the existence of a correlation but also its temporal structure, functional form, and heterogeneity across different geographical areas (U.S., Europe, Japan, and Spain). Using monthly data on net flows from INVERCO and market indices, the study employs Ordinary Least Squares (OLS) regression models, segmented regressions, and fixed-effects panel models to obtain robust estimates. The results confirm a positive and statistically significant relationship between past returns and subsequent investment flows, with a temporal lag ranging from one to three months. This delay varies notably by geographical region, suggesting the existence of different investor profiles and information channels. The study also finds evidence of a convex relationship, indicating that investors react asymmetrically, aggressively pursuing high returns more than penalizing low ones. These findings, interpreted through the lens of behavioral finance, point to pro-cyclical and reactive behavior of Spanish investors, driven by biases such as loss aversion, trend-following, and delays in information processing. The study contributes to the academic literature by providing updated and methodologically robust evidence on Spain, a market that has traditionally been underexplored, and offers practical implications for investors, fund managers, and regulators in terms of financial education and risk management. Full article

We conducted a PRISMA-guided systematic review to summarize recent methodological advances in joint modeling. A PubMed search for English-language, peer-reviewed, full-text available articles published between 1 January 2019 and 30 January 2025 was conducted using the keywords “joint model”, “joint modeling”, “longitudinal and survival”, “longitudinal and time-to-event”, and “public health”, resulting in 70 methodological studies from 793 records after screening. Original studies proposing methodological innovations in joint modeling were eligible, while clinical applications, reviews, comparative or predictive studies, and articles without full text were excluded. The reviewed methods introduced advances in both longitudinal and/or survival sub-models, including generalized linear mixed models, functional or latent class approaches, and flexible survival models, such as frailty, accelerated failure time, B-spline, and competing risks models. In total, 49% of the studies focused on longitudinal sub-model adaptations. This review is subject to limitations, including potential omission of relevant studies due to database, search term, and language restrictions. These developments have enhanced the flexibility of joint models for analyzing complex data structures, particularly in cardiovascular and oncology research, as well as broader public health applications. Despite these advances, challenges remain, including handling high-dimensional sparse data, reducing computational burden, and the lack of standardized evaluation metrics. This research received no external funding. Full article