Search Results (13,046)

The Fuzzy Cognitive Map (FCM) framework provides a useful tool for representing the complex interdependencies involved in wastewater treatment selection, particularly when social, ecological, climatic, and economic criteria are considered simultaneously. In this study, the FCM approach was applied to compare two wastewater treatment approaches in Ahvaz, Iran: constructed wetlands (CWs) as a nature-based solution and energy-based wastewater treatment plants. The developed model included 30 components and 127 causal links, and was used to examine four scenarios representing CWs, energy-based treatment, a hybrid approach, and direct wastewater discharge. The results showed that both CWs and energy-based solutions had similar effects on public health, while the hybrid scenario produced the greatest improvement. CWs had a positive effect on ecosystem restoration and showed better performance in heavy metal removal, whereas energy-based solutions had a greater negative influence on environmental conditions and climate-related components. In addition, the economic results indicated that CWs were more favorable in terms of capital cost, energy consumption, and operational cost. Sensitivity analysis using ±10% variations in causal weights showed that the main scenario-response patterns remained generally unchanged. Overall, the findings suggest that CWs and energy-based systems each have specific advantages and limitations, while the hybrid approach offers the most balanced performance across the evaluated criteria. This study demonstrates the usefulness of the FCM approach for supporting wastewater management decisions and for identifying trade-offs among treatment alternatives in sustainable water resource planning. Full article

Skin cancer represents a growing global health burden. Current diagnostic pathways combine clinical examination and dermoscopy with histopathological confirmation; however, overlap between benign and malignant lesions can create diagnostic uncertainty and lead to potentially avoidable biopsies. Electrical impedance spectroscopy (EIS) has emerged as a non-invasive technique with potential for portable and cost-efficient implementation that quantifies the dielectric contrast between malignant and healthy tissue, providing objective information that may support clinical decision-making. This review synthesizes the field across four levels. First, we describe the biophysical origins of the impedance contrast in skin cancer, spanning the cellular, tissue architecture, and molecular scales, together with the equivalent circuit and Cole–Cole frameworks used to interpret it. Second, we examine hardware advances, including electrode–skin interface strategies, flexible and wearable architectures, computational electrode design, and the translation from laboratory prototypes to commercial systems such as Nevisense. Third, we critically appraise clinical evidence from large multicenter trials, focusing on the sensitivity–specificity trade-off and the demonstrated reduction in the number needed to excise. Finally, we discuss emerging frontiers, including artificial intelligence-driven analysis and multimodal fusion with dermoscopy, reflectance confocal microscopy, optical coherence tomography, and near-infrared spectroscopy. We conclude that EIS is most valuable as a complementary component within an integrated, AI-supported multimodal diagnostic framework. Full article

Background/Objectives: Although current guidelines (European Society of Gastrointestinal Endoscopy [ESGE] 2024, U.S. Multi-Society Task Force [USMSTF] 2020) recommend cold snare polypectomy (CSP) over cold forceps polypectomy (CFP) for small colorectal polyps, CFP remains widely used. Comparative economic data using real institutional pricing are scarce, limiting evidence for guideline-concordant resource allocation. We evaluated the healthcare economics and procedural outcomes of CSP versus CFP to assess their institutional resource implications. Methods: This prospective cohort study analyzed 153 consecutive patients (181 polyps ≤ 9 mm) at a single tertiary care center (June–October 2025). Technique allocation was based on endoscopist preference. The primary outcome was histopathologically confirmed complete resection; secondary outcomes were one-piece resection rate, procedure time, and cost outcomes based on institutional pricing. Firth penalized logistic regression, propensity score matching, and a neoplastic-restricted sensitivity analysis were performed. Results: Complete resection rates did not differ significantly (CSP 97.4% vs. CFP 94.2%, p = 0.29). CSP achieved higher one-piece resection rates (96.2% vs. 84.5%, p = 0.011) and shorter procedure time (median 3.2 vs. 5.1 min, p < 0.001). For 6–9 mm polyps, piecemeal resection was reduced with CSP (6.8% vs. 28.6%, p = 0.010). Despite higher device costs ($6 vs. $3), direct device-plus-labor cost was lower for CSP ($18.06 vs. $22.24, p < 0.001), with no statistically significant difference in complete resection. High-grade dysplasia was the only variable independently associated with incomplete resection. Findings were consistent in propensity score-matched (n = 61 pairs) and neoplastic-restricted (n = 134) analyses. Conclusions: By reducing direct device-plus-labor costs by 19% while improving one-piece resection, and remaining consistent across multivariable, propensity score-matched, and sensitivity analyses, these findings indicate that, within a cost-minimization framework, CSP is a cost-saving, guideline-concordant technique with no statistically significant difference in complete resection or observed adverse events. Full article

Rising recognition of attention deficit hyperactivity disorder (ADHD) in adults and children is reshaping how Australian health systems organise diagnosis, prescribing and long-term management. This has coincided with sharp increases in ADHD medicine dispensing, high private assessment costs and prolonged waiting times for psychiatrists and paediatricians. Australian states and territories have commenced reforms that expand the role of general practitioners (GPs) in ADHD diagnosis, prescribing and long-term management. This commentary assesses whether these reforms can expand timely and equitable access while maintaining diagnostic accuracy, medication safety and specialist referral. It uses the New South Wales (NSW) model as a detailed exemplar because it has developed a staged pathway: trained continuation prescribers support previously diagnosed patients who are stable on psychostimulant treatment, while endorsed prescribers receive further accredited training or recognition of prior learning to assess, diagnose, initiate and adjust psychostimulant treatment. The commentary distinguishes professional specialty status from ADHD-specific competency: specialist registration in general practice establishes the professional status of qualified Australian GPs, whereas safe extension of ADHD diagnosis and psychostimulant prescribing requires condition-specific education, competency assessment, prescribing authority, monitoring and defined referral pathways. It reviews Australian reforms, explains the NSW training and governance pathway, compares overseas approaches, and identifies safeguards needed to avoid diagnostic compression, overdiagnosis, stimulant diversion and widening inequity. The central argument is that GP involvement should be framed as trained, governed primary-care capacity. If adequately funded, audited and linked to specialist escalation pathways, the model may reduce access barriers while preserving diagnostic rigour. Full article

Low-level radioactive wastewater requires effective treatment to minimize risks to human health and the environment. This study evaluated the performance of activated carbons derived from regional biomass (Gurgurey, Pine, and Debregeasia woods) and Thar coal for the simultaneous removal of radionuclides (¹³⁷Cs, ¹³⁴Cs, ¹²⁴Sb, and ¹²²Sb) from real low-level radioactive wastewater. The activated carbons were characterized by proximate analysis and Fourier Transform Infrared Spectroscopy (FTIR), and their adsorption performance was investigated through batch experiments followed by kinetic and isotherm modeling. Among the investigated materials, activated carbons derived from Gurgurey wood, Pine wood, and Thar coal exhibited superior physicochemical properties, including low moisture (3.8–4.8%), low volatile matter (10.7–15.3%), high fixed carbon content (77.8–84.3%), and adsorption capacities ranging from 205.6 to 251.9 Bq g⁻¹. In contrast, Debregeasia-derived activated carbon showed the poorest performance owing to its high moisture, volatile matter, and ash contents, resulting in adsorption capacities of only 53.4–161.2 Bq g⁻¹. FTIR analysis confirmed the presence of phosphate-containing functional groups on all biomass-derived activated carbons except Thar coal. The adsorption data were best described by the pseudo-second-order kinetic model and the Langmuir isotherm, indicating that chemisorption and monolayer adsorption were the dominant removal mechanisms. These findings demonstrate that activated carbons derived from Gurgurey wood, Pine wood, and Thar coal are promising low-cost adsorbents for the simultaneous removal of multiple radionuclides from real low-level radioactive wastewater and provide a sustainable approach for radioactive wastewater treatment. Full article

Oral, live-attenuated rotavirus vaccines (ORVs) have significantly reduced severe diarrheal disease and deaths; however, vaccine performance in low- and middle-income countries (LMICs) remains lower than in high-income countries. With increasing global use, real-world data now provide important insights into strategies to improve vaccine impact in these settings. This review summarizes current evidence on the effectiveness and impact of ORVs in LMICs, with a focus on approaches to optimize performance, including alternative dosing schedules, booster doses in late infancy, and mixed vaccine regimens. Evidence on vaccine interchangeability offers practical solutions for countries facing supply disruptions and financial constraints. The review also highlights the growing importance of economic sustainability, particularly in the context of transitions from external funding support. Despite lower efficacy, ORVs continue to provide substantial public health benefits in LMICs. Sustained impact will depend on strengthening programme delivery, ensuring stable vaccine supply, and advancing next-generation vaccines. Continued evaluation of effectiveness, cost, and implementation strategies will be critical to maximizing long-term benefits in high-burden settings. Full article

Diabetes mellitus represents a growing global health challenge, establishing oral antidiabetic drugs as a therapeutic class of paramount importance. Consequently, to ensure drug safety, therapeutic efficacy, and accurate therapeutic drug monitoring, robust, selective and highly reproducible analytical methods are indispensable. This review provides a comprehensive overview of instrumental analytical techniques developed between 1985 and 2026 for quantifying oral antidiabetic agents. Based on a literature search across major databases—including PubMed, ScienceDirect and Springer—we systematically evaluated the application of UV-VIS spectrophotometry, liquid chromatography, and advanced electroanalytical methods. The reviewed literature encompasses methodologies ranging from routine quality control of bulk powders and pharmaceutical formulations to complex bioanalytical and pharmacokinetic applications. Liquid chromatography–tandem mass spectrometry (LC-MS/MS) emerged as the gold standard for precise bioanalysis due to its superior selectivity and sensitivity in complex biological matrices. Conversely, UV-VIS spectrophotometry and electrochemical methods remain highly relevant for cost-effective routine quality control in industrial manufacturing. Methodologies are categorized by drug therapeutic class, including biguanides, sulfonylureas, DPP-4 inhibitors, SGLT2 inhibitors, meglitinides, highlighting key validation parameters such as linearity, accuracy, and limits of detection. Finally, this review outlines future directions in the field of antidiabetic drug quantification. Full article

Wenchang chicken, a premium indigenous yellow-feathered broiler in China, faces production constraints due to high feed costs and soybean meal dependence. Black soldier fly larvae meal (BSFLM) is a promising alternative protein source, but its effects on Wenchang chickens are largely unknown. This study evaluated the effects of dietary BSFLM on growth performance, meat quality, intestinal health, and cecal microbiota. A total of 192 fifty-day-old female Wenchang chickens were randomly assigned to diets with 0%, 5%, 10%, or 15% full-fat BSFLM for 42 days. The 15% BSFLM inclusion increased final body weight (p < 0.05) while reducing the feed conversion ratio (p < 0.01) and feed cost per kg gain (p < 0.001). Regarding meat quality, 15% BSFLM enhanced redness (a*) and reduced shear force, 48 h drip loss, and cooking loss (p < 0.05). It also elevated antioxidant enzyme activities, upregulated Nrf2–Keap1, improved intestinal villus architecture and tight junction proteins, and reduced serum diamine oxidase (p < 0.05). Cecal microbiota underwent distinct restructuring, with dose-dependent proliferation of beneficial taxa. Overall, BSFLM exerts beneficial effects on the feed efficiency, meat quality, and intestinal health of Wenchang chickens, and the 15% inclusion level achieved relatively better comprehensive outcomes. This study provides a scientific reference for insect protein utilization and contributes to sustainable high-quality Wenchang chicken production. Full article

Background/Objectives: Healthcare workforce shortages and the challenges facing healthcare professionals are among the most pressing issues confronting contemporary health systems. This study examines the social representations of public, private, and public–private partnership (PPP) healthcare organisational models and professional practice elicited from public-sector physicians and nurses in Portugal. Methods: A cross-sectional survey was conducted between October 2022 and May 2023 using a non-probability sample of 308 physicians and nurses classified as public-sector professionals. Participants completed a free-association task concerning the public, private, and PPP healthcare models and their professional practice. The evoked terms were examined using prototypical analysis within the structural approach to Social Representations Theory. The representation of the public healthcare sector included elements such as accessibility, universality, equity, slowness, disorganisation, and resource limitations. The private healthcare sector was characterised by elements including cost, profit, speed, organisation, inaccessibility, and service quality. Results: The representation of PPPs included better management, efficiency, profit, interests, and quality, alongside a relatively frequent “No opinion” response. Professional practice was characterised by elements including caring, dedication, empathy, resilience, exhaustion, perceived undervaluation, and remuneration. Conclusions: These findings describe the social representations elicited from the present sample of public-sector physicians and nurses and should not be interpreted as evidence of objective differences between healthcare organisational models or as direct measures of motivation, resilience, burnout, sector preference, or working conditions. The findings are exploratory and hypothesis-generating and may inform future comparative research involving professionals working across different healthcare settings, as well as studies using dedicated measures of professional and occupational outcomes. Full article

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease with a relapsing course and a substantial multidimensional burden. Conventional clinical and patient-reported outcome measures mainly provide cross-sectional evaluations and may not fully capture the long-term impact of the disease. The concept of cumulative life course impairment (CLCI) has been proposed to describe the progressive and lifelong consequences of chronic dermatologic conditions. Methods: This narrative review is based on a non-systematic literature search conducted in PubMed/MEDLINE and Embase up to July 2026. Relevant studies addressing quality of life, mental health, comorbidities, and economic burden in AD were identified and narratively synthesized, with particular focus on evidence supporting the CLCI framework. Results: AD exerts a cumulative burden across multiple domains. Pruritus and sleep disturbance emerge as key drivers, contributing to a self-reinforcing cycle involving psychological distress and impaired daily functioning. Increased rates of anxiety and depression, along with social stigmatization, negatively affect interpersonal relationships, educational attainment, and work productivity. Comorbidities and the chronic relapsing nature of AD further amplify long-term impairment. Economic burden, including both direct and indirect costs, acts as both a consequence and a driver of cumulative disadvantage. Recurrent disease flares play a central role in sustaining and amplifying this trajectory over time. Conclusions: AD should be considered a life-course disease in which interacting biological, psychological, and social factors shape long-term outcomes. A CLCI-oriented approach may improve patient stratification and support earlier, multidisciplinary, and proactive management strategies aimed at reducing long-term burden and improving overall outcomes. Full article

Brazil presents a distinctive convergence of continental-scale climatic diversity, extensive urbanization, large-scale biomass burning, rapid land-use change, persistent air-quality monitoring gaps, and deep social inequalities, producing highly heterogeneous and compound environmental health risks. In this context, treating air pollution and climate change as parallel environmental crises obscures their structural interconnections through shared emission sources, mutually reinforcing exposure pathways, and overlapping health and social consequences. In this narrative review, we critically synthesize scientific and institutional lines of evidence and argue that air pollution and climate risks can be more effectively addressed in Brazil through a single strategic agenda for science, public health, and governance. We first discuss why these challenges cannot be managed in isolation, emphasizing the effects of heat, drought, stagnation events, biomass burning, and extreme weather on pollutant formation, dispersion, and health burden. We then examine Brazil as a critical case where recent regulatory advances coexist with structural limitations in monitoring, data integration, and territorial coverage. Based on this diagnosis, we propose an integrated national agenda organized around five mutually reinforcing priorities: monitoring through hybrid networks; predictive science through climate-informed modeling and early warning; public health through the convergence of epidemiology, toxicology, and mechanistic research; equity-oriented research and action through the explicit incorporation of vulnerability, inequality, and climate justice; and policy appraisal through the assessment of disease burden, economic costs, mitigation co-benefits, and trade-offs. We further discuss the governance mechanisms needed to connect these priorities and translate evidence into coordinated action and adaptive public policies. We also argue that the Amazon should be approached not as an isolated ecological exception but as a central component of a broader Brazilian and Global South discussion on environmental health, land-use change, and climate justice. In this scenario, Brazil has the scientific capacity and regulatory momentum to become a reference in the integrated management of air pollution and climate risks, but this will depend on replacing fragmented approaches with a coordinated framework capable of linking exposure, mechanism, burden, inequality, and action. Full article

Background: Miscarriage is a significant global health concern, affecting approximately 10–20% of recognized pregnancies and resulting in substantial physical and psychological consequences. Chronic inflammatory conditions such as periodontitis may contribute to pregnancy loss through systemic inflammatory and immune-mediated pathways. However, the combined predictive value of periodontal destruction and hematological inflammatory markers for miscarriage risk remains insufficiently understood. This study aimed to evaluate the potential of periodontal and hematological parameters for predicting miscarriage risk using artificial intelligence-based models. Methods: A total of 82 participants (41 women who experienced miscarriage and 41 healthy pregnant controls) were included in this study. Fourteen clinical variables, including maternal age, periodontal indices, and hematological inflammatory markers, were analyzed. Artificial Neural Network (ANN) and eXtreme Gradient Boosting (XGBoost) models were developed to predict miscarriage risk. Model performance was assessed using the coefficient of determination (R²), mean squared error (MSE), root mean square error (RMSE), mean absolute error (MAE), and Willmott’s Index of Agreement. Results: Clinical attachment loss (CAL) was identified as a primary predictor of miscarriage risk within the study cohort. Both machine learning models exhibited promising predictive potential; however, the XGBoost model showed enhanced performance compared to the ANN. XGBoost achieved an R² of 0.92088 and an MSE of 0.0235, indicating consistent predictive capabilities for this preliminary dataset. Conclusions: The results highlight a significant relationship between oral health, systemic inflammation, and adverse pregnancy outcomes. The integration of periodontal and hematological biomarkers within machine learning frameworks provides a non-invasive, cost-effective, and preliminary proof-of-concept approach for miscarriage risk assessment. These findings support the development of personalized risk prediction strategies and may facilitate earlier clinical interventions aimed at improving maternal and fetal health outcomes. Full article

Pulsed Electric Fields (PEF) offer significant potential to enhance energy efficiency and reduce reliance on SO₂ and other chemical preservatives, aligning with current sustainability and health demands. This work evaluates PEF industrial viability for wine stabilisation through a multidisciplinary pilot-scale approach (108 L/h). A sulfur-free comparative trial evaluated four sequential bipolar PEF treatments (20–23 kV/cm; 19–34 kJ/kg) against stabilisation with a commercial chitosan–glucan complex. PEF caused significant effects on microbial kinetics: B. bruxellensis was successfully maintained below the detection limit and lactic acid bacteria (LAB) were undetected by the end of the trial. Standard oenological parameters showed no relevant changes, except for lactic acid dynamics, corroborating LAB knockdown. Regarding metal ion migration into the food matrix, Fe, Ni, and Cr were assessed. No significant variations were found for Fe and Ni compared to the control group; all elements presented residual concentrations compatible with international regulatory guidelines. Sensory analysis revealed that PEF-treated wines exhibited lower perceived bitterness and higher colour intensity, driven by B. bruxellensis proliferation in control wines. In total, 75% of panellists preferred PEF wines. OPEX analysis demonstrates industrial competitiveness for medium-to-large scale, reducing consumable costs over 10-fold (0.6064 vs. 6.50 €/hL), excluding initial CAPEX. These findings validate multi-stage, pilot-scale PEF as a competitive and electrochemically safe technology to transition toward sustainable reduced-SO₂ or SO₂-free winemaking. Full article

Background/Objectives: Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults, and in Mexico’s rapidly growing older-adult population it may place increasing pressure on hospital-based care; however, Mexico-specific evidence to inform adult RSV immunization policy remains limited. This study estimated the long-term clinical and economic burden of medically attended RSV among adults aged 60–99 years in Mexico and evaluated the health impact and cost-effectiveness of a year-round RSVpreF vaccination program. Methods: A population-based Markov cohort model compared the RSVpreF vaccination with no vaccination in a hypothetical Mexican cohort aged 60–99 years over a lifetime horizon. Outcomes included RSV-related hospitalizations, emergency department (ED) and physician office (PO) encounters, in-hospital deaths, life-years (LYs), and quality-adjusted life-years (QALYs). Analyses were conducted from Mexican healthcare system and societal perspectives in 2025 Mexican pesos (MXN$) and US dollars (US$), with costs and outcomes discounted at 5% annually. One-way and probabilistic sensitivity analyses and scenario analyses assessed the robustness of the findings. Results: With 58% uptake, RSVpreF reduced hospitalizations by 187,825, ED encounters by 178,278, PO encounters by 465,976, and RSV-related deaths by 15,384. In the first 5 years, hospitalizations, ED encounters, and deaths declined by 31% each, and PO encounters by 14%. Over the lifetime horizon, vaccination generated an additional 96,227 discounted LYs and 71,526 discounted QALYs, while avoiding MXN$ 19,484 million (US$ 1061 million) in direct medical costs and MXN$ 3324 million (US$ 181 million) in indirect costs. Conclusions: Year-round RSVpreF vaccination in Mexico among adults aged 60–99 years could substantially reduce medically attended RSV cases and RSV-related mortality and is projected to be cost-effective, thereby supporting the adoption of preventive strategies to address the growing clinical and economic burden of RSV in Mexico’s aging population. Full article

Background/Objectives: Clostridioides difficile infection (CDI) is associated with substantial morbidity and high recurrence rates. Current guidelines recommend fidaxomicin over oral vancomycin due to reduced recurrence; however, its high acquisition cost limits widespread adoption. Our health system implemented criteria restricting fidaxomicin to patients with the highest risk for recurrence. This study evaluated the impact of this strategy on CDI recurrence and antimicrobial expenditures. Methods: We conducted a multicenter, retrospective matched cohort study across a rural health system from January 2023 through March 2026. The fidaxomicin criteria for use (intervention) went into effect on 1 January 2025. Adult hospitalized patients with an initial CDI episode treated with oral vancomycin and/or fidaxomicin were included. Patients with severe CDI or prior CDI episodes were excluded. A 2:1 matching algorithm based on key recurrence risk factors was used to compare pre-implementation (before criteria for use) and post-implementation (after criteria for use) cohorts. The primary outcomes were 28-day and 90-day CDI recurrences. Secondary outcomes included antimicrobial utilization and annualized expenditures. Results: A total of 144 matched patients were analyzed (96 control and 48 intervention). Fidaxomicin use decreased from 40.6% to 8.3% following implementation (p < 0.001). Annualized fidaxomicin expenditures declined by 54.7%. CDI recurrence rates were similar between groups: 28-day recurrence was 5.2% in the control group versus 6.2% in the intervention group, and 90-day recurrence was 7.3% versus 10.4%, respectively, with statistical non-inferiority at 28 days (p = 0.014). Conclusions: Implementation of risk-based fidaxomicin use criteria significantly reduced utilization and costs without a statistically significant increase in CDI recurrence. These findings support a targeted stewardship approach to optimize resource use while maintaining comparable clinical outcomes. Full article