Search Results (17,954)

Integrated sensing and communication (ISAC) enables concurrent wireless communication and target sensing using shared hardware and spectrum resources, and is regarded as a key technology for next-generation mobile networks. To address the challenge of coordinating sensing and communication in multiuser scenarios, this paper investigates an unmanned aerial vehicle (UAV)-enabled ISAC system employing rate-splitting multiple access (RSMA) and proposes a joint beamforming and trajectory optimization framework. Specifically, ground users are first clustered subject to a capacity–diameter constraint, and the UAV employs RSMA to serve users within each cluster. The sensing performance is characterized by the composite transmit beampattern gain in the target direction contributed by the common stream and all private streams. Under constraints on users’ downlink rates, transmit power, and sensing quality, we formulate an optimization problem to maximize the average downlink rate. By adopting a block coordinate descent (BCD) framework, the resulting non-convex problem is decomposed into three subproblems, namely cluster scheduling, rate allocation and beamforming, and UAV trajectory optimization. These subproblems are then solved via linear programming, semidefinite relaxation, and successive convex approximation, respectively. Numerical results demonstrate that, while satisfying the sensing-quality requirement, the proposed algorithm significantly improves the achievable system downlink rate. Full article

Background: The Victorian Cerebral Palsy Register (VCPR) project collects information on all individuals born or living in Victoria since 1970. It is one of the largest cerebral palsy (CP) registers internationally, with over 6800 participants. Methods: This paper will explain how the VCPR was established, how data are collected and the main outcomes from its use over an extended period of time. Results: The knowledge generated through the VCPR has contributed to information about epidemiology including trends in prevalence over time, and rates and causes of death; the VCPR has been used to investigate causal pathways and potential avenues for prevention or amelioration. It has been valuable in identifying cohorts for multidisciplinary studies resulting in improved understanding of the management of associated problems. The VCPR has also been used in the development of measurement tools and has enabled data linkage studies contributing to knowledge about CP. Conclusion: The Register not only provides an efficient means of identifying eligible cohorts, but the population basis of the VCPR provides the ability to assess the generalisability of research cohorts and a means of adjusting for selection bias and potential misinterpretation of study results. The project has gained international recognition for the knowledge generated on prevalence, risk factors, mortality, clinical profiles, neuroimaging patterns, health service use, assessment tools, participation, epidemiology in paediatric orthopaedics, and quality of life. It has underpinned significant improvements in clinical care for children with CP by enabling researchers from diverse disciplines to complete 157 studies. Full article

Digital ecosystems, misinformation exposure, mental-health vulnerability and unequal access to care create distinctive challenges for young people. Although youth participation in health governance is increasingly advocated internationally, structured evidence from youth deliberative processes remains limited in Portugal. This study synthesises priorities expressed in two national deliberative initiatives coordinated by the Sociedade Portuguesa de Literacia em Saúde: the Mini-Assemblies of Health 2022–2023, with particular attention to the 3rd Mini-Assembly on Fighting Health Misinformation, and the Youth Health Choices Forum 2024. Both processes used a structured nominal-group logic to support idea generation, clarification, recording and prioritisation. The analysis used low-inference cross-session thematic aggregation to preserve propositional integrity and remain close to participants’ formulations. Five priority domains were identified: digital health communication and misinformation control; curriculum-integrated and peer-mediated health literacy; low-threshold and non-stigmatising mental-health access; equity and functional accessibility of services; and institutional youth participation in health governance. Participant quotations are retained, in translated form, to preserve youth voice and to show how recommendations emerged from concrete deliberative formulations. The findings suggest that nominal group technique (NGT)-based youth deliberation can generate operational recommendations for policy and practice, including credibility mechanisms for digital health information, school-based health-literacy integration, autonomy-preserving access routes for mental-health support, and permanent youth participation structures. The findings support recognising young people not only as vulnerable recipients of health information but also as interpreters of digital health ecosystems and contributors to the design of more responsive health governance. Full article

Background: In September 2024, South Korea launched a nationwide Tertiary Hospital Restructuring Project to refocus tertiary hospitals on severe, emergency, and rare disease care, amid a tertiary care system long burdened by patient concentration and acutely strained by the mass resignation of trainee doctors. In the early phase of implementation, understanding how the decision-makers who translate policy into institutional change perceive the project is essential. Methods: We employed a qualitative design using reflexive thematic analysis. Semi-structured, in-depth interviews were conducted with directors from five tertiary hospitals—four in the capital area and one in a non-capital area—selected through purposive sampling. Interviews were conducted between 30 October and 7 November 2025, transcribed verbatim, and analyzed following the six-phase approach of Braun and Clarke. Results: Four themes were constructed. First, directors described the project as catalyzing a cultural shift toward a high-severity-centered model, though contested at the departmental level. Second, a severity paradox emerged, in which treating sicker patients worsened profitability while large restructuring costs strained sustainability. Third, referral networks expanded but were constrained by the absence of an integrated information technology (IT) system across the referral network. Fourth, a specialist- and physician assistant (PA)-centered workforce model stabilized care yet remained institutionally unsettled. Participants recommended refined severity criteria, complexity-based reimbursement, a legal framework for PAs, an integrated IT referral system, and network-based training. Conclusions: As perceived by the participating directors, the project reshaped organizational culture and clinical case-mix, but its long-term viability depends on financial, infrastructural, and workforce supports that have not kept pace with structural change. Sustaining the reform will likely require a shift from competition toward a collaborative, region-centered network. Full article

Background/Objectives: The mental health of university students is a global public health priority. While pathological narcissism is increasingly recognized as a source of significant psychological suffering, its developmental and somatic correlates remain insufficiently explored. This study examines the sociodemographic, familial, and health-related correlates of pathological narcissism and its association with global psychological distress. Methods: A cross-sectional study was conducted with 888 university students (M = 21.3 years; 78.5% female) recruited from three faculties—Humanities and Social Sciences, Civil Engineering, and Medicine. Participants completed the Pathological Narcissism Inventory (PNI), Brief Symptom Inventory (BSI), and sociodemographic, familial, and health-related characteristics, including trauma exposure. Multivariable linear regressions and hierarchical regression analyses were conducted. Results: Pathological narcissism was robustly and positively associated with global psychological distress (r = 0.636, p < 0.001). Multivariable regression models identified chronic fatigue as the strongest somatic correlate of narcissistic pathology, consistent with an ego-depletion account of self-regulatory failure. Additional significant correlates included trauma history, insomnia, and prior use of psychological services. Students from the Faculty of Humanities and Social Sciences reported significantly higher narcissism scores than medical students. Poorer perceived family relationship quality was associated with higher narcissism scores. The full models accounted for 14.4% to 16.9% of the variance in narcissistic dimensions. Conclusions: These cross-sectional findings suggest that pathological narcissism is not merely a personality trait but a clinically relevant construct deeply intertwined with psychological distress and somatic exhaustion. The strong association between narcissism and chronic fatigue points to a substantial physiological cost of sustained self-regulatory effort. Findings highlight the need for integrated screening protocols in university counseling services that account for somatic symptoms (fatigue, insomnia), traumatic experiences, and family dynamics, alongside efforts to destigmatize help-seeking, given that fewer than 1% of students turn to faculty for support. Full article

Point-of-care and near-patient diagnostics can shorten the time between testing and clinical or public-health action, but a technically effective test does not by itself create a sustainable diagnostic service. Evidence from diagnostic-access research, digitally connected point-of-care testing, human-centered design, and implementation science indicates that diagnostic technologies must be developed as components of wider service systems encompassing workflows, quality assurance, data governance, maintenance, supply chains, user trust, and linkage to care. Drawing on these bodies of literature, this Perspective introduces the I2Med digital infrastructure framework for point-of-care diagnostics in low-resource and infrastructure-constrained settings. These settings are defined functionally as clinical or public-health environments in which resource or infrastructure constraints can disrupt one or more stages between testing and appropriate action. The I2Med framework integrates six domains: (1) access and context of use; (2) the result-to-action diagnostic workflow; (3) digital interfaces and data governance; (4) quality, risk, usability, and design-control alignment; (5) sustainability, maintenance, and supply continuity; and (6) equity, trust, and community accountability. Operational tools—including a setting typology, a domain-to-artifact matrix, an evidence-to-scale maturity ladder, and a hypothetical application vignette—illustrate how the framework can guide development and implementation planning. The I2Med framework’s central contribution is to reposition the diagnostic device as one component of an interconnected service system and to provide academic, translational, and early-stage development teams with a common structure for identifying implementation dependencies, evidence gaps, and responsibilities. As a conceptual framework, it requires prospective application and evaluation across diverse settings before its utility and transferability can be established. Full article

Background: Foodborne illness surveillance commonly focuses on reported outbreaks and laboratory-confirmed infections. Nationwide information on foodborne illness-related diagnoses recorded during routine healthcare encounters remains limited in South Korea. This study described the volume and distribution of claims-defined foodborne illness-related episodes and associated diagnostic category records documented in the 2023 HIRA database. Methods: This nationwide retrospective descriptive study used administrative reimbursement claims data from the Health Insurance Review and Assessment Service in 2023. Repeated qualifying encounters for the same patient were grouped into episodes using a 30-day gap rule. For the monthly analysis, each episode was counted once and assigned to the diagnostic category first recorded during the episode; other category-specific analyses used non-mutually exclusive diagnostic category records. Unique episodes were summarized by calendar month, whereas diagnostic category records were summarized by demographic characteristics, selected underlying diseases, healthcare institution type, and region. Results: A total of 6,829,577 unique claims-defined episodes generated 7,754,215 diagnostic category records because an episode could contribute to more than one diagnostic category. Unspecified records accounted for 79.3%, followed by bacterial records (12.1%), viral records (8.6%), and protozoal/other-cause records (<0.1%). Viral and unspecified records were more frequently observed in younger age groups, whereas bacterial records were concentrated among adults aged 19–64 years. Most records were associated with clinic visits (80.3%). Monthly episode counts showed variation, with the highest count observed in July and relatively high counts also observed in January, August, and September. Crude record rates based on healthcare institution location varied across regions. Conclusions: Foodborne illness-related diagnostic records were predominantly unspecified and were most frequently documented in clinics, suggesting limited etiologic specificity in routine diagnostic coding. Claims-based findings may complement existing surveillance but should not be interpreted as confirmed disease incidence or etiologic distribution. Full article

Background/Objectives: Respiratory intermediate care units (RICUs) manage patients with severe respiratory disease requiring advanced monitoring and non-invasive respiratory support. Early identification of patients requiring RICU care after emergency department (ED) assessment remains challenging. This study assessed whether initial admission to a conventional hospital ward followed by early RICU transfer was associated with in-hospital mortality among patients ultimately admitted to a RICU. Methods: We conducted a 10-year prospective observational cohort study including consecutive patients admitted to the RICU of a tertiary hospital after ED assessment. Patients admitted directly from the ED to the RICU were classified as the direct RICU admission group. Patients initially admitted to a conventional ward and transferred to the RICU within 48 h were classified as the early ward-to-RICU transfer group. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included ICU admission and hospital length of stay. Multivariable logistic regression was used to assess the association between admission pathway and in-hospital mortality. Results: A total of 1784 patients were included: 1285 (72%) in the direct RICU admission group and 499 (28%) in the early ward-to-RICU transfer group. In-hospital mortality was higher in the early ward-to-RICU transfer group than in the direct RICU admission group (13.43% versus 5.76%; p < 0.0001), as were ICU admission rates (6.01% versus 2.57%; p = 0.0004). In the complete-case multivariable model, early ward-to-RICU transfer remained associated with higher in-hospital mortality after adjustment for sex, ECOG performance status, APACHE II score at ED presentation, Charlson Comorbidity Index, heart failure, and interstitial lung disease (OR 2.99, 95% CI 1.96–4.56; p < 0.0001). Conclusions: Among patients ultimately admitted to a RICU after ED assessment, initial ward admission followed by early RICU transfer was associated with higher in-hospital mortality. These findings suggest that initial ward admission followed by early RICU transfer may help identify a clinically vulnerable subgroup among patients ultimately requiring respiratory intermediate care. However, because admission pathway may be influenced by evolving severity, diagnostic uncertainty, treatment decisions, and organisational factors, no causal inference can be made from this observational study. Full article

Interdisciplinary dialogue between religion and psychoanalysis has long been regarded as an important approach to addressing modern psychological suffering. Erich Fromm sought to integrate Zen Buddhist practice with psychoanalytic reflections on integration of the unconscious, self-awareness, and personality, proposing a framework that links spiritual cultivation with psychological growth. However, this framework’s explanatory power and limitations in the contemporary Chinese context remain insufficiently explored through empirical research. Drawing on semi-structured interviews with 14 Chinese Zen practitioners in China, this study employs thematic analysis to examine their practices, psychological changes, and understandings of the relationship between Zen and mental health. Most participants regarded Zen practice as a long-term process involving cognitive reorientation, emotional regulation, and behavioral transformation, broadly resonant with Fromm’s integrative framework. However, the framework should not be treated as a directly applicable model of psychological intervention, as its practical relevance depends on sustained cultivation, community support, situated understanding, and clear professional and ethical boundaries. These qualitative findings underline potential risks when Zen cultural resources are introduced into contemporary mental health services, including decontextualization, instrumentalization, and an orientation toward immediate results. Therefore, within clearly defined ethical boundaries, a limited and responsible form of collaboration between Zen teachers and mental health professionals may be worth further exploration. Full article

Agricultural subsidy policies have increasingly shifted from production-oriented support toward incentives that reward environmental stewardship and the provision of ecosystem services. Despite their rapid expansion, evidence regarding the environmental effectiveness, economic efficiency, market implications, and food-security consequences of these eco-centric agricultural subsidies remains fragmented across policy frameworks and regions. This review synthesizes current evidence on eco-centric agricultural subsidies by comparatively evaluating their environmental, economic, and policy outcomes across developed and developing economies. The review was conducted using a structured literature search following PRISMA-informed review procedures, drawing upon peer-reviewed articles, systematic reviews, policy evaluations, and international institutional reports retrieved from major scientific databases and policy sources. The evidence indicates that eco-centric subsidies generally improve biodiversity conservation, soil health, carbon sequestration, water quality, and reductions in chemical inputs when payments are appropriately targeted and supported by effective monitoring and institutional capacity. Performance-based and results-oriented payment schemes frequently demonstrate greater environmental additionality and cost-effectiveness than conventional practice-based payments; however, their broader implementation remains constrained by monitoring costs, verification requirements, administrative complexity, and regional institutional capacity. Economic outcomes are more heterogeneous, with benefits depending on program design, agroecological conditions, market structures, and farm characteristics. While these subsidies can enhance environmental returns on public investment, challenges including land-value capitalization, unequal benefit distribution, transaction costs, market distortions, and potential short-term productivity trade-offs remain important policy concerns. Evidence regarding food-security impacts is similarly context-dependent and varies across production systems and geographical regions. Overall, the review demonstrates that no single subsidy instrument is universally effective. Instead, the greatest environmental and economic benefits are achieved through integrated policy portfolios combining targeted incentives, outcome-based payments, robust monitoring systems, digital technologies, carbon-market integration, and equitable program design. The review also identifies important evidence gaps concerning developing-country experiences, long-term cost-effectiveness, and standardized evaluation frameworks, providing priorities for future research and policy development. Full article

Based on microscopic survey data of 10,057 kiwifruit growers from the Shaanxi, Guizhou, and Sichuan provinces in China, this study takes the initial and sustained adoption of low-carbon agricultural technology by farmers as dependent variables. A comprehensive evaluation system is constructed based on the digital capability of farmers. The system covers four dimensions, namely, digital access, digital acquisition, digital processing, and digital sharing. Multiple empirical models, including Lasso regression, extreme gradient boosting, random forest, and back propagation neural network are adopted to compare the fitting and predictive performance of different approaches. The model comparison results demonstrate that the random forest model presents the optimal fitting performance among all alternative specifications. To identify the core influencing factors and explore the underlying mechanisms, this study employs the SHAP method to quantitatively evaluate the marginal contribution of each variable. The empirical findings reveal that the digital capability of farmers significantly and positively promote both initial and sustained adoption of low-carbon agricultural technology with distinct dimensional heterogeneity. Specifically, digital access and digital acquisition capability act as core driving factors for the initial adoption of technologies by farmers, while digital processing and digital sharing capability play a decisive role in facilitating sustained low-carbon technology application. In addition, farmers’ education level, health status, household income, cooperative participation, and household labour scale are crucial characteristic variables affecting the behaviours of farmers in the adoption of low-carbon technology across different stages. Accordingly, this study proposes targeted policy implications for low-carbon agricultural development. On the basis of promoting digital rural construction and improving the systems of digital skill training and digital agricultural technical services, it is essential to strengthen dynamic tracking surveys of farmers, accurately identify their technology adoption stages, and implement differentiated supporting policies. These targeted measures can effectively consolidate and assess the low-carbon production behaviours of farmers and promote the long-term and sustainable development of low-carbon agriculture. Full article

The structural and immunomodulatory properties of arabinogalactan proteins (AGPs) from edible medicinal plants remain largely unexplored. Here, A homogenous AG-II-like arabinogalactan protein (CTSP-W2, 9862 Da) was isolated from Cynanchum thesioides via hot-water extraction, ethanol precipitation, and column chromatography. Its structure was thoroughly characterized by high-performance gel permeation chromatography (HPGPC), Fourier-transform infrared spectroscopy (FT-IR), nuclear magnetic resonance (NMR), Congo-red, scanning electron microscopy (SEM), sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), methylation analysis. The mechanism of immune activity was examined using specific inhibitors, Western blotting, and molecular docking. It comprises galactose, arabinose, glucose, galacturonic acid, xylose, and 18 amino acids (asparagine-rich), with a backbone of →3,6)-Galp-(1→ and →6)-Galp-(1→. CTSP-W2 significantly enhanced macrophage proliferation, phagocytosis, and secretion of Nitric oxide (NO), Tumor necrosis factor-alpha (TNF-α), and Interleukin-6 (IL-6). Inhibitor assays showed that Toll-like receptor 4 (TLR4, TAK-242) and Toll-like receptor 9 (TLR9, E6446) antagonists markedly reduced CTSP-W2-induced TNF-α, IL-6, and NO in a dose-dependent manner, whereas Toll-like receptor 2 (TLR2) inhibition (C29) unexpectedly upregulated these mediators. Western blot revealed that CTSP-W2 upregulated TLR4 and TLR9 protein expression and increased phosphorylation of Inhibitor of nuclear factor kappa-B alpha (IκBα), nuclear factor kappa B (NF-κB p65), and p38, indicating activation of the TLR4/9–NF-κB–p38 mitogen-activated protein kinase (MAPK) signaling axis. Furthermore, Molecular docking analysis further indicated that CTSP-W2 forms extremely strong hydrogen-bonding and hydrophobic interactions with TLR4 through its galactose chains. This study elucidates the immunoregulatory mechanism of CTSP-W2 and establishes a molecular basis for arabinogalactan proteins as potential natural immunomodulators. Full article

Delayed discharge represents a persistent challenge in healthcare systems, contributing to inefficiencies in hospital bed utilization, increased costs, and reduced patient flow. In small and centralized healthcare systems, these effects may be further amplified due to limited post-acute care capacity and restricted patient redistribution. This study quantified the prevalence of inappropriate hospital days as a proxy for delayed discharge and examined their relationship with patient demographics, medical specialty, and associated costs in an acute general hospital. A quantitative analysis of 220 medical records was conducted using a modified Appropriateness Evaluation Protocol (AEP). Descriptive statistics and non-parametric tests were applied to identify significant associations between inappropriate hospital days and selected variables. According to the findings, within this intentionally enriched sample of patients with a length of stay exceeding seven days in the selected wards, nearly half of all accumulated inpatient bed days failed to meet acute necessity criteria, with the vast majority of these service backlogs stemming from placement delays in downstream rehabilitation facilities and long-term care institutions. Within this high-risk cohort, inappropriate hospital days, used here as a proxy for delayed discharge, were more common among older patients and among medical specialties than in other specialties, while no consistent relationship was observed with gender. Cost analysis (carried out over a three-month period) indicated an order-of-magnitude estimate of the acute bed day resources associated with inappropriate hospital days in the units studied. These findings are consistent with the interpretation that inappropriate hospital days, used here as a proxy indicator of delayed discharge, may be influenced by a combination of external capacity constraints and internal operational inefficiencies, although causality cannot be established from this observational design. While the findings cannot be generalised to the entire inpatient population or health system, within this intentionally enriched cohort of long stay inpatients the study highlights the need to strengthen post-acute care provision, improve discharge coordination processes, and enhance system integration to optimise hospital efficiency and patient flow in similar operational contexts. Full article

Hip fractures are among the most devastating fragility fractures, associated with excess mortality, disability, loss of independence, and substantial healthcare costs. Although age-standardized incidence has declined in several high-income countries, absolute case numbers continue to rise because of population aging. This review summarizes contemporary PubMed-indexed evidence on the epidemiology, risk stratification, and prevention of proximal femoral fractures, with emphasis on hip-fracture outcomes rather than vertebral or composite endpoints alone. We discuss secular trends, FRAX-based case findings and screening, non-pharmacologic strategies, pharmacologic therapy, and health-system interventions relevant to both primary and secondary prevention. Among non-pharmacologic measures, long-term balance-challenging and resistance-based exercise has the most consistent evidence for reducing falls and likely contributes to fracture prevention, whereas multifactorial interventions, home hazard modification, calcium/vitamin D supplementation, and hip protectors are best targeted to selected high-risk populations and care settings. Among medications, bisphosphonates, denosumab, and romosozumab-based sequential strategies show the strongest evidence for reducing hip-fracture risk, while teriparatide and abaloparatide have important roles in very-high-risk patients despite less direct hip-fracture evidence. Menopausal hormone therapy reduces hip fractures in younger postmenopausal women but is limited by extra-skeletal risk, and selective estrogen receptor modulators are primarily vertebral-fracture agents. A major message of this review is that effective prevention depends not only on drug efficacy but also on implementation. Fracture liaison services, orthogeriatric co-management, prompt treatment after fragility fracture, and sustained adherence support are essential to close persistent care gaps. Preventing hip fractures therefore requires an integrated, risk-stratified approach that combines skeletal protection, falls prevention, and reliable health-system delivery. Full article

Background/Objectives: Meropenem is a broad-spectrum carbapenem antibiotic with demonstrated efficacy against multidrug-resistant Gram-negative pathogens. Although its use as an ophthalmic formulation is off-label, growing clinical evidence supports its application in severe ocular infections such as keratitis and endophthalmitis. However, the intrinsic instability of meropenem in aqueous solutions and the absence of standardized ophthalmic preparations limit its routine use. Furthermore, no stability studies are currently available for meropenem 50 mg/mL eye drops stored in polypropylene (PP) dropper bottles under freezing and subsequent refrigerated conditions. The aim of this study was to evaluate the physicochemical and microbiological stability of a 50 mg/mL meropenem ophthalmic solution prepared in a hospital pharmacy using a commercial meropenem pharmaceutical product, and packaged in PP containers. Methods: Eye drops were aseptically prepared from a commercially available pharmaceutical product, containing 1g de meropenem and anhydrous sodium carbonate as an excipient. After preparation, the drops were stored at −20 ± 2 °C for up to 42 days, followed by refrigerated storage (5 ± 3 °C) after thawing for up to 7 days. Chemical stability was assessed using a validated stability-indicating HPLC method in accordance with ICH guidelines and was defined as 90–110% recovery of the initial concentration. Physical stability (appearance, pH, particulate matter) and microbiological stability were also evaluated under simulated in-use conditions. Results: The HPLC method demonstrated excellent linearity, precision, and accuracy. Meropenem concentrations remained within the predefined acceptance limits throughout the 42-day study period under freezing conditions, with no significant changes in pH, color, or particulate formation. After thawing, a progressive decrease in drug concentration was observed under refrigerated conditions, falling below 90% of the initial concentration within 24–48 h. A concomitant color change from colorless to yellow was also detected, consistent with β-lactam ring hydrolysis. Despite this degradation, no significant changes in physical parameters other than color were observed, and microbiological testing confirmed sterility for up to 7 days under refrigerated conditions. Conclusions: Meropenem drops 50 mg/mL in PP dropper bottles are physicochemically and microbiologically stable for 43 days (42 days under frozen conditions plus 1 day, in-use conditions, after opening and under refrigeration). Full article