Search Results (697)

Background/Objectives: Sepsis and septic shock remain leading causes of morbidity and mortality in intensive care units (ICUs) worldwide. While activation of the hypothalamic–pituitary–adrenal (HPA) axis is a vital adaptive response, the dissociation between cortisol and adrenal androgens like dehydroepiandrosterone (DHEA) is hypothesized to correlate with poor outcomes. This study aimed to evaluate the prognostic value of serum cortisol, DHEA, and the Cortisol/DHEA ratio in patients with sepsis admitted to the ICU. Methods: Clinical and laboratory data from 106 adult sepsis patients in a tertiary care hospital were retrospectively analyzed. Disease severity was assessed using Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Glasgow Coma Scale (GCS) scores. Baseline cortisol and DHEA levels were measured at the time of diagnosis. Logistic regression and Cox proportional hazards models were employed to identify predictors of in-hospital mortality and time to death, respectively. Results: A total of 106 adult sepsis patients with a mean age of 73.63 ± 13.70 years (55 female, 51.9%) were included in the study population. In the final logistic regression model, higher SOFA score was associated with greater odds of in-hospital mortality Odds ratio (OR) = 1.39 per 1-point increase, 95% Confidence interval (CI): 1.15–1.69, p < 0.001). Higher platelet count (PLT) was associated with lower odds of mortality (OR = 0.958 per 10 × 10⁹/L increase, 95% CI: 0.919–0.998, p = 0.042), whereas higher urea was associated with greater odds of mortality (OR = 1.112 per 10 mg/dL increase, 95% CI: 1.020–1.212, p = 0.016). The model area under the curve (AUC) was 0.7956. In univariable Cox analysis, higher baseline DHEA was associated with a greater hazard of death (Hazard ratio (HR) = 1.03, 95% CI: 1.014–1.046, p = 0.0002). In the final multivariable Cox proportional hazards model, baseline cortisol remained independently associated with the hazard of death (HR = 1.014, 95% CI: 1.007–1.022, p < 0.001), whereas DHEA was not retained. Notably, the Cortisol/DHEA ratio did not demonstrate independent prognostic value in either modeling approach. Conclusions: Higher baseline DHEA levels were associated with an increased hazard of death in univariable Cox proportional hazards analysis but did not retain independent prognostic significance in the final multivariable Cox proportional hazards model. While SOFA score remains the central prognostic tool, integrating continuous markers such as platelets and urea enhances risk stratification. The Cortisol/DHEA ratio offers no incremental prognostic utility over established clinical parameters. Full article

Drowning is a largely preventable global public health problem. Many unintended drownings are linked to the initial responses to cold-water immersion (cold shock), which includes a rapid involuntary cardio-respiratory response that increases the risk of aspirating water within the first two minutes of immersion. Floating rather than struggling to swim can help survival in this circumstance. In light of early research and subsequent changes in anthropometry, we are re-examining whether bone mineral density (BMD) in people from African, Caribbean, and Asian communities influences their float. This study examined predictors of float outcome. A total of 101 participants of African, Caribbean, Asian, or mixed heritage were recruited; 96 attempted a two-minute supine float following instruction and practice, of whom 89 were successful. Body fat percentage strongly correlated with buoyancy and floating outcome, while other predictors, including BMD, showed weak or no association. Passive floaters (no movement required) demonstrated greater buoyancy and less exertion than active floaters (purposeful movement required). These findings suggest that body fat percentage is the primary factor influencing float outcome, and that with appropriate instruction and practice, individuals of African, Caribbean and Asian heritage can “find their float”. The results indicate that floating is a learnable competence and highlight the need for integrated drowning prevention strategies combining existing campaigns with accessible, community-based practices and co-produced approaches to improve engagement and equity. Full article

Small harvesting compartments and steep terrain in South Korea favor harvesting systems in which a single machine performs multiple processes. Multifunctional systems based on small tracked excavators, equipped with a grapple saw for felling and a clambunk skidder for extraction, have therefore been increasingly adopted to address labor shortages and to improve operational safety. However, because these base machines lack a chassis suspension system and their operator seats provide limited vibration isolation, operators of small-excavator-based systems may be exposed to elevated levels of whole-body vibration (WBV) and shock vibration. This study quantified operator ride-vibration exposure and assessed the associated health risks during small-excavator-based timber harvesting in accordance with ISO 2631-1; the assessment was based on measured vibration exposure rather than on direct medical evaluation. Tri-axial accelerations were measured simultaneously at the operator seat and the cab floor of a 5-ton-class excavator over eight workdays, and one representative workday was analyzed at the work-element level. The harvesting process was divided into timber felling (machine travel, positioning, clearing, and cutting and bunching) and timber extraction (machine travel on forest roads, machine travel on skid trails, and loading and unloading). Exposure was evaluated using the frequency-weighted root-mean-square (RMS) acceleration, the crest factor (CF), and the total vibration dose value (TVDV). The CF exceeded 9 for all work elements, indicating shock-dominated vibration and justifying the TVDV as the primary evaluation metric. Timber extraction generated higher vibration exposure than timber felling, and the seat TVDV differed significantly among the work elements within each operation (p < 0.001). The highest seat TVDV occurred during loading and unloading (123.05 m/s^1.75), exceeding the upper ISO 2631-1 Health Guidance Caution Zone limit for an 8-h exposure by more than eight times, and all major work elements exceeded the ISO 2631-1 health guidance limits. To our knowledge, this study provides the first work-element-level quantification of WBV exposure for small-excavator-based timber harvesting systems in South Korea. The findings underscore the need for improved seat suspension systems, vibration mitigation technologies, and vibration-aware work planning strategies. Full article

Heat shock proteins (HSPs) are a family of conserved molecular chaperons present in both prokaryotic and eukaryotic species, playing a crucial role in maintaining cellular proteostasis and enhancing stress resilience. HSPs have a multitude of roles in regulating cell signaling transduction, antioxidant defenses, apoptosis, and protein folding, thereby contributing to overall cellular homeostasis. Insulin resistance is characterized by elevated oxidative stress, dysregulated pro-inflammatory signaling, and impaired cellular stress response, ultimately leading to deficient glucose uptake in skeletal muscle. Many studies have illustrated the benefits of exercise in improving insulin resistance and reducing the risk of metabolic disorders, such as type 2 diabetes. Habitual exercise and lifestyle modifications have been shown to activate heat shock response, enhancing HSP70 expression and promoting cellular adaptations that protect against metabolic dysfunction. However, the link between HSPs, particularly HSP70, and skeletal muscle insulin resistance remains complex and not fully elucidated. In this review, we discuss the mechanistic pathways by which HSP70 modulates insulin resistance, mitochondrial function, and inflammatory responses in skeletal muscle. Additionally, we discuss the protective effects of exercise-induced HSP70 expression and its potential as a therapeutic target for improving insulin sensitivity and metabolic health. Full article

Public responses during health crises are shaped by interacting risk perceptions, affect, trust, information needs, overload, misinformation, and protective behavior. Existing applications of the Risk Information Seeking and Processing (RISP) model are largely static and therefore cannot represent stochastic multichannel exposure, delayed correction, or policy feedback. We develop the Stochastic Probabilistic Dynamic RISP (SP-D-RISP) model, which recasts RISP as a bounded stochastic state-space system. Its symmetry structure is explicit: the channel-allocation mechanism is equivariant under simultaneous relabeling of channels and their parameter blocks, while the multi-agent dynamics are invariant to agent relabeling under exchangeable sampling and a label-independent policy. Channel-specific effects, heterogeneous traits, rumor shocks, and interventions generate symmetry breaking. The model combines softmax–multinomial channel competition, discounted Bayesian trust updating, and policy-coupled state transitions. Projection guarantees feasible states by construction, whereas stronger stochastic stability is conditional on a coefficient-level small-gain criterion. For the stationary bounded-memory specification, this criterion is sufficient for Wasserstein contraction, uniqueness of the invariant distribution, and geometric forgetting of initial conditions. The criterion is formulated at the coefficient level and is kept distinct from finite-horizon simulation diagnostics. For the fully disclosed semi-synthetic coefficient vector, the scenario-specific gain matrices have spectral radii between $0.852765$ and $0.857123$; the worst-case column-sum norm is $0.983948$. Thus, the fixed-policy kernels satisfy the stated contraction certificate. For deterministic time-varying paths, the calculation is used only as a common-path one-step certificate, and for the threshold-adaptive rule, it is used only mode by mode rather than as a stationary invariant-law claim. While concentration bounds and Monte Carlo inference quantify population and replication uncertainty, a semi-synthetic experiment with 2500 heterogeneous agents over 90 days examines trust and literacy heterogeneity, clarification delays, communication volume, and intervention portfolios. Within the calibrated SP-D-RISP scenarios, the simulations suggest that higher communication volume may reduce modeled protective behavior when overload effects dominate knowledge gains, delayed clarification may increase transient misinformation, and an integrated portfolio can yield a more favorable simulated outcome profile than the evaluated single-lever strategies. Full article

Artificial intelligence (AI) is increasingly regarded as a key instrument for sustainability governance, but its role may differ across risk domains. Rather than functioning solely as an anticipatory tool, AI may also develop reactively in response to risk shocks. Using monthly Chinese data from January 2013 to December 2023, this study examines the dual role of AI in sustainability governance by analyzing its time–frequency relationships with climate-related government response and infectious disease-related market attention. The continuous wavelet transform and partial wavelet coherence are employed, with the World Uncertainty Index controlled. The results show that AI-sector development is positively associated with both risk-related signals, but the lead–lag patterns differ substantially. In the climate-response domain, the relationship shifts from risk-signal precedence in 2015–2016 to AI-sector precedence in short-term bands after 2020, suggesting that AI-related capacity may have become increasingly embedded in anticipatory climate governance. In contrast, infectious disease-related attention mainly precedes AI-sector movements, especially during 2017–2018 and the COVID-19 period, indicating a more reactive role of AI in public health risk contexts. These findings do not provide causal evidence that AI directly reduces physical climate risks or epidemiological burdens. Instead, they reveal the dual role of AI as both a response to sustainability-related risk shocks and a potential contributor to forward-looking governance capacity. This study contributes to AI and sustainability governance research by clarifying the conditions and boundaries under which AI shifts from reactive crisis response toward anticipatory risk preparedness. Full article

European wild ungulates are captured for different purposes, requiring the assessment of animal welfare and health. Specific guidelines to assess stress and pathophysiological compromise in captured wild ungulates are lacking. This review aims to set the bases for establishing standardised protocols allowing the evaluation of capture and handling stress in wild European ungulates. Physical and chemical capture and handling elicit stress, a physiological response activating sympathetic–adrenal medulla and hypothalamic–pituitary–adrenal cortex axes, releasing catecholamines and corticosteroids, respectively. While being an adaptive response, if prolonged over time, the effects become harmful and life-threatening, increasing body temperature and heart rate, and provoking muscular and renal ischemia. This clinical outcome is known as capture myopathy, which encompasses four sequential syndromes: Hyper acute or capture shock, Acute or ataxic-myoglobinuric, Sub-acute or ruptured muscle, and Chronic debility or delayed per-acute. Monitoring temperature, heart rate, serum muscular enzyme (CK, AST, ALT, and LDH) activities and lactate, creatinine, urea, and potassium concentrations characterises pathophysiological compromise. Wild ungulate capture and handling protocols should include not only methodology but also monitoring, data recording, sample collection, and analyses. This information should serve to improve protocols and eventually develop specific guidelines for stress and welfare assessment when capturing and handling wild ungulates. Full article

Amid rising global economic uncertainty and frequent external shocks, strengthening marine economic resilience has become a core priority for coastal nations to stabilize industrial supply chains and achieve sustainable marine development. China’s traditional resource-driven marine economy faces persistent structural bottlenecks, including homogeneous industrial structure, low value addition and weak risk resistance. As a landmark national policy for sustainable marine economic growth, the Marine Economic Innovation and Development Policy (MEIDP) has been piloted in 15 coastal cities across two batches, yet its causal impact on marine economic resilience remains under systematic evaluation. Using panel data of 51 Chinese coastal cities from 2008 to 2023, this study employs a multi-period difference-in-differences approach with supporting analyses to systematically evaluate the MEIDP’s impact on marine economic resilience, as well as its moderating mechanisms and heterogeneous patterns. The key findings are threefold. First, the MEIDP significantly improves coastal cities’ marine economic resilience, and this positive effect remains stable after multiple robustness tests. Second, public health emergencies exert a significant positive moderating effect, where the industrial support capacity and risk-resilience foundations established through policy implementation function more effectively under shock conditions, thereby amplifying the enhancement of resilience. Third, the policy effect shows prominent heterogeneity, being more pronounced in high-tourism cities and the Northern Marine Economic Circle, while statistically insignificant in low-tourism cities and the Southern Marine Economic Circle. This study enriches the theoretical framework of marine economic policy evaluation and provides empirical evidence from a major developing country for global marine governance, confirming that marine policies that promote innovation are an effective path to strengthen economic risk resistance. In light of these findings, we propose targeted policy recommendations to steadily enhance overall marine economic resilience. Coastal regions should deepen marine policies that promote innovation to bolster industrial upgrading and technological empowerment, adopt differentiated schemes aligned with local industrial foundations and resource endowments, promote marine industrial diversification and chain extension to reduce structural vulnerability, and improve public risk response mechanisms to strengthen the counter-cyclical buffering capacity of the marine economy. Full article

Backgrounds/Objectives: Probiotics confer health-promoting and immunomodulatory effects on the host. However, a lot remains to be understood regarding their safety profile, characteristics and functional mechanisms. This study was conducted to comprehend the functional mechanisms of Limosilactobacillus reuteri isolated from chickens and characterize some of its uncharacterized proteins (hypothetical proteins). Methods: The chicken-isolated Limosilactobacillus reuteri genome, sequenced using Illumina MiSeq sequencing technology, was explored for proteome comparison analyses, comprehensive antibiotic resistance analysis, interleukin-4 (IL-4) expression across various conditions as well as IL-4-inducing potential. Results: Five antibiotic resistance-associated genes were found. Hypothetical proteins labeled QHPv.2.1, QHPv.2.12 and QHPv.2.16 induced IL-4, but QHPv.2.12 was not immunogenic. Immunogenic IL-4-inducing mutants from QHPv.2.1 (0.7013) and QHPv.2.16 (0.7040) had the best support vector machine (SVM) values, which were significantly (p < 0.05) higher than the rest of the group, followed by those from QHPv.2.12 (0.4587). QHPv.2.5 (0.0560) had the lowest value. QHPv.2.1 (5484.71) and QHPv.2.16 (5491.05) had significantly (p < 0.05) larger molecular weights (MWs), followed by QHPv.2.12 (5302.05). The lowest value was obtained for QHPv.2.7 (3386.74). Conclusions: This explorative study revealed the IL-4 inducing capacity of the hypothetical proteins of L. reuteri and their mutants, as well as identified heat and cold shock proteins associated with L. reuteri. Full article

Background/Objective: Antimicrobial resistance poses a critical public health crisis, highlighting the urgent requirement to investigate bacterial evolutionary adaptations and pioneer alternative therapeutics. Consequently, bacteriophages and metal-based compounds are emerging as viable options to combat drug-resistant infections. Building on our finding that T4 phage resistance in E. coli B also confers adaptation to high iron(III), we used RNA-sequencing (RNA-seq) to explore bacterial gene expression in resistant and control populations. We analyzed samples from our five experimental groups—Ancestor (ANC), control (CON), phage-selected (Phage), iron(III)-selected (FE), and phage/iron(III)-selected (PF), to understand how these regimes drive transcriptional changes. Method: Total RNA was extracted using the TRIzol protocol, and sequencing libraries were prepared with the Illumina RNA Total Library Prep Kit. Sequencing was performed on the Illumina NextSeq 1000/2000 platform. Reads were aligned to the E. coli B ATCC 11303 reference genome, and pairwise comparisons between the five experimental groups were conducted to determine differential gene expression profiles. Results: Principal component analysis (PCA) showed that iron-adapted populations (FE and PF) separated distinctly from the Ancestor and control populations along PC1 (capturing 40% of the variance), while the phage-selected replicates were split, with one (Phage5) clustering with CON3 and two (Phage2, Phage4) falling closer to, but clearly separated from, the Ancestor. Differential expression analysis (P_adj < 0.05 and |log₂FC| ≥ 1) revealed extensive transcriptional rewiring, with 482 and 381 differentially expressed genes (DEGs) in the FE and PF populations, respectively, compared to the Ancestor, and 177 DEGs in the phage-selected population compared to the Ancestor. The direct pairwise comparison between the iron-selected and phage/iron-selected populations yielded zero DEGs, demonstrating that both iron-adapted populations converged on a near-identical gene expression profile regardless of their distinct genetic and evolutionary backgrounds. Conclusions: This study suggests that pmrB and arn pathway genes may serve as primary markers for resistance to iron stress. These results are significant because they demonstrate a coordinated, multi-gene defense mechanism in E. coli B against high iron(III) stress, in which the arn operon and eptA remodel lipid A and the outer membrane, while glycerol-3-phosphate metabolism and phage-shock/chaperone pathways are repressed. Full article

Background: Prematurity remains a major global health challenge and is a leading cause of neonatal morbidity and mortality worldwide. The risk of adverse outcomes is inversely associated with gestational age and birth weight. Although advances in neonatal intensive care have improved survival rates over recent decades, very-low-birth-weight (VLBW) preterm neonates continue to experience substantial morbidity and remain vulnerable to long-term complications. Objective: This study aimed to evaluate the morbidity and mortality of very-low-birth-weight preterm neonates (<1500 g) admitted to the Neonatal Intensive Care Unit (NICU) of the Hospital Regional de Alta Especialidad de Ciudad Victoria (HRAEV), Mexico. Materials and Methods: A retrospective observational cohort study was conducted through a review of medical records of VLBW preterm neonates admitted to the NICU between January 2019 and December 2023. Demographic, perinatal, clinical, and outcome-related data were collected and analyzed. Results: A total of 58 VLBW preterm neonates were included. Mean gestational age was 29.8 ± 2.7 weeks, and mean birth weight was 1109 ± 238 g. The most common morbidities were respiratory distress syndrome (81.0%), apnea of prematurity (72.4%), hyperbilirubinemia (68.9%), pneumonia (34.5%), sepsis (32.7%), patent ductus arteriosus (25.8%), bronchopulmonary dysplasia (26.9% among infants who survived to 36 weeks’ PMA), necrotizing enterocolitis (15.5%), and intraventricular hemorrhage (12.0%) and retinopathy of prematurity (8.6%). Overall mortality was 10.3%. Conclusions: VLBW preterm neonates remain at high risk for significant morbidity despite relatively favorable survival rates. Respiratory distress syndrome, apnea of prematurity, hyperbilirubinemia, and sepsis were the most frequent complications, whereas deaths occurred mainly in the context of severe respiratory and systemic complications, including neonatal asphyxia, pulmonary hypertension, sepsis, shock, and multiple organ failure. Survival outcomes should be interpreted cautiously because of differences in study populations, referral patterns, local viability practices, and study design across neonatal settings. Full article

Sustainable rural development requires households to move beyond defensive medical spending and emergency borrowing toward more productive, forward-looking resource allocation. This study uses panel data from the China Household Finance Survey (CHFS), covering the 2017, 2019, and 2021 waves plus a newly released 2023 green-channel wave. We examine whether improvements in safe drinking water, clean cooking energy, and sanitation are associated with lower rural household economic vulnerability. We employ a staggered difference-in-differences design with household and year fixed effects, complemented by event–study tests, mediation analysis, and robustness checks. Environmental infrastructure improvements are significantly associated with lower child hospitalization and out-of-pocket medical expenditure, reduced reliance on high-cost informal credit, and higher income-generating asset shares. Mechanism analysis supports a “health–credit–income” channel, in which environmental improvements reduce preventable health shocks, ease emergency borrowing, and relax liquidity constraints on productive asset allocation. Threshold results further show that these financial-resilience benefits are strongest among households with the lowest baseline resource endowments. The study focuses on rural China, yet the identified health–credit–income mechanism offers a broader, scalable framework. Environmental infrastructure first reduces preventable disease burden, then eases emergency informal borrowing, and finally frees liquidity for income-generating assets. This sequence helps explain how environmental investment can create the financial preconditions for sustainable consumption and investment across developing economies. These findings offer micro-level evidence for integrating environmental infrastructure, rural financial resilience, and ESG social-value assessment. Full article

The safety of non-food products is embedded in the United Nations 2030 Agenda for Sustainable Development and the European Union (EU) framework, supporting health protection, responsible production and consumption, and market surveillance. The EU Rapid Alert System for dangerous non-food products, known as Safety Gate (formerly RAPEX), was established in 2005 to facilitate the exchange of information on products posing risks within the internal market. The aim of this study was to present the interdependencies reported in the Safety Gate system/RAPEX in 2005–2025, considering: product category, type of risk, country of origin, notifying country and year, as well as measures taken. The VOSviewer 1.6.20 and Statistica 13.3 were used. The results highlighted the following problems: toys from China with chemical, choking and injury risks; electrical appliances also from China with electric shock hazards; motor vehicles from Germany with injury risks; cosmetics from Italy with chemical and microbiological risks; and clothing from Turkey with suffocation risks. Reporting is expected to continue under existing regulatory frameworks, although changing the name of the system from RAPEX to “Safety Gate” may reduce its recognition. The findings highlight the need for targeted enforcement, improved risk profiling by product category and origin, and ongoing monitoring of emerging safety risks. Full article

The occupational health implications of solar photovoltaic (PV) recycling remain critically under-investigated. This study assessed occupational exposure across the PV recycling value chain in Taiwan, evaluating primary mechanical dismantling and downstream reuse sectors (glass milling and controlled low-strength material [CLSM] batching). Area and personal samples were analyzed for total dust, respirable dust, and trace heavy metals. Results indicated that primary mechanical crushing yielded relatively low ambient dust and negligible toxic heavy metal (e.g., Pb, Cd) aerosols, attributed to the macroscopic ductility of metallic ribbons and EVA shock-absorbing properties. Conversely, a critical “hazard transfer” phenomenon was empirically identified downstream, where intensive secondary grinding and aggregate blending in the downstream reuse sector (glass milling and CLSM batching) systematically shifted the aerodynamic particle size distribution, causing the respirable dust fraction to surge to 38.9–72.6%. The pursuit of zero-waste material circularity inadvertently amplifies highly dispersive, respirable dust hazards in downstream sectors, necessitating targeted occupational exposure controls. Full article

This study investigates the relationship between economic growth, health expenditure, institutional quality, gross fixed capital formation, and foreign direct investment in EU countries outside the euro area over the period 2000–2024. The analysis is grounded in neoclassical and endogenous growth theory, with particular emphasis on the role of institutional quality as a conditioning factor in the growth process. Methodologically, this study employs an integrated empirical time-series framework focusing on selected health, institutional and investment-related determinants of growth, including linear and nonlinear unit root tests, structural break analysis, and an Autoregressive Distributed Lag/Error Correction Model (ARDL/ECM) approach to capture both long-run equilibrium relationships and short-run dynamics. ECM-based Granger causality tests are further applied to examine the direction of causal interactions. The results confirm the existence of a long-run cointegration relationship across all countries, although the magnitude and direction of the effects vary considerably. Gross fixed capital formation exerts a robust positive influence on economic growth, while foreign direct investment mainly affects growth in the short run and is highly sensitive to external shocks. Health expenditure contributes to growth through human capital formation, with predominantly lagged effects. Institutional quality is associated with growth dynamics, although the direction and strength of this relationship vary across countries and should be interpreted in light of feedback effects identified in the causality analysis. Overall, the findings highlight significant cross-country heterogeneity and underscore the importance of institutional quality in enhancing the effectiveness of investment and public spending for sustainable economic growth. Full article