Search Results (12,636)

Influenza remains a significant national health security threat, particularly for vulnerable populations, as existing control measures do not fully mitigate its impact. This gap in protection is especially pronounced early in a pandemic when a well-matched vaccine may not yet be available, as well as in populations unable to mount an optimal vaccine response. Clinical studies support pre-exposure prophylaxis (PrEP) therapeutics as a promising complementary strategy to reduce influenza transmission and disease severity, potentially easing the strain on healthcare systems during outbreaks. This manuscript outlines the Biomedical Advanced Research and Development Authority’s (BARDA’s) target product profile (TPP) for a long-acting influenza PrEP product, reviews the current development landscape, and models the potential impact of early PrEP product deployment using agent-based modeling in a synthetic population of 19.5 million people across pandemic scenarios resembling the 1918, 1968, and 2009 influenza pandemics. Simulations showed that early deployment of a 70%–effective PrEP reduced cumulative and peak infections, delayed the epidemic peak, and provided the greatest benefit in less transmissible pandemics; at 40–50% coverage, PrEP fully mitigated a 2009-like pandemic and substantially reduced transmission in 1918- and 1968-like scenarios. The TPP defines key characteristics of an effective PrEP option for seasonal and pandemic influenza that (1) demonstrates a strong safety and tolerability profile across all populations; (2) targets a direct-acting antiviral mechanism of action; (3) reduces the relative risk of symptomatic influenza infection by at least 70% in an unvaccinated population and (4) provides single-dose, season-long protection to optimize patient adherence. In this context, integrating PrEP into influenza prevention strategies could improve control of virus spread, strengthen protection for high-risk groups, and significantly reduce the overall public health impact of seasonal and pandemic influenza. Full article

The main objective of the current study is to assess the techno-economic feasibility, climate change adaptability, and sustainability of photovoltaic energy systems in six large hospitals in Turkey (Adana, Başakşehir, Bursa, Elazig, Gaziantep, and Yozgat) to achieve United Nations recommendations as Sustainable Development Goal 7 (affordable and clean energy) and Sustainable Development Goal 13 (climate action). This study aims to determine the impact of long-term climate change on the availability of photovoltaic (PV) energy resources. To achieve this goal, this research was conducted through a multi-step approach combining (1) the detection of long-term climate trends using linear regression on the TerraClimate database, (2) the spatial analysis of photovoltaic solar energy potential using high-resolution satellite imagery (Google Maps) for roof suitability and parking areas, (3) the estimation of photovoltaic electricity generation and the calculation of the capacity factor, (4) the application of the Response Surface Methodology (RSM) based on NASA Giovanni data to model the nonlinear reciprocal relationships between precipitation (R), aerosol optical thickness (AOT), photovoltaic solar energy production, and (5) the techno-economic analysis using the Levelized energy cost (LCOE), payback period, and CO₂ emission reductions. The results show statistically consistent warming trends across all sites with trends for Tmax ranging from +0.0205 to +0.0268 °C/year and for Tmin from +0.0208 to +0.0300 °C/year. The temperature of PV cells increases at a rate of +0.0197 °C/year and the wind speed decreases by −0.0031 to −0.0149 m/s/year, which indicates a reduction in convective cooling. Solar radiation, on the other hand, is relatively constant with small trends ranging from +0.0002 to +0.0566 W/m²/year, and confirms the consistent solar resource availability. Seasonal PV resource potential varies from ~70–95 W/m² in winter to 290–310 W/m² in summer. Furthermore, the installed PV capacities are between 6 MW (Yozgat) and 47 MW (Başakşehir) with capacity factors of 17.0–19.7% and payback periods of 4.31–4.88 years. RSM models have high explanatory power (R² = 0.57–0.74) with AOT as the most important negative driver of PV performance. Consequently, the results show that while the solar resource of Türkiye is stable and highly exploitable, PV efficiency is increasingly determined by climate-induced thermal stress and reduced wind cooling. The study highlights the economic viability, environmental advantages, and strategic relevance of PV systems at hospitals for resilient, low-carbon healthcare infrastructure in future climate scenarios. Full article

Background: Definitions of BCG-unresponsive non-muscle-invasive bladder cancer (NMIBC) have become central to therapeutic decision making and clinical trial eligibility. This perspective synthesizes regulatory frameworks with real-world observations to examine how structural conditions shape the applicability of current definitions. These definitions rely on structural prerequisites—adequate BCG exposure, routine maintenance therapy, standardized surveillance, timely access to early radical cystectomy, and complete tumour-level documentation—that are not consistently achievable across diverse health-care environments. This study examines the structural and operational factors that limit the applicability of current BCG-unresponsive criteria in real-world NMIBC care. Methods: A multilevel analysis was performed and integrated four complementary sources of evidence—regulatory frameworks, national claims datasets, multicenter clinical studies, and real-world practice observation—selected for their ability to capture distinct structural dimensions of NMIBC care. Operational assumptions embedded in contemporary definitions were compared with real-world treatment patterns. Structural barriers were categorized across macro-level system constraints, meso-level institutional practices, and micro-level clinical workflows. Results: As a result, a substantial proportion of patients cannot be classified under existing criteria because the exposure-based and time-dependent conditions required by regulatory definitions are not met in routine practice. Maintenance BCG is infrequently delivered, surveillance intervals vary widely, early radical cystectomy is limited by system-level and institutional factors, and key tumour-level variables required for classification are often missing in large-scale datasets. As a result, many patients cannot be reliably classified using existing criteria—not because of tumour biology or clinician behavior, but because the structural assumptions underlying the definitions are unmet. Conclusions: Current BCG-unresponsive criteria rely on structural conditions that are not universally present in real-world NMIBC care. These findings suggest that context-specific operational definitions, together with complementary strategies such as improving guideline implementation, enhancing data completeness, standardizing surveillance practices, and strengthening healthcare infrastructure, may help align regulatory expectations with real-world practice and support equitable access to bladder-sparing therapies. Full article

The coronavirus disease 2019 (COVID-19) pandemic highlighted the critical need for rapid, accessible, and accurate diagnostic tools to support timely clinical decision-making, outbreak control, and public health surveillance. Point-of-care testing (POCT) has emerged as an essential component of decentralized healthcare by enabling diagnostic testing outside conventional laboratory settings. This review was based on a structured literature search of PubMed, Scopus, and Web of Science databases covering studies published between January 2020 and January 2026. The review evaluates current advances in COVID-19 POCT technologies, including molecular assays, antigen-based tests, antibody-based assays, biosensor platforms, and artificial intelligence (AI)-assisted diagnostic approaches. Molecular POCT methods, including rapid reverse transcription polymerase chain reaction (RT-PCR), loop-mediated isothermal amplification (LAMP), and CRISPR-based technologies, provide high analytical sensitivity and specificity and are increasingly suitable for decentralized diagnostic applications. Antigen-based assays offer rapid and cost-effective screening solutions, although diagnostic performance may vary depending on viral load, symptom onset, and circulating variants. Antibody-based POCT remains valuable for seroprevalence studies, retrospective diagnosis, and immune-response monitoring rather than acute infection detection. Emerging biosensor technologies and AI-enabled diagnostic systems demonstrate promising analytical capabilities and operational advantages; however, many remain at the prototype or early-validation stage and require further clinical evaluation before widespread implementation. The findings indicate that no single POCT modality is optimal for all clinical scenarios. Instead, molecular, antigen, antibody, biosensor, and AI-assisted approaches provide complementary strengths that support different diagnostic and public health objectives. Continued advances in assay design, digital connectivity, multiplex testing, and variant-resilient detection strategies are expected to further enhance the role of POCT in COVID-19 management and future infectious disease preparedness. Full article

Background: Pharmacogenetic (PGx) testing could identify actionable drug–gene interactions, reducing the risks of inappropriate prescribing of certain medications in some patients. An area of growing public health concern is rising global rates of depression and antidepressant use over the last two decades. Prior research has elucidated perspectives of healthcare providers who prescribe antidepressants regarding the clinical utility of genetic information, including PGx testing, but there is a gap in understanding how individual perspectives and systemic contextual factors may combine to influence PGx testing adoption. Objective: The objective of this study was to elucidate combinations of individual and contextual conditions associated with willingness to adopt PGx testing for Cytochrome P450 Subfamily IID, Polypeptide 6 (CYP2D6) and Subfamily IIC, Polypeptide 19 (CYP2C19) among antidepressant prescribers. Methods: We conducted a cross-sectional, mixed-methods study using structured questionnaires and semi-structured interviews with healthcare providers who prescribe antidepressants within their scope of practice across four healthcare systems in the United States. We collected data on implementation science concepts from the Theoretical Domains Framework, the Consolidated Framework for Implementation Research (CFIR), and the Implementation Outcomes Framework. Coincidence analysis (CNA), a case-based, Boolean logic-based method that identifies minimally sufficient combinations of conditions that lead to a particular outcome, was used to identify combinations of conditions for PGx test adoption among antidepressant prescribers. Interviews were also conducted with 10 patients who received pharmacogenetic testing within these healthcare systems to contextualize findings with patient perspectives. Results: Prescribers adopted PGx testing when they believed it would be beneficial to patients and were not deterred by cost-related concerns; the combination of these conditions led to PGx adoption in the most highly supported CNA model. Patient perspectives were also consistent with the selected model, with data suggesting they may have greater willingness to tolerate costs when they perceived or experienced benefits from testing. Conclusions: Insights from this study may be used by health system administrators and public health policymakers to inform future PGx implementation strategies that enhance uptake and awareness of existing evidence for clinical benefits of PGx testing and mitigate cost-related barriers to adoption. Full article

Haptic technology restores the sense of touch to robotic systems and has become increasingly important for safe and intuitive human–robot interaction in healthcare. Despite substantial advances over the past two decades, widespread clinical adoption remains limited, highlighting a persistent gap between laboratory research and real-world medical deployment. This review synthesizes research from robotics, human–computer interaction, neuroscience, and clinical medicine based on a systematic literature search conducted in IEEE Xplore, PubMed, and Scopus (2000–2025). The review adopts an information-centric perspective, focusing on the clinically relevant information conveyed through haptic feedback rather than force reproduction alone. The review examines tactile, kinesthetic, and hybrid feedback modalities; summarizes key principles of haptic rendering, stability, and control; and evaluates applications in surgical robotics, teleoperation, rehabilitation, prosthetics, and medical training. Evidence indicates that haptic feedback can improve performance, reduce excessive forces, and enhance situational awareness, although benefits remain task-dependent. Clinical translation continues to be constrained by sensing limitations, miniaturization challenges, stability requirements, human factors, and regulatory considerations. Current research is increasingly directed toward sensorless force estimation, artificial intelligence-assisted haptic rendering, wearable and soft haptic interfaces, and neurohaptic technologies, reflecting a shift toward task-oriented and information-centric feedback. Future progress will depend less on maximizing physical realism and more on delivering clinically meaningful information through stable, interpretable, and user-centered haptic systems. This review provides a roadmap for advancing clinically deployable haptic technologies in healthcare. Full article

Background/Objectives: Nurses working in Anaesthesia and Intensive Care Units (AICUs) face high job demands that may negatively affect their well-being and increase turnover intention. In healthcare systems experiencing workforce shortages, such as Romania, understanding these mechanisms is essential for developing effective retention strategies. This study examined the relationship between job demands and turnover intention among Romanian AICU nurses, focusing on the mediating roles of professional fatigue and depressive symptoms. Methods: A cross-sectional survey was conducted among 1001 nurses from the AICUs of 68 Romanian public hospitals. Job demands were measured using a composite index including night shifts, long working hours, schedule changes, exposure to aggressive patients, calls from home, and alarm-related stress. Professional fatigue was assessed as subjective exhaustion after work, depressive symptoms with the Patient Health Questionnaire-9, and turnover intention as the intention to leave the workplace within 12 months. Mediation analyses were performed using PROCESS macro (Model 4) with logistic regression. Results: Job demands were positively associated with turnover intention. Higher job demands predicted increased professional fatigue and depressive symptoms, both significantly associated with turnover intention. Mediation analyses demonstrated significant indirect associations through both professional fatigue and depressive symptoms, indicating partial mediation. Conclusions: Job demands are related to turnover intention among Romanian AICU nurses both directly and indirectly through professional fatigue and depressive symptoms. Retention strategies should address not only workload reduction, but also prevention and coping interventions targeting fatigue and psychological distress. Full article

Electricity is fundamental for all modern infrastructures, while disruptions in transmission networks could result in severe failures in healthcare, transportation, communication, industry, and all related to public safety. However, inspection of overhead lines and their components is costly and labor-intensive. The convergence of Unmanned Aerial Vehicles (UAVs), advanced imaging sensors, and deep-learning-based Computer Vision has reshaped this domain. To this end, this work presents a systematic review of Computer Vision applications in electric power transmission line inspection. From an initial 1493 Scopus records, 148 studies published between 2018 and 2026 were retained through a transparent, multi-stage screening and quality-scoring process based on PRISMA guidelines. The reviewed literature was synthesized across four axes: (1) monitoring platforms and sensor technologies, (2) Computer Vision approaches per vision task, (3) datasets, metrics, and evaluation practices, and (4) synthesis of results and industrial adoption. The analysis of the literature confirms the dominance of You Only Look Once (YOLO) family models for real-time edge deployment and the rising adoption of Transformer architectures, while exposing persistent gaps in dataset availability, domain generalization, and field validation. The review concludes with the open challenges and concrete future directions toward fully autonomous, robust, and sustainable inspection systems. Full article

Intensive care medicine represents one of the most challenging setting in modern healthcare, where specific mechanisms intertwine and form a dynamic biological model, where organ dysfunction can easily evolve to multi-organ dysfunction, continuously reshaping the patient’s clinical course. The critically ill patient represents a biological system resulted from interaction between maladaptive and adaptative mechanisms, therefore generates a large volume of data that can exceeds human cognitive capacity. Artificial intelligence can integrate multimodal physiological, laboratory, and clinical data into a dynamic representation of the patient’s biological trajectory. AI-tools and machine learning technologies have evolved to potential clinical support tools, with great perspectives for future implementation, but currently with limited use in clinical practice. This article is a narrative review of artificial intelligence in ICU, aiming to present current evidence and limitations. Full article

Background: Although cervical cancer is preventable, Latinas are twice as likely to receive a late diagnosis compared with non-Hispanic Whites (NHW). We currently know very little about the experiences of cervical cancer among middle- to older-age Latinas in the U.S. This study aimed to document Latina cervical cancer survivors’ journeys with an emphasis on improving the cervical cancer system of care to address inequities among a rapidly aging Latina population. Methods: We interviewed participants aged ≥ 40 years with a diagnosis of cervical cancer of three months or greater who identify as Latina. Recruitment was multi-pronged, including electronic healthcare records search, community tabling events, and snowball sampling. We conducted a qualitative study using the Database of Individual Patient Experiences (DIPEx) methodology and identified themes using grounded theory constructivist analysis. Results: A total of 20 Latinas (43 to 85 years old) participated, including 16 Spanish-language interviews. We identified three themes: formative experiences driving screening and prevention behaviors, provider communication that was suboptimal throughout the cancer continuum, and survivorship impacts including isolation and stigma with implications for the next generation. Conclusions: A central takeaway was the pervasiveness of Latinas’ feelings of shame, lack of communication, and isolation. Healthcare systems must improve culturally responsive communication, survivorship support, and screening equity for aging Latina populations. Abuelas, tias, and/or primas (grandmothers, aunts, and cousins) could play a critical role in raising awareness and increasing timely and early screening among the wider Latina population. Full article

Background and Objectives: Advanced practice nurses (APNs) play an increasingly important role in improving healthcare quality and outcomes. This systematic review synthesized evidence on APN roles and healthcare outcomes in Thailand. Methods: The review protocol was prospectively registered in PROSPERO (CRD420261331793). Four databases (PubMed, CINAHL, Scopus, and Thai Journals Online) were searched from inception to January 2026. Two independent reviewers performed study selection, data extraction, and methodological quality assessment using the Mixed Methods Appraisal Tool (MMAT, 2018) for mixed-methods studies and the Joanna Briggs Institute (JBI) critical appraisal checklists for quasi-experimental, analytical cross-sectional, and qualitative studies. A narrative synthesis was undertaken because of methodological heterogeneity. Results: Twenty studies were included, comprising eight quasi-experimental studies, six cross-sectional studies, four mixed-methods studies, one retrospective study, and one qualitative descriptive study. APNs performed diverse roles, including direct clinical care, care coordination, consultation, patient education, mentoring, and implementation of evidence-based practice. APN-led models of care were associated with favorable clinical outcomes, enhanced self-care and quality of life, increased patient and caregiver satisfaction, and reduced hospital length of stay and healthcare costs. Conclusions: The available evidence suggests that APN-led models of care may be associated with favorable patient, family, and health system outcomes in Thailand. However, these findings should be interpreted cautiously because the evidence was derived predominantly from non-randomized and observational studies, and the independent effects of APN practice could not always be isolated. Full article

HIV-tuberculosis (HIV-TB) co-infection remains a leading cause of morbidity and mortality among people living with HIV and disproportionately affects immigrant and refugee communities in the United States. While antiretroviral therapy has improved HIV outcomes, cultural, social, and psychological barriers hinder timely diagnosis and sustained HIV-TB co-infection care in these populations. This integrative review aims to synthesize evidence on cultural, social, and psychological factors influencing access to diagnosis, treatment, and management of HIV, TB, and HIV-TB co-infection among immigrant and refugee populations in the United States. This study is an integrative review guided by Whittemore and Knafl’s framework. We conducted a systematic search of PubMed, Scopus, and CINAHL for peer-reviewed, mixed-methods, quantitative, qualitative, and review articles published in English between 2015 and 2025. After duplications were removed and dual screening of 107 retrieved records, 16 articles met inclusion criteria for this study. Findings were thematically categorized and synthesized. The themes generated were placed into three main categories: cultural factors including stigma and misperceptions about disease transmission; social factors such as limited healthcare access, lack of insurance, and socioeconomic marginalization; and psychological factors including fear of deportation, trauma, and mistrust of healthcare systems. Addressing HIV-TB co-infection in immigrant and refugee populations requires holistic, trauma-informed, and community-engaged strategies that integrate mental health support, culturally and linguistically tailored education, and policy reforms to remove structural obstacles. Future research should employ culturally validated measures to co-create sustainable interventions and advance health equity. Full article

Tuberculosis (TB) remains a leading cause of infectious disease-related mortality worldwide despite major advances in diagnostics, treatment, and programmatic control. Achieving the goals of the World Health Organization End TB Strategy requires a greater emphasis on prevention alongside improvements in diagnosis and treatment. This viewpoint examines evolving priorities in TB prevention and highlights key insights from studies included in the Special Issue ‘New Perspectives in Tuberculosis Prevention and Control’. The articles published in the Special Issue highlight the importance of identifying populations at increased risk of infection, disease transmission, and disease progression; strengthening the implementation of tuberculosis preventive treatment among household contacts and people living with HIV; and addressing the behavioral, social, and structural determinants that influence access to TB prevention and care. They also demonstrate persistent challenges related to medicine availability, healthcare worker capacity, patient initiation and follow-up, program monitoring, and the implementation of preventive interventions in resource-constrained settings. Emerging developments in diagnostics, biomarkers, vaccines, and digital health may contribute to the longer-term TB prevention agenda but require further evaluation of their feasibility, affordability, and programmatic relevance. Collectively, the evidence indicates that effective TB prevention extends beyond individual biomedical interventions and requires coordinated approaches involving healthcare systems, communities, surveillance systems, and social support mechanisms. Continued investment in implementation research, health-system strengthening, program management, economic evaluation, and multisectoral action will be critical to translate existing evidence into sustainable, equitable, and context-specific strategies for reducing the global burden of TB. Full article

Background/Objectives: Previous studies have found system quality, information quality, and service quality to be significant factors affecting the adoption of e-health services. However, little research has been conducted on factors related to the patient and the healthcare environment that may have an effect on the aforementioned relationship. This paper addresses this gap by extending the Information Systems Success Model to examine the moderating effects of patient empowerment, healthcare sustainability, and value co-creation on the adoption of e-health services in Saudi Arabia. Methods: Data were gathered using purposive sampling through an online survey from 377 adult participants in Saudi Arabia who have previously used e-health systems. Selection of participants with prior experience was done to make sure that their judgments about the quality of the system, information, and the service offered were not made in the absence of usage. Partial Least Squares Structural Equation Modeling was used to examine proposed relationships and moderating effects. Results: System quality (β = 0.312, p < 0.001), information quality (β = 0.202, p < 0.001), and service quality (β = 0.274, p < 0.001) significantly influenced the adoption of e-health services. Patient empowerment and healthcare sustainability significantly strengthened the relationships between all three quality dimensions and e-health adoption. Value co-creation had a significant effect on the relationships between system quality and e-health adoption, as well as between service quality and e-health adoption. Nonetheless, value co-creation failed to have any significant moderating effect on the relationship between information quality and e-health adoption (β = 0.106, p = 0.126). This shows that its moderating influence was not consistent across all quality dimensions. Conclusions: The findings demonstrate that system quality, information quality, and service quality are important determinants of e-health adoption. In addition, patient empowerment, healthcare sustainability, and value co-creation serve as important contextual factors that enhance the effects of quality dimensions on e-health adoption, although variations exist across specific interactions. These findings show that patient and healthcare conditions need to be considered when discussing the impact of system, information, and service quality on adoption of e-health, while at the same time providing context-based insights for the healthcare sector in Saudi Arabia. Full article

The rising prevalence of cardiovascular diseases (CVDs) worldwide imposes a substantial economic burden on healthcare systems. Despite major advances in evidence-based therapies and modern healthcare, the demand for novel, time- and cost-effective treatment options continues to grow. Extracellular vesicles (EVs), including apoptotic bodies, microvesicles, and exosomes, are released by numerous cell types and mediate intercellular communication in both physiological and pathological contexts. To date, researchers have amassed compelling evidence for the functional roles of EVs in the development and progression of myocardial disease, supporting their exploration for clinical applications. In this review, we examine the multifunctional roles of EVs from diverse cellular origins in prominent CVD manifestations, highlighting publications of the last eight years and their key findings. They confirm that EVs carry disease-specific molecular cargo, particularly microRNAs, long non-coding RNAs, proteins, and other bioactive molecules, contributing to inflammation, oxidative stress, fibrosis, endothelial dysfunction, and cardiac remodeling, while also serving as promising diagnostic and prognostic biomarkers. Furthermore, emerging preclinical evidence demonstrates the therapeutic potential of engineered or tissue-derived EVs for promoting cardiac repair and limiting adverse cardiac remodeling. Full article