Search Results (71)

Background: Intracellular bacteria frequently result in chronic and recurrent infections. MRSA is one of the most prevalent facultative intracellular bacteria in clinical infections. The drug resistance of MRSA and the difficulty of most antibiotics in entering cells result in a suboptimal clinical efficacy of antibiotics in the treatment of intracellular MRSA. Bacteriophages represent a promising alternative therapy in the context of the current antimicrobial resistance crisis. Nevertheless, the low efficiency of phage entry into cells and their rapid inactivation remain challenges in the treatment of intracellular MRSA using phages. The utilization of functionalized carriers for the delivery of phages into cells and their protection represents a feasible strategy. Methods: In this study, a new MRSA bacteriophage (vB_SauS_PHM) was isolated from hospital sewage, exhibiting the characteristics of short incubation period, large lytic amount, and good environmental tolerance. Subsequently, vB_SauS_PHM was encapsulated by TAT peptide-functionalized liposomes through microfluidic technology and size-exclusion chromatography (SEC), forming a phage delivery system, designated TAT-Lip@PHM. Results: The encapsulation rate of the phage by TAT-Lip@PHM was 20.3%, and the cell entry efficiency was ≥90% after 8 h. The 24 h eradication rate of 300 μg/mL TAT-Lip@PHM against intracellular MRSA was 94.05% (superior to the 21.24% and 44.90% of vB_SauS_PHM and Lip@PHM, respectively), while the mammalian cell activity was >85% after 24 h incubation. Conclusions: The TAT-Lip@PHM effectively delivered the phage into the cell and showed an excellent killing effect on intracellular MRSA with low cytotoxicity. This work provides a technical reference for the application of phages in the treatment of intracellular bacterial infection. Full article

Background: Reduced-port totally robotic pancreaticoduodenectomy (rpRPD) has been introduced to address limitations of conventional robotic pancreaticoduodenectomy (cRPD), particularly regarding assistant mobility and visualization. This study aimed to evaluate the clinical feasibility and procedural consistency of rpRPD in comparison with cRPD and laparoscopic pancreaticoduodenectomy (LPD). Methods: We conducted a retrospective cohort study of patients who underwent pancreaticoduodenectomy between January 2015 and December 2024. Patients were categorized into rpRPD (n = 40), cRPD (n = 60), and LPD (n = 262) groups. Clinical outcomes and learning curves were compared using regression and cumulative sum (CUSUM) analysis. Results: Baseline characteristics were similar across groups. The rpRPD group demonstrated significantly shorter operative time (p < 0.001) and lower blood loss (p < 0.05) than cRPD, with no significant differences in postoperative complications or hospital stay. The learning curve analysis revealed that rpRPD had lower variance (5839.3 vs. 8919.1) and more stable performance than cRPD despite a slightly longer stabilization point. Lymph node retrieval was comparable across groups, supporting oncological equivalence. Conclusions: rpRPD offers comparable perioperative and oncologic outcomes to cRPD and LPD while improving operative efficiency and procedural predictability. It represents a technically feasible and safe option for minimally invasive pancreatic surgery. Full article

Hospitals discharge wastewater containing toxic pollutants that pose risks to human health and the environment if not properly treated. Therefore, effective treatment techniques are essential. Although various reviews have explored hospital wastewater treatment (HWWT) methods, few have comprehensively assessed their sustainability—including technical, environmental, economic, and social aspects. This paper reviews the literature on these dimensions and identifies critical research gaps. Technically, the combination of biological and tertiary techniques can achieve removal efficiencies between 60% and 99% for emerging contaminants. Environmentally, electricity consumption is a major concern, ranging from 0.2 to 3 kWh/m³, depending on the technique. Economically, costs rise with energy-intensive methods; ultraviolet disinfection operates at 0.016 €/m³, while Fenton treatment reaches 23.38 €/m³. No dedicated social assessments exist for HWWT; therefore, municipal wastewater studies were used as references. This paper proposes public health-related social indicators tailored for HWWT. Two key research gaps are identified: the lack of integrated sustainability and social assessments and limited comparability across studies. This review adapts the life cycle sustainability assessment framework to HWWT and offers recommendations for improved comparability and targeted future research. Addressing these gaps will support more holistic evaluations and guide effective and informed decision-making in hospital wastewater management. Full article

Perihilar cholangiocarcinoma (pCCA) is the most common subtype of a rare malignancy arising from the biliary tract. Its challenging diagnosis results in delayed treatment, most often when the disease is locally advanced or widespread. Management includes surgery followed by systemic chemotherapy; however, a negative resection margin (R0) is the mainstay for achieving an adequate survival benefit, in the absence of metastatic disease. While minimally invasive surgery (MIS) initially is adopted across every surgical field, laparoscopy’s inherent limitations hinder its implementation for the treatment of pCCA and results in skepticism even for the robotic approach. However, since its initial feasibility phase fifteen years ago, comparable results to open surgery have been reported regarding its safety and oncologic outcomes, in highly selected patients. Moreover, the robotic approach seems to be associated with favorable outcomes regarding post-operative complications, length of hospital stay, and estimated blood loss. International guidelines for the diagnosis and management of pCCA, centralization, definition of a learning curve for MIS, and more comparative studies assessing long term outcomes and randomization are key elements to ensure patient’s safety and technical efficiency. The aim of our review is to provide an updated perspective of the existing literature in the utilization of MIS for patients with pCCA. Full article

Background/Objectives: Lumbar spine surgery has undergone significant technological transformation in recent years, driven by the goals of minimizing invasiveness, improving precision, and enhancing clinical outcomes. Emerging tools—including robotics, augmented reality, computer-assisted navigation, and artificial intelligence—have complemented the evolution of minimally invasive surgical (MIS) approaches, such as endoscopic and lateral interbody fusions. Methods: This systematic review evaluates the literature from February 2020 to February 2025 on technological and procedural innovations in LSS. Eligible studies focused on degenerative lumbar pathologies, advanced surgical technologies, and reported clinical or perioperative outcomes. Randomized controlled trials, comparative studies, meta-analyses, and large case series were included. Results: A total of 32 studies met the inclusion criteria. Robotic-assisted surgery demonstrated high accuracy in pedicle screw placement (~92–94%) and reduced intraoperative blood loss and radiation exposure, although long-term clinical outcomes were comparable to conventional techniques. Intraoperative navigation improved instrumentation precision, while AR enhanced ergonomic workflow and reduced surgeon distraction. AI tools showed promise in surgical planning, guidance, and outcome prediction but lacked definitive evidence of clinical superiority. MIS techniques—including endoscopic discectomy and MIS-TLIF—offered reduced blood loss, shorter hospital stays, and faster recovery, with equivalent pain relief, fusion rates, and complication profiles compared to open procedures. Lateral and oblique approaches (XLIF/OLIF) further optimized alignment and indirect decompression, with favorable perioperative metrics. Conclusions: Recent innovations in lumbar spine surgery have enhanced technical precision and perioperative efficiency without compromising patient outcomes. While short-term benefits are clear, long-term clinical advantages and cost-effectiveness require further investigation. Integration of robotics, navigation, AI, and MIS into spine surgery reflects an ongoing shift toward personalized, data-driven, and less invasive care. Full article

To address the significant problems of high fire risk and low evacuation efficiency in large and complex medical buildings, this study uses Ezhou Hospital as the empirical object to construct a multi-dimensional threat and risk assessment and fire evacuation dynamic coupling model and proposes a systematic optimization scheme to improve personnel evacuation safety. This study proposes an innovative full-chain analysis framework of “threat and risk assessment-dynamic coupling-multi-strategy optimization”. The specific methods employed include the following: (1) Using the probabilistic threat and risk assessment (PRA) method and the risk index (RII) method to identify the most unfavorable scenarios where the fire source is located in the outpatient hall (risk value C2 = 9.86). (2) Combining PyroSim and Pathfinder to construct a dynamic coupling model of fire smoke diffusion and personnel evacuation. Multiple groups, such as patients with mobility problems and rescue personnel, are added to address the limitations of traditional single-factor simulations. (3) Considering the failure of fire shutters, a two-stage optimization strategy is proposed for when the number of personnel is at its peak: the evacuation time is shortened by 23% by using internal intelligent guidance to shunt the congestion node crowd, and the addition of external fire ladders forms a multi-channel coordinated evacuation that further reduces the total evacuation time from 1780 s to 1266 s and improves the efficiency by 29%. The results show that the coupled multi-path coordination strategy and three-dimensional rescue facilities can significantly reduce the bottleneck associated with a single channel. This study provides a multi-dimensional dynamic evaluation framework and comprehensive optimization paradigm for the design of the evacuation of high-rise medical buildings and has important theoretical and technical reference values for improving the fire safety performance of public buildings and the intelligence of emergency management. Full article

It is necessary for the allocation of resources to be more efficient, and making more adequate operational strategies to realize productivity change is contributed to by the kind of output sources in the hotel’s production process. This study tries to propose hotel productivity change models from overall and disaggregate perspectives by using the Luenberger productivity index based on directional distance function. Empirical findings briefly show that the overall productivity change of ITHs in Taiwan has a growing trend and is driven from a technical change rather than an efficiency change. Moreover, the disaggregate hotel productivity growth comes from the service of hotel facilities, but improving the performance of the catering service is more important to a hotel’s overall performance. Individual ITHs can grasp the contribution of disaggregate hotel productivity growth on the overall productivity change, maintaining or developing competitive advantages in the hotel’s operation and management. Therefore, the viewpoint of this study can not only be used to examine the hotel issues but also be applied to other issues in the hospitality and tourism industry that target overall and disaggregate productivity growth. Full article

This study presents an integrated approach for adapting building energy systems using Machine Learning (ML), the Internet of Things (IoT), and Building Information Modeling (BIM) in a hotel retrofit in Italy. In a concise multi-stage process, long-term climatic data and on-site technical documentation were analyzed to create a detailed BIM model. This model enabled energy simulations using the Carrier–Pizzetti method and supported the design of a hybrid HVAC system—integrating VRF and hydronic circuits—further enhanced by a custom ML algorithm for adaptive, predictive energy management through BIM and IoT data fusion. The study also incorporated photovoltaic panels and solar collectors, reducing reliance on non-renewable energy sources. Results demonstrate the effectiveness of smart energy management, showcasing significant potential for scalability in similar building typologies. Future improvements include integrating a temporal evolution model, refining feature selection using advanced optimization techniques, and expanding validation across multiple case studies. This research highlights the transformative role of ML, IoT, and BIM in achieving sustainable, smart, and efficient building energy systems, offering a replicable framework for sustainable renovations in the hospitality sector. Full article

The COVID-19 pandemic has led to significant increases in morbidity, mortality, and energy consumption, primarily due to infection control measures. Hospitals, as frontline responders, are particularly vulnerable to infection risks due to dense populations and numerous viral carriers. Integrating natural ventilation to optimize air-conditioning systems is crucial for mitigating these risks while balancing energy efficiency. However, existing research has predominantly focused on mechanical ventilation upgrades, with limited attention given to the effective integration of natural ventilation. This study presents an innovative air-conditioning system that incorporates easily installable automatic window control units into existing fresh-air-handling units and fan coil unit systems. This approach allows for multi-zone simultaneous control, making it suitable for both new and retrofitted hospitals. Additionally, the study proposes an optimal multi-zone ventilation strategy aimed at reducing infection risks while enhancing energy efficiency. The performance of the proposed system and ventilation strategy is evaluated considering five common respiratory diseases, with their seasonal transmission characteristics across a wide range of climatic conditions integrated into a revised version of the traditional Wells–Riley equations. The results demonstrate that conventional systems, following China’s GB55015-2021 standard, incur high infection risks during peak-season hours for COVID-19 (1347 h), influenza (470 h), and measles (1386 h). In contrast, the proposed multi-zone ventilation strategy eliminates infection risks while only increasing energy consumption by 3–10%, utilizing outdoor wind pressure as a key resource. This solution not only enhances hospital resilience but also provides valuable technical guidance for the design and retrofitting of hospital buildings, ensuring enhanced infection control and energy efficiency across diverse climates. Full article

Mental health illness is the single biggest cause of inability within the UK, contributing up to 22.8% of the whole burden compared to 15.9% for cancer and 16.2% for cardiovascular disease. The more extensive financial costs of mental ailments in Britain have been evaluated at British Pound Sterling (GBP) 105.2 billion each year. This burden could be decreased with productive forms and utilization of computerized innovations. Electronical health records (EHRs), for instance, could offer an extraordinary opportunity for research and provide improved and optimized care. Consequently, this technological advance would unburden the mental health system and help provide optimized and efficient care to the patients. Using natural language processing methods to explore unstructured EHR text data from mental health services in the National Health Service (NHS) UK brings opportunities and technical challenges in the use of such data and possible solutions. This descriptive study compared technical methods and approaches to leverage large-scale text data in EHRs of mental health service providers in the NHS. We conclude that the method used is suitable for mental health services. However, broader studies including other hospital sites are still needed to validate the method. Full article

Background/Objectives: China has introduced a series of policies to encourage family physicians (FPs) to provide remote diagnosis and treatment (RDT) services, with the ultimate goal of providing more continuous, convenient, and efficient medical services for all residents, especially elderly patients and patients with chronic diseases. However, few studies have focused on this important issue. The aim of this study was to provide a comprehensive description of FPs’ use of, barriers to, and attitudes toward RDT in China. Methods: A cross-sectional survey was implemented for this study. The data were analyzed via basic descriptive statistics and are expressed as percentages. Additionally, a single-factor logistic regression was used to compare groups in terms of outcome measures. Results: Among the 682 respondents, 63.8% had participated in RDT, and 36.2% had never participated in RDT. Among the 435 respondents who participated in RDT, 19.1% were high-frequency users, and 80.9% were low-frequency users. The results of the single-factor logistic regression revealed that there were significant differences in the use of RDT among FPs in terms of age (p = 0.034), educational background (p < 0.001), hospital type (p = 0.008), income as a result of their work as an FP (p = 0.002), form of employment (p = 0.001), and general practitioner status (p < 0.001). Moreover, there were significant differences in the use frequency of RDT among FPs in terms of age (p = 0.009), years of practice as a health service provider (p = 0.001), years of practice as an FP (p = 0.003), educational background (p = 0.048), and working hours as an FP (p = 0.014). However, a lack of policy support (58.5%), technology support (55.3%), and information support (52.5%) were the top three factors hindering FPs from participating in RDT. Overall, FPs had positive attitudes toward RDT services, with more than half of the respondents expressing that they could benefit from such services and showing increasing interest in using them. Conclusions: The findings of this research can improve policymakers’ understanding of FPs’ use of, barriers to, and attitudes toward RDT. Our findings also provide suggestions, such as those for improving the promotion of RDT, optimizing relevant laws, and providing technical support for FPs to use RDT, which may help optimize related policies. There are also some limitations in our study; for example, the sample in this study included provincial administrative regions across China, but not all provinces were covered. In the future, research covering all provinces of the country could be carried out to make the research more nationally representative. Full article

Background: Technical efficiency evaluates a hospital’s economic performance and plays an important role in variations in quality of care and outcomes. The study objective was to examine the association between hospital efficiency and quality of care among fee-for-service Medicare beneficiaries with prostate cancer and to assess if race moderates this association. Design: Retrospective study using Surveillance, Epidemiological, and End Results—Medicare (SEER-Medicare) data from 1998 to 2016 for prostate cancer patients aged ≥ 66. We computed hospital technical efficiency using a data envelopment analysis. Outcomes were emergency room visits, hospitalizations, cost, and mortality (all-cause and prostate cancer-specific). We used competing risk regression for survival, log-link GLM models for cost, and Poisson models for count data. The propensity score approach was used to minimize selection bias. Results: The cohort consisted of 323,325 patients. Compared to higher efficiency hospitals (upper quartile), low hospital efficiency (i.e., lower quartile) was associated with a higher hazard of long-term mortality (Hazard ratio (HR) = 1.06, 95% CI = 1.05, 1.08) and long-term prostate cancer-specific mortality (HR = 1.14, 95% CI = 1.11, 1.17). Compared to higher efficiency levels, lower levels were associated with impaired emergency room visits, hospitalizations, and costs. A one unit increase in the efficiency score was associated with greater benefits for cost and mortality for African American and white patients. The benefit was larger for African American patients compared to white patients. Conclusions: Increasing hospital efficiency may help improve outcomes among Medicare prostate cancer patients. Policies to redirect patients to hospitals with higher efficiency can enhance the quality of care and outcomes. Full article

Introduction: Individuals experiencing homelessness have higher rates of chronic disease and face challenges accessing primary care. Virtual health care can reduce health inequity but needs user acceptance. A virtual health hub (VHH) for people experiencing homelessness in Sydney provided virtual GP and psychologist care within a crisis accommodation service. This included nursing assistance. Method: The VHH evaluation assessed the feasibility of the service specifically examining accessibility, efficiency, costs, technology, quality, and outcomes through attendance data, patient measures, stakeholder interviews, and case studies. Findings: Data indicated 40% client utilisation with high attendance for GPs and/or psychologists. All clients reported a high quality of care, appointment benefits, understanding clinicians, and treatment help, and that privacy was maintained. If the VHH was not available, one-third would not have sought treatment. The majority agreed that virtual care was the same or better than in-person care. Only a few experienced technical issues. Service provider interviews indicated the benefits of accessible and affordable care, perceived reduced hospital presentations, staff time saved, and reduced client costs. Limitations were the lack of physical examinations and lack of follow-up due to temporary accommodation. Strong stakeholder partnerships enabled implementation success. Conclusions: The VHH service is feasible and replicable with on-site assistance and stakeholder commitment. Full article

Antibiotics, widely used pharmaceuticals, enter wastewater treatment systems and ultimately the aquatic environment through the discharge of wastewater from residential areas, hospitals, breeding farms, and pharmaceutical factories, posing potential ecological and health risks. Due to the misuse and discharge of antibiotics, the spread of antibiotic resistance genes (ARGs) in water bodies and significant changes in microbial community structure have direct toxic effects on aquatic ecosystems and human health. This paper summarizes the occurrence of antibiotics in wastewater treatment systems and their ecological and health risks, focusing on the impact of antibiotics on aquatic microorganisms, aquatic plants and animals, and human health. It points out that existing wastewater treatment processes have poor removal capabilities for antibiotics and even become an important pathway for the spread of some antibiotics. In terms of detection technology, the article discusses the application of immunoassays, instrumental analysis, and emerging sensor technologies in detecting antibiotics in sewage, each with its advantages and limitations. Future efforts should combine multiple technologies to improve detection accuracy. Regarding the removal methods of antibiotics, the paper categorizes physical, chemical, and biodegradation methods, introducing various advanced technologies including membrane separation, adsorption, electrochemical oxidation, photocatalytic oxidation, and membrane bioreactors. Although these methods have shown good removal effects in the laboratory, there are still many limitations in large-scale practical applications. This paper innovatively takes urban wastewater treatment systems as the entry point, systematically integrating the sources of antibiotics, environmental risks, detection technologies, and treatment methods, providing targeted and practical theoretical support and technical guidance, especially in the removal of antibiotics in wastewater treatment, on a scientific basis. Future efforts should strengthen the control of antibiotic sources, improve the efficiency of wastewater treatment, optimize detection technologies, and promote the formulation and implementation of relevant laws and standards to more effectively manage and control antibiotic pollution in the aquatic environment. Full article

A lack of personnel in care institutions and high proportions of older people in need of care pose central challenges for today’s aging society, often resulting in the hospitalization of geriatric patients. In many cases, these hospitalizations are not medically necessary and cause deterioration of health. Applying telemedicine in nursing homes represents one approach aimed at a reduction of unnecessary hospitalizations of geriatric patients and supporting care personnel in medically uncertain situations. For a sustainable and successful implementation of technical innovations such as telemedical consultations, the care personnel’s perspectives and acceptance are especially essential. The Optimal@NRW project implemented telemedical consultations in 24 nursing homes in Germany, investigating medical and economic efficiency and in particular also the social acceptance of digital care in nursing homes. This paper presents quantitative results comparing the acceptance evaluations before (PRE: N = 130) and after (POST: N = 87) the implementation of the telemedical consultations in the nursing homes from the perspective of care professionals. The results showed positive evaluations of the telemedical consultations in both evaluation phases: POST evaluations especially showed a lower evaluation of perceived barriers of using telemedical consultations in nursing homes. This study’s insights enable one to derive guidelines and recommendations regarding the communication and information of telemedical applications considering the needs and wishes of care personnel as a central user group. Full article