Search Results (1,011)

Rising cancer incidence and survival rates have led to an unprecedented demand for psychosocial care. Yet, limited financial and practical resources present a barrier to the provision of evidence-based care. Clinical practice guidelines (CPGs) are well-positioned to enhance the quality and efficiency of psychosocial oncology care; however, little is known about their use and perceptions in the field. The present study explored the use and perceptions of CPGs among 172 Canadian psychosocial oncology clinicians via a cross-sectional, online survey. Findings revealed substantial variation in awareness, with over 20% of participants reporting no familiarity with CPGs, and low to moderate use of CPGs (M = 2.97, SD = 2.96) among users. Key barriers included a lack of formal training, limited applicability to local contexts, and systemic constraints such as high workloads. Conversely, participants highly endorsed facilitators, including accessible training programs, relevant tools/interventions, and greater institutional and community engagement. Clinician perspectives are paramount to the dissemination and implementation of psychosocial oncology CPGs. Our findings suggest that successful implementation requires broader accessibility, widespread adaptation, and greater community engagement. By addressing these systemic constraints, CPGs may be better positioned to bridge the gap between evidence and real-world service provision. Full article

Buffalo meat is widely consumed in Egypt; however, it may pose serious food safety risks due to microbial contamination during handling, preparation, and processing. This study investigated the prevalence and characterization of multidrug-resistant (MDR) enterotoxigenic Staphylococcus aureus in raw ground buffalo meat and ready-to-eat (RTE) kofta and liver sandwiches marketed in Mansoura, Egypt. S. aureus was detected in 62% (62/100) of raw buffalo ground meat, 41% (41/100) of RTE kofta, and 60% (60/100) of RTE liver samples, with an overall prevalence of 54.3% (163/300). All 660 isolates were confirmed as S. aureus via nuc gene detection, among which 46.8% (309/660) were mecA-positive and verified as methicillin-resistant (MRSA), and 21.8% (144/660) were vanA-positive and verified as vancomycin-resistant (VRSA). Enterotoxigenic strains were identified in 42.7% (282/660) of isolates, with the sea gene being most prevalent (67.7%; 191/282), followed by seb (58.2%; 164/282) and sec (39.7%; 112/282). The highest frequency of enterotoxigenic strains occurred in raw ground meat (47.2%), followed by kofta (45.1%) and liver (36%). Antimicrobial susceptibility testing against 15 antibiotics revealed that 7.6% (50/660) of isolates were extensively drug-resistant (XDR) with a MAR index of 0.9, while 82.9% (547/660) were MDR with MAR values between 0.3 and 0.7, indicating exposure to environments of intensive antibiotic use. The present findings highlight a high contamination level of buffalo meat products with MDR enterotoxigenic MRSA and VRSA, representing a significant public health hazard. Implementation of strict hygiene measures, wise antibiotic usage, and continuous surveillance is essential to control their dissemination through the food chain. Full article

Introduction: AQUArestore is a three-year project focused on promoting adaptive ecological restoration strategies for river ecosystems in the vulnerable cross-border region of Portugal. The project responds to pressing environmental challenges across the territory, including severe habitat degradation, climate vulnerability, declining water security, and biodiversity loss, with particular concern for freshwater fish communities, making river restoration essential to preserve native species and freshwater ecosystem services. Objective: The project aims to develop a replicable framework for restoration of Mediterranean transboundary riverine habitats, supporting the objectives of the EU Nature Restoration Law (NRL, Regulation 2024/1991). The consortium AQUArestore will develop (1) robust restoration indicators, (2) implement living labs for restoration experimentation, and (3) establish capacity-building and training programs for technicians and citizens. Methodology: The project kick-off meeting was used to operationalize project tasks, detail the implementation calendar and milestones, and clarify responsibilities of each project member and partner institutions within the different work tasks. The meeting gathered consortium members from the coordinating institution CEF-ISA (researchers at the Instituto Superior de Agronomia) and partners WWF Portugal (an environmental NGO) and Mushmore Cooperative, each one contributing according to their respective expertise and institutional objectives. Results: The AQUArestore project kick-off meeting took place in January 2026 at ISA, Lisbon, and included a presentation of the NRL and a detailed discussion of project task development. In detail, the activities will begin with the compilation of information on previously restored sites (Task 1). This will support the development and validation of environmental and biodiversity indicators of restoration outcomes, including those linked to freshwater fish assemblages and riparian vegetation (Task 2). The project will then establish two living labs as platforms to test nature-based solutions in collaboration with stakeholders and local communities (Task 3). In parallel, AQUArestore will strengthen technical capacity through training for practitioners and public authorities (Task 4). Finally, dissemination will be supported through citizen science, communication activities, and stakeholder engagement, fostering a broader impact (Task 5). Together, these tasks provide an integrated, science-based, and participatory framework aiming to support adaptive river restoration under climate and environmental changes. Conclusions: By integrating ecological restoration, biodiversity and environmental monitoring, and stakeholder engagement, AQUArestore is expected to contribute to the recovery of Mediterranean freshwater ecosystems and improve habitat quality and connectivity for native fish communities, enhancing resilience to climate change and other anthropogenic pressures. Full article

The mineralogical characteristics of low-grade hard-rock uranium ore from the Zoujiashan deposit were systematically investigated via multiple analytical techniques, including chemical analysis, X-ray fluorescence (XRF) spectrometry, uranium occurrence analysis, 3D X-ray micro-computed tomography (CT), an automated mineral identification and characterization system (AMICS), and scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy (SEM-EDS). The results revealed that the uranium grade of the ore was only 0.202%, among which 65.87% existed in the form of independent uranium minerals, while the remaining 34.13% existed in a dispersed ionic state. Except for quartz, most uranium minerals and gangue minerals were finely disseminated and closely intergrown. The pre-concentration of the ore is therefore necessary to separate uranium-rich particles from barren particles at a coarse particle size. Ore density analysis demonstrated that the feed particle size exerted a significant impact on the separation performance, and the optimum feed particle size was determined to be 20 mm. Subsequently, dense medium cyclone (DMC) separation tests were conducted. The experimental results indicated that fine grains were prone to report to low-density products (tailings) during mixed-size beneficiation. Under a tailings yield of 54%, for the −20 + 8 mm coarse fraction, the tailings uranium grade was 0.025% and the uranium recovery of the concentrate was 88.05%. Therefore, classified separation can effectively promote separation efficiency. To reveal the density control mechanism of the particle separation behavior inside the DMC, computational fluid dynamics (CFD) simulations were implemented with the Eulerian–Eulerian multiphase model in ANSYS-Fluent (version 2020R2). The simulation results suggested that a density difference of 8.6% realized effective separation. This work achieved the effective treatment of low-grade hard-rock uranium ore via DMC separation, providing a novel technical route for uranium ore pre-concentration. Full article

Introduction: The invasive European catfish (Silurus glanis) is actively spreading across Iberian freshwaters, with no effective management measures in place to control its growing abundance or prevent its establishment in new localities. It poses a severe threat to endemic and already endangered species, and is simultaneously a preferred target by few anglers who continuously promote its spread. The LIFE-PREDATOR project aims to stop the spread of European catfish in lentic systems in Portugal and Italy, particularly in protected areas. Objectives: This talk will present the mid-term results of the LIFE-PREDATOR in Portugal, and discuss the difficulties and future challenges to reduce the size of local populations of European catfish. Methodology: The LIFE-PREDATOR team developed several tasks in Portugal: (1) established the reference situation of fish communities in six reservoirs in the Tagus Basin, using scientific fishing, fish telemetry and eDNA-based tools; (2) determined the optimal protocols for sampling catfish; (3) implemented an early detection programme based on warning teams, data-mining and eDNA tools; (4) developed population control actions in four reservoirs; and (5) organised dissemination events for the general public, anglers, and students from kindergarten to university levels. Results: Overall, there is a grim view about recipient communities in the studied lentic systems, which tend to be dominated by invasive fish species, including common carp (Cyprinus carpio), gibel carp (Carassius gibelio), European catfish, pikeperch (Sander lucioperca), European perch (Perca fluviatilis) and largemouth bass (Micropterus nigricans). At least three new localities harbouring catfish were identified from online data-mining and warning teams. A total of 8 tons of catfish were removed by mid-June of 2025, mostly from the Natural Park of International Tagus. Outreach activities were conducted in nearly 60 schools, reaching more than 5000 students. Moreover, 67 general public events have reached more than 4500 people since the project started (September 2023). Conclusions: Despite its positive outcomes, the LIFE-PREDATOR team has encountered challenges in engaging key stakeholders such as anglers, involving local municipalities, and implementing catfish removal actions in remote areas. Difficulties and challenges in catfish management must therefore be debated in order to assure the after-LIFE implementation across Portuguese protected areas. Full article

Objectives: This study aims to assess the acceptance of vaccinations among pregnant women, particularly against influenza, pertussis, COVID-19, and RSV, and to identify factors influencing their willingness to get vaccinated. It also seeks to evaluate the impact of the COVID-19 pandemic on maternal attitudes and behaviors regarding vaccination. Methods: The analysis involved a review of existing literature and studies to evaluate the level of vaccine acceptance among pregnant women before and after the COVID-19 pandemic. Factors contributing to vaccine hesitancy, including misinformation, lack of knowledge, and the influence of healthcare professionals, were examined. Results: The findings indicated that, despite scientific evidence supporting the safety and efficacy of vaccines during pregnancy, public concerns remain about their impact on the developing fetus. The outbreak of the COVID-19 pandemic has increased awareness of the risk of infectious diseases, but at the same time, its impact on vaccination rates among pregnant women is ambiguous and geographically diverse. Misinformation and decreased access to healthcare during the pandemic negatively affected vaccine uptake. Trustworthy information provided by healthcare professionals emerged as a key factor in promoting vaccine acceptance. Conclusions: To improve vaccination rates among pregnant women, it is essential to provide clear, evidence-based information through healthcare professionals, particularly those directly caring for pregnant women. Educational campaigns should address concerns calmly and without judgment, emphasizing the safety and benefits of vaccinations. Enhanced access to healthcare and vaccinations, along with strategic information dissemination, can significantly improve vaccine acceptance during pregnancy. Lessons learned from past pandemics should be incorporated into the development of healthcare strategies aimed at implementing recommended vaccinations for pregnant women in the future. Full article

Frequent engineering changes in manufacturing require worker instructions to be updated quickly and reliably. In many production environments, however, update handling still depends on manual comparison procedures, delayed communication, or repeated traversal of large document collections, limiting responsiveness during ongoing production changes. This paper presents a hierarchical hash-based method for change detection in structured manufacturing documents as the computational core of a worker assistance system for near-real-time instruction updates in the context of in-line qualification. Heterogeneous instruction data are transformed into canonical hierarchical document structures, from which SHA-512 digests are generated at multiple structural levels. During repeated comparison operations, document-state evaluation is reduced to digest comparison, while structural differences can be localized through hierarchical refinement of affected substructures. The method is integrated into a system architecture that combines predecessor-linked version management with role-specific filtering for controlled dissemination of relevant instruction updates. The approach was implemented in an automotive assembly use case involving structured work instructions and evolving production documentation. The evaluation demonstrates that the proposed approach reduces repeated comparison effort relative to conventional field-wise traversal methods while maintaining the ability to localize structural changes through hierarchical refinement. The reported results focus on computational behavior and implementation feasibility in structured manufacturing environments rather than hardware-specific throughput benchmarks. Overall, the results indicate that hierarchical comparison of structured instruction states provides a practical basis for change-aware worker assistance and controlled propagation of instruction updates in evolving manufacturing environments. The evaluation focuses on repeated-comparison scenarios in structured manufacturing settings and does not address semantic interpretation of detected changes or large-scale distributed deployments. Full article

Background: Armed conflict and geopolitical instability increasingly affect mental health beyond directly exposed populations through continuous media exposure and digital information dissemination. Nursing students may be particularly vulnerable because of high academic demands, emotional sensitivity to human suffering, and intensive engagement with social media and online news platforms. This study examined the association between conflict related news exposure and depression, anxiety, and stress among nursing students in Saudi Arabia during the February 2026 regional military escalation involving Iran, and explored the role of perceived safety concern and the potential indirect associations involving sleep difficulty and study disruption. Methods: A multi-center cross sectional study was conducted among nursing students from different public universities across five regions of Saudi Arabia. Psychological distress was assessed using the Depression Anxiety Stress Scale. A composite conflict exposure index was developed from conflict news following frequency and exposure intensity measures. We used Gamma generalized linear models, interaction analyses, and structural equation modeling to evaluate associations, moderation by information source, and mediation pathways. Results were reported as arithmetic mean ratios (AMRs) with 95% confidence intervals, representing the relative change in mean psychological distress scores associated with each predictor. Models were adjusted for sociodemographic, academic, and living-related factors. Results: A total of 247 nursing students were included. Moderate to severe depression, anxiety, and stress were reported by 50.2%, 59.9%, and 32.4% of participants, respectively. Our findings showed that higher conflict exposure was associated with increased stress levels (AMR = 1.17, 95% CI: 1.02–1.34), while associations with depression (AMR = 1.14, 95% CI: 0.99–1.30) and anxiety (AMR = 1.13, 95% CI: 0.99–1.28) were weaker. Associations between conflict-related exposure and depression, anxiety, and stress were substantially attenuated after accounting for perceived safety concern, which remained strongly associated with all psychological distress outcomes (AMR = 1.32, 95% CI: 1.19–1.47), anxiety (AMR = 1.31, 95% CI: 1.18–1.44), and stress (AMR = 1.36, 95% CI: 1.24–1.51). Compared with television news users, students relying on online news demonstrated substantially higher depression (AMR = 1.92, 95% CI: 1.32–2.78), anxiety (AMR = 1.84, 95% CI: 1.29–2.64), and stress scores (AMR = 1.88, 95% CI: 1.29–2.74). Structural equation modeling identified significant indirect associations involving sleep difficulty and study disruption, whereas direct associations between exposure and psychological distress were comparatively weak. Conclusions: Conflict-related media exposure was associated with poorer mental health among nursing students, with perceived insecurity, sleep difficulties, and study disruption showing strong associations with psychological distress and patterns consistent with indirect relationships. Universities and nursing education programs should consider implementing mental health support, media literacy interventions, sleep health promotion, and psychosocial support strategies during periods of regional geopolitical instability. Full article

Background: Pancreatic ductal adenocarcinoma (PDAC) exhibits high post-resection relapse and early systemic dissemination rates. The level of circulating tumor cells (CTCs) correlates with early metastatic failure, motivating CTC interception strategies. Methods: In this hypothesis-driven review, we synthesized the contemporary evidence on PDAC staging and therapy, CTC detection (including portal versus peripheral sampling), and circulating tumor DNA (ctDNA)-based minimal residual disease (MRD), and evaluated the translational rationale for CTC-targeted adoptive immunotherapy focusing on CEACAM6 and CAR-T cells. Results: Prospective studies report higher portal versus peripheral CTC yields and stronger associations with relapse; tumor-informed ctDNA positivity in peri-operative and surveillance windows predicts shorter disease-free survival. CEACAM6 is overexpressed in PDAC and linked to invasion and metastasis, supporting antigen selection. However, target overexpression alone does not establish clinical suitability for adoptive cell transfer. Consequently, its therapeutic implementation must contend with assay heterogeneity, on-target/off-tumor risks, and the lack of interventional outcome data in PDAC, all of which remain key hurdles. Conclusions: CTC-targeting is biologically plausible and operationally measurable in PDAC. Consequently, a CEACAM6-directed CAR-T approach is proposed as a potential strategy for the interception of minimal residual disease (MRD). Randomized and biomarker-selected trials with composite MRD-clearance endpoints (CTC < LOQ and ctDNA-negative) may be justified to validate this interventional hypothesis. Full article

Dog aggression toward humans represents a relevant public health issue. In Italy, small animal veterinarians are expected to contribute to the early identification of at-risk situations and to aggression prevention. This study aimed to assess, through a nationwide survey, veterinarians’ perception of this role, regulatory awareness, and clinical practices related to dog aggression prevention in Italy. A cross-sectional study was conducted between November 2025 and February 2026 using an anonymous online questionnaire disseminated through provincial veterinary boards to private veterinarians working in small animal practice. A total of 1088 valid responses were analyzed using descriptive, inferential, and multivariable analyses. Almost all respondents reported frequent encounters with aggressive behavior, with more than 60% managing at least five aggressive dogs per year. Although 80% recognized an active preventive role for veterinarians, only 55% were aware of the current Ministerial Ordinance and 19% had ever submitted a report to public veterinary services. Specific training in behavioral medicine was independently associated with greater regulatory awareness and reporting behavior. Strong support also emerged for mandatory owner training and early behavioral assessment. A substantial gap persists between the preventive role assigned to veterinarians and the practical implementation of preventive tools. These findings support the need for strengthened behavioral medicine training and improved integration between private practitioners and public veterinary services. Full article

Background/Objectives: Rabbit farming in Romania is increasingly important for providing high-quality meat, yet productivity is frequently threatened by enteric diseases, particularly in young animals. Among bacterial etiologies, Clostridioides difficile (C. difficile) has emerged as a significant gastrointestinal pathogen, with findings suggestive of systemic dissemination and public health implications. This study aimed to investigate a fatal case of C. difficile infection in a farmed rabbit and to characterize the pathogen’s microbiological, toxigenic, and antimicrobial profile. Methods: An 11-month-old male German Giant Spotted rabbit presenting acute diarrhea, anorexia, and rapid deterioration after unsupervised administration of enrofloxacin and sulfaquinoxaline was submitted postmortem. Necropsy was performed, and samples from cecum, colon, liver, spleen, mesenteric lymph nodes, lungs, and femoral bone marrow were collected. Microbiological analysis included selective culture on CCFA medium, ELISA for toxin A and B detection, MALDI-TOF MS identification, PCR confirmation, and antimicrobial susceptibility testing with the VITEK 2 system. Histopathological examination was conducted on intestinal and parenchymal tissues. Results: Necropsy revealed severe congestion and necrosis of the cecal and colonic mucosa, hepatomegaly, splenic congestion, and petechial hemorrhages. C. difficile was isolated from intestinal sites, confirmed as toxigenic by ELISA and PCR. Histopathology showed necrotizing colitis with epithelial desquamation, fibrin deposition, and heterophilic infiltration. The strain exhibited resistance to clindamycin, ampicillin, and tetracycline, with susceptibility to vancomycin, linezolid, and tigecycline. Conclusions: This case demonstrates that C. difficile can cause severe disease in rabbits, particularly following antimicrobial-induced dysbiosis. The findings underscore the importance of prudent antibiotic use, monitoring of toxigenic strains in rabbit populations, and implementation of preventive strategies to mitigate health risks in both animals and potentially humans. Full article

Background: Multimodal rehabilitation represents standard practice in musculoskeletal care, where exercise therapy is routinely combined with manual therapy, electrotherapy, education, and cognitive–behavioral strategies. However, research has largely evaluated these modalities in isolation, and no bibliometric synthesis has characterized multimodal rehabilitation despite its predominance in routine practice. Objective: To characterize global research activity, thematic clusters, and diagnostic patterns underpinning multimodal musculoskeletal rehabilitation and to examine their alignment with contemporary rehabilitation guidelines and practice models. Methods: A bibliometric and altmetric analysis was performed using Web of Science Core Collection (1989–2026). Studies indexed under exercise therapy, manual therapy, electrotherapy, education, and cognitive–behavioral approaches were included. Network analyses (co-occurrence, co-authorship, thematic evolution, and bibliographic coupling) were conducted using Bibliometrix and VOSviewer. Diagnostic subgroups included osteoarthritis, low back pain, chronic musculoskeletal pain, tendinopathy, and shoulder disorders. Results: A total of 409 publications were identified. Five multimodal combinations were recurrent: exercise + education, exercise + cognitive–behavioral therapy, exercise + manual therapy, exercise + electrotherapy, and mixed multimodal programs. Diagnostic subgrouping showed distinct patterns, with osteoarthritis and low back pain clustering around exercise + education, chronic musculoskeletal pain around exercise + CBT/self-management, and tendinopathy/shoulder disorders around exercise + manual therapy. Temporal analyses demonstrated a shift from unimodal electrophysical agents toward guideline-aligned biopsychosocial models. Altmetric signals suggested relevant dissemination and policy attention. Conclusions: Multimodal musculoskeletal rehabilitation is research-intensive, diagnosis-specific, and aligned with guideline recommendations prioritizing exercise, education, self-management, and behavioral strategies. These findings support multimodal rehabilitation as a maturing evidence-based practice model with implications for pragmatic trials, guideline implementation, and clinical service delivery. Beyond research implications, these patterns are relevant for musculoskeletal care pathways, training of rehabilitation professionals and health system planning. Full article

Background: While equine patient-mediated introduction of A. baumannii into hospital settings has been documented, its environmental dissemination and the risk of hospital-acquired surgical site infection remain poorly understood. Objective: Therefore, this descriptive observational study examined (a) the environmental distribution of Acinetobacter spp. in an equine university hospital, (b) the impact of the implementation of new hygiene protocols, (c) the specification of resistance patterns, and (d) the evaluation of the presence of Acinetobacter spp. in hospital-acquired wound infections. Methods: During three sampling periods, environmental samples of the stables, the treatment, and surgery areas were collected before and after cleaning and disinfection. After sampling period 1 (December 2021), the cleaning routines were optimized by reviewing the cleaning and disinfection process, as well as including further surfaces in the cleaning schedule for January 2022). This was followed by a second (February 2022) and a third (June 2022) sampling period. During sampling periods 1 and 2, 76 surfaces were sampled; in sampling period 3, only 21 critical surfaces were examined. Samples were cultured on selective agar plates and incubated at 37 °C, with bacterial growth evaluated after 24–48 h. Wound swabs were enriched in broth before culturing. Bacteria were identified using MALDI-TOF mass spectrometry. During the first sampling period, antibiotic susceptibility testing was performed using broth microdilution according to CLSI-vet standards. Results: During each sampling period, Acinetobacter spp. was detected in at least one sample in each of the different areas; however, there was a reduced detection rate from sampling period 1 throughout sampling period 3. The isolates were highly resistant against beta-lactam and macrolide antibiotics but mostly sensitive to fluroquinolones (enrofloxacin, 2.2% resistance; marbofloxacin, 0.0% resistance), aminoglycosides (gentamicin, 6.5% resistance; kanamycin, 8.7% resistance), and tetracyclines. Acinetobacter spp. was not detected in surgical site infections. Conclusions: Environmental persistence of Acinetobacter spp. in an equine clinical setting does not necessarily translate into surgical site infections. Through prudent antibiotic use, the antibiotic susceptibility of the isolates may be perceived. Full article

Background: China and India represent a large proportion of the Asian birth cohort and have produced extensive but heterogeneous evidence on neonatal hearing screening. This scoping review summarizes studies published between 2005 and 2025 on otoacoustic-emission-based neonatal hearing screening programs in these countries, with emphasis on program implementation, screening coverage, the prevalence of congenital and bilateral hearing loss, follow-up, and intervention pathways. Methods: Searches were conducted in PubMed, Scopus, and Google Scholar using predefined keywords. Studies reporting screening protocols, coverage, prevalence, or follow-up outcomes were included. The standard English language filter was used. A total of 19 papers were considered for this review. Results: The data from the two assessed Asian states show two clearly different screening implementation profiles. In China, universal hearing screening has evolved into a large-scale and increasingly standardized system, supported by technical specifications and regional or municipal databases. The reported screening coverage was 85.8% in early rural programs, 93.6% in Shanghai, and 97.9% in Liuzhou. National institutional surveys indicate that UNHS has now been substantially implemented in many regions. Reported hearing loss prevalence estimates generally ranged from 1.66 to 3.43 per 1000 newborns, although follow-up and regional equity remain problematic, especially in rural settings. In India, the evidence is dominated by tertiary-hospital feasibility studies rather than a uniformly implemented national program. Reported hearing loss prevalence estimates varied more widely, from 0.29 to 5.60 per 1000 screened newborns, largely reflecting differences in study design, screening timing, referral completion, and population risk profile. Across both countries, OAE-based two-stage or sequential OAE + AABR protocols reduced referral rates and improved case identification, but loss to follow-up remained a recurrent limitation. Conclusions: China and India provide complementary models of neonatal hearing screening expansion. China demonstrates the effects of system-level scale-up, whereas India highlights the feasibility and constraints of hospital-based implementation in a highly diverse healthcare environment. Future priorities include stronger follow-up systems, harmonized reporting standards, and broader dissemination of outcome data through peer-reviewed publications. Full article

Endogenous candidiasis remains an underrecognized yet clinically relevant complication in non-neutropenic critically ill patients. This study examines Candida spp. infections in the intensive care unit (ICU) within a patient-safety and risk-management framework, focusing on the identification of patients at highest risk and the development of an early diagnostic and therapeutic strategy. The target population comprises long-stay ICU patients requiring prolonged mechanical ventilation who develop multiple organ dysfunction syndrome (MODS) associated with immunoparalysis, typically reflected by a Sequential Organ Failure Assessment (SOFA) score ≥ 5. In this population, Candida spp. colonization may evolve into multifocal candidiasis and subsequently invasive or disseminated disease. Notably, candidemia often represents a late manifestation and therefore lacks sensitivity as an early diagnostic marker. Drawing on a series of clinical investigations conducted from 1978 to the early 2000s, the authors developed a standardized diagnostic–therapeutic algorithm based on systematic surveillance cultures, identification of multifocal Candida spp. colonization, and early initiation of antifungal therapy. Implementation of this strategy, together with progressive individualization of antifungal treatment, was associated with a marked reduction in attributable mortality related to candidiasis in ICU patients. These findings support the concept of Candida spp. infection as a sentinel indicator of systemic immune dysfunction and physiological fragility in critical illness. Integrating risk-based surveillance with early targeted therapy may substantially improve outcomes and reinforce patient-safety strategies in the ICU. Full article