Search Results (4,931)

Background: Bayesian model-informed precision dosing (MIPD) is increasingly used to individualize drug therapy; therefore, this review aimed to identify and characterize its implementation in routine clinical practice. Methods: A focused systematic review was conducted. Web of Science Core Collection and PubMed were searched from inception to February 2026. Eligible studies were original research articles evaluating Bayesian MIPD in routine clinical practice using software platforms that supported dosing decisions. Data were synthesized descriptively. No formal risk-of-bias assessment was performed due to heterogeneity in study design. Results: Fifteen studies met the inclusion criteria. Anti-infective therapy predominated, particularly vancomycin (n = 11), with additional studies involving busulfan, mycophenolate mofetil, amikacin, and tobramycin. Commonly reported software platforms included InsightRx (n = 6) and DoseMeRx (n = 4), along with Abbottbase, NextDose, and ISBA. MIPD was mainly applied with therapeutic drug monitoring, reflecting predominant a posteriori use in routine care. Across studies, implementation was associated with improved pharmacokinetic target attainment, while a subset reported clinical benefits, including reduced nephrotoxicity and favorable effectiveness-related outcomes. Pharmacist involvement was commonly described. Conclusions: Published evidence indicates that Bayesian MIPD is being implemented in routine clinical settings, but current published experience is dominated by vancomycin-focused studies. Although the evidence base remains limited, it has grown since 2020 and suggests that software-supported Bayesian dosing can improve pharmacokinetic target attainment and may support better clinical outcomes. Full article

Background/Objectives: Blood transfusion is a crucial component in the treatment of individuals with sickle cell disease [SCD]; nonetheless, multiple transfusions can lead to considerable complications, notably alloimmunization. However, the prevalence of alloimmunization and its predictors remain incompletely explained. This review aimed to determine its global prevalence and identify associated risk factors. Method: Our protocol was registered in PROSPERO [ID: CRD420251167042] in accordance with the PRISMA 2020 criteria. A thorough literature search was conducted across PubMed, Embase, Web of Science, Scopus, and the Cochrane Library to identify studies reporting the prevalence of alloimmunization in adults with confirmed sickle cell disease who have received blood transfusions. This search included all publications up to 16 April 2026. Two reviewers independently screened and extracted data, and the Newcastle–Ottawa Scale was used to evaluate the study’s quality. After the Freeman–Tukey transformation, a random-effects model was used to estimate the pooled prevalence. We examined disparities among groups and geographies, study designs, and matching procedures to determine their differences. We additionally employed meta-regression to identify potential predictors. Results: Nine studies [n = 1711; 1978–2026] met the inclusion criteria. The overall rate of alloimmunization was 28.9% [95% CI 22.4–35.4; I² = 88.5%]. The most prevalent antibodies were those of the Rh and Kell systems, with anti-E antibodies being the most frequent, followed by anti-C and anti-K antibodies. A higher number of transfusions and the HbSβ⁰ genotype were both persistent risk factors, while older age at first transfusion appeared protective. Extended antigen matching dramatically reduced prevalence, though approximately 9% of individuals remained affected. Conclusions: Alloimmunization continues to challenge transfusion management in adults with SCD. Broader implementation of extended antigen matching and genotype-informed transfusion strategies may help mitigate this risk. Full article

In Latin America and the Caribbean, the circular economy approach is embedded in productive structures characterized by a dependence on natural resources and the persistence of informal economies. The general objective of this article is to analyze the circular economy as an approach to production and consumption in Latin America and the Caribbean through a bibliometric and qualitative analysis of scientific literature. This study adopted a mixed, descriptive, and analytical research design. International and regional databases (Scopus, Web of Science, SciELO, and Redalyc) were used to identify articles published between 2015 and 2025. The selection process followed the PRISMA protocol, resulting in a final qualitative analysis of 47 articles. The results reveal an accelerated and sustained growth in scientific production in the region, with a maximum increase of 250% in 2017, indicating a progressive consolidation of the field. The documentary corpus consists mainly of original articles (65%), with a clear preeminence of environmental sciences, engineering, and energy. Qualitatively, the literature shows a conceptual heterogeneity that adapts the circular economy to sustainable development and industrial ecology, uniquely incorporating grassroots recyclers and cooperatives into a “just transition.” However, there is evidence of an implementation gap: while large industries are making progress in eco-design and remanufacturing, adoption in SMEs and responsible consumption—especially in repair and reuse—remains at incipient levels due to structural and cultural limitations. Ultimately, the results suggest a growing concentration of circular economy research within selected Latin American institutions, indicating the emergence of regionally grounded research agendas that may differ in emphasis from dominant Global North framings. Full article

Couples generally manage chronic diseases together and the management takes an emotional toll on both patients and their romantic partners. Consequently, recognizing the emotions of each partner in daily life could provide insight into their emotional well-being in chronic disease management. Currently, the process of assessing each partner’s emotions is manual, time-intensive, and costly. Despite the existence of works on emotion recognition among couples, none of these works have used data collected from couples’ interactions in daily life. In this work, we collected 85 h (1021 5-min samples) of real-world multimodal smartwatch sensor data (speech, heart rate, accelerometer, and gyroscope) and self-reported emotion data (n = 612) from 26 partners (13 couples) managing diabetes mellitus type 2 in daily life. We extracted physiological, movement, acoustic, and linguistic features, and trained machine learning models (support vector machine and random forest) to recognize each partner’s self-reported emotions (valence and arousal). Our results from the best models—balanced accuracies of 63.8% and 78.1% for arousal and valence respectively—are better than the results from (1) chance, (2) prior work that also used data from German-speaking, Swiss-based couples, and (3) partners’ perceptions of each other’s emotions. This work contributes toward building automated emotion recognition systems that would eventually enable partners to monitor their emotions in daily life and enable the delivery of interventions to improve their emotional well-being. Full article

Background: The importance of evidence-based practice (EBP) is well recognized, yet its implementation remains challenging across healthcare systems, especially in low- and middle-income countries, where resource constraints, workforce turnover, and organizational barriers can hinder practice change. The traditional approach to implementation has focused on training, guidelines, and leadership support; however, these strategies do not always sustain frontline staff engagement. Objective: This descriptive case study examined how social movement strategies supported a multi-year EBP implementation initiative within a Philippine academic–clinical partnership. Methods: Program documents, training records, implementation reports, curriculum materials, and internal records of guideline-related activities were reviewed. Data were organized using the Social Movement Action Framework, with attention to preconditions for change, social movement mechanisms, and implementation outcomes. Results: The initiative included champion training, guideline integration, awareness activities, academic–clinical collaboration, and practice-focused implementation efforts related to breastfeeding, vascular access device management, and pressure injury prevention. These activities provided observable process indicators of stakeholder engagement, shared ownership, and continued use of guideline-informed practices. Conclusions: Social movement strategies may offer a useful complementary lens for understanding how EBP implementation gains momentum in real-world healthcare settings. Additional studies should explore their relationship to implementation outcomes and clinical care processes. Full article

Background/Objectives: Simulation-based education is increasingly used in health sciences to promote active learning and the development of clinical and non-technical skills. However, its implementation in undergraduate dental education remains limited. This study aimed to explore dental students’ perceptions of the Self-Learning Methodology in Simulated Environments (MAES©) applied to high-fidelity simulation. Methods: A mixed-methods, cross-sectional pilot study was conducted with 80 fourth-year dental students enrolled in a Pediatric Dentistry course at a Spanish university. Quantitative data were collected using a validated satisfaction questionnaire (Cronbach’s alpha = 0.905), and descriptive statistics were performed. Qualitative data were obtained through open-ended questions and analyzed using inductive content analysis. Results: Students reported high levels of satisfaction, motivation, and perceived learning, with mean scores above 8.5 out of 10 across all evaluated dimensions. The facilitator’s role received the highest ratings. Qualitative analysis identified four main themes: perceived advantages of the methodology, increased engagement and participation, the value of structured debriefing, and areas for improvement related to group dynamics and performance-related stress. Conclusions: The MAES© methodology was well received and perceived as a feasible approach in dental simulation-based education. It may support student-centered learning, collaboration, and reflective practice, providing practical guidance for educators interested in implementing active learning strategies. As an exploratory pilot study conducted in a single institution, these findings should be interpreted cautiously and warrant further research. Full article

Background/Objectives: Lipidomics has become a key component of systems biology, enabling comprehensive characterisation of lipid species and their roles in health and disease. As regulators of membrane architecture, energy balance, inflammation, and cellular signalling, lipids offer a powerful framework for understanding metabolic dysfunction. In veterinary medicine, however, lipidomics remains comparatively underdeveloped. In cats, lipid metabolism is central to disorders such as hepatic lipidosis, cystitis, obesity, diabetes mellitus, and chronic inflammatory enteropathies, yet available data remain limited. This systematic review synthesised current evidence on lipidomics and lipid-focused profiling in feline disease and identified lipid alterations with potential clinical relevance. Methods: Following PRISMA 2020 guidelines, PubMed, ScienceDirect, and Scopus were searched for original studies (1994–2026) evaluating lipidomics or lipid-focused profiling in cats. Eligible studies assessed lipid species, fatty acids, lipid mediators, or lipoproteins in disease or physiological states. Owing to methodological heterogeneity, findings were synthesised narratively. Results: Seventeen studies met inclusion criteria, covering hepatic, urinary, gastrointestinal, renal, neurological, oncological, metabolic, and pharmacologically modulated conditions. Recurring alterations involved lipoproteins, triglycerides, phospholipids, sphingolipids, fatty acids, and oxylipins. More consistent patterns emerged in hepatic lipidosis, where lipoprotein disturbances may aid diagnosis; in lower urinary tract disease, where PUFA-derived oxylipins differentiated bacterial from idiopathic cystitis; and in obesity, where phospholipid and triglyceride shifts reflected metabolic risk. Fatty acid remodelling in chronic enteropathies aligned with mucosal inflammation, while sphingolipid changes in neurological disease correlated with severity. Heterogeneity in analytical platforms, dietary control, and study design limited comparability. Conclusions: Feline lipidomics reveals biologically meaningful alterations with emerging diagnostic and prognostic value. Although still developing, lipid-focused approaches may enhance disease characterisation and support translational research. Larger, standardised studies and robust reference datasets are needed to validate lipid signatures for clinical implementation. Full article

The widespread adoption of Generative Artificial Intelligence (GenAI) in regulated enterprises is currently hindered by the “Static Alignment Trap”: the inability of traditional safety methods, such as Reinforcement Learning from Human Feedback (RLHF), to adapt to rapidly shifting compliance landscapes without costly retraining. This paper introduces and evaluates the Agreement Validation Interface (AVI), a modular governance architecture that functions as a deterministic middleware layer. By decoupling governance from the core inference engine, AVI implements Dynamic Bilateral Alignment (DBA), enforcing policy constraints at both the input and output stages through vector-based semantic retrieval. Adopting a Design Science Research (DSR) methodology, we validated the system against the FinanceBench financial benchmark ($N=150$ queries, three repeated runs, 450 total observations) and a proprietary Russian-language provocative content dataset developed internally at MWS AI ($N=201$ queries; not publicly available). The empirical results demonstrate that the architecture achieves an 83.2% Large Language Model (LLM)-judge compliance rate (95% confidence interval, CI: 79.4–87.1%), statistically significantly exceeding the unfiltered baseline of 63.7% ($\Delta =+19.5$ percentage points (pp), $t=4.02$, $p=0.002$). The vector-based input filter achieves perfect detection performance (Precision $=1.000$, Recall $=1.000$, F1 $=1.000$). Cross-domain validation on 201 Russian-language provocative queries confirms generalizability (Recall $=0.985$, LLM compliance among triggered queries $=0.977$). The operational Time-to-Compliance for enforcing new rules was reduced from hours (model fine-tuning) to under five seconds (vector indexing). These findings suggest that enterprise AI safety requires an architectural shift from model-centric training to system-centric control, complemented by system-prompt-level anti-inference governance. We conclude that AVI offers a scalable, cost-effective, and statistically validated framework for auditable AI compliance, independent of the underlying model provider. Full article

Modular construction (MC) is frequently promoted as a path to circular economy (CE) outcomes in built environments, yet circular adoption and performance remain uneven. This study investigates how systemic barriers shape the implementation of circular strategies in MC. A systematic literature review combined with bibliometric mapping and systems-oriented synthesis was conducted using 124 Web of Science records published between 2011 and August 2025. Bibliographic coupling, co-citation, and keyword co-occurrence analyses were used to characterise the field’s intellectual structure, while 30 studies were selected for thematic coding and systems mapping. Ten recurrent barriers were identified and consolidated into six clusters: technical, financial, regulatory, stakeholder and organisational, quality assurance, and institutional and knowledge-based challenges. Their relative severity was assessed across four MC-relevant circular strategies: reuse, repurposing, design for disassembly, and multifunctionality. Systems mapping revealed three reinforcing feedback dynamics involving financial, stakeholder, and supply-chain pressures, knowledge and quality assurance constraints, and regulatory and design lock-in effects that stabilise conventional delivery and constrain circular implementation. Despite being underrepresented in the literature, multifunctionality emerges as a cross-cutting leverage point for enabling adaptable modular systems. The study synthesises five implementation pathways, including adaptable multifunctional design, interoperable interfaces, digital traceability, collaborative life-cycle integration, and policy alignment, and outlines systems-derived leverage points to guide future research and practice in circular modular construction. Full article

Background: Acute aortic dissection compresses diagnosis, transfer, and operative readiness into a narrow time window in which hospital capability may influence survival. Yet U.S. studies define specialized or high-volume care inconsistently, limiting translation of the literature into actionable regionalization criteria. We reviewed U.S. evidence comparing outcomes for acute aortic dissection across hospitals categorized by procedural volume or center specialization. Methods: We performed a PRISMA-aligned systematic review with narrative synthesis. We searched PubMed, Embase, Scopus, Web of Science, and CINAHL for English-language, peer-reviewed studies published from January 2000 through July 2025. Eligible studies included adult U.S. cohorts with acute aortic dissection and reported outcomes stratified by hospital volume tier or center designation. Two reviewers independently screened studies and extracted study characteristics, exposure definitions, analytic approach, and outcomes. We assessed quality to inform interpretation. Results: Searches identified 457 records, and 7 observational U.S. studies met eligibility criteria. Across most studies, higher-volume or specialized-center care was associated with lower in-hospital or 30-day mortality. Two studies showed no meaningful difference. Hospital length of stay was often longer in higher-volume strata. Neurologic complications were inconsistently associated with the center category. Definitions and thresholds used to denote “high volume” or “aortic center” varied substantially across studies. Conclusions: In U.S. observational data, higher-volume or specialized-center care for acute aortic dissection is most consistently associated with improved short-term survival, whereas secondary outcomes are heterogeneous. A major barrier to implementation is definitional inconsistency. Future work should pair transparent volume thresholds with explicit, measurable system capabilities. Full article

Background: Human papillomavirus (HPV) is a serious infection which is primarily transmitted through sexual intercourse. Almost 100% of cervical cancers are caused by HPV. Limited awareness of HPV leads to delayed cancer diagnoses, significantly increasing mortality and morbidity rates. Aim: The purpose of this study was to develop strategies to increase awareness of human papillomavirus screening and vaccination among women in Limpopo Province, South Africa. Setting: This study was carried out in the Vhembe District of the Thulamela Municipality of Limpopo Province. Methods: The E-Delphi method was used, and the researcher used a quantitative approach. A total population of 15 nursing managers was part of the study. Questionnaires were used to collect data. Data were analysed using the statistical package for the social sciences version 26. Results: In Round 1, 8 (53.3%) of the 15 participants strongly supported the strategy of updating women with the most recently revised HPV screening guidelines. In Round 2, consensus was achieved, with 14 (93.3%) of the participants strongly agreeing that the development of teaching programmes in healthcare facilities is necessary. This indicates a strong convergence of expert opinion on the importance of structured educational interventions to support the implementation of the strategy. The consensus in this study was defined as ≥70% agreement between participants on each item. Conclusions: The lack of awareness of HPV is concerning because early detection and treatment can prevent serious health problems. The study used the E-Delphi method to assess the effectiveness of strategies to increase awareness of HPV screening and vaccination in women. Contribution: Health policy initiatives may improve public awareness of HPV and vaccination, especially by focusing on educating nurses, which could improve women’s awareness and encourage HPV screening and vaccination. Full article

Implementation remains a central challenge in urban policy, yet the knowledge formats designed to bridge the gap between policy goals and on-the-ground delivery remain under-examined. This study treats 250 UN-Habitat Best Practice reports not as proof of effectiveness but as a standardized genre through which local interventions are narrated, compressed, and made portable for replication. We extract three focal sections, namely Results, Lessons Learned, and Transferability, apply systematic thematic coding with 906 open codes consolidated into axial categories, and compute co-occurrence networks using Jaccard similarity and Lift to detect thematic bundles, holes, and silos within and across sections. Three findings emerge. First, the reporting repertoire narrows progressively, as mean thematic richness declines by 28.2% from Results to Transfers while concentration increases 4.2 times, with substantive dimensions such as governance, equity, sustainability, and evidence losing prevalence to circulation-oriented themes. Second, formal bundle detection yields zero qualifying pairs across all six matrices, indicating a loosely coupled reporting grammar anchored by generic silos rather than integrated implementation packages. Third, structural holes concentrate at the pipeline’s end, where infrastructure transfer and sustainability as transferable value are the most systematically disconnected themes. These patterns reveal a portability paradox in which the reporting format achieves institutional legibility, making practices comparable within a shared vocabulary, but progressively filters out the physical, evidentiary, and context-sensitive content that operational reproduction would require. Full article

Background/objective: The Immunisation Agenda 2030, led by the World Health Organization, aims to ensure that people of all ages benefit from vaccination. South Africa remains committed to these goals, strengthening childhood immunisation largely through the Expanded Programme on Immunisation. However, despite progress, the number of unvaccinated and partially vaccinated children continues to rise in some urban settings. This study sought to identify barriers to childhood immunisation in selected zero-dose urban communities in Gauteng Province. Methods: A qualitative exploratory–descriptive design was used to examine factors influencing childhood immunisation. Data were collected through seven focus group discussions and fifteen key informant interviews with purposively selected caregivers, community leaders, community health workers and healthcare workers involved in routine immunisation services at public healthcare facilities across the Cities of Johannesburg, Ekurhuleni, and Tshwane. Thematic analysis was conducted using NVivo^® software. Results: The study identified multiple demand-side and supply-side barriers. Demand-side barriers included limited parental knowledge, lack of trust in the government and immunisation services, religious beliefs, migration, and perceptions of caregiver substance use. Supply-side barriers involved distance to the facility, negative healthcare worker attitudes, long queues and waiting times, and frequent vaccine stock-outs. These barriers collectively contributed to missed opportunities and decreased uptake of immunisation services. Conclusions: Childhood immunisation remains a critical and cost-effective public health intervention. The findings demonstrate the complex interplay of individual and system-level factors influencing vaccine demand, uptake and persistent zero-dose status in urban Gauteng communities. Addressing these barriers requires a comprehensive approach that strengthens community trust, improves caregiver vaccine literacy, and ensures accessible, responsive, and respectful immunisation services. Full article

Background/Objectives: Multidrug-resistant tuberculosis (MDR-TB) remains a major public health challenge in the WHO European Region, which reports the highest global proportion of rifampicin-resistant and MDR-TB cases. Whole-genome sequencing (WGS) has emerged as a key tool for improving drug-resistance detection and supporting molecular surveillance. However, the level of genomic implementation across Central and Eastern Europe (CEE) remains insufficiently characterized. This scoping review aimed to evaluate the use of WGS for MDR-TB in CEE countries and to classify implementation maturity using a predefined framework (L0–L4). Methods: A structured search of PubMed/MEDLINE and Web of Science identified original studies published in English between 2015 and 2026 reporting genomic applications in MDR-TB across 13 predefined CEE countries. Data were extracted on sequencing approaches, resistance prediction, transmission analysis, monitoring of new or repurposed drugs, bioinformatic pipelines, and programmatic integration. Countries were categorized according to a five-level maturity model based on documented capacity, scope of application, and integration into national tuberculosis programs (NTPs). Results: Twenty-eight studies were included. WGS was used in 23/28 studies (82.1%), predominantly for genomic resistance prediction (25/28). Transmission analysis was reported in 19/28 studies, with heterogeneous single nucleotide polymorphism (SNP) thresholds and clustering methodologies. Monitoring of resistance to new or repurposed drugs was described in 8/28 studies. No country achieved Level L4 (formally integrated genomic surveillance). Four countries were classified as L3 and nine as L2, while no L0 or L1 settings were identified. Conclusions: Countries in Central and Eastern Europe demonstrate increasing operational use of WGS for MDR-TB, primarily driven by clinical resistance prediction. However, the lack of formal integration into national surveillance systems highlights a persistent gap between technological adoption and structured public health implementation. Strengthening programmatic integration and methodological standardization is essential for advancing genomic surveillance of MDR-TB in the region. Full article

China’s agricultural development not only has the weakness of insufficient technological investment but also faces the constraint of a shortage of financial support. In this context, promoting the combination of technology with finance in agricultural production activities is very important for China’s agricultural modernization. Based on two batches of “the pilot policy for promoting the combination of science and technology with finance”, this paper investigates the policy effect and mechanism of sci-tech finance on agricultural production efficiency. The results show that sci-tech finance policy is able to promote the improvement of agricultural production efficiency significantly in pilot areas compared with non-pilot areas, and this treatment effect continues to expand over a long period after the implementation of the policy. In terms of space partition, the agricultural support effect of sci-tech finance not only shows regional heterogeneity but also performs better in cities with weaker technological innovation ability and a lower degree of financial deepening. The “offering fuel in snowy weather” effect on non-central cities is stronger than the “adding brilliance to its present splendor” effect on central cities. Lastly, the sci-tech finance policy successfully builds a long-term mechanism for policies to take effect at multiple points and continues to exert force from three aspects: accelerating the process of agricultural mechanization, promoting the development of modern rural industries and improving the human capital of farmers. The research conclusions provide policy recommendations for promoting science and technology finance from policy pilot to comprehensive promotion, and promoting and implementing the construction of agricultural power, for example, by “strengthening agricultural science and technology and equipment support” and “improving [the] rural financial service system” proposed by the report of the 20th National Congress. Full article