Search Results (6,390)

Oral health problems among older adults represent a growing public health concern due to increasing life expectancy and treatment needs. This study aimed to assess dental treatment needs and cost burden within the context of oral health policies. This retrospective study included anonymized data from 250 patients aged ≥65 years (F/M: 121/129; 65–89 years). Sociodemographic characteristics, treatment needs, and costs were obtained from the Hospital Information Management System (HIMS). Costs were adjusted to 2025 Turkish lira values using the Consumer Price Index and converted to international dollars using purchasing power parity (PPP). Patients were classified by total treatment costs using K-means cluster analysis. Periodontal (61.2%), restorative (36.0%), and endodontic (41.2%) treatment needs, which are largely preventable through oral hygiene practices, were more frequent among patients with a lower mean age, whereas tooth loss and prosthodontic treatment needs (89.6%) increased with mean age. Cluster analysis identified two groups: a low-cost group (67.6%) and a high-cost group (32.4%). The high-cost group had a lower mean age (68.84 ± 4.27 years) compared to the low-cost group (70.73 ± 5.18 years), indicating that relatively younger patients needed more complex and costly treatments. Out-of-pocket payments were notable for prosthodontic and surgical treatments, although Social Security Institution (SSI) payments constituted most of the costs. Preventive and early dental care strategies are essential to reduce treatment complexity and cost burden among older adults within the framework of oral health policy. Full article

Background: Intracranial pressure (ICP) monitoring remains the cornerstone of neurocritical care in severe traumatic brain injury (TBI), yet its prognostic value as a standalone metric is limited. The Pressure Reactivity Index (PRx), a continuous measure of cerebrovascular reactivity derived from ICP and arterial blood pressure, may offer additional or complementary prognostic information. This systematic review aimed to compare the prognostic performance of PRx-derived metrics versus standard ICP monitoring for mortality and functional outcome in patients with TBI. Methods: A systematic search of PubMed, Web of Science, and Scopus was conducted for studies published between January 2000 and December 2025. Studies were eligible if they included adult TBI patients with continuous multimodal monitoring and reported comparative prognostic data for PRx- and ICP-based metrics. Risk of bias within the studies was appraised via the QUIPS tool, and the GRADE system was used to rate the strength of the evidence. Due to methodological heterogeneity, findings were synthesized narratively. Results: Nine studies were included. Applying a maximum-cohort estimation to account for overlapping registries, the pooled sample comprised a minimum of 1240 unique patients. In the majority of included studies, direct within-cohort head-to-head comparisons demonstrated that specific PRx-derived metrics—such as the individualized ICP threshold (iICP), Longest Continuous Duration of Autoregulatory Impairment (LCAI), Lower Limit of Reactivity (LLR), and time-integrated burdens (%Time > Threshold)—yielded stronger prognostic discrimination compared to standard ICP thresholds for both mortality (PRx: AUC 0.747–0.648 and ICP: AUC 0.660–0.614) and functional outcome. When added to established predictive models, PRx-derived metrics provided clinically meaningful incremental improvements in prognostic accuracy, with descriptive incremental AUC gains ranging from +0.039 to +0.170 across the six studies reporting model augmentation. Due to heterogeneity in baseline models, PRx-derived metrics, and patient populations, these findings are presented strictly as a descriptive range. Conclusions: PRx and PRx-derived cerebrovascular reactivity metrics-namely iICP, LCAI, LLR, and time-integrated burdens of autoregulatory failure—show potential to offer additive prognostic value beyond standard ICP monitoring in severe TBI. However, because current evidence is strictly observational and likely influenced by institutional confounders, it cannot currently support definitive clinical recommendations. Further prospective, multicenter studies utilizing standardized thresholds are necessary to confirm these associative findings and isolate their true prognostic value. Full article

Deaf people experience significant barriers to education, healthcare, employment, and information access, resulting in inequities across a myriad of contexts. To better understand these disparities, our all-deaf research team conducted semi-structured interviews with deaf and hearing (parents, caregivers, and educators) adults across Ecuador, exploring how structural, institutional, and social factors influence daily life and well-being. Participants (n = 36) described systemic exclusion from education and employment, limited access to interpreters and assistive technologies, and constrained autonomy due to insufficient family support and institutional resources. These barriers compound health risks by restricting access to care, information, and social participation. Participants’ narratives highlighted how political and economic instability, institutional neglect, and discrimination create structural vulnerabilities that extend beyond individual-level factors. Findings underscore the importance of public health interventions that address structural and communicative inequities, including inclusive education, accessible health services, and community-based support, to improve health equity and quality of life for deaf populations in Ecuador. Full article

Pesticide-residue risk perceptions among agricultural professionals are shaped by factors that extend beyond knowledge gaps. This study examines how trust in regulatory systems and information sources jointly shape residue-related attitudes among Greek agronomists. We used principal components analysis (PCA) to identify coherent domains and then latent profile analysis (LPA) to derive person-centered profiles based on standardized component scores. Two dominant profiles emerged, differing in regulatory confidence, reliance on institutional/scientific information channels, and comparative risk framing. Residue-Concerned Skeptics expressed lower confidence in enforcement capacity (implementation and staffing) and in the system’s alignment with other EU Member States, together with concerns about chronic pesticide exposure. The System-Confident profile reported higher regulatory confidence and greater reliance on official and scientific channels, as well as stronger endorsement of IPM effectiveness and comparative risk rankings. External validation supported profile differences in perceived training adequacy, IPM beliefs, and organic avoidance behavior. Professional involvement in plant protection and older age were associated with membership in the System-Confident profile. These findings suggest that interventions should emphasize clear communication, capacity building, and address concerns about chronic exposure, beyond information provision alone. Full article

Introduction: Patients are increasingly aware of ways to manage their own health—especially regarding chronic diseases—along with the fundamental factors that should be present in well-organized and patient-oriented healthcare organizations. Due to the fact that the image of healthcare organizations depends on patients’ opinions, healthcare organizations are continuously improving and transforming their processes to increase patient satisfaction. This study aimed to analyze the relationship between patients’ opinions about the public hospitals in which they were treated and selected factors, including socio-demographic characteristics, previous hospital experiences, sources of information, and satisfaction with hospitalization in Poland. Methods: A cross-sectional survey was conducted among patients hospitalized in eight public hospitals in Wrocław. A self-developed questionnaire included two sections: (I) opinions about the hospital (11 items) and (II) expectations and satisfaction (12 items). Questionnaires were distributed in person. Data were analyzed using descriptive and inferential statistics, including correlation and chi-square tests. Results: Hospital image was shaped mainly by interpersonal factors, particularly staff kindness (82.9%), access to specialists (75.4%), and a sense of safety (54.4%). Women were more likely than men to seek information about hospitals before admission (47.6% vs. 39.3%; p = 0.021). A positive correlation was found between patient expectations and satisfaction with hospitalization (ρ = 0.425; p < 0.001). Media exposure played a minor role in shaping hospital image (22.1%), while personal recommendations and previous experience were the dominant sources of influence. Conclusion: Patients’ assessments of hospital image are determined primarily by relational and communication factors rather than infrastructural or technical aspects. Sociodemographic characteristics, such as gender and previous contact with the institution, may moderate these perceptions. The findings highlight the need to strengthen patient-centered care models, improve communication competencies among health professionals, and develop transparent institutional communication strategies. Full article

Background and Objectives: This study aimed to examine the level of depression in children who had undergone pediatric liver transplantation and to evaluate the potential role of liver enzymes as biomarkers of depression. Materials and Methods: The study was conducted with 50 pediatric liver transplant recipients followed at the Liver Transplantation Institute of İnönü University, and data were collected through face-to-face interviews. The Personal and Transplant Information Form, Child Revised Impact of Event Scale, and Patient Health Questionnaire–Depression were used as data collection tools. In addition to descriptive statistics, Student’s t-test, Mann–Whitney U test, correlation analyses, and regression analyses were performed. Results: The median PHQ-9 score was 1.00 (Q1–Q3: 0.00–5.00), indicating generally low levels of depression. A significant positive correlation was found between CRIES and PHQ-9 scores (r = 0.414, p < 0.01). In contrast, no consistent significant associations were observed between liver enzyme levels and depression scores in multivariate analyses, although bilirubin showed a modest negative correlation with PHQ-9 scores. In the multivariate analysis, although the overall regression model was not statistically significant, the CRIES score showed an individual association with PHQ-9 scores within the model (B = 0.117, p = 0.037). Conclusions: Liver enzymes cannot be considered strong biomarkers of depression in pediatric liver transplant recipients; however, post-traumatic stress symptoms may be an important clinical indicator for assessing psychological adjustment. Full article

Background: Liver diseases are an increasing public health concern in Morocco; reliable national population-based estimates of liver fibrosis and cirrhosis in Morocco are currently unavailable. Existing evidence is largely limited to selected high-risk groups and hospital-based cohorts. Generating reliable prevalence data is crucial for designing evidence-based screening pathways, targeting high-risk groups and informing prevention and treatment policies. Objectives: Our aim was to comprehensively review studies on the prevalence of liver fibrosis and cirrhosis in Morocco, focusing on characterizing study populations, specifically high-risk populations and hospital-based cohorts, diagnostic methods and thresholds used. The review also summarizes hospital-based cirrhosis cohorts without merging them with prevalence estimates, and identifies gaps in the literature, particularly the absence of population-based prevalence studies and national epidemiological data in Morocco. Methods: The study systematically reviewed literature up to 26 October 2025, including studies conducted in Morocco among high-risk populations or hospital-based cirrhosis cohorts, using multiple databases. Two reviewers independently screened and extracted data, assessing bias with the Joanna Briggs Institute (JBI) checklist. Due to heterogeneity in study populations and diagnostic approaches, a narrative synthesis was performed. Hospital-based cohorts were analyzed separately to provide contextual information and were not included in prevalence estimates. Results: From 1198 records, four Moroccan studies providing prevalence data on liver fibrosis and cirrhosis were included, primarily involving patients with hepatitis C, HIV, or rheumatoid arthritis. Additionally, three hospital-based cirrhosis cohorts were incorporated for a contextual analysis of disease severity and complications. In total, seven studies were included, with prevalence and hospital-based data analyzed separately to ensure clarity. Conclusions: Current evidence on liver disease in Morocco is limited but suggests a significant burden among high-risk groups. The findings highlight major gaps in national epidemiological data and underscore the urgent need for comprehensive nationwide data and improved diagnostic tools to guide effective screening, prevention, and resource allocation. Full article

Artificial intelligence (AI) and digital platforms are increasingly influencing how universities manage experiential learning, interdisciplinary collaboration, and innovation-oriented educational activities. Challenge-based capstone and graduation projects play an important role in this context because they connect technical learning with teamwork, stakeholder engagement, project management, and applied innovation. However, many universities still rely on fragmented and highly manual coordination processes, which can limit scalability, transparency, and effective alignment between project requirements and participant capabilities. This study presents Smart Innovation Hub, an AI-enabled information system developed to support challenge-based innovation and capstone-project coordination in higher education. The platform brings together challenge intake, participant profiling, AI-supported recommendations, mentor coordination, workflow governance, and human review within a shared educational innovation environment. The system operationalizes an Innovation Bridge ecosystem model that connects students, faculty mentors, research centers, and external partners through a data-supported coordination framework. A Design Science Research (DSR) methodology guided the development and pilot evaluation of the platform within a public university environment. The pilot evaluation relied on several evidence sources, including platform logs, coordinator records, stakeholder surveys, milestone documentation, and partner feedback collected during implementation activities. Early pilot observations suggested an approximate 60% reduction in average team-formation cycle time, together with positive stakeholder perceptions regarding workflow usability and recommendation quality. These findings should be interpreted as preliminary implementation indicators within a single-institution pilot environment. The study contributes an AI-enabled educational innovation ecosystem architecture, a hybrid semantic-structured recommendation framework for challenge-based coordination, and a structured workflow model that integrates explainability and human oversight into educational innovation management. The findings further suggest that AI-enabled information systems may improve the transparency and coordination of challenge-based innovation workflows while preserving institutional governance and human decision-making. Full article

This study examines how green bond financing costs in China are jointly shaped by market pricing mechanisms and institutional investor behavior. It develops an integrated two-level framework linking issuance-level bond characteristics with investor decision-making to explain green bond pricing in an emerging market. Using a comprehensive dataset of Chinese green bond issuances, the results show that financing costs are driven mainly by conventional credit-related signals, including issuer and bond ratings, guarantee structures, issuance size, and maturity. However, market frictions such as liquidity constraints and rating inertia weaken the capitalization of environmental attributes in yields. A survey-based Logit analysis of institutional investors in Shanghai further shows that green bond investment is influenced more by trading activity, information transparency, and risk management than by environmental awareness alone. Institutional heterogeneity also suggests that securities firms display stronger participation than investment companies, reflecting differences in bond-market exposure, product familiarity, and institutional investment mandates. Overall, the findings reveal a feedback mechanism in which market signals shape investor behavior, which in turn reinforces or moderates pricing dynamics. The study clarifies the structural and behavioral drivers of green bond pricing and offers policy implications for improving transparency, liquidity, and investor incentives. Full article

This paper presents an organization-managed IMAP Agent framework for extending email functionality in environments that rely on outsourced mail services. In this study, outsourced mail services refer to externally operated mailbox providers offering sufficiently scalable email infrastructures and standard IMAP interfaces, such as Gmail, Microsoft 365, and other commercial mailbox providers. In the proposed framework, IMAP Agents are operated within an organization, while user authentication continues to rely on existing institutional infrastructures such as Identity Providers (IdP) or Integrated Authentication Infrastructure (IAI). The IMAP Agent operates as a post-authentication processing component using credentials issued by these infrastructures, without modifying or intervening in the outsourced mail service itself. The framework enables organization-managed mailbox-side email processing without requiring administrative control over the mail server or dependence on provider-specific APIs. As a proof of concept, representative email-processing functions are implemented, including detection of suspicious messages based on header-level authentication information and automatic insertion of thread-consistent warning messages without altering the original email content. To evaluate the feasibility of the proposed framework, a prototype system was implemented using multiple containerized IMAP Agent instances. The experimental results showed that warning messages were typically appended within approximately 300 ms after message detection. Multi-container evaluations ranging from 1 to 100 concurrent IMAP Agent instances demonstrated low CPU overhead and approximately linear memory growth under idle-monitoring conditions, indicating the operational feasibility of deploying multiple IMAP Agent instances on a single host. These results suggest that the proposed framework can provide provider-independent and organization-managed extension of email functionality in outsourced mail environments through standard IMAP operations. Full article

The role of financial institutions in climate governance is increasingly being recognized, particularly in relation to Scope 3 emissions. While existing research has focused primarily on lending and investment activities, the potential influence of insurance operations on lifecycle emissions remains underexplored. This study examines electric vehicle (EV) insurance underwriting as a form of indirect climate governance, with particular attention being paid to claim-related decision processes that affect repair-, replacement-, and battery-related outcomes. A decision-analytical, scenario-based portfolio model is developed to analyze how underwriting and claims parameters may influence lifecycle emissions exposure. The model incorporates literature-informed and scenario-based parameter ranges derived from the lifecycle assessment literature and industry-relevant assumptions, while explicitly accounting for regulatory, technical, and behavioral constraints that limit insurer decision making. An exposure-based attribution framework is applied to link insurance-mediated outcomes to emissions associated with vehicle and battery manufacturing. The results suggest that claim-related parameters—particularly total-loss probability—are associated with variations in modeled emissions exposure within the analytical framework. Scenario analysis indicates that, under plausible parameter configurations, differences in claims decision structures may contribute to variation in lifecycle emissions at the portfolio level. Sensitivity analysis further indicates that these relationships appear stable across a range of parameter assumptions. The findings should be interpreted as scenario-based insights rather than empirical estimates, highlighting potential pathways through which insurance operations may influence emissions outcomes within existing constraints. The study contributes to the literature by extending Scope 3 governance analysis to insurance and by proposing an operational framework for interpreting insurance-associated emissions in lifecycle terms. Full article

Background/Objectives: Trabectedin is a standard-of-care chemotherapy for recurrent/metastatic liposarcomas, including myxoid/round cell liposarcoma (MRCLS). This pooled analysis was performed to evaluate trabectedin efficacy in MRCLS across multiple trials to establish a standard-of-care efficacy baseline. Methods: The Yale University Open Data Access (YODA) Project was queried for prospective trabectedin trials. Data on patients with unresectable, locally advanced/metastatic MRCLS who received ≥ 1 trabectedin dose(s) (1.0–1.5 mg/m² administered as a 24-h continuous infusion every 3 weeks) were extracted from three trials: NCT00060944, NCT00210665, and NCT01343277. The primary outcome was the objective response rate as per the Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. Secondary outcomes included disease control rate and overall survival, defined as the time from first trabectedin administration to death. Responses were assessed using RECIST by investigators in NCT01343277 and by independent review in NCT00060944. In NCT00210665, tumor assessment followed institutional standards, so only overall survival was analyzed. Results: Sixty-three patients were included (42 from NCT01343277, 13 from NCT00060944, 8 from NCT00210665): 32% were female, the median age was 50 years, and 79% were White. The objective response rate was 16.3% (8/49) of patients (37 from NCT01343277, 12 from NCT00060944). The disease control rate was 77.6% (38/49). Overall survival data were available for 63 patients: the median overall survival was 22.51 months (95% CI: 16.99–34.33). Conclusions: This analysis represents one of the largest pooled populations to date of patients with advanced MRCLS treated with trabectedin in prospective clinical trials to be reported. Whilst limited by typical factors affecting pooled analyses, including cross-study heterogeneity, nevertheless the results estimate a trabectedin efficacy baseline against which to inform other therapies for MRCLS. Full article

Climate hazards increasingly unfold as information crises alongside physical impacts, producing rapid shifts in what people search for and discuss online. This case study demonstrates how AI-supported analysis of online data can complement conventional disaster intelligence by providing a scalable social sensing layer for climate hazard resilience in Galicia. It integrates Google Trends as a proxy for changing public attention and information demand, and YouTube videos and comment threads to capture public sensemaking and resilience-relevant signals. Monthly Google Trends series were used for eight hazards, with floods showing the highest mean interest, followed by wildfires and heatwaves. For the three highest-salience hazards, the study analyzed YouTube comments using gpt-5-mini to extract sentiment, emotions, topics, institutional trust cues, collective efficacy cues, calls to action, impacts, vulnerable groups, and coping actions. The corpus included 184 heatwave comments, 20,427 wildfire comments, and 4882 flood comments. Across hazards, discourse is predominantly negative but differs in structure. Heatwave threads skew toward mockery and normalization, wildfire threads center on anger, governance and low institutional trust, and flood threads combine solidarity with demands for localized warnings and guidance. The study translates comment-level signals into traceable policy recommendations emphasizing actionable risk communication, early warning and response capacity, and trust-building practices. The study concludes with an operational pipeline concept for continuous monitoring and dashboard-based decision support, while emphasizing limitations related to Google Trends sampling and normalization, platform and API biases, and model-mediated uncertainty. Full article

Botanical gardens are multifunctional institutions that perform a wide range of functions using limited resources. Their social significance has grown alongside global challenges like biodiversity loss, the climate crisis, and food security, as well as the need to train future professionals. This study analyzes public preferences for the diverse functions of botanical gardens to inform sustainable management strategies, using the Sejong National Arboretum in South Korea as a case study. We identified seven attributes, including five traditional functions (collection, conservation, research, exhibition, and education) and two extended functions (healing and networking) that reflect the contemporary roles of botanical gardens. We conducted a discrete choice experiment in 2024 with 1200 respondents to assess preferences and marginal willingness to pay. Respondents showed the strongest preferences for research commercialization and global conservation, followed by urban outreach in healing. In contrast, we observed negative marginal willingness to pay values for exhibition, professional certification, national networking, and nationwide outreach in healing. Our findings indicate that the public interest in botanical garden activities extends beyond visitor-oriented functions to include conservation, research commercialization, and locally embedded healing services. These results offer an empirical basis for resource allocation and sustainable management strategies in botanical gardens. Full article

Higher education institutions, particularly those with teaching and research laboratories, play an important role in transmitting knowledge and attitudes regarding chemical safety to their students. As such, this study aims to assess the knowledge and attitudes of higher education students across different study programs regarding laboratory chemical safety. A cross-sectional study was conducted using a questionnaire adapted and translated into Portuguese. The instrument comprised twenty-seven questions and was distributed to students enrolled in undergraduate and graduate programs that include laboratory practices in their curricula in March and July of 2025. A total of 284 students participated in the study, divided among the different study programs (CTeSP = 4.2%; Bachelor’s = 70.4%; Master’s = 21%; Doctorate = 4.2%). The results showed that, although a large percentage of students have a high level of knowledge, their attitudes are not always the most appropriate, which could jeopardize their safety and that of those around them. Our findings revealed that there is room for curriculum adjustments. Early exposure to chemical and laboratory safety concepts can promote the development of students’ awareness and future professionals’ competence. Integrating safety modules into education may enhance knowledge and skills for making informed decisions that reduce accidents/incidents in laboratory environments. Full article