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20 pages, 3231 KB  
Article
Silk Fibroin/Chitosan Blended Microparticles: Preparation, Characterization, and Oil Absorption
by Ansaya Thonpho, Suchai Tanisood, Wilaiwan Simchuer, Yodthong Baimark and Prasong Srihanam
Polymers 2026, 18(12), 1496; https://doi.org/10.3390/polym18121496 (registering DOI) - 14 Jun 2026
Abstract
In this work, we extracted silk fibroin (SF) via a tertiary solvent system (CaCl2:Ethanol:H2O) and then blended it with chitosan (CS) solution to construct microparticles using the water-in-oil-emulsion–diffusion method. For the mixture of SF/CS solution aqueous phase (W) was [...] Read more.
In this work, we extracted silk fibroin (SF) via a tertiary solvent system (CaCl2:Ethanol:H2O) and then blended it with chitosan (CS) solution to construct microparticles using the water-in-oil-emulsion–diffusion method. For the mixture of SF/CS solution aqueous phase (W) was prepared at ratios of 4:0, 3:1, 1:1, 1:3, and 0:4, using ethyl acetate as the oil phase (O). After the microparticles were prepared, their morphology was examined using scanning electron microscopy (SEM). The optimal preparation conditions were determined to be a 1% (w/v) aqueous phase with a volume of 1 milliliter, 100 milliliters of oil phase, and a stirring speed of 700 rpm. The average microparticle size was 50–100 micrometers. ATR−FTIR spectra showed unique functional groups of SF and CS, as well as interactions between the two polymers. The results of the thermal property study using a TGA instrument showed that SF microparticles had a higher maximum decomposition temperature (Td,max) than chitosan, and the blended microparticles’ Td,max increased with the proportion of SF. Most microparticles exhibited a semi-crystalline polymer structure, with SF microparticles being the most hydrophobic, followed by blended microparticles and CS, respectively. Testing for absorption capacity, the SF microparticles were more effective at absorbing used engine oil than vegetable oil and chloroform, while CS microparticles showed the highest capacity for vegetable oil. The experimental results indicated that all SF/CS blended particles played an efficiency of absorption variable by ratios of SF or CS blended. This suggested that the prepared microparticles might be useful for oil/water separation application. Full article
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14 pages, 772 KB  
Systematic Review
A Systematic Review of Clinical Outcomes and Technical Considerations: Endoscopic Spine Surgery for Primary Spinal Tumors
by MaryLourdes Andreu, Anshul Ratnaparkhi, Long Di, Robert Kamil, Khushi H. Shah, Tyler M. Cardinal, Seth S. Tigchelaar, Adham M. Khalafallah and Gregory W. Basil
J. Clin. Med. 2026, 15(12), 4623; https://doi.org/10.3390/jcm15124623 (registering DOI) - 14 Jun 2026
Abstract
Background: Endoscopic spine surgery (ESS) is an established minimally invasive approach for degenerative spinal conditions. Advances in instrumentation and visualization have expanded its application to spinal tumor resection. This review synthesizes reported clinical outcomes and technical considerations of ESS for primary spinal tumors. [...] Read more.
Background: Endoscopic spine surgery (ESS) is an established minimally invasive approach for degenerative spinal conditions. Advances in instrumentation and visualization have expanded its application to spinal tumor resection. This review synthesizes reported clinical outcomes and technical considerations of ESS for primary spinal tumors. Methods: PubMed was queried from 2000 to 2025 for studies reporting endoscopic resection of primary spinal tumors. Studies involving metastatic disease or non-resective interventions were excluded. Data were descriptively analyzed given heterogeneity and limited sample size. Results: Eleven patients across seven studies were included (mean age = 50.3 years). Pathologies comprised schwannoma (n = 5), meningioma (n = 3), osteoid osteoma (n = 2), and Ewing sarcoma (n = 1). Seven tumors were intradural extramedullary (63.6%) and four were extradural (36.4%); no intramedullary lesions were included. Of the seven intradural cases, one was performed via uniportal full-endoscopic technique, one via biportal endoscopy, and five via tubular retractor-assisted endoscopy. Across all eleven patients, gross total resection was achieved in 90.9% of cases. Gross total resection was achieved in 100% of cases in which it was the operative intent (10/10); the remaining case was a planned biopsy of recurrent Ewing sarcoma. One transient postoperative lower extremity weakness was reported; no cerebrospinal fluid leaks, reoperations, or perioperative deaths occurred. No recurrences were observed across a mean follow-up of 21.9 months (range 4–48 months), though this duration may be insufficient to assess long-term recurrence for slow-growing tumors such as meningioma and schwannoma. Conclusions: ESS of primary spinal tumors appears feasible and safe in carefully selected cases, particularly for small, well-circumscribed lesions in favorable anatomical locations. Intradural resection introduced distinct technical challenges, including irrigation management and dural closure, which influence platform selection. These findings are limited by small sample size, short follow-up, and likely publication bias. ESS should be considered an emerging minimally invasive option rather than a replacement for established microsurgical approaches. Prospective comparative studies are needed to better define its role in spinal oncology. Full article
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22 pages, 983 KB  
Article
Short-Term Profitability Pressure Following Green Bond Issuance: Evidence from China’s Listed Heavy-Polluting Enterprises
by Yilin Cai, Meng Feng, Yueming Qiu and Yi David Wang
Sustainability 2026, 18(12), 6114; https://doi.org/10.3390/su18126114 (registering DOI) - 14 Jun 2026
Abstract
Green bonds have become an important financial instrument for supporting environmental investment and industrial transformation. This paper examines short-term profitability dynamics around first green bond issuance among heavy-polluting firms listed on China’s A-share market. Using a staggered-adoption framework based on the group-time average [...] Read more.
Green bonds have become an important financial instrument for supporting environmental investment and industrial transformation. This paper examines short-term profitability dynamics around first green bond issuance among heavy-polluting firms listed on China’s A-share market. Using a staggered-adoption framework based on the group-time average treatment effect estimator of Callaway and Sant’Anna we compare issuing firms after issuance with never-issuing and not-yet-issuing firms while controlling for firm characteristics, firm fixed effects, and year fixed effects. The estimates show that issuing firms experience an average post-issuance ROE decline of approximately 4.9 percentage points during the four years following issuance. Given that the average ROE in the sample is 0.0702, this estimate is economically substantial. Because green bond issuance is a voluntary corporate financing decision rather than an externally assigned policy shock, the estimates are interpreted as treatment-on-the-treated effects under the assumptions of no anticipation, overlap, and conditional parallel trends. Additional diagnostics and a DuPont-style mechanism analysis suggest that the post-issuance ROE decline is mainly associated with lower net profit margins and, to a lesser extent, lower asset turnover. Heterogeneity analyses indicate that the post-issuance profitability pressure varies across ownership types, regions, and industries. Full article
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18 pages, 2518 KB  
Article
Design and Field Assessment of a Pressurized Driving-Down Air Multilevel Sampler for Depth-Discrete Groundwater Monitoring in NAPL Impacted Wells
by Giuseppe Passarella, Rita Masciale, Antonio Di Fazio and Costantino Masciopinto
Sensors 2026, 26(12), 3788; https://doi.org/10.3390/s26123788 (registering DOI) - 14 Jun 2026
Abstract
This study presents the development and field testing of a Pressurized Driving-Down Air Multilevel Sampler (PDA-MLS), an integrated groundwater sampling device designed for depth-discrete sampling in boreholes affected by floating non-aqueous phase liquids (NAPLs). Conventional sampling methods—such as low-flow pumps, bailers, and packer-isolated [...] Read more.
This study presents the development and field testing of a Pressurized Driving-Down Air Multilevel Sampler (PDA-MLS), an integrated groundwater sampling device designed for depth-discrete sampling in boreholes affected by floating non-aqueous phase liquids (NAPLs). Conventional sampling methods—such as low-flow pumps, bailers, and packer-isolated systems—often fail under these conditions due to limited accessibility, cross-contamination, or disturbance of the water column. The proposed system addresses these limitations through a controlled pressurized-gas actuation mechanism that transfers groundwater from multiple PTFE-membrane chambers installed at discrete depths. This configuration enables low-disturbance sampling below floating contaminant layers. The use of chemically inert materials (stainless steel and PTFE) minimizes sampling artifacts and ensures compatibility with volatile organic compound (VOC) analyses. A simplified hydraulic conceptual framework describing inflow, outflow, and pressure-driven displacement was developed to support purge-duration estimation and operational parameter definition. The device was tested in a 90 m deep fractured limestone aquifer contaminated by tetrachloroethylene (PCE), where floating hydrocarbons limited the applicability of conventional sampling techniques. Field testing showed stable discharge conditions (~145–160 mL/min), repeatable sampling cycles, and successful collection of depth-discrete groundwater samples under the investigated site conditions. No evidence of sampler-related hydrocarbon entrainment was observed in the collected samples within the analytical detection limits of the adopted laboratory methods. To the authors’ knowledge, the PDA-MLS represents one of the few groundwater sampling systems specifically designed to combine low-disturbance multilevel sampling with operation in wells affected by floating NAPL. These features make it a promising tool for environmental monitoring, high-resolution characterization of fractured aquifers, and long-term assessment of contaminated sites. Full article
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30 pages, 411 KB  
Article
Regional Digital Financial Inclusion and Corporate Financial Investment Efficiency: An Environmental Spillover Perspective
by Yaxin Li and Chan Lyu
Sustainability 2026, 18(12), 6113; https://doi.org/10.3390/su18126113 (registering DOI) - 14 Jun 2026
Abstract
Based on panel data of Chinese A-share listed firms from 2011 to 2023 (29,868 firm-year observations in total), this paper explores the environmental spillover relationship between regional digital financial inclusion (a proxy for the external digital financial ecosystem) and corporate financial investment efficiency. [...] Read more.
Based on panel data of Chinese A-share listed firms from 2011 to 2023 (29,868 firm-year observations in total), this paper explores the environmental spillover relationship between regional digital financial inclusion (a proxy for the external digital financial ecosystem) and corporate financial investment efficiency. To identify causal effects, we adopt firm fixed effects and three strategies to mitigate endogeneity, namely, interactive fixed effects, lagged terms of regional digital financial inclusion, and instrumental variable estimation. The results suggest that regional digital financial inclusion, when interpreted as an environmental spillover from the external digital financial ecosystem, is associated with curbed inefficient financial investment and thus with improved investment efficiency. This effect operates through three channels: easing financing constraints, improving managerial sentiment, and accelerating digital transformation. Moreover, the positive effect is statistically significant and concentrates among non-state-owned enterprises, firms in eastern China, and sectors with limited traditional financial access (e.g., manufacturing and low-contact industries). Different from prior studies focusing on real investment efficiency, this paper enriches the literature on regional digital financial inclusion from an environmental spillover perspective. It also offers policy implications for fostering sustainable economic growth, strengthening the resilience of the real economy, and improving capital allocation efficiency. Full article
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23 pages, 4967 KB  
Article
LOAC2: The Improved Version of the Light Optical Aerosols Counter for Measurements at Ground Level and Within the Atmosphere Under Balloons
by Jean-Baptiste Renard, Gwenaël Berthet, Matthieu Jeannot, Patrick Jacquet, Benjamin Langerome, Thomas Lecas, Stéphane Chevrier, Emmanuel Briaud, Gilles Chalumeau, Florent Grenard, Benjamin Charpentier, Maylis Gaulin, Slimane Bekki and Jérôme Giacomoni
Sensors 2026, 26(12), 3786; https://doi.org/10.3390/s26123786 (registering DOI) - 14 Jun 2026
Abstract
The new LOAC2 optical aerosol counter is designed to detect liquid and solid particulates across 19 to 30 size classes within the 0.15–90 µm size range, and to provide their main typology. The instrument can be used at ground level and on all [...] Read more.
The new LOAC2 optical aerosol counter is designed to detect liquid and solid particulates across 19 to 30 size classes within the 0.15–90 µm size range, and to provide their main typology. The instrument can be used at ground level and on all kinds of balloons, including weather balloons, up to an altitude of about 35 km. The measurements are based on principles established for the previous version of LOAC, now incorporating improved electronics and detection geometry. Counting is performed at small scattering angles in the diffraction domain, making it insensitive to the refractive indices and the porosity of the particles, thus allowing a direct relationship between scattered intensity and aerosol size. Typology identification is now performed at three additional scattering angles, where the scattered flux is highly sensitive to the refractive index of the different aerosol families present in the atmosphere. The calibration was conducted using calibrated spherical and irregular grains, as well as different types of solid particles. Several intercomparison sessions with other counters and with reference mass-concentration air quality monitoring stations were carried out indoors, in an atmospheric simulation chamber, and in outdoor ambient air. The agreement between LOAC2 and the other instruments is good, confirming the ability of LOAC2 to be used for scientific studies and for monitoring atmospheric aerosols. Full article
(This article belongs to the Special Issue Advanced Sensing Technologies for Environmental Applications)
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16 pages, 6171 KB  
Article
An Isothermal Amplification Method for SARS-CoV-2 Variant Differentiation via Targeted Genomic RNA Detection
by Alfonso Shin, Marc J. Madou, Lawrence Kulinsky, Elliot E. Hui, Rie Nakajima and Philip Felgner
Chemosensors 2026, 14(6), 135; https://doi.org/10.3390/chemosensors14060135 (registering DOI) - 14 Jun 2026
Abstract
The rapid emergence of SARS-CoV-2 variants underscores the need for accurate, rapid, and affordable diagnostic tools, particularly in resource-limited settings. An isothermal amplification-based assay was developed integrating reverse-transcriptase recombinase polymerase amplification (RT-RPA), T7 transcription, and duplex-specific nuclease (DSN)-mediated detection for variant discrimination. The [...] Read more.
The rapid emergence of SARS-CoV-2 variants underscores the need for accurate, rapid, and affordable diagnostic tools, particularly in resource-limited settings. An isothermal amplification-based assay was developed integrating reverse-transcriptase recombinase polymerase amplification (RT-RPA), T7 transcription, and duplex-specific nuclease (DSN)-mediated detection for variant discrimination. The assay targets three genomic regions: a conserved region within ORF1a and two variant regions, ORF1a (Δ3675–3677) and the S gene (Δ69–70), enabling differentiation between the Wuhan-Hu-1 reference isolate and the B.1.1.7 variant. The method demonstrated high specificity and a limit of detection of 200 copies per sample using low-cost instrumentation. DSN-mediated cleavage improved discrimination between matched and mismatched RNA targets while enabling signal amplification through target recycling. The assay requires minimal laboratory infrastructure, relying on a heat block and fluorescent plate reader. These results demonstrate a scalable and cost-effective strategy for SARS-CoV-2 variant screening with potential as a future strategy for pathogen screening and variant surveillance. Full article
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16 pages, 1087 KB  
Article
Age-Related Aesthetic Outcomes of Anterior Direct Composite Restorations: Color Match, Patient–Clinician Concordance, and Oral Health-Related Quality of Life
by Magda Mihaela Luca, Roxana Buzatu and Bogdan Andrei Bumbu
J. Clin. Med. 2026, 15(12), 4610; https://doi.org/10.3390/jcm15124610 (registering DOI) - 13 Jun 2026
Abstract
Background/Objectives: Anterior direct composite restorations are evaluated through instrumental color matching, clinician appraisal, and patient perception, but these endpoints may diverge by age. This cross-sectional study compared adolescents/young adults (AYA, 15–25 years) with adults/elderly (AE, 50–75 years) for spectrophotometric color difference (ΔE*ab), [...] Read more.
Background/Objectives: Anterior direct composite restorations are evaluated through instrumental color matching, clinician appraisal, and patient perception, but these endpoints may diverge by age. This cross-sectional study compared adolescents/young adults (AYA, 15–25 years) with adults/elderly (AE, 50–75 years) for spectrophotometric color difference (ΔE*ab), patient and clinician aesthetic ratings, patient–clinician agreement, and oral-health-related quality of life (OHRQoL). Methods: Consecutive recall patients with at least one anterior direct composite restoration placed ≥6 months earlier were screened; 128 were enrolled, and 126 completed all assessments (AYA n = 64; AE n = 62). Participants completed the OHIP-14 and aesthetic visual analogue scale (VAS) before receiving any USPHS, clinician VAS, or spectrophotometric feedback. A separate clinician, masked to patient scores and spectrophotometric outputs but not to patient age, recorded clinician VAS and modified USPHS criteria. Results: AE restorations showed higher ΔE*ab than AYA restorations (4.8 ± 1.6 vs. 3.2 ± 1.1; p < 0.001), whereas AYA reported lower patient VAS (72.4 ± 12.3 vs. 81.6 ± 10.8; p < 0.001) and higher OHIP-14 psychosocial burden (7.2 ± 2.8 vs. 4.0 ± 2.3; p < 0.001). Clinician VAS was higher in AYA (85.2 ± 7.3 vs. 79.4 ± 8.9; p < 0.001). Patient VAS correlated modestly with ΔE*ab (ρ = −0.38 in AYA; ρ = −0.31 in AE) and more strongly with psychosocial OHIP-14 scores (ρ = −0.54 and −0.47, respectively). Patient-clinician agreement was poor in AYA (ICC = 0.26) and moderate in AE (ICC = 0.58), with larger negative patient-minus-clinician discrepancies in AYA. Exploratory mediation statistically decomposed the age-related patient-satisfaction difference more through patient–clinician discrepancy than through ΔE*ab; causality cannot be inferred. Conclusions: Younger patients may experience dissatisfaction and psychosocial burden despite better instrumental color match. Assessment of anterior composites should combine objective shade measurement with patient-centered expectation clarification, and longitudinal studies should test temporal mechanisms and communication interventions. Full article
(This article belongs to the Special Issue Clinical Updates on Prosthodontics)
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21 pages, 967 KB  
Article
Unlocking Private Investment for Sustainable Infrastructure in the Pacific Islands: Japan’s JCM and ESG Innovation
by Noriyuki Segawa, Suliasi Vunibola and Viliame Kasanawaqa
Sustainability 2026, 18(12), 6100; https://doi.org/10.3390/su18126100 (registering DOI) - 13 Jun 2026
Abstract
Developing countries in which infrastructure development is heavily dependent on overseas development aid face significant sustainability challenges, including financing gaps and inadequate maintenance. Increasing private-sector investment is crucial for addressing these challenges. This paper proposes an innovative framework linking environmental, social, and governance [...] Read more.
Developing countries in which infrastructure development is heavily dependent on overseas development aid face significant sustainability challenges, including financing gaps and inadequate maintenance. Increasing private-sector investment is crucial for addressing these challenges. This paper proposes an innovative framework linking environmental, social, and governance (ESG) principles with a revised joint credit mechanism (JCM) to attract private investment in infrastructure development, particularly in Pacific Island countries facing the climate crisis. Under the revised JCM, by allocating generated carbon credits to participating Japanese companies, rather than the Japanese government, corporations can monetise credits through market transactions, creating compelling economic incentives for private-sector engagement. In ESG-advanced markets, credits serve as strategic instruments for corporate value enhancement beyond revenue generation, while corporations require continuous credit acquisition to sustain investor confidence. Our revised framework provides a sustainable solution to both financing gaps and infrastructure maintenance challenges. Our analysis demonstrates that integrating market dynamics and corporate incentives into bilateral climate mechanisms holds substantial potential for mobilising private capital for sustainable climate infrastructure finance. This approach represents a promising departure from traditional donor-dependent models, effectively aligning corporate interests with sustainable development objectives while advancing national emission reduction commitments. Full article
29 pages, 1083 KB  
Article
Corporate ESG Greenwashing Governance Under Fiscal–Financial Policy Coordination: Evidence from a Quasi-Natural Experiment of the Green Loan Interest Subsidy Policy
by Zhaoxia Wu and Xinyu Zeng
Sustainability 2026, 18(12), 6099; https://doi.org/10.3390/su18126099 (registering DOI) - 13 Jun 2026
Abstract
As sustainable finance continues to advance, an important question is how scientifically designed and well-targeted policies can curb corporate ESG greenwashing and improve the quality of firms’ ESG and sustainability disclosure. From the perspective of fiscal–financial policy coordination, we exploit the green loan [...] Read more.
As sustainable finance continues to advance, an important question is how scientifically designed and well-targeted policies can curb corporate ESG greenwashing and improve the quality of firms’ ESG and sustainability disclosure. From the perspective of fiscal–financial policy coordination, we exploit the green loan interest subsidy policy (GLIS) as a quasi-natural experiment and develop an analytical framework around four policy components: commercial banks’ information screening, local governments’ green screening, the subsidy instrument’s leverage and certification effects, and firms’ internal green governance. Within this framework, we examine whether the GLIS can restrain corporate ESG greenwashing. Using Chinese listed firms from 2009 to 2022 as the sample and identifying the effect through a multi-period difference-in-differences (DID) model, we find that the GLIS significantly curbs corporate ESG greenwashing. In exploring the underlying channels, we find that the GLIS curbs corporate ESG greenwashing by strengthening commercial banks’ information screening, enhancing local governments’ green screening, easing firms’ external financing constraints, and reinforcing firms’ internal green governance. Further analysis indicates that the inhibitory effect of the GLIS on corporate ESG greenwashing is more pronounced among non-state-owned firms, firms in the growth stage, firms in heavily polluting industries, and firms located in regions with weaker resource endowments. In addition, the stronger a firm’s digital technology R&D capability and corporate governance capability, the greater the restraining effect of the GLIS on its ESG greenwashing. By systematically evaluating the governance effect of fiscal–financial policy coordination on corporate ESG greenwashing, our study provides useful insights for governments seeking to improve green finance policies and optimize the coordination of green policy instruments. Full article
17 pages, 382 KB  
Review
Review of 2D Spectral Image Processing Techniques
by Bo Qiu, Tao Lu, Siqi Liu and Ali Luo
Universe 2026, 12(6), 177; https://doi.org/10.3390/universe12060177 (registering DOI) - 13 Jun 2026
Abstract
The processing of two-dimensional (2D) spectral images constitutes a critical and multifaceted discipline in contemporary astronomical data analysis. As spectroscopic instruments evolve towards higher multiplexing, resolution, and sensitivity, the raw 2D data captured by detectors present increasingly complex challenges that transcend simple one-dimensional [...] Read more.
The processing of two-dimensional (2D) spectral images constitutes a critical and multifaceted discipline in contemporary astronomical data analysis. As spectroscopic instruments evolve towards higher multiplexing, resolution, and sensitivity, the raw 2D data captured by detectors present increasingly complex challenges that transcend simple one-dimensional extraction. This review provides a systematic and comprehensive examination of the methodological evolution in this field over the past two decades. It gathered relevant studies by searching mainstream academic repositories and general search engines with the core keyword ‘2D Spectral Image’, and selected qualified references according to accessibility and research relevance. We categorize the landscape into three major paradigms: (1) physics-based modeling and algorithmic correction techniques for geometric distortion, scattered light, and sky background; (2) data-driven machine learning and deep learning approaches for image correction, spectral classification, and faint signal detection; and (3) the development of open-source software pipelines that democratize advanced processing. A central contribution of this review is a detailed comparative analysis of the performance metrics, underlying assumptions, and practical limitations of prominent algorithms. We highlight the transformative impact of convolutional neural networks (CNNs) and vision transformers (ViTs) on tasks such as celestial object classification and exoplanet detection, while also acknowledging the enduring importance of robust physical models for calibration and uncertainty quantification. The discussion culminates in an assessment of persistent challenges—including computational scalability, model generalizability, and interpretability—and outlines promising future directions at the intersection of AI, statistical inference, and large-scale survey science. Full article
(This article belongs to the Special Issue Applications of Artificial Intelligence in Modern Astronomy)
17 pages, 921 KB  
Article
The Societal Burden of Breast Cancer in Working-Age Women in Croatia: A Multicentre Cross-Sectional Study
by Vid Duplančić, Ana Bobinac, Luka Vončina, Katarina Hraste, Ana Tečić Vuger, Robert Šeparović and Eduard Vrdoljak
Healthcare 2026, 14(12), 1693; https://doi.org/10.3390/healthcare14121693 (registering DOI) - 12 Jun 2026
Abstract
Background/Objectives: Breast cancer affects working-age women not only through treatment and survival but also through health-related quality of life (HRQoL), work capacity and informal caregiving needs. Evidence from Central and Eastern Europe remains limited. This study estimated the indirect societal burden of breast [...] Read more.
Background/Objectives: Breast cancer affects working-age women not only through treatment and survival but also through health-related quality of life (HRQoL), work capacity and informal caregiving needs. Evidence from Central and Eastern Europe remains limited. This study estimated the indirect societal burden of breast cancer among working-age women in Croatia and reported economic indirect costs separately from monetised HRQoL/welfare loss. Methods: A multicentre cross-sectional study conducted in 2024 included women aged 18–65 years receiving outpatient oncology care at two tertiary centres in Croatia. HRQoL was assessed with the EuroQol five-dimension five-level instrument (EQ-5D-5L) and compared with Croatian general-population norms. Utility decrements were annualised and monetised using a national willingness-to-pay threshold of €17,000 per quality-adjusted life year (QALY). Work productivity impairment was measured using the Work Productivity and Activity Impairment: General Health (WPAI:GH) questionnaire and valued, together with informal care, using the human-capital approach. Deterministic sensitivity analyses and approximate 95% confidence intervals were used to show how the estimates changed under key assumptions. Results: A total of 271 women participated (mean age 51.3 years among age-eligible records). Mean EQ-5D-5L utility was 0.76 versus 0.91 in the general population, corresponding to an annual QALY loss of 0.15 and a monetised HRQoL/welfare loss of €2550 per patient-year (95% CI €2083–€3017). Among employed participants, mean overall work productivity loss was 43.9% (842.9 h/year), equivalent to €7333 annually (95% CI €6311–€8355). Informal caregiving was reported by 54.7% of participants, with mean annual costs of €1566 (95% CI €1269–€1863). Economic indirect costs were €8899 per patient-year (95% CI €7835–€9963). In an extended welfare-inclusive scenario, the estimated burden was €11,449 per patient-year (95% CI €10,287–€12,611), corresponding to an illustrative national estimate of €86 million (95% CI €77–€95 million; 0.11% of gross domestic product). Conclusions: Breast cancer in working-age women imposes a substantial societal burden in Croatia, driven by reduced HRQoL, productivity losses and informal caregiving needs. These findings support taking societal burden into account in public health planning, survivorship care and health policy decision-making. Full article
(This article belongs to the Section Public Health and Preventive Medicine)
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16 pages, 302 KB  
Article
Self-Reported Depressive Symptomatology Among University Students: Evidence from the PROTEGER-SE Project
by Karine Santana de Azevedo Zago, Raissa Pereira Dutra, Clesnan Mendes-Rodrigues, Amanda Viana Hortêncio, Analicy Rodrigues Xavier, Sarah Campos Moura Rabelo, Gustavo Henrique Borges de Souza, Felipe Rodrigues Torres, Polyana Alvarenga Matumoto, Mônica Rodrigues da Silva, Hélder Eterno da Silveira, Elaine Saraiva Calderari, Tiago Rocha Pinto, Ricardo Wagner Machado da Silveira, Cynthia Daniela Figueiredo de Souza, Tatiana Benevides Magalhães Braga, Marciana Gonçalves Farinha, Luiza Pereira Silva Assis, Beatriz da Silva Vieira and Fabiola Alves Gomes
Psychiatry Int. 2026, 7(3), 136; https://doi.org/10.3390/psychiatryint7030136 (registering DOI) - 12 Jun 2026
Abstract
This study aimed to assess the self-reported depressive symptomatology of university students during their first therapeutic online consultation and intervention at PROTEGER-SE Project, using the Patient Health Questionnaire-9 (PHQ-9) as a screening instrument. A cross-sectional, retrospective, and analytical study was conducted with 350 [...] Read more.
This study aimed to assess the self-reported depressive symptomatology of university students during their first therapeutic online consultation and intervention at PROTEGER-SE Project, using the Patient Health Questionnaire-9 (PHQ-9) as a screening instrument. A cross-sectional, retrospective, and analytical study was conducted with 350 records of university students from 2020–2023 collected immediately after their first appointment. Many students presented moderate to severe depressive symptoms, with one-third classified as severe. Logistic regression showed that female sex was associated with higher symptomatology severity, while lower PHQ-9 scores and Humanities field of study enrollment predicted perceived improvement after consultation. Findings reinforce the importance of university-based mental health support, gender-sensitive approaches, and the systematic use of PHQ-9 for early screening and continuous monitoring. Full article
37 pages, 11129 KB  
Article
Automated Feature-Level Analysis of the Draw-a-Person Test Using a Hybrid CNN and Rule-Based Framework
by Asma Abdullah Alwadai and Emad Sami Jaha
Appl. Sci. 2026, 16(12), 5975; https://doi.org/10.3390/app16125975 (registering DOI) - 12 Jun 2026
Abstract
The Draw-a-Person (DAP) test has been a widely used practical instrument in psychological and developmental assessments to measure children’s cognitive development via human-figure drawings. Unfortunately, its traditional scoring process relies on manual inspections conducted by professionals, which is highly subjective and difficult to [...] Read more.
The Draw-a-Person (DAP) test has been a widely used practical instrument in psychological and developmental assessments to measure children’s cognitive development via human-figure drawings. Unfortunately, its traditional scoring process relies on manual inspections conducted by professionals, which is highly subjective and difficult to scale. In order to resolve these problems, this paper presents a hybrid approach that leverages deep-learning-based visual recognition and rule-based structural reasoning for automated evaluation of children’s DAP drawings. Specifically, the model assesses drawings based on 40 features, including anatomical parts, appearance-derived attributes, and high-level structural-drawing relations. A multi-label CNN built upon the ResNet-50 model predicts the visibles, and rule-based geometrical reasoning is adopted to infer structures, including attachments, proportions, symmetries, and placements. These two aspects are combined into a single hybrid representation yielding interpretable feature scoring consistent with developmental-evaluation standards. The proposed framework performs very well across multiple feature analyses, achieving a Micro-F1 of 95.32% and Macro-F1 of 91.72% on the test dataset, and demonstrating robust multi-label classification ability even on rare features. It provides a promising method for evaluating Draw-a-Person drawings, while offering reliable capabilities for feature analysis and scoring with accurate anatomical feature detection and reasonable structural and higher-level feature detection despite the challenging diversity of children’s drawing styles. The enforced rule-based structural reasoning improves interpretability and objectivity. Our future work includes extending the framework to cover further detailed DAP features. Full article
(This article belongs to the Special Issue Advances in Computer Vision and Digital Image Processing)
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Article
Sustainability Challenges and Opportunities for Social Enterprises in Romania: A Multidimensional Analysis
by Sorin Cace, Nina Stănescu, Dan Adrian Nicolae and Corina Cace
Sustainability 2026, 18(12), 6076; https://doi.org/10.3390/su18126076 (registering DOI) - 12 Jun 2026
Abstract
Over the last two decades, social enterprises in Romania have taken on an increasingly important role in the production and provision of social goods and services for vulnerable groups. Although forms of the social economy have long existed in Romanian society, sustainability remains [...] Read more.
Over the last two decades, social enterprises in Romania have taken on an increasingly important role in the production and provision of social goods and services for vulnerable groups. Although forms of the social economy have long existed in Romanian society, sustainability remains a constant concern, particularly in the context of dependence on European Union structural funds. This study identifies the multidimensional factors influencing the sustainability of social enterprises in Romania, combining a quantitative analysis of 121 certified social enterprises from the National Register (2016–2022) with qualitative case studies of 15 selected organisations. Revenue diversification was significantly associated with financial sustainability (β = −0.28, p < 0.01), whilst high dependence on EU funding (>50% of revenue) was negatively associated with long-term viability (HR = 2.18, p = 0.002). Participation in networks was associated with markedly higher five-year survival rates (87.2% for network members versus 69.5% for non-members). Six key sustainability strategies were identified: hybrid revenue models, integration into the value chain, community inclusion, adaptive leadership, strategic partnerships, and effective communication of results and impact. Environmental sustainability is addressed with preliminary proxy evidence from the qualitative component; systematic measurement of this dimension represents a priority for future research. The findings confirm the absence of an integrated support framework for the sustainable activities of the social economy and, in some cases, the limited capacity of public institutions to support vulnerable groups. Policy recommendations include phased funding mechanisms, transitional support instruments and the systematic development of regional ecosystems. Full article
(This article belongs to the Section Economic and Business Aspects of Sustainability)
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