Search Results (7,284)

This study examines how investment efficiency and risk jointly shape sustainable grain supply-chain upgrading. Using firm-level panel data for 25 listed grain supply-chain firms in China from 2015 to 2023, this study examines efficiency–risk structures and their heterogeneity across upstream, midstream, and downstream segments. A three-stage data envelopment analysis (DEA) is applied to measure investment efficiency while controlling for environmental heterogeneity and statistical noise, and a multidimensional investment risk index is constructed using principal component analysis (PCA), with an emphasis on sustainability metrics. The results reveal a clear supply-chain gradient: downstream firms exhibit the highest mean third-stage investment efficiency (crete = 0.633) and scale efficiency (scale = 0.634), midstream firms are intermediate (crete = 0.308; scale = 0.326), and upstream firms remain lowest (crete = 0.129; scale = 0.138). This ordering is also visible year by year, while risk profiles indicate higher exposure upstream and pronounced volatility midstream. Efficiency decomposition shows that upstream inefficiency is mainly driven by scale inefficiency rather than insufficient pure technical efficiency. Overall, efficiency–risk mismatch—manifested as persistent low scale efficiency and elevated risk exposure in upstream, volatility in midstream, and stability in downstream—constitutes a key micro-level barrier to long-term and resilient upgrading. The study thus offers policy-relevant insights for segment-specific interventions that align with sustainable agricultural development: facilitating land consolidation and integrated risk management for upstream scale inefficiency, promoting supply-chain finance and digital integration for midstream risk volatility, and leveraging downstream stability to drive coordinated upgrading and sustainable value creation through market-based incentives. Full article

Introduction: Nursing informatics aims to improve patient care through rapid access to patient data, systematic assessment, a reduction in clinical errors, evidence-based practice, cost-effectiveness, and improved patient outcomes and safety. Background: Despite being the largest workforce in healthcare, nurses are not being adequately prepared to use nursing informatics, and this has been attributed to poor digital literacy, limited professional development, and a lack of undergraduate informatics education. Objectives: This scoping review aims to review contemporary published literature on the benefits, barriers, and enablers for embedding nursing informatics into undergraduate nursing education with a focus on the Australian healthcare context. Methods: A scoping review was conducted using the PRISMA-ScR checklist and the JBI Manual for evidence synthesis in adherence with an a priori scoping review protocol. A comprehensive search of JBI, Cochrane, CINAHL, Ovid, ProQuest, PubMed, and Scopus databases was performed. Two reviewers independently screened the results via Covidence, with discrepancies resolved via a third reviewer. Results: Two searches were conducted for this scoping review. In the first search, a total of 3227 articles were identified through database searches, with an additional 76 articles identified through bibliographic and grey literature searches. Following duplicate removal and screening, 46 articles met the inclusion criteria. In the second search, a total of 1555 articles were identified, and after duplicate removal and screening, 16 articles met the inclusion criteria. Duplicate removal during the second search round included those articles identified in the first search. The combined searches resulted in a total of 62 sources for this review. Conclusions: Despite the early adoption of nursing informatics in Australia in the 1980s, barriers remain to effective nursing informatics engagement and proficiency, including a lack of understanding of nursing informatics, limited infrastructure and resources, inadequate digital literacy of students and faculty, and the evolving nature of nursing informatics. Definitions of nursing informatics and associated fields, development of university faculty competency, access to digital health technologies, competency standards, digital literacy of the student cohort, faculty digital proficiency, and leadership from professional nursing bodies are all viewed as integral foundations for the development of student competency in nursing informatics. Full article

The escalating global incidence of ulcerative colitis (UC) underscores the demand for novel therapeutic strategies. This study investigated the fermentation of Periplaneta americana (PA) powder using two conventional dairy starter strains, Lactobacillus delbrueckii subsp. bulgaricus SN22 and Streptococcus thermophilus SN05, to enhance its functional properties, particularly anti-inflammatory activity, via microbial processing. Both strains demonstrated favourable safety and antimicrobial activity. Untargeted metabolomics revealed that fermentation significantly altered the metabolite profile of the PA supernatant, enriching compounds with potential bioactivities, notably anti-inflammatory (e.g., 3-anisic acid) and antioxidant (e.g., vitamin U) properties. In the DSS-induced mouse colitis model, treatment with the fermented supernatant alleviated intestinal inflammation compared to the unfermented group. This was demonstrated by significantly reduced levels of the pro-inflammatory cytokines IL-1β and TNF-α, along with improved maintenance of intestinal barrier integrity. Further in vitro assays showed that the fermented supernatant significantly suppressed proliferation and clonogenicity in human HT-29 colon cancer cells, while also inducing reactive oxygen species accumulation and apoptosis. Results demonstrate these strains are multifunctional starters possessing superior antimicrobial and anti-inflammatory efficacy. This study employed LAB fermentation of insect-derived matrices to derive bioactive components. The fermentation products exhibited anti-inflammatory potential, offering a potential microbial transformation strategy for developing functional products for adjunctive UC intervention. Full article

Background: Evidence-based practice (EBP) has become a foundational component of modern healthcare globally. In Saudi Arabia, the understanding and application of EBP by respiratory therapists (RTs) remains underexplored. This study aimed to assess RTs’ behaviors, attitudes, awareness, knowledge, and barriers related to EBP. Methods: A previously validated online questionnaire was distributed to RTs across Saudi Arabia between February and July 2025. The survey collected sociodemographic data and included 14 items assessing behaviors, attitudes, awareness, knowledge, prior formal EBP training, and perceived barriers to EBP implementation. Results: A total of 301 RTs participated, with 290 completing the survey. Most participants (75.2%) held a bachelor’s degree. Overall, respondents demonstrated positive attitudes toward EBP, with more than 60% agreeing that understanding research methods is essential to respiratory therapy practice. The most frequently used resources for clinical decision-making were personal experience (67.3%), expert opinion (65.5%), and national or international guidelines (65.5%). Awareness of core EBP concepts was moderate; approximately 30% of participants reported a good understanding of terms such as “systematic review,” “quality of evidence,” and “risk of bias.” Several barriers to EBP implementation were identified, most commonly limited access to resources (25.2%), insufficient research knowledge and skills (23.8%), and lack of interest (21.0%). Conclusions: RTs in Saudi Arabia generally support EBP principles and use evidence-based resources in clinical decision-making. However, gaps in training, access to resources, and research competency limit full EBP implementation. Targeted strategies, including integrating mandatory EBP education, expanding professional development, and enhancing access to research resources, are recommended. Full article

This review synthesizes four decades of scientific and industrial developments in packaging glass, integrating structural, technological, and sustainability perspectives. Glass remains the benchmark material for inert, transparent, and fully recyclable containment, yet its scope has expanded from conventional bottles and vials to advanced functional and electronic encapsulation. Packaging glasses are classified into five main families—soda–lime, borosilicate, aluminosilicate, recycled (cullet-rich), and functional/electronic—and compared across key domains: mechanical, thermal, chemical, optical, barrier, and hermetic. Quantitative tables and normalized diagrams illustrate how compositional and processing trends govern structure, processability, and performance. Advances in forming, surface engineering, and melting practice are analyzed for their contributions to lightweighting, durability, and decarbonization. Sustainability is addressed through cullet utilization, energy demand, life-cycle indicators, and regulatory alignment, defining pathways toward circular and low-carbon production. Overall, packaging glass emerges as a circular, chemically stable, and traceable material system, while advances in high-integrity glass formulations now support hermetic encapsulation for diagnostic, electronic, and energy devices. Full article

Ocular disorders such as keratitis, glaucoma, age-related macular degeneration (AMD), diabetic retinopathy (DR), and dry eye disease (DED) are highly prevalent worldwide and remain major causes of visual impairment and blindness. Conventional therapeutic approaches for ocular diseases, such as eye drops, surgery, and laser therapy, are frequently hampered by limited drug bioavailability, rapid clearance, and treatment-related complications, primarily due to the eye’s unique anatomical and physiological barriers. Hydrogels, characterized by their three-dimensional network structure, high water content, excellent biocompatibility, and tunable physicochemical properties, have emerged as promising platforms for ophthalmic drug delivery. This review summarizes the classification, fabrication strategies, and essential properties of hydrogels, and highlights recent advances in their application to ocular diseases, including keratitis management, corneal wound repair, intraocular pressure regulation and neuroprotection in glaucoma, sustained drug delivery for AMD and DR, vitreous substitutes for retinal detachment, and therapies for DED. In particular, we highlight recent advances in stimuli-responsive hydrogels that enable spatiotemporally controlled drug release in response to ocular cues such as temperature, pH, redox state, and enzyme activity, thereby enhancing therapeutic precision and efficacy. Furthermore, this review critically evaluates translational aspects, including long-term ocular safety, clinical feasibility, manufacturing scalability, and regulatory challenges, which are often underrepresented in existing reviews. By integrating material science, ocular pathology, and translational considerations, this review aims to provide a comprehensive framework for the rational design of next-generation hydrogel systems and to facilitate their clinical translation in ophthalmic therapy. Full article

Background: The rapid advancement in artificial intelligence (AI) has fundamentally reshaped gut microbiome research by enabling high-resolution analysis of complex, high-dimensional microbial communities and their functional interactions with the human host. Objective: This narrative review aims to synthesize recent methodological advances in AI-driven gut microbiome research and to evaluate their translational relevance for therapeutic optimization, personalized nutrition, and precision medicine. Methods: A narrative literature review was conducted using PubMed, Google Scholar, Web of Science, and IEEE Xplore, focusing on peer-reviewed studies published between approximately 2015 and early 2025. Representative articles were selected based on relevance to AI methodologies applied to gut microbiome analysis, including machine learning, deep learning, transformer-based models, graph neural networks, generative AI, and multi-omics integration frameworks. Additional seminal studies were identified through manual screening of reference lists. Results: The reviewed literature demonstrates that AI enables robust identification of diagnostic microbial signatures, prediction of individual responses to microbiome-targeted therapies, and design of personalized nutritional and pharmacological interventions using in silico simulations and digital twin models. AI-driven multi-omics integration—encompassing metagenomics, metatranscriptomics, metabolomics, proteomics, and clinical data—has improved functional interpretation of host–microbiome interactions and enhanced predictive performance across diverse disease contexts. For example, AI-guided personalized nutrition models have achieved AUC exceeding 0.8 for predicting postprandial glycemic responses, while community-scale metabolic modeling frameworks have accurately forecast individualized short-chain fatty acid production. Conclusions: Despite substantial progress, key challenges remain, including data heterogeneity, limited model interpretability, population bias, and barriers to clinical deployment. Future research should prioritize standardized data pipelines, explainable and privacy-preserving AI frameworks, and broader population representation. Collectively, these advances position AI as a cornerstone technology for translating gut microbiome data into actionable insights for diagnostics, therapeutics, and precision nutrition. Full article

The construction industry is undergoing a rapid digital transformation, with Digital Twins (DTs) and Extended Reality (XR) as two emerging technologies with great potential. Despite their potential, there are several challenges regarding DT and XR use in construction projects, including implementation barriers, interoperability issues, system complexity, and a lack of standardized frameworks. This study presents a systematic literature review (SLR) of DT and XR technologies—including Virtual Reality (VR), Augmented Reality (AR), and Mixed Reality (MR)—in the construction industry. The study analyzes 52 peer-reviewed articles identified using the Web of Science database to explore thematic findings. Key findings highlight DT and XR applications for safety training, real-time monitoring, predictive maintenance, lifecycle management, renovation or demolition, scenario risk assessment, and education. The SLR also identifies core enabling technologies such as Building Information Modeling (BIM), Internet of Things (IoT), Big Data, and XR devices, while uncovering persistent challenges including interoperability, high implementation costs, and lack of standardization. The study highlights how integrating DTs and XR can improve construction by making it smarter, safer, and more efficient. It also suggests areas for future research to overcome current challenges and help increase the use of these technologies. The primary contribution of this study lies in deepening the understanding of DT and XR technologies by examining them through the lenses of their benefits as well as drivers for and challenges to their adoption. This enhanced understanding provides a foundation for exploring integrated DT and XR applications to advance innovation and efficiency in the construction sector. Full article

Very Low Earth Orbit (VLEO) satellites, operating at altitudes below 450 km, provide tremendous potential in the domain of remote sensing. Their proximity to Earth offers high resolution, low latency, and rapid revisit rates, allowing continuous monitoring of dynamic systems and real-time delivery of vertically integrated earth observation products. Nonetheless, the application of VLEO is not yet fully realized due to numerous complexities associated with VLEO satellite development, considering atmospheric drag, short satellite lifetimes, and social, political, and legal regulatory fragmentation. This paper reviews the recent technological developments supporting sustainable VLEO operations with regards to aerodynamic satellite design, atomic oxygen barriers, and atmospheric-breathing electric propulsion (ABEP). Furthermore, the paper provides an overview of the identification of regulatory and economic barriers that extort additional costs for VLEO ranging from frequency band allocation and space traffic management to life-cycle cost and uncertain commercial demand opportunities. Nevertheless, the commercial potential of VLEO operations is widely acknowledged, and estimated to lead to an economic turnover in the order of 1.5 B USD in the next decade. Learning from the literature and prominent past experiences such as the DISCOVERER and CORONA programs, the study identifies key gaps and proposes a roadmap to sustainable VLEO development. The proposed framework emphasizes modular and serviceable satellite platforms, hybrid propulsion systems, and globally harmonized governance in space. Ultimately, public–private partnerships and synergies across sectors will determine whether VLEO systems become part of the broader space infrastructure unlocking new capabilities for near-Earth services, environmental monitoring, and commercial innovation at the edge of space. Full article

Chronic Pseudomonas aeruginosa lung infections in cystic fibrosis (CF) represent one of the most treatment-refractory bacterial diseases, sustained by biofilm formation, metabolic dormancy, and adaptive antibiotic resistance evolution. While bacteriophage (phage) therapy has emerged as a promising alternative for multidrug-resistant (MDR) pathogens, clinical studies in CF have demonstrated transient reductions in bacterial burden without achieving complete eradication. This review integrates molecular, evolutionary, and immunological findings to explain the multifactorial barriers that limit phage therapeutic efficacy in chronic CF infections. We highlight three major obstacles: (i) bacterial dormancy and persistence within biofilms that restrict phage adsorption and replication; (ii) hypermutability and extensive genotypic diversification of CF-adapted P. aeruginosa, which accelerate phage resistance evolution and necessitate broad host-range coverage; and (iii) CF-specific immune constraints—including a dysfunctional innate immune system and phage-neutralizing humoral immunity—that reduce phage bioavailability and undermine sustained bacterial clearance. Emerging strategies to overcome these challenges include the discovery of dormant-targeting phages capable of replicating in metabolically quiescent cells, evolution-informed phage training to delay resistance evolution, and synthetic phage engineering approaches designed to disrupt biofilms and expand host-range coverage. In parallel, computational or artificial intelligence (AI)-guided frameworks for phage cocktail design and cystic fibrosis transmembrane conductance regulator (CFTR) modulator-mediated restoration of host immune function together offer a more integrated therapeutic paradigm that unites phage biology and host immune context. By unifying clinical outcomes with mechanistic, evolutionary, and immunological perspectives, this review outlines a next-generation framework for phage therapy in CF aimed at achieving more durable therapeutic outcomes. Full article

The informal street food sector serves as a vital component of urban economies in South Africa, providing affordable nutrition and employment. However, this industry struggles to comply with required health and safety practices and standards. This study protocol outlines a mixed-methods investigation into hygiene practices, regulatory compliance, and the intersection with business sustainability among informal food vendors in Johannesburg’s inner city. This study aims to investigate how vendors’ perceptions of health risks and benefits influence compliance behaviours and, in turn, how these behaviours impact operational efficiency, financial stability, and customer trust. Grounded in the Health Belief Model (HBM) and the Balanced Scorecard (BSC) framework, the research seeks to explore both behavioural drivers and performance outcomes associated with hygiene adherence. The study will employ structured stall observations, semi-structured vendor interviews, and customer surveys across high-density vending zones. Quantitative data will be analysed using descriptive and inferential statistics, while qualitative data will be thematically analysed and triangulated with observed practices. The expected outcome is to identify key barriers and enablers of hygiene compliance and demonstrate how improved food safety practices contribute to business resilience, customer trust, and urban public health. The findings aim to inform inclusive policy and innovative business support strategies that integrate informal vendors into safer and more sustainable food systems. Full article

(1) Background: Education serves as a catalyst for social transformation toward sustainability, yet limited empirical evidence exists regarding primary education’s contribution to regional sustainable development, particularly in island contexts facing unique environmental and economic pressures. This study examined primary education teachers’ perceptions, practices, and challenges in implementing Education for Sustainable Development (ESD) in Zakynthos, Greece. (2) Methods: A triangulated quantitative approach surveyed a representative sample of 105 primary education teachers from the Zakynthos Primary Education Directorate using a 28-item structured questionnaire assessing ESD knowledge, teaching practices, barriers, and improvement strategies. Teacher questionnaire data were triangulated with KEPEA (Center for Environmental Education and Sustainability) program documentation (103 programs, 2020–2025) and school implementation records from 75 participating schools. Data were analyzed using descriptive statistics, Mann–Whitney U tests, Kruskal–Wallis tests, and Spearman correlations. (3) Results: Most teachers (65.7%) reported adequate knowledge of sustainable development concepts, with 75.3% incorporating ESD into teaching practice often or very often. Triangulation revealed convergent findings: environmental sustainability dominated teacher perceptions (67.3%) and KEPEA programming (78.4%), while economic sustainability received limited attention (18.1%). Female teachers demonstrated significantly higher ESD knowledge (U = 892.5, p < 0.05, r = 0.34). The majority (98.1%) considered ESD integration important, yet only 48.5% felt adequately prepared to teach sustainability topics. A notable attitude-action gap emerged: while 86.6% valued community partnerships, only 47.6% engaged frequently, and KEPEA documented 33.7% of formal collaborations. Primary barriers included insufficient curriculum time (61.9%) and limited resources (51.4%). Teachers identified training programs (71.4%) and access to educational materials (71.4%) as priority interventions. (4) Conclusions: Primary education teachers in Zakynthos demonstrate strong commitment to ESD but face structural barriers limiting implementation effectiveness. The environmental-economic imbalance suggests a need for professional development, integrating economic sustainability concepts through place-based approaches relevant to the island’s tourism-dependent economy. The attitude-action gap in partnerships indicates structural rather than attitudinal barriers requiring policy intervention. Findings support targeted teacher training, curriculum reform, and strengthened school-community collaboration to enhance ESD’s contribution to regional sustainable development. Full article

Bovine respiratory disease (BRD) remains one of the most consequential health and economic challenges in U.S. beef production, particularly within integrated systems where microbial, environmental, and management factors intersect. This review synthesizes contemporary epidemiological insights, emphasizing BRD’s multifactorial pathogenesis driven by dynamic host–pathogen–environment interactions involving agents such as Mannheimia haemolytica, Pasteurella multocida, and Mycoplasma bovis, alongside stressors from transportation, weaning, and commingling. BRD imposes annual losses exceeding two billion dollars through diminished feed efficiency, reduced carcass yield, increased treatment costs, and mortality. Despite progress in vaccination, biosecurity, and therapeutic interventions, BRD persists due to diagnostic subjectivity and limitations of traditional control measures. The review underscores emerging innovations, including precision livestock technologies, AI-enabled surveillance, and metabolomic biomarkers as transformative tools for early detection and targeted mitigation, while noting barriers related to cost, data harmonization, and scalability. The rising threat of antimicrobial resistance further highlights the need for stewardship frameworks that balance therapeutic effectiveness and public health priorities. Additionally, the paper analyzes policy and economic considerations, arguing for coordinated efforts among producers, veterinarians, researchers, and regulators. BRD is reframed as a systems-level challenge requiring integrated scientific, operational, and regulatory strategies to enhance resilience and sustainability across U.S. beef production. Full article

Milk is an essential component of the diet. Among its diverse molecular constituents, it contains nanoscale entities, known as extracellular vesicles (EVs), which play a pivotal role in intercellular communication. In particular, milk-derived EVs (MEVs) influence intestinal homeostasis by mitigating inflammatory responses, modulating gut microbiota composition, and contributing to epithelial integrity preservation and restoration. Currently, there are no information regarding their impact on intestinal connective tissue. Here, we investigate bovine MEV effects on the porcine gut stromal compartment, exposing intestinal decellularized bio-scaffolds repopulated with primary intestinal stromal fibroblasts, to different MEV concentrations (10⁶, 10⁸, and 10¹⁰ particles/mL). We observed a dose-dependent effect of MEVs on stromal fibroblast proliferation rate at concentrations higher than 10⁶ particles/mL. In addition, when MEVs were used to pre-condition the decellularized intestinal bio-scaffolds prior to cell repopulation, fibroblast growth was further boosted. Overall, these findings suggest that MEVs may play a significant role in promoting tissue remodeling and repair. This activity appears particularly relevant for enhancing intestinal homeostasis and resilience, as stromal fibroblasts contribute to the maintenance of gut integrity, barrier function, and immune balance. Moreover, the data here presented suggests the possibility of using MEVs to develop serum-free, chemically defined culture media for the generation of advanced three-dimensional (3D) models and intestinal artificial organs. Full article

Pediatric tuberculosis (TB) remains a critically underrecognized contributor to global childhood morbidity and mortality, with the highest burden concentrated in low-resource settings. Although children comprise a minority of overall TB cases, mortality is disproportionately high, particularly among those under five years of age, driven largely by delayed diagnosis, inadequate linkage to care, and limited access to effective treatment. The continued rise of pediatric multidrug-resistant TB (MDR-TB), especially in regions with low sociodemographic development, further highlights persistent gaps in current control strategies. This review synthesizes key aspects of pediatric TB pathogenesis and host immune responses that predispose young children to rapid disease progression and severe outcomes, including immune immaturity and paucibacillary infection. We summarize pulmonary and extrapulmonary disease manifestations and identify populations at heightened risk, including children with HIV, malnutrition, type 1 diabetes mellitus, and congenital or treatment-related immunosuppression. Ongoing challenges in diagnosis and treatment are discussed, including limitations of existing microbiologic and immunologic tests, specimen collection constraints, regimen toxicity, and barriers to adherence. Prevention remains central to reducing pediatric TB mortality. We highlight the sustained importance of bacille Calmette–Guérin (BCG) vaccination in preventing severe disease and death, the context-dependent variability in vaccine effectiveness, and the structural and socioeconomic determinants of vaccine coverage. We conclude that integrating equitable vaccine delivery, scalable preventive therapy, and child-adapted diagnostic strategies is essential to meaningfully reduce the global pediatric TB burden. Full article