Search Results (6,038)

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/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

Cooperatives play a significant role within organizational models by providing essential services such as technical support, advocacy, information, knowledge, and guidance, which contribute to the production of high-quality animal products in a safe, efficient, and responsible manner. Furthermore, cooperatives aim to enhance the livelihoods of marginalized populations and address consumer needs. In this context, a study focusing on the status of women’s cooperatives in the Eastern Mediterranean offers valuable insights into women’s participation in economic and social life, as well as their challenges and expectations. This research aims to evaluate the status, perspectives, participation, activities, and expectations of women’s cooperatives in Lebanon and Turkey. The findings indicate that 90% of respondents in Lebanon and 45.5% in Turkey expressed satisfaction with their respective cooperatives. Additionally, 90% of Lebanese respondents and 59.1% of Turkish respondents would recommend that women establish their own cooperatives. The most common motivation for forming cooperatives in both countries was the belief that women are stronger when they collaborate. Furthermore, 75% of respondents in Lebanon and 45.4% in Turkey believe that cooperatives are suitable for conducting business, while those who disagreed emphasized the need for specialized traders to address specific business requirements. Respondents who expressed dissatisfaction with cooperative collaboration often mentioned difficulties in making joint decisions and challenges in group cohesion. These findings underline the importance of cooperatives in enhancing women’s roles in economic activities and the challenges they face in both Lebanon and Turkey. Despite these challenges, women’s cooperatives continue to be perceived as a valuable means of empowerment and a key strategy for fostering collaboration and economic growth. Full article

Background/Objectives: The management of moderate-to-severe psoriasis in patients with a recent history of internal malignancy is a clinical challenge, as systemic immunosuppressive therapies are often avoided because of concerns about cancer recurrence. While Psoralen and Ultraviolet A (PUVA) photochemotherapy remains a valuable non-immunosuppressive alternative, regional variations in therapeutic response are not well-characterized in this population. This study aimed to evaluate total and segmental Psoriasis Area and Severity Index (PASI) responses to PUVA in patients with chronic plaque psoriasis and recent internal organ malignancy. Methods: This prospective, single-center, real-world cohort study enrolled 20 adults with moderate-to-severe chronic plaque psoriasis and a recent (<5 years) diagnosis of internal organ malignancy in complete remission. Participants received oral PUVA three times weekly for up to 30 sessions. Primary and secondary outcomes included changes in total PASI, segmental PASI (head/neck, trunk, upper limbs, and lower limbs), and Dermatology Life Quality Index (DLQI) at baseline, completion of therapy, and 6 months post-treatment. Results: PUVA led to a significant reduction in mean total PASI from 18.6 ± 3.2 at baseline to 5.7 ± 6.0 at treatment completion (69% reduction; p < 0.001). However, regional responses differed significantly: the head and neck improved the most (80.4%), followed by the trunk (72.2%) and upper limbs (72.3%), while the lower limbs showed the weakest response (59.5%; p < 0.001). At baseline, trunk contributed the most to total PASI (38%), while post-treatment, lower-limb lesions accounted for approximately 47% of the remaining total disease burden, showing the highest contribution to total PASI of all body regions. At 6 months, the lower limbs remained the most affected area, with significantly lower improvement (52.9%) compared to other regions. Mean DLQI also improved significantly from 17.2 ± 2.8 to 5.6 ± 2.6 (p < 0.001). Conclusions: PUVA is an effective and safe treatment for patients with psoriasis and a recent history of malignancy. Nevertheless, lower-limb psoriasis is relatively recalcitrant and contributes disproportionately to residual disease burden and relapse. These findings support the use of regional PASI assessment to guide individualized management and clinical expectations in this complex patient group. Full article

This article examines how managers in the Norwegian construction industry—represented by bachelor’s students in construction site management—perceive and understand the concepts of Industry 5.0 and Society 5.0. The study focuses on participants’ interpretations, reflections, and expectations regarding these emerging frameworks. Using qualitative data, the research draws on insights from 70 part-time students with full-time industry positions, organised into 15 interdisciplinary groups. The findings show that participants were familiar with the core ideas of Industry 5.0 and Society 5.0 and were able to identify both opportunities and challenges. They emphasised the increasing importance of human roles in Industry 5.0 compared with Industry 4.0. A successful transition toward these paradigms will require strengthened competence, self-directed learning, and investment in both skills and technology, aligning with the needs of a knowledge-intensive and sustainability-oriented society. Participants highlighted the Norwegian working life model as an advantage, noting its compatibility with the human-centred principles of Industry 5.0. The article contributes to understanding how future construction managers interpret these concepts and offers an analysis of resilience, including vulnerability and capacity, within a Norwegian context. Full article

Environmental change, accelerated by increasing global temperatures, has become a defining economic, ecological, and public health issue of the twenty-first century. This study presents an economic evaluation of early mortality associated with air pollution, a major factor underlying worldwide patterns of illness and premature mortality, through which climate change affects global population health. Using secondary global mortality estimates and an economic valuation framework, both tangible costs (e.g., economic output and income losses) and quality-of-life loss (e.g., welfare loss associated with premature mortality) are estimated. The paper contributes to planetary health scholarship by integrating established economic valuation approaches with harm-reduction and systems-based perspectives to reinterpret air pollution as an interconnected environmental, economic, and societal challenge rather than solely a public health issue. Air pollution is associated with reduced life expectancy and approximately 3 million premature deaths annually worldwide. The estimated annual tangible economic burden is approximately US$940.9 billion (range: US$550.5 billion–US$1.65 trillion), while intangible costs are estimated at US$37.8 trillion annually (range: US$13.3 trillion–US$48.8 trillion). The findings suggest that air pollution should be understood not merely as a health-related challenge but also as a broader planetary health challenge with implications for environmental sustainability, economic resilience, and long-term societal well-being. Targeted air quality interventions and pollution reduction strategies may therefore generate substantial public health and societal co-benefits worldwide. Full article

The integration of artificial intelligence (AI) into the life sciences has accelerated significantly between 2022 and 2026, accompanied by global investment exceeding USD 100 billion and widespread expectations of a transformative impact in drug discovery. Despite these advances, the extent to which AI has improved clinical outcomes remains unclear. This study presents a structured narrative review evaluating the economic, technical, clinical, and regulatory dimensions of AI adoption in drug discovery. Current evidence indicates that clinical attrition rates remain high, with approximately 90% of drug candidates entering clinical development failing to achieve regulatory approval. Although AI systems such as AlphaFold have achieved high structural prediction accuracy, with predicted local distance difference test (pLDDT) scores exceeding 90 for well-structured proteins and root mean square deviation (RMSD) values comparable to experimental methods, limitations persist in modelling protein dynamics, post-translational modifications, and protein–ligand interactions. Clinical case studies demonstrate that while AI can accelerate early-stage discovery timelines, these advantages do not consistently translate into improved late-stage success rates. Furthermore, reproducibility challenges, limited data transparency, and regulatory gaps continue to constrain reliable implementation. These findings suggest that AI in drug discovery is currently in a transitional phase characterised by high investment but limited validated clinical impact. Future progress will depend on strengthening validation frameworks, improving data sharing practices, and aligning regulatory standards with real-world clinical performance. Full article

Community-based tourism (CBT) destinations are increasingly expected to align visitor experiences with climate responsibility, yet local managers often lack product-level carbon evidence that can guide practical route redesign and service decisions. This study addresses this aggregation-to-action gap by developing a route-level carbon footprint baseline for a CBT itinerary in Ban Boonjaem, Phrae Province, Thailand. Using an exploratory and applied case study design, the study treats one completed six-hour, non-overnight itinerary as the functional unit and applies a life-cycle-informed operational boundary covering transportation, food and beverage consumption, and solid waste generated during the route test. Primary activity data were collected from one organized route test involving 20 Thai domestic volunteer tourists and were matched with relevant emission factors to estimate total and per-tourist emissions. The tested itinerary generated 0.2234 tCO2e, equivalent to 223.4 kgCO2e in total and approximately 11.2 kgCO2e per tourist per trip. Transportation was the largest emission domain, accounting for 55.89% of total route emissions, followed by food and beverage consumption at 38.55%, while waste contributed 5.56%. Together, transportation and food and beverage represented 94.44% of measured emissions, indicating that the route’s carbon profile was shaped mainly by mobility arrangements and service provisioning rather than waste generation alone. The study contributes a transparent, route-specific operational baseline for low-carbon CBT management. The findings should be interpreted as case-specific decision-support evidence rather than as a destination-wide carbon inventory or statistically generalizable estimate. Full article

Background: Hepatocellular carcinoma (HCC) is a leading indication for liver transplantation (LT), representing a curative treatment option for selected patients. A remaining clinical challenge is the recurrence of HCC after transplantation, impacting long-term graft and patient survival. The impact of different bridging therapies (BTs) such as transarterial chemoembolization (TACE), local ablation or liver resection on recurrence rates remains unclear. We assessed post-transplant HCC recurrence and survival focusing on the role of pre-transplant bridging therapies. Methods: Adult recipients undergoing LT for HCC at Hannover Medical School from January 2007 to September 2022 were retrospectively analyzed (n = 185). Recurrence was defined as confirmed intra or extrahepatic HCC after LT. Overall survival (OS) and recurrence-free survival (RFS) were analyzed using Kaplan–Meier estimation and log-rank testing; multivariable Cox proportional hazards regression was used to identify independent factors influencing OS. Results: Pre-transplant BT was administered in 85.4% of patients, consisting of only TACE, (n = 20; 10.8%), local ablation, (n = 32; 17.3%), liver resection (n = 27; 14.6%) or a multimodal approach (n = 50; 27%). Post-transplant HCC recurrence rate was 9.2% with a median time to recurrence of 845 days (range 126–3978 days). Patients with post-transplant HCC recurrence had a significantly higher prevalence of viral hepatitis (70.6% vs. 57.1%; p = 0.01), higher pre-transplant AFP peak levels (37.5 vs. 10 ng/mL; p = 0.03), larger tumor sizes (median 3.95 cm vs. 2.6 cm; p = 0.03) and more poorly differentiated tumors (G3; 25.0% vs. 5.3%, p = 0.04). Kaplan–Meier analysis showed significant overall differences in OS and RFS among bridging therapy groups (p = 0.03). In the subgroup of early HCC < 3 cm, local ablation was associated with significantly improved OS compared to TACE (p = 0.035). Last measured pre-transplant AFP < 15 ng/mL was a significant predictor of both improved OS (p = 0.006) and RFS (p = 0.008), whereas peak AFP did not reach significance after correction. Multivariable Cox regression revealed HCC recurrence, high recipient BMI and low LabMELD as independently associated with reduced OS after LT. Median OS after HCC recurrence was 13 months. Conclusions: Our monocentric retrospective data indicate that post-transplant HCC recurrence is uncommon but remains a challenge regarding life expectancy and is influenced by pre-transplant bridging therapy. In the subgroup of early HCC < 3 cm, local ablation was associated with significantly improved OS compared to TACE. Last measured pre-transplant AFP < 15 ng/mL was associated with both improved OS and RFS, suggesting that treatment response may also represent a prognostically relevant factor. Further prospective validation of contemporary locoregional and systemic bridging approaches, especially in the context of tumor biology and treatment response, is warranted. Full article

Background: Bladder pain syndrome (BPS) is a chronic, debilitating condition defined by the International Continence Society as bladder-related pelvic pain accompanied by urinary symptoms in the absence of identifiable pathology. Its heterogeneous presentation, unclear pathophysiology, and variable treatment response make management challenging for general urologists. This review aims to provide a practical narrative review of current understanding of BPS, with particular emphasis on diagnosis, phenotyping, and non-operative management strategies relevant to the general urologist. Methods: A narrative literature review was undertaken using PubMed/MEDLINE, Embase, Google Scholar, and major international guideline documents to identify evidence relating to the diagnosis and non-operative management of BPS. Publications from January 2015 to December 2025 were reviewed, with selected landmark earlier studies included, where clinically relevant. Priority was given to guidelines, systematic reviews, randomised trials, and cohort studies. Owing to heterogeneity in study design, patient phenotypes, and reported outcomes, findings were synthesized narratively. Results: BPS represents a heterogeneous spectrum, including Hunner-lesion and non-Hunner phenotypes, with proposed mechanisms involving urothelial dysfunction, chronic inflammation, immune dysregulation, and central sensitisation. Diagnosis remains one of exclusion, relying on careful history, examination, symptom scoring, and selective investigations. Non-operative management is stepwise and multidisciplinary, combining lifestyle modification, pelvic floor therapy, oral agents and intravesical therapy. Available evidence suggests that symptom improvement is often modest but clinically meaningful in selected patients, supporting an individualized, phenotype-informed approach to care with realistic patient counselling. Conclusions: Bladder pain syndrome remains a chronic, multifaceted disorder with profound impact on quality of life, requiring clinicians to approach patients with empathy while recognising the physical, psychological, and social burden of the condition. Effective management requires early recognition, thoughtful phenotyping, exclusion of confusable conditions, and realistic expectation-setting within a multidisciplinary framework. For the general urologist, a structured and compassionate non-operative approach can improve symptom control, support shared decision-making, and help guide timely escalation when required. Full article

Background: Stress urinary incontinence (SUI) is defined as involuntary urine loss during activities that increase intra-abdominal pressure. It is highly prevalent among women and significantly affects physical, emotional, and social well-being. Pelvic floor muscle training (PFMT) is the gold-standard conservative therapy. Second-generation radiofrequency (RF) therapy has shown promise as an alternative. It stimulates collagen synthesis and promotes tissue remodeling. This study will compare the effects of PFMT, RF, and their combination on pelvic floor function, urethral stability, and health-related quality of life (HRQoL) in women with SUI due to urethral hypermobility. Methods/Design: This will be a single-blinded, three-arm, randomized controlled trial conducted at Clínica Traña (San José, Costa Rica). Women aged ≥18 years with clinically confirmed SUI and a retrovesical (β) angle ≥ 140° during the Valsalva maneuver on functional transperineal ultrasound will be randomized (1:1:1) to PFMT (16 weeks, twice-weekly supervised sessions), RF (5 weekly sessions using Capenergy^® C500 Urogyne), or combined RF + PFMT (39 per arm; total N = 117 accounting for 30% attrition). The primary outcome is the change from baseline in pelvic floor muscle strength at 12 months post-intervention, measured by the modified Oxford scale and vaginal manometry. Secondary outcomes will include urethral stability (retrovesical β angle and bladder neck descent on ultrasound), incontinence severity (Sandvik Severity Index), and HRQoL (ICIQ-UI SF and King’s Health Questionnaire). All outcomes will be assessed at baseline, immediately post-intervention, 15 days, 3 months, 6 months, and 12 months follow-up. Assessments will be performed by blinded evaluators. Analysis will follow intention-to-treat principles using repeated-measures ANOVA or non-parametric equivalents (SPSS v.29; p < 0.05). The trial was prospectively registered on ClinicalTrials.gov (NCT07095283, registered on 24 July 2025), prior to the recruitment of the first participant. Expected outcomes: This study will provide comparative effectiveness data on whether the addition of RF to PFMT offers additional benefits over PFMT alone in the management of SUI. Full article

This study investigates whether the optimal utilization of the biomass potential contained in municipal solid waste (MSW) can support the implementation of circular economy (CE) principles and contribute to climate policy objectives, particularly the reduction in greenhouse gas (GHG) emissions in the waste management sector. The analysis evaluates whether waste-to-energy recovery can support the objectives of the European Green Deal, including a 55% reduction in GHG emissions by 2035 and the achievement of climate neutrality by 2050. The assessment was conducted for two MSW streams generated in a Polish municipality: separately collected biowaste and residual MSW remaining after meeting European reuse and recycling targets. The study summarizes the results of detailed experimental investigations of the physicochemical and fuel properties of these waste streams. Proven and commercially available energy recovery technologies, including anaerobic digestion (AD) of biowaste and incineration of residual waste, were analyzed. GHG emissions were assessed using a life cycle assessment (LCA) approach, taking into account both direct emissions and avoided emissions resulting from the substitution of conventional energy and fertilizer production. The experimental results revealed significant variability in the biodegradability and energy potential of individual biowaste fractions, with the highest biogas yields observed for kitchen waste. Residual waste exhibited a considerable calorific value and a significant share of renewable energy due to its biomass content. The results indicate that the share of renewable energy in electricity generated from waste is expected to increase from 46.1% in 2025 to 49.9% in 2040. In relation to the total electricity demand of the analyzed city, energy recovered from waste accounts for 1.8 ± 0.3% in 2025 and 1.3 ± 0.2% in 2040. Scenario-based modeling demonstrated that the target system, maximizing energy recovery from both biowaste and residual waste, achieves a consistently negative GHG emission balance throughout the analyzed period (2025–2040), ranging from −72 ± 15 kg CO₂-eq/ton in 2025, through the most favorable value of −81 ± 17 kg CO₂-eq/ton in 2035, to −57 ± 12 kg CO₂-eq/ton in 2040, expressed per ton of total managed biowaste and residual waste. Full article

Recent advances in machine learning are transforming biological research by offering powerful tools to address complex challenges across the life sciences. In particular, deep learning approaches now enable accurate predictions of protein structure and function, opening new avenues for investigating proteomic diversity in non-model organisms. In this study, we conducted a genomic case study that examines the predicted structure and diversity of odorant receptor (OR) proteins in two species of longhorn beetles (Cerambycidae) with divergent life histories: the highly specialized red milkweed beetle (Tetraopes tetrophthalmus) and the broadly polyphagous Asian longhorned beetle (Anoplophora glabripennis). Using leading predictive algorithms, we inferred the structure of beetle-encoded OR genes, compared confidence scores, and assessed protein diversity across OR families and between the two genomes. Unsupervised clustering applied to pairwise protein comparisons revealed an expected strong correlation between structure and sequence, while supporting the evolutionary classification of previously predicted OR groups and revealing new evidence of previously unrecognized OR subclusters. Notably, we identify specific proteins exhibiting substantial structural divergence despite relatively low sequence divergence with other paralogs, suggesting potential outliers subject to unusual evolutionary processes. These results highlight the utility of statistical learning for uncovering patterns of protein evolution and structural diversity in understudied insect genomes. Full article

Traditional petroleum-based packaging suffers from pollution and functional limits, making it unsuitable for next-generation food systems. In contrast, bio-based smart packaging—combining renewable substrates with responsive components—transforms packaging from a passive shell into an active quality monitor and supply chain information node through three interconnected pillars: renewability, real-time responsiveness to freshness markers, and digital traceability. Market figures confirm this shift, with the smart food packaging sector projected to reach USD 48.97 billion by 2028 (CAGR 4.49% from 2023). This review covers recent progress in natural polymers (cellulose, chitosan, alginate, gelatin) and bio-based polyesters (PLA, PHA). Their multiscale structures enable tunable mechanical and barrier properties while serving as hosts for intelligent functions. Two functional directions stand out: active preservation (antimicrobial, antioxidant, gas-regulating, stimulus-controlled release) and intelligent sensing (colorimetric indicators, bio-based sensors, nano-amplified signals for real-time freshness monitoring). Beyond material functions, digital tools such as IoT and blockchain turn packaging into interactive data nodes, linking material intelligence with full traceability to enhance food safety and supply chain efficiency. Key challenges remain with long-term operational stability, production costs, scalable manufacturing, and life cycle assessments. Nevertheless, bio-based smart packaging is expected to evolve through biomimetic design, process innovation, and system-level integration toward adaptability, multifunctionality, and intelligence, ultimately supporting safer, more transparent, efficient, and sustainable food systems. Full article

The xylem feeder Bathyllus albicinctus (Aphrophoridae: Cercopoidea: Hemiptera) has been identified as one of the most abundant and widely distributed cercopoid insects in Australia. This native Australian species might potentially vector Xylella fastidiosa, an exotic and deadly plant pathogen, if it were to arrive in Australia. Previous surveys indicated that B. albicinctus is associated with a wide range of plants, further elevating its impact as a potential disease vector. However, it is unknown if all the associated plants are equally viable hosts. Due to the variety of plant records and distribution across the southern half of Australia, it was expected that B. albicinctus would successfully feed and survive on a taxonomically diverse range of plants. In the present study, a small-scale no-choice feeding-controlled glasshouse experiment was completed where insect nymphs were supplied with plants that are economically significant and susceptible to X. fastidiosa. In this experiment, we monitored the maturation and longevity of B. albicinctus, specifically by comparing insect cohorts distinguished by nymph size, host species, or feeding season. This study documented important interactions of life-history factors for B. albicinctus, including suitability of host plant species among insect sex and season. This could indicate that the ability for B. albicinctus to spread X. fastidiosa may vary with host plant species and time of year. These findings provide a vital knowledge framework for future research and surveys to consider when implementing control efforts or tracking plant pathogens that may be spread by B. albicinctus. Full article