Search Results (478)

Background: Cervical cancer remains a major public health problem, causing approximately 660,000 new cases and 348,000 deaths annually, with more than 90% occurring in low- and middle-income countries. The WHO African Region accounts for approximately 20% of global cases and 30% of deaths. In November 2020, the World Health Assembly adopted the Global Strategy for Cervical Cancer Elimination with 90–70–90 targets for 2030. Multi-age cohort (MAC) campaigns have emerged as a high-impact strategy for achieving population-level HPV vaccination coverage. This study documents the implementation and outcomes of HPV MAC campaigns across Côte d’Ivoire, Ghana, Liberia, and Sierra Leone in 2025. Methods: This multi-country mixed-methods analysis integrated quantitative administrative campaign data with qualitative programmatic assessments across eight operational readiness domains from the WHO Immunization Readiness Assessment Tool. Data were collected between January and December 2025 from national reports, WHO supervision missions, and partner reports. Coverage analysis used administrative data triangulated with independent monitoring. Equity analysis used school enrolment data and geographic accessibility indices. Results: The campaigns targeted 7,376,096 girls aged 9–18 years and reached approximately 6,306,294, achieving 85.5% overall coverage. Côte d’Ivoire, Ghana, Liberia and Sierra Leone reported administrative coverage of 88.0%, 84.5%, 60.0% and 100%, respectively. All four countries achieved the minimum operational readiness threshold of 80% across all assessed domains. A total of 35,860 health workers were trained, with post-training competency scores increasing from 58.8% to 89.5%. Cold chain functionality exceeded 98% across all campaigns. A total of 314 cases of Adverse Events Following Immunization (AEFIs) were reported, all classified as mild, giving an approximate rate of 5.0 per 100,000 doses. Coverage gaps between in-school and out-of-school girls ranged from 18 to 35 percentage points. Conclusions: The findings suggest that large-scale adolescent HPV immunization can be successfully implemented in resource-limited settings when supported by political commitment, multisectoral coordination and adequate operational resources. The single-dose schedule transition under Gavi 6.0 offers opportunities to simplify delivery. Priority actions include integrating HPV into routine immunization, scaling equity strategies for out-of-school girls and ensuring sustainable financing. Full article

Historic university campuses increasingly face simultaneous demands for functional renewal and heritage conservation amid rapid urbanization. However, the relationship between campus landscape perceptions and students’ built heritage conservation intention, together with the psychological pathways underlying this relationship, remains insufficiently understood. This cross-sectional study examines the association between Campus Landscape and Built Heritage Conservation Intention, focusing on the mediating roles of Place Identity and Place Dependence. Using a multidimensional place-attachment framework, the proposed model was tested with structural equation modeling (SEM) based on 569 student questionnaires collected at the Jungong Road Campus of the University of Shanghai for Science and Technology (formerly Hujiang University), which contains the Hujiang University modern architectural complex, designated as a major historical and cultural site protected at the national level in China. Campus Landscape was positively associated with Built Heritage Conservation Intention. Place Identity showed a significant positive indirect association, whereas the indirect association through Place Dependence was not statistically significant. In subgroup analyses, the estimated indirect association through Place Dependence was positive among undergraduates and negative among postgraduates, but it was not statistically significant in either subgroup and should therefore be interpreted as exploratory. These findings highlight the significant indirect association through Place Identity and offer illustrative implications for campus landscape planning that is attentive to place identity and for the conservation of historic campuses in active use. Full article

Objectives: A percutaneous native kidney biopsy remains the gold standard for diagnosing glomerular, tubulointerstitial and vascular kidney diseases. Although generally safe, it may cause major haemorrhagic complications. Using the French national registry, Kaczmarek et al. developed a simplified bleeding risk score (anaemia, female sex, heart failure, acute kidney injury; range: 0–5), achieving an AUC of 0.755 in native biopsies. We aimed to externally validate this score in a Romanian cohort and to assess whether additional clinically relevant predictors could improve discrimination for major bleeding. Methods: We conducted a retrospective cohort study of all consecutive adults undergoing an ultrasound-guided percutaneous native kidney biopsy at a tertiary nephrology centre in Romania between January 2008 and December 2024. The primary outcome was a composite major bleeding event: clinically significant haematoma or haemorrhage, blood transfusion, angiographic intervention or nephrectomy. The Kaczmarek score was validated using a receiver operating characteristic (ROC) analysis. Candidate predictors were assessed by multivariable logistic regression, and a simplified score was derived from the regression coefficients. Results: Among 3081 patients, 162 (5.3%) experienced major bleeding. The Kaczmarek score showed modest discrimination (AUC: 0.624, 95% CI: 0.585–0.663). In the multivariable analysis (n = 2506 complete cases), anaemia, heart failure, solid neoplasm and fibrinogen were independently associated with major bleeding. An eight-component score (anaemia, heart failure, solid neoplasm, and fibrinogen < 511 mg/dL; female sex, hypertension, liver disease, and eGFR < 30 mL/min/1.73 m²) achieved an AUC of 0.676 (95% CI: 0.631–0.717), outperforming the Kaczmarek score. Conclusions: The French score performed only modestly in our cohort. Adding comorbidities, kidney function and haemostatic parameters, particularly fibrinogen, improved the risk discrimination. Full article

Maritime routes ensure connectivity between nations, carrying a vast flow of goods across borders, while ports serve as the critical junctions within this network, managing a wide spectrum of commodities from raw materials to finished goods. Ports also generate employment across numerous sectors and underpin a broad range of allied industries. A seaport is a maritime facility equipped with docks, cranes, and storage infrastructure for international trade, where ships load and unload cargo, containers, and passengers. Key functions of seaports include customs processing, warehousing, and vessel services, with major global hubs such as Shanghai, PSA Singapore, DP World, and Rotterdam handling immense volumes of cargo each year. In contrast, Bangladesh’s ports, Chittagong, Mongla, and Payra, play a vital role in sustaining regional commerce. Today, ports are widely recognized as essential capital infrastructure and prime movers of economic activity. Smart ports are automated facilities that leverage advanced digital technologies, including sensors, big data analytics, artificial intelligence (AI), machine learning (ML), deep learning (DL), augmented reality (AR), digital twins, the Internet of Things (IoT), and various automation systems, to optimize overall operational efficiency. These tools streamline cargo movement while embedding sustainable practices to protect the environment. Beyond operational gains, smart ports deliver faster, more advanced services to all stakeholders involved in port operations, including shipping companies, customs agencies, local communities, and other relevant parties. Renewable energy sources, electric vehicle charging stations, onshore power supply, and smart logistics infrastructure are among the defining sustainability features of smart ports in the present-day context. This study examines the current status and future development trajectory of Bangladesh’s sea ports in relation to the broader global imperative toward smart port transformation. Full article

Background: Residential wood combustion (RWC) is a major local source of fine particulate matter (PM_2.5) in Nordic regions. We quantified the health impacts and economic costs of long-term exposure to PM_2.5 from RWC in Västerbotten County, northern Sweden. Methods: High-resolution annual mean concentrations of PM_2.5 from small-scale residential heating in 2023 were obtained from a national dispersion-modelling system. Population-weighted exposure was calculated by combining grid-level concentrations with home address coordinates for the resident population. Health impact assessment (HIA) followed the framework used in Nordic studies and the VALESOR project, applying a near-source PM_2.5–mortality exposure–response function with a relative risk of 1.26 per 10 µg/m³ for natural-cause mortality and VALESOR default functions for morbidity (ischaemic heart disease, stroke, COPD, lung cancer, type 2 diabetes, dementia, childhood asthma, cardiovascular hospital admissions). Attributable cases and years of life lost (YLL) were estimated, and the economic valuation used VALESOR unit costs for Sweden to derive central, low and high damage-cost estimates. Results: The population (n = 280,742)-weighted mean RWC-PM_2.5 exposure was 0.16 µg/m³ (interquartile range 0.10–0.21). This was associated with an estimated 30 years of life lost (YLL) per year from natural-cause mortality, plus incident morbidity of approximately 0.3 lung cancer cases, four childhood asthma cases, three COPD cases, three IHD events, one stroke, two dementia cases, one diabetes case and 0.8 cardiovascular hospital admissions annually. The total annual health-related cost attributable to RWC-PM_2.5 was about €7.0 million (95% uncertainty range €4.6–9.4 million), dominated by mortality and disutility costs. Conclusions: PM_2.5 concentrations from residential wood burning are associated with health impacts costing multi-million Euros in a Nordic region, supporting policies to reduce emissions from residential wood heating and to promote cleaner heating alternatives. Full article

China launched the major function-oriented zone planning (MFZP) strategy in 2010 to address regional imbalances and resource–environment pressures through differentiated regulation. Using county-level data from 2010 to 2020, this study develops a “scale–structure–efficiency” framework and applies a self-organizing feature map (SOFM) model to examine construction land supply across four functional zones. The findings show that: (1) Key development zones provide the largest supply, while optimized zones supply the smallest but at the highest intensity, and restricted zones generally meet control targets. (2) Optimized zones record the highest incremental–stock supply index (ISSI), yet incremental supply still dominates; urbanized zones have balanced functional structures, whereas agricultural and ecological zones are more concentrated. (3) Supply efficiency in urbanized zones exceeds that of agricultural and ecological zones. (4) SOFM clustering identifies four distinct supply modes, reflecting regional heterogeneity in policy alignment. Overall, China’s differentiated land supply strategy broadly matches national goals, though some regions face excessive intensity and low efficiency, calling for tailored optimization measures. Full article

Background: Dementia is a major geriatric syndrome associated with nutritional vulnerability and functional decline among older adults. This study aimed to compare oral functional impairment, nutritional risk, and functional dependence according to dementia status and to examine their associations with dementia among community-dwelling older Koreans. Methods: This cross-sectional study analyzed data from 10,078 adults aged ≥65 years who participated in the 2023 National Survey of Older Koreans. Dementia was defined based on self-reported physician diagnosis. Oral functional impairment, nutritional risk factors, and functional dependence, including activities of daily living (ADL) and instrumental activities of daily living (IADL), were assessed using structured survey questionnaires. Chi-square tests and multivariable logistic regression analyses were performed using four sequentially adjusted models. Results: Older adults with dementia exhibited significantly greater oral functional impairment, nutritional risk, and functional dependence than those without dementia. In the fully adjusted model, denture use remained independently associated with dementia (OR = 1.692, 95% CI: 1.179–2.428). Fewer than two meals per day (OR = 3.156, 95% CI: 1.771–5.623) and difficulty shopping for or preparing meals (OR = 2.408, 95% CI: 1.648–3.520) were significantly associated with dementia. In addition, severe ADL dependence (OR = 5.895, 95% CI: 2.947–11.794) and IADL dependence (OR = 4.598, 95% CI: 3.099–6.822) showed strong associations with dementia. Conclusions: Dementia was significantly associated with oral functional impairment, nutritional risk, and functional dependence, indicating multidimensional geriatric vulnerability and highlighting the need for integrated assessment in dementia care. Full article

Natural mineral water standards use compositional criteria to define product identity and distinguish natural mineral water from other drinking water categories. China’s National Food Safety Standard—Drinking Natural Mineral Water (GB 8537) specifies seven alternative minimum threshold parameters for this purpose. This study assessed how these parameters function in four dimensions: regulatory identity, hydrogeological resource recognition, health-related interpretation, and label-based market communication. We compared major international regulatory frameworks, qualitatively synthesized health-related evidence, reviewed representative source-scale hydrogeological evidence from China, and analyzed label information from 150 commercial products. China’s system differs from the Codex and European Union frameworks, which emphasize source authenticity, compositional stability, permitted treatment, and disclosure, and from the United States system, which primarily defines mineral water by total dissolved solids. Regional studies showed that mineral water composition reflects site-specific combinations of lithology, geological structure, recharge, groundwater circulation, and water–rock interaction. The same parameter may occur in more than one hydrogeological setting, whereas different parameters within one groundwater system may arise through distinct geochemical processes. Health-related evidence varies substantially and should not be interpreted as establishing consumer health claims. In the label survey, metasilicic acid, TDS, and strontium were the most frequently declared parameters, while zinc and free carbon dioxide were less frequently declared. We propose a functional framework that distinguishes statutory identity, hydrogeological resource, health/safety, sensory/technical, and consumer-communication roles. This framework clarifies why the seven parameters should not be treated as functionally equivalent and provides a basis for refining natural mineral water standards and label communication. Full article

Plant secondary metabolites play important roles in plant defense, environmental adaptation, and ecosystem functioning, yet large-scale monitoring of foliar phenolics remains limited because of the high cost and restricted spatial coverage of airborne imaging spectroscopy and the limited spectral resolution of multispectral satellites. This study explored a cross-scale remote sensing framework to map foliar phenolics through the synergy of airborne imaging spectroscopy and Sentinel-2 multispectral imagery. Foliar samples were collected from 634 plots across seven National Ecological Observatory Network (NEON) ecological domains in the United States, representing six plant functional types. Community-weighted mean foliar phenolic concentrations were linked with NEON Airborne Observation Platform (AOP) imaging spectroscopy to develop phenolic retrieval models using partial least squares regression (PLSR) and Gaussian process regression (GPR). The optimized airborne-derived phenolics were subsequently aggregated across multiple spatial windows and used as reference data to train Sentinel-2 models using PLSR, random forest regression (RFR), and GPR. Both airborne hyperspectral models achieved strong predictive performance, with comparable accuracy between PLSR (R² = 0.770, RMSE = 16.11 mg·g⁻¹) and GPR (R² = 0.771, RMSE = 16.16 mg·g⁻¹). However, PLSR showed substantially lower predictive uncertainty (4.62 mg·g⁻¹) than GPR (12.58 mg·g⁻¹), indicating more stable predictions across NEON samples. Spectral importance analysis identified consistent phenolic-sensitive wavelength regions in the visible and shortwave infrared domains, particularly near previously reported absorption features. For Sentinel-2 upscaling, prediction accuracy increased consistently with larger spatial aggregation windows, indicating improved agreement between Sentinel-2 observations and airborne-derived phenolics through reduced spatial scale mismatch and geolocation misalignment. Among the evaluated approaches, RFR achieved the best performance, improving from R² = 0.479 at the 10-pixel window to R² = 0.776 (NRMSE = 7.0%) at the 100-pixel window. Feature importance analysis showed increasing contributions of red-edge and shortwave infrared information at larger aggregation scales. Spatial comparisons demonstrated that Sentinel-2 successfully reproduced major phenolic distribution patterns observed by airborne imaging spectroscopy. These results demonstrate that airborne imaging spectroscopy can effectively bridge field observations and satellite multispectral imagery for foliar phenolics estimation and highlight the potential of Sentinel-2 as a scalable approach for monitoring vegetation chemical traits across heterogeneous ecosystems. Full article

Importance: Chronic liver disease requires sustained engagement with the health system, which co-occurring social and functional risks may disrupt. Whether these risks form reproducible patterns with different mortality associations is uncertain. Objective: To identify social and functional risk patterns among US adults with chronic liver disease and evaluate their associations with all-cause mortality. Design, Setting, and Participants: Nationally representative cohort study of National Health Interview Survey sample adults interviewed from 2011 through 2018 and linked to the National Death Index through 31 December 2019. Participants were aged 18 years or older, eligible for mortality linkage, reported a chronic liver condition, and had no baseline liver cancer. Exposures: Latent class membership derived from 7 binary indicators: poverty, food insecurity, uninsurance, cost-related delayed care, no usual place of care, single-adult household status, and activity limitation. A complete 0- to 7-item count was a secondary exposure. Main Outcomes and Measures: All-cause mortality. Survey-weighted Cox models estimated hazard ratios (HRs) with sequential demographic, clinical, and liver-specific adjustment. Prespecified sensitivity analyses used 20 multiple imputed data sets, sampling-weighted pseudo-likelihood latent class models, complete-case re-estimation, a fixed 5-year horizon, and class-by-age interaction testing. Results: Among 3407 adults (weighted mean age, 54.0 years; 49.4% female), 529 deaths occurred over 17,297.6 person-years (median follow-up, 5.0 years [IQR, 3.0–7.0]). Four classes were retained: low social and access burden (weighted prevalence, 63.1%); functional limitation with financial strain (13.2%); poverty, single-adult household, and functional limitation (15.0%); and uninsurance with major access barriers (8.7%). Compared with the low-burden class, the functional-limitation/financial-strain class had higher adjusted mortality (HR, 1.95; 95% CI, 1.34–2.82; p < 0.001); the other 2 classes did not differ significantly. Sampling-weighted latent class analysis after multiple imputation reproduced 97.2% of modal assignments, and the association persisted with attenuation (HR, 1.55; 95% CI, 1.08–2.22; p = 0.02). Each additional risk was associated with higher mortality (exact count: HR, 1.24 [95% CI, 1.13–1.36]; imputed count: HR, 1.19 [95% CI, 1.10–1.29]). The class-by-age interaction was not significant (p = 0.41). Conclusions and Relevance: Among US adults with self-reported chronic liver disease, social and functional adversity was both cumulative and patterned. A profile combining functional limitation, food insecurity, and cost-related delayed care had the clearest independent mortality association despite largely retained insurance coverage. These profiles are not a validated clinical score, but the findings argue against reliance on any single indicator, particularly insurance status, as a marker of vulnerability. Full article

Background: Surgical release of post-burn contractures aims to restore mobility and improve scar quality; however, the relationship between scar improvement and functional recovery remains incompletely understood, particularly in the hand. Methods: We performed a retrospective cohort study of 208 patients undergoing surgical correction of post-burn contractures (2021–2025) at a national referral center. Scar outcomes were assessed using the Vancouver Scar Scale (VSS). Functional outcomes were evaluated with joint-specific range-of-motion (ROM) measurements at 3, 6, and 12 months. For digital contractures, extension deficit was defined as ≥10° loss of active extension. Owing to non-normal distributions, data are presented as medians (IQR), and non-parametric tests were used. Results: VSS improved significantly across all domains (all p < 0.001). Median VSS remained stable between 3 and 6 months, followed by a marked decrease by 12 months. Functional recovery varied by region: major joints showed near-complete restoration of functional ROM, whereas extension deficit remained persistently prevalent, affecting 27.0% of patients at 3 months and 29.2% at 12 months. Full flexion was maintained in 88.8% of patients throughout follow-up. At the cohort level, flexion and extension demonstrated largely independent recovery trajectories. Conclusions: Surgical treatment improves scar characteristics; however, functional recovery—particularly extension in digital contractures—may remain incomplete. Combined assessment of scar characteristics and functional outcomes may provide a more comprehensive evaluation of postoperative recovery following contracture release. Full article

Background/Objectives: Food insecurity (FI) is a major public health challenge and is monitored globally using the Food Insecurity Experience Scale (FIES). In Peru, the recent incorporation of the FIES into the National Household Survey (ENAHO) enables the generation of nationally representative estimates. This study evaluated the statistical validity of the FIES and estimated the prevalence of food insecurity among Peruvian households. Methods: A cross-sectional study was conducted using ENAHO 2025 data. FI was assessed using the eight-item FIES. Rasch analysis evaluated item fit, severity ordering, reliability, residual correlations, and differential item functioning. National prevalence estimates of moderate-or-severe and severe FI were calculated using the Food and Agriculture Organization of the United Nations (FAO) FIES methodology and household sampling weights. Results: The study included 32,041 households, representing approximately 9.9 million households nationwide. The FIES demonstrated satisfactory statistical validity, with a Rasch reliability of 0.796. Item severities followed the expected progression of FI, residual correlations remained below the recommended threshold, and no substantial differential item functioning was observed. The prevalence of moderate-or-severe FI was 30.9%, while severe FI affected 4.0% of households. Higher prevalence was observed among households living in extreme poverty, with unmet basic needs, lower educational attainment, permanent functional limitations, and in rural and Amazonian areas. Conclusions: The FIES demonstrated adequate validity for household-level monitoring of FI in Peru. Nearly one-third of households experienced moderate-or-severe FI, and prevalence varied across socioeconomic and geographic groups. The integration of the FIES into ENAHO provides a valuable platform for routine monitoring and food security policymaking. Full article

Belief in ghosts, spirits, and sacrificial culture is important in the Confucian tradition. Across different periods, Confucian interpretations have changed. Pre-Qin Confucianism distanced itself from earlier wu-shi 巫史 (shaman) culture, remaining agnostic about whether ghosts and spirits possess supernatural powers to govern national prosperity or personal fate. In governance and social practice, it prioritized human agency over the authority of ghosts and spirits, marginalizing their influence. While affirming the didactic function of sacrifice, Pre-Qin Confucians venerated ghosts and spirits but insisted on “ji er bu qi” (祭而不祈, “sacrificing without supplication”). Song–Ming Confucianism, responding to challenges from Buddhism and Daoism, reinterpreted these concepts and understood ghosts and spirits in terms of qi (氣, ether), framing them as the contraction and expansion of “qi” (“qi zhi qu shen”, 氣之屈伸). They did not recognize the independent existence, sentience, or supernatural powers of ghosts and spirits. Because the qi of ancestors and the living are identical, communication with ghosts and spirits could be established during ancestral worship. They favored sacrifice to ghosts and spirits but criticized the Buddhist practice of making images of them. In summary, Pre-Qin and Song–Ming Confucianism offered different explanations for why ghosts and spirits should be venerated and the relationship between sacrifice and blessings. These interpretations, shaped by efforts to distinguish themselves from wu-shi traditions and Buddhist–Daoist doctrines, reveal differences and contradictions between the two major phases of Confucian thought. Both, however, shared the aim of negating shamanistic practices and countering heterodoxy. Full article

Background: Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive infiltrative cardiomyopathy associated with substantial morbidity and mortality. This systematic review evaluates the effects of tafamidis on echocardiographic parameters, cardiac biomarkers, functional outcomes, mortality, and safety in patients with ATTR-CM. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420261391553). PubMed, Embase, and Web of Science were searched through 20 March 2026. Eligible studies included adults with ATTR-CM treated with tafamidis and reporting, echocardiographic, biomarker, functional, mortality, or safety outcomes. Randomized controlled trials and observational studies were included. Risk of bias was assessed using the Cochrane RoB 2 tool and Newcastle–Ottawa Scale. Due to substantial heterogeneity, a narrative synthesis was performed. Results: Seventeen studies were included with a total of 1890 patients. Tafamidis treatment was potentially associated with stabilization of global longitudinal strain, preservation of functional status, and lower all-cause mortality compared with untreated or control cohorts. Biomarker findings, including N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT), were heterogeneous and did not demonstrate a consistent pattern of improvement. Functional outcomes, including New York Heart Association (NYHA) class, 6-minute walk distance (6MWT), National Amyloidosis Center (NAC) staging, and quality-of-life measures, suggested slower clinical deterioration among treated patients. Limited available safety data indicated that tafamidis was generally well tolerated, with no major safety concerns identified. Conclusions: Current evidence may suggest that tafamidis slows disease progression and may potentially be associated with improved survival in ATTR-CM. Further prospective studies with standardized outcome reporting are needed. Evidence was limited by heterogeneity in study design, outcome reporting, and follow-up duration, with most included studies being observational. Full article

China is a major producer, consumer, and exporter of automobiles. As an important component of the national industrial system, the automotive industry is associated with strong economic support functions, notable industrial spillover effects, and significant technological externalities, and its core values constitute a powerful driving force in achieving the global Sustainable Development Goals. Accordingly, this paper establishes a complex network evolutionary game model that involves two types of automobile manufacturers (established and latecomer automakers) in a strategic interaction within an exogenous environment jointly shaped by the government and the consumer community. We conduct a numerical simulation analysis to explore the organic relationships between the core elements within the system and the long-term performance of the automotive industry. The main findings are as follows. First, in adopting sustainable business models (SBMs), latecomer automakers exhibit a “high-start, low-end” evolutionary trajectory, whereas established automakers follow a “low-start, high-end” convergence path. Second, regarding the characteristics of game rules, the proportion of automakers that adopt SBMs is positively correlated with a larger proportion of ESG consumer groups, stronger comprehensive production and consumption subsidy standards, a more favorable expected payoff, and stronger market advantages on the part of established automakers. Finally, regarding network-structure characteristics, the proportion of automakers that adopt SBMs is positively correlated with a moderate total number of automakers, a reasonable proportion of established automakers, and a higher edge-addition probability. Moreover, this proportion is nearly independent of the noise interference coefficient, thus indicating that the mathematical model constructed as part of this study exhibits strong anti-interference capability. Full article