Search Results (39,659)

The use of chemical pesticides in agriculture has led to the development of resistant pest populations, posing a challenge to long-term pest management. This review aims to evaluate the scientific literature on the individual and combined use of baculoviruses with conventional chemical and biological insecticides to combat Plutella xylostella, Spodoptera exigua, and Spodoptera frugiperda in broccoli, tomato, and maize crops. Notable findings include that both individual Plutella xylostella nucleopolyhedrovirus (PxNPV) and the combination of Plutella xylostella granulovirus (PxGV) and azadirachtin at a low dose effectively control Plutella xylostella; both combinations of Spodoptera exigua multiple nucleopolyhedrovirus (SeMNPV) with emamectin benzoate and chlorfenapyr reduced resistance in Spodoptera exigua and increased the efficacy of the insecticides; and the combination of Spodoptera frugiperda nucleopolyhedrovirus (SfMNPV) and spinetoram is effective against Spodoptera frugiperda. Integrating baculoviruses into pest management strategies offers a promising approach to mitigate the adverse effects of chemical pesticides, such as resistance development, health risks, and environmental damage. However, there remains a broad spectrum of research opportunities regarding the use of baculoviruses in agriculture. Full article

Background: Aortic stenosis (AS) is the most common valvular heart disease, associated with poor outcomes if left untreated. Current guidelines recommend that transcatheter aortic valve implantation (TAVI) procedures be performed in hospitals with an on-site cardiac surgery unit due to potential complications requiring surgical intervention. Objective: Based on our experience, we evaluated the feasibility and outcomes of implementing a TAVI program in a cardiology department without an on-site cardiac surgery unit, in collaboration with a remote hospital for surgical backup. Methods: The TAVI program involved pre- and post-procedural evaluations conducted at Meir Medical Center (Kfar Saba, Israel) with a remote surgical team available. The study population included 149 consecutive patients with severe aortic stenosis treated at the Meir valve clinic between November 2019 and December 2023. Procedures were performed by the center’s interventional cardiology team. Results: The mean age of the 149 patients was 80 ± 6 years, and 75 (50%) were female. The average STS score was 4.3, and the EuroSCORE II was 3.1. Among the patients, 68 (45%) were classified as New York Heart Association (NYHA) class III-IV. The valve types used included ACURATE neo2 (57 patients, 38%), Edwards SAPIEN 3 (43 patients, 28%), Evolut-PRO (41 patients, 27%), and Navitor (7 patients, 4%). There were no cases of moderate to severe paravalvular leak and no elevated post-implantation gradients, and there was no need for urgent cardiac surgery. One case of valve embolization was successfully managed percutaneously during the procedure. In-hospital follow-up revealed no deaths and only one major vascular complication. At one-year follow-up, six patients had died, with only one death attributed to cardiac causes. Conclusions: Our findings support the safe and effective performance of transfemoral TAVI in cardiology departments without on-site cardiac surgery, in collaboration with a remote surgical team. Further prospective, multicenter studies are warranted to confirm these results and guide broader clinical implementation of this practice. Full article

Background/Objectives: Evidence-based nursing practice (EBNP) is essential in high-acuity settings such as intensive care units (ICUs) and emergency departments (EDs), where nurses are frequently required to make time-critical, high-stakes clinical decisions that directly influence patient safety and outcomes. Despite its recognized importance, the implementation of EBNP remains inconsistent, with frontline nurses often facing barriers to accessing and applying current evidence. Methods: This descriptive, cross-sectional study systematically mapped and prioritized clinical questions generated by ICU and ED nurses at a tertiary hospital in South Korea. Using open-ended questionnaires, 204 clinical questions were collected from 112 nurses. Each question was coded and classified according to the Nursing Interventions Classification (NIC) taxonomy (8th edition) through a structured cross-mapping methodology. Inter-rater reliability was assessed using Cohen’s kappa coefficient. Results: The majority of clinical questions (56.9%) were mapped to the Physiological: Complex domain, with infection control, ventilator management, and tissue perfusion management identified as the most frequent areas of inquiry. Patient safety was the second most common domain (21.6%). Notably, no clinical questions were mapped to the Family or Community domains, highlighting a gap in holistic and transitional care considerations. The mapping process demonstrated high inter-rater reliability (κ = 0.85, 95% CI: 0.80–0.89). Conclusions: Frontline nurses in high-acuity environments predominantly seek evidence related to complex physiological interventions and patient safety, while holistic and community-oriented care remain underrepresented in clinical inquiry. Utilizing the NIC taxonomy for systematic mapping establishes a reliable framework to identify evidence gaps and support targeted interventions in nursing practice. Regular protocol evaluation, alignment of continuing education with empirically identified priorities, and the integration of concise evidence summaries into clinical workflows are recommended to enhance EBNP implementation. Future research should expand to multicenter and interdisciplinary settings, incorporate advanced technologies such as artificial intelligence for automated mapping, and assess the long-term impact of evidence-based interventions on patient outcomes. Full article

The construction industry has been troubled by a shortage of skilled labor and safety accidents in recent years. Therefore, more and more robots are introduced to undertake dangerous and repetitive jobs, so that human workers can concentrate on higher-value and creative problem-solving tasks. Nevertheless, although human–robot collaboration (HRC) shows great potential, most existing evaluation methods still focus on the single performance of either the human or robot, and systematic indicators for a whole HRC team remain insufficient. To fill this research gap, the present study constructs a comprehensive evaluation framework for HRC team performance in construction projects. Firstly, a detailed literature review is carried out, and three theories are integrated to build 33 indicators preliminarily. Afterwards, an expert questionnaire survey (N = 15) is adopted to revise and verify the model empirically. The survey yielded a Cronbach’s alpha of 0.916, indicating excellent internal consistency. The indicators rated highest in importance were task completion time (µ = 4.53) and dynamic separation distance (µ = 4.47) on a 5-point scale. Eight indicators were excluded due to mean importance ratings falling below the 3.0 threshold. The framework is formed with five main dimensions and 25 concrete indicators. Finally, an AHP-TOPSIS method is used to evaluate the HRC team performance. The AHP analysis reveals that Safety (weight = 0.2708) is prioritized over Productivity (weight = 0.2327) by experts, establishing a safety-first principle for successful HRC deployment. The framework is demonstrated through a case study of a human–robot plastering team, whose team performance scored as fair. This shows that the framework can help practitioners find out the advantages and disadvantages of HRC team performance and provide targeted improvement strategies. Furthermore, the framework offers construction managers a scientific basis for deciding robot deployment and team assignment, thus promoting safer, more efficient, and more creative HRC in construction projects. Full article

Wheelchair-mounted assistive robotic manipulators can provide reach and grasp functions for power wheelchair users. This in-lab study evaluated a vision-guided shared control (VGS) system with twelve users completing two multi-step kitchen tasks: a drinking task and a popcorn making task. Using a mixed methods approach participants compared VGS and manual joystick control, providing performance metrics, qualitative insights, and lessons learned. Data collection included demographic questionnaires, the System Usability Scale (SUS), NASA Task Load Index (NASA-TLX), and exit interviews. No significant SUS differences were found between control modes, but NASA-TLX scores revealed VGS control significantly reduced workload during the drinking task and the popcorn task. VGS control reduced operation time and improved task success but was not universally preferred. Six participants preferred VGS, five preferred manual, and one had no preference. In addition, participants expressed interest in robotic arms for daily tasks and described two main operation challenges: distinguishing wrist orientation from rotation modes and managing depth perception. They also shared perspectives on how a personal robotic arm could complement caregiver support in their home. Full article

Background/Objectives: Celiac disease (CD) is an autoimmune disorder characterized by small intestinal enteropathy triggered by gluten ingestion, often associated with gut dysbiosis. The most effective treatment is strict adherence to a gluten-free diet (GFD), which alleviates symptoms. This study uniquely integrates taxonomic, functional, and resistance profiling to evaluate the gut microbiota of women with CD on a GFD. Methods: To evaluate the long-term impact of a GFD, this study analyzed the gut microbiota of 10 women with CD on a GFD for over a year compared to 10 healthy controls with unrestricted diets. Taxonomic diversity (16S rRNA gene sequencing and the analysis of α and β-diversity), metabolic functionality (Biolog EcoPlates^®), and antibiotic resistance profiles (Cenoantibiogram) were assessed. Results: Metagenomic analysis revealed no significant differences in taxonomic diversity but highlighted variations in the abundance of specific bacterial genera. Women with CD showed increased proportions of Bacteroides, Streptococcus, and Clostridium, associated with inflammation, but also elevated levels of beneficial genera such as Roseburia, Oxalobacter, and Paraprevotella. Despite no significant differences in metabolic diversity, higher minimum inhibitory concentrations (MICs) in women in the healthy control group suggest that dietary substrates in unrestricted diets may promote the proliferation of fast-growing bacteria capable of rapidly developing and disseminating antibiotic resistance mechanisms. Conclusions: These findings indicate that prolonged adherence to a GFD in CD supports remission of gut dysbiosis, enhances microbiota functionality, and may reduce the risk of antibiotic resistance, emphasizing the importance of dietary management in CD. Full article

Introduction/Objective: Post-bariatric surgery patients require long-term, coordinated care to address complex nutritional, physiological, and behavioral challenges. Personalized smart nutrition, combining individualized dietary strategies with targeted monitoring, has emerged as a valuable direction for optimizing recovery and long-term outcomes. This article examines how traditional medical protocols can be enhanced by digital solutions in a multidisciplinary framework. Methods: The study analyzes current clinical practices, including personalized meal planning, physical rehabilitation, biochemical marker monitoring, and psychological counseling, as applied in post-bariatric care. These established approaches are then analyzed in relation to the NutriMonitCare system, a digital health system developed and tested in a laboratory environment. Used here as an illustrative example, the NutriMonitCare system demonstrates the potential of digital tools to support clinicians through real-time monitoring of dietary intake, activity levels, and physiological parameters. Results: Findings emphasize that medical protocols remain the cornerstone of post-surgical management, while digital tools may provide added value by enhancing data availability, supporting individualized decision making, and reinforcing patient adherence. Systems like the NutriMonitCare system could be integrated into interdisciplinary care models to refine nutrition-focused interventions and improve communication across care teams. However, their clinical utility remains theoretical at this stage and requires further validation. Conclusions: In conclusion, the integration of digital health tools with conventional post-operative care has the potential to advance personalized smart nutrition. Future research should focus on clinical evaluation, real-world testing, and ethical implementation of such technologies into established medical workflows to ensure both efficacy and patient safety. Full article

Demand Side Management (DSM) plays a crucial role in modern energy systems, enabling more efficient use of energy resources and contributing to the sustainability of the power grid. This study examines DSM strategies within a multi-environment context encompassing residential, commercial, and industrial sectors, with a focus on diverse appliance types that exhibit distinct operational characteristics and user preferences. Initially, a single-objective optimization approach using Genetic Algorithms (GAs) is employed to minimize the total energy cost under a real Time-of-Use (ToU) pricing scheme. This heuristic method allows for the effective scheduling of appliance operations while factoring in their unique characteristics such as power consumption, usage duration, and user-defined operational flexibility. This study extends the optimization problem to a multi-objective framework that incorporates the minimization of CO₂ emissions under a real annual energy mix while also accounting for user discomfort. The Non-dominated Sorting Genetic Algorithm II (NSGA-II) is utilized for this purpose, providing a Pareto-optimal set of solutions that balances these competing objectives. The inclusion of multiple objectives ensures a comprehensive assessment of DSM strategies, aiming to reduce environmental impact and enhance user satisfaction. Additionally, this study monitors the Peak-to-Average Ratio (PAR) to evaluate the impact of DSM strategies on load balancing and grid stability. It also analyzes the impact of considering different periods of the year with the associated ToU hourly schedule and CO₂ emissions hourly profile. A key innovation of this research is the integration of detailed, category-specific metrics that enable the disaggregation of costs, emissions, and user discomfort across residential, commercial, and industrial appliances. This granularity enables stakeholders to implement tailored strategies that align with specific operational goals and regulatory compliance. Also, the emphasis on a user discomfort indicator allows us to explore the flexibility available in such DSM mechanisms. The results demonstrate the effectiveness of the proposed multi-objective optimization approach in achieving significant cost savings that may reach 20% for industrial applications, while the order of magnitude of the trade-offs involved in terms of emissions reduction, improvement in discomfort, and PAR reduction is quantified for different frameworks. The outcomes not only underscore the efficacy of applying advanced optimization frameworks to real-world problems but also point to pathways for future research in smart energy management. This comprehensive analysis highlights the potential of advanced DSM techniques to enhance the sustainability and resilience of energy systems while also offering valuable policy implications. Full article

Mangoes are an important part of Hainan’s tropical characteristic agriculture. In response to the requirements of building an ecological civilization pilot demonstration zone in Hainan, China, green and sustainable development will be the future development trend of the mango planting system. However, the economic benefits and environmental impact during its planting and management process remain unclear. This paper combines emergy, life cycle assessment (LCA), and economic analysis to compare the system sustainability, environmental impact, and economic benefits of the traditional mango cultivation system (TM) in Dongfang City, Hainan Province, and the early-maturing mango cultivation system (EM) in Sanya City. The emergy evaluation results show that the total emergy input of EM (1.37 × 10¹⁶ sej ha⁻¹) was higher than that of TM (1.32 × 10¹⁶ sej ha⁻¹). From the perspective of the emergy index, compared with TM, EM exerted less pressure on the local environment and has better stability and sustainability. This was due to the higher input of renewable resources in EM. The LCA results showed that based on mass as the functional unit, the potential environmental impact of the EM is relatively high, and its total environmental impact index was 18.67–33.19% higher than that of the TM. Fertilizer input and On-Farm emissions were the main factors causing environmental consequences. Choosing alternative fertilizers that have a smaller impact on the environment may effectively reduce the environmental impact of the system. The economic analysis results showed that due to the higher selling price of early-maturing mango, the total profit and cost–benefit ratio of the EM have increased by 55.84% and 36.87%, respectively, compared with the TM. These results indicated that EM in Sanya City can enhance environmental sustainability and boost producers’ annual income, but attention should be paid to the negative environmental impact of excessive fertilizer input. These findings offer insights into optimizing agricultural inputs for Hainan mango production to mitigate multiple environmental impacts while enhancing economic benefits, aiming to provide theoretical support for promoting the sustainable development of the Hainan mango industry. Full article

Integrated hydrological modeling plays a crucial role in advancing sustainable water resource management, particularly in regions facing seasonal and extreme precipitation events. However, comprehensive studies that assess hydrological variability in temperate river basins remain limited. This study addresses this gap by evaluating the performance of the Soil and Water Assessment Tool (SWAT) in simulating streamflow, water balance, and seasonal hydrological dynamics in the Chikugo River Basin, Kyushu Island, Japan. The basin, originating from Mount Aso and draining into the Ariake Sea, is subject to frequent typhoons and intense rainfall, making it a critical case for sustainable water governance. Using the Sequential Uncertainty Fitting Version 2 (SUFI-2) approach, we calibrated the SWAT model over the period 20072–2021. Water balance analysis revealed that baseflow plays dominant roles in basin hydrology which is essential for agricultural and domestic water needs by providing a stable groundwater contribution despite increasing precipitation and varying water demand. These findings contribute to a deeper understanding of hydrological behavior in temperate catchments and offer a scientific foundation for sustainable water allocation, planning, and climate resilience strategies. Full article

With the continuous increase in urban population, the subway is the main way to alleviate traffic congestion. However, the construction environment of subway stations is complex, and the safety risks are extremely high. Therefore, it is of great practical significance to scientifically and systematically evaluate the safety vulnerability of subway station construction. This paper takes the Chengdu subway project as an example, and establishes a metro station construction safety vulnerability evaluation index system based on the driving forces–pressures–state–impacts–responses (DPSIR) theory with 5 first-level indexes and 23 second-level indexes, and adopts the fuzzy hierarchical analysis method (FAHP) to calculate the subjective weights, and the improved Harris Hawks optimization–projection pursuit method (HHO-PPM) to determine the objective weights, combined with game theory to calculate the comprehensive weights of the indicators, and finally uses the improved cloud model of Bayesian feedback to determine the vulnerability level of subway station construction safety. The study found that the combined empowerment–improvement cloud model assessment method is reliable, and the case study verifies that the vulnerability level of the project is “very low risk”, and the investigations of safety hazards and the pressure of surrounding traffic are the key influencing factors, allowing for the proposal of more scientific and effective management strategies for the construction of subway stations. Full article

Background: Pancreatic cystic lesions (PCLs), including intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs), pose a diagnostic challenge due to their variable malignant potential. Current guidelines, such as Fukuoka and American Gastroenterological Association (AGA), have moderate predictive accuracy and may lead to overtreatment or missed malignancies. Artificial intelligence (AI), incorporating machine learning (ML) and deep learning (DL), offers the potential to improve risk stratification, diagnosis, and management of PCLs by integrating clinical, radiological, and molecular data. This is the first systematic review to evaluate the application, performance, and clinical utility of AI models in the diagnosis, classification, prognosis, and management of pancreatic cysts. Methods: A systematic review was conducted in accordance with PRISMA guidelines and registered on PROSPERO (CRD420251008593). Databases searched included PubMed, EMBASE, Scopus, and Cochrane Library up to March 2025. The inclusion criteria encompassed original studies employing AI, ML, or DL in human subjects with pancreatic cysts, evaluating diagnostic, classification, or prognostic outcomes. Data were extracted on the study design, imaging modality, model type, sample size, performance metrics (accuracy, sensitivity, specificity, and area under the curve (AUC)), and validation methods. Study quality and bias were assessed using the PROBAST and adherence to TRIPOD reporting guidelines. Results: From 847 records, 31 studies met the inclusion criteria. Most were retrospective observational (n = 27, 87%) and focused on preoperative diagnostic applications (n = 30, 97%), with only one addressing prognosis. Imaging modalities included Computed Tomography (CT) (48%), endoscopic ultrasound (EUS) (26%), and Magnetic Resonance Imaging (MRI) (9.7%). Neural networks, particularly convolutional neural networks (CNNs), were the most common AI models (n = 16), followed by logistic regression (n = 4) and support vector machines (n = 3). The median reported AUC across studies was 0.912, with 55% of models achieving AUC ≥ 0.80. The models outperformed clinicians or existing guidelines in 11 studies. IPMN stratification and subtype classification were common focuses, with CNN-based EUS models achieving accuracies of up to 99.6%. Only 10 studies (32%) performed external validation. The risk of bias was high in 93.5% of studies, and TRIPOD adherence averaged 48%. Conclusions: AI demonstrates strong potential in improving the diagnosis and risk stratification of pancreatic cysts, with several models outperforming current clinical guidelines and human readers. However, widespread clinical adoption is hindered by high risk of bias, lack of external validation, and limited interpretability of complex models. Future work should prioritise multicentre prospective studies, standardised model reporting, and development of interpretable, externally validated tools to support clinical integration. Full article

Objectives: To investigate the reliability and validity of the Singer Reflux Symptom Score (sRSS), a new patient-reported outcome questionnaire documenting the severity of reflux symptoms in singing voice is proposed. Methods: Amateur and professional singers consulting the European Reflux Clinic for laryngopharyngeal reflux disease (LPRD) symptoms and findings were prospectively recruited from January 2022 to February 2023. The diagnosis was based on a Reflux Symptom Score (RSS) > 13 and Reflux Sign Assessment (RSA) > 14. A control group of asymptomatic singer subjects was recruited from the University of Mons. The sRSS was rated within a 7-day period to assess test–retest reliability. Internal consistency was measured using Cronbach’s α in patients and controls. A correlation analysis was performed between sRSS and Singing Voice Handicap Index (sVHI) to evaluate convergent validity. Responsiveness to change was evaluated through pre- to post-treatment sRSS changes. The sRSS threshold for suggesting a significant impact of LPRD on singing voice was determined by receiver operating characteristic (ROC) analysis. Results: Thirty-three singers with suspected LPRD (51.5% female; mean age: 51.8 ± 17.2 years) were consecutively recruited. Difficulty reaching high notes and vocal fatigue were the most prevalent LPRD-related singing complaints. The sRSS demonstrated high internal consistency (Cronbach-α = 0.832), test–retest reliability, and external validity (correlation with sVHI: r = 0.654; p = 0.015). Singers with suspected LPRD reported a significant higher sRSS compared to 68 controls. sRSS item and total scores significantly reduced from pre-treatment to 3 months post-treatment except for the abnormal voice breathiness item. ROC analysis revealed superior diagnostic accuracy for sRSS (AUC = 0.971) compared to sRSS-quality of life (AUC = 0.926), with an optimal cutoff at sRSS > 38.5 (sensitivity: 90.3%; specificity: 85.0%). Conclusions: The sRSS is a reliable and valid singer-reported outcome questionnaire for documenting singing symptoms associated with LPRD leading to personalized management of Singers. Future large-cohort studies are needed to evaluate its specificity for LPRD compared to other vocal fold disorders in singers. Full article

Background/Objectives: Preoperative strategies for hepatocellular carcinoma (HCC) requiring major hepatectomy remain controversial, particularly in “borderline resectable” cases. This study aimed to evaluate the oncological benefit and perioperative safety of Yttrium-90 transarterial radioembolization (TARE) in patients undergoing right or extended right hepatectomy for HCC. Material and Methods: All consecutive patients who underwent right or extended right hepatectomy for HCC at a single tertiary center between January 2013 and December 2023 were retrospectively reviewed. Patients were grouped based on whether they received preoperative TARE or underwent upfront resection. Outcomes analyzed included perioperative morbidity and long-term oncological endpoints. Results: A total of 39 patients were included, of whom 18 received preoperative TARE and 21 underwent upfront surgery. Patients in the TARE group showed significantly greater tumor necrosis at pathology (70% vs. 10%, p = 0.002) and more frequent extended resections. Five-year cancer-specific survival (80.4% vs. 33.5%, p = 0.011), recurrence-free survival (33.8% vs. 14.0%, p = 0.047), and curative-intent disease-free survival (69.3% vs. 18.9%, p = 0.0037) were significantly higher in the TARE group. Overall survival showed a favorable trend. Intraoperative outcomes, postoperative morbidity, and 90-day mortality were comparable between groups. Conclusions: Preoperative TARE is a safe and effective neoadjuvant strategy in selected patients with HCC undergoing major hepatectomy. It may enhance long-term oncological outcomes without increasing surgical risk, supporting its potential role in the management of borderline resectable HCC. Full article

Introduction: Cystic fibrosis (CF) is a genetic condition affecting several organs and systems, including the pancreas, colon, respiratory system, and reproductive system. The detection of a growing number of CFTR variants and genotypes has contributed to an increase in the CF population which, in turn, has had an impact on the overall statistics regarding the prognosis and outcome of the condition. Given the increase in life expectancy, it is critical to better predict outcomes and prognosticate in CF. Thus, each person’s choice to aggressively treat specific disease components can be more appropriate and tailored, further increasing survival. The objective of our narrative review is to summarize the most recent information concerning the value and significance of clinical parameters in predicting outcomes, such as gender, diabetes, liver and pancreatic status, lung function, radiography, bacteriology, and blood and sputum biomarkers of inflammation and disease, and how variations in these parameters affect prognosis from the prenatal stage to maturity. Materials and methods: A methodological search of the available data was performed with regard to prognostic factors in the evolution of CF in children and young adults. We evaluated articles from the PubMed academic search engine using the following search terms: prognostic factors AND children AND cystic fibrosis OR mucoviscidosis. Results: We found that it is crucial to customize CF patients’ care based on their unique clinical and biological parameters, genetics, and related comorbidities. Conclusions: The predictive significance of more dynamic clinical condition markers provides more realistic future objectives to center treatment and targets for each patient. Over the past ten years, improvements in care, diagnostics, and treatment have impacted the prognosis for CF. Although genotyping offers a way to categorize CF to direct research and treatment, it is crucial to understand that a variety of other factors, such as epigenetics, genetic modifiers, environmental factors, and socioeconomic status, can affect CF outcomes. The long-term management of this complicated multisystem condition has been made easier for patients, their families, and physicians by earlier and more accurate identification techniques, evidence-based research, and centralized expert multidisciplinary care. Full article