Search Results (999)

Background: Infectious diseases remain a leading cause of mortality in South Africa, compounded by a high HIV prevalence. This study aimed to delineate the spectrum and clinicopathological characteristics of fatal infectious diseases through a postmortem audit to inform clinical practice and public health strategy. Methods: A retrospective, cross-sectional descriptive study was conducted on all autopsies with a final cause of death attributed to infectious disease at a National Health Laboratory Service, in Northern Pretoria, Gauteng, South Africa, from 2012 to 2021. Using the Systematised Nomenclature of Medicine Clinical Terms (SNOMED) code and word search engines codes, 55 cases were identified. Data on demographics, clinical presentation, HIV status, antiretroviral therapy (ART), comorbidities, and final autopsy diagnosis were extracted from the laboratory information system. Histological confirmation was performed using standard stains. Descriptive statistical analysis was conducted using STATA-18. Results: The cohort (n = 55) had a median age of 31 years (IQR 19–45) and was predominantly female (67%). HIV prevalence was 35%, with 68% of those on ART. The leading cause of death was multilobar pneumonia (36%), followed by bronchopneumonia (22%). AIDS-defining illnesses were present in 27% of cases, with disseminated tuberculosis being the most common (46%). Septic shock was identified in 18% of decedents. A significant proportion (60%) of the cohort was HIV-negative. Conclusions: This autopsy series reveals a high burden of fatal community-acquired pneumonias and HIV-associated opportunistic infections, with a notable proportion of deaths occurring in HIV-negative individuals. The findings underscore diagnostic gaps and highlight the critical role of autopsy in accurate mortality surveillance, advocating for enhanced antemortem diagnostic protocols and targeted public health interventions. Full article

Background/Objectives: South Korea has experienced a rapid transition from widespread food insecurity and undernutrition to a comprehensive and institutionalized nutrition policy system. This study aimed to examine the historical evolution of Korean nutrition policy and nutrition education from the 1960s to the present and to explore its implications for global nutrition governance and nutrition-related Official Development Assistance (ODA). Methods: A narrative review was conducted using historical documents, government reports, nutrition policies, national health plans, legislation, and previous academic studies related to Korean nutrition policy and nutrition education. Results: Korean nutrition policy evolved through several developmental phases, including an aid-dependent relief period, a state-led food security and school feeding expansion phase, a preventive health and nutrition education phase, and a stage of legal and institutional consolidation. More recently, policies have shifted toward evidence-based, equity-oriented, and life-course approaches. Korea has also expanded its nutrition policy experience through ODA initiatives by supporting institutional development, workforce training, community-based nutrition education, and adaptable nutrition management systems in developing countries. Conclusions: Korea’s experience demonstrates how long-term governmental commitment, legislation, surveillance systems, and nutrition education can contribute to national nutrition improvement during rapid socioeconomic transition. These findings may provide useful insights for countries facing the double burden of malnutrition and seeking sustainable and adaptive nutrition policy systems. Full article

This article develops an understanding of Derek Jarman’s Blue (1993) as a testament film. It considers the filmmaker’s personal philosophy and concept of history, proposing the resonance of Walter Benjamin’s angel of history, the epitome of Benjamin’s contention with the ‘continuum of history’ in his final text, Theses on the Philosophy of History. This article considers the testament of Blue as a concept of history, contextualised by Jarman’s reckoning with the HIV/AIDS pandemic, and thereby with his own mortality, as Jarman’s attestation of a model of history (both personal and national, or coinhered as ‘memory’), which answers the demand of the ‘tradition of the oppressed.’ Theories of profane illumination, second nature, and the crisis of representation are explicated for the purposes of identifying Jarman’s model of history, and of his refusal of a historicist conception. In addition, it proposes the context of the AIDS crisis, as the ‘state of emergency’, the condition which compels this concept of history. Full article

Developing countries in which infrastructure development is heavily dependent on overseas development aid face significant sustainability challenges, including financing gaps and inadequate maintenance. Increasing private-sector investment is crucial for addressing these challenges. This paper proposes an innovative framework linking environmental, social, and governance (ESG) principles with a revised joint credit mechanism (JCM) to attract private investment in infrastructure development, particularly in Pacific Island countries facing the climate crisis. Under the revised JCM, by allocating generated carbon credits to participating Japanese companies, rather than the Japanese government, corporations can monetise credits through market transactions, creating compelling economic incentives for private-sector engagement. In ESG-advanced markets, credits serve as strategic instruments for corporate value enhancement beyond revenue generation, while corporations require continuous credit acquisition to sustain investor confidence. Our revised framework provides a sustainable solution to both financing gaps and infrastructure maintenance challenges. Our analysis demonstrates that integrating market dynamics and corporate incentives into bilateral climate mechanisms holds substantial potential for mobilising private capital for sustainable climate infrastructure finance. This approach represents a promising departure from traditional donor-dependent models, effectively aligning corporate interests with sustainable development objectives while advancing national emission reduction commitments. Full article

The diversity and abundance of the brain virome is an active field of investigation. However, how the brain virome relates to the presence of viruses outside of the nervous system remains unclear. The rationale for this study is that analyses across multiple biologically linked compartments within the same individuals provide an important opportunity to evaluate virome discordance and viral burden. To characterize viral prevalence and burden across anatomical compartments, we applied the targeted viral enrichment method ViroFind to matched postmortem brain (n = 66), cerebrospinal fluid (CSF; n = 24), and peripheral samples (spleen, peripheral blood mononuclear cells, and lymph nodes; n = 66) from individuals with and without human immunodeficiency virus (HIV) infection and substance use disorder (SUD) in the National NeuroAIDS Tissue Consortium. We detected nucleic acids from 27 viruses representing 12 taxa. Several viruses, including adenovirus, torque teno virus, Epstein–Barr virus, human herpesvirus 6 and 7, cytomegalovirus, parvovirus, and JC polyomavirus, showed significant inter-compartment differences in prevalence or burden. CSF exhibited lower overall viral diversity than brain or peripheral samples, whereas peripheral samples showed the highest viral burden. CNS viral detection was more likely when the same virus was also detected in the periphery. We also detected HBV and HCV in CNS samples despite them not being classically regarded as neurotropic. Broader virome profiling showed greater peripheral viral burden and diversity in HIV-positive than HIV-negative individuals, whereas SUD was not associated with overall viral burden differences. These findings highlight important cross-compartment differences in viral detection, including occurrence of occult HBV infection within the CNS, and support the value of CNS–periphery comparisons in virome studies. These findings can contribute to improved diagnosis and management of viral infections. Full article

Background/Objectives: Obesity is an increasing challenge among people living with HIV (PLWH). This study aimed to assess the prevalence of general and abdominal obesity and its association with lifestyle in adult Romanian PLWH, providing the first national data. Methods: A single-center, cross-sectional study involved 106 adult PLWH. Eating behavior was assessed using the Rapid Eating Assessment for Participants—Short Version (REAP-S) and physical activity with the General Practice Physical Activity Questionnaire (GPPAQ), both standardized and validated. Anthropometric, clinical, and virological data were collected from medical records and direct measurement. Results: Median age was 36 years [IQR 33–42], 83.3% were male, and 73.6% lived in urban areas. Median time since HIV diagnosis was 11 years, and 60.4% had AIDS-defining illness. General obesity (BMI ≥ 30 kg/m²) occurred in 17.9%, overweight in 29.2%, and high-risk abdominal obesity in 22.6%. Physical inactivity was reported by 20.8%. Multivariable analysis showed that being moderately or physically active was the only independent predictor of abdominal obesity (OR 0.19; 95% CI, 0.07–0.51; p = 0.001). Conclusions: In this young Romanian cohort of PLWH, physical activity reduces the risk of abdominal obesity, underscoring the need to integrate such interventions into the standard of care to reduce metabolic risk associated with HIV. Full article

To investigate the interaction between artificial intelligence development (AID) and water–energy–food system technical efficiency (WEF-TE), panel data from 264 cities in China from 2013 to 2023 were utilized, and WEF-TE in the study areas was estimated using Stochastic Frontier Analysis (SFA). Subsequently, the Error Correction Model (ECM) and a random forest model were adopted for empirically examining the adjustment and driving mechanisms of AID on WEF-TE from three dimensions, namely enterprise scale, application level, and workforce literacy. The results indicate the following: (1) China’s WEF-TE generally shows an increasing trend; however, clear differences remain between high-value and low-value regions, and the deviation in lagging areas can reach 0.507. Meanwhile, the Yellow River Basin, which is the core region of China’s WEF system, remains below the national average in the process of technical efficiency optimization. (2) AID has a long-term equilibrium relationship with WEF-TE across the research dimensions and can effectively adjust technological inefficiencies in the short term, with adjustment coefficients ranging from 0.004 to 0.021 under different test rules. (3) In terms of enterprise scale and application level, the driving effect of AID on WEF-TE is relatively strong, with feature weights of 0.16 and 0.155, which are close to those of human capital input (0.172) and industrial structure rationalization (0.15). This study provides important reference value for constructing an interdisciplinary research framework that integrates WEF Nexus with AID. Full article

Informed consent is a core ethical and legal requirement in clinical practice. For individuals with aphasia, language impairments can hinder communication during consent processes. However, aphasia is primarily a language disorder and does not inherently imply cognitive impairment, a distinction frequently overlooked in clinical and legal settings. This scoping review examines how decision-making capacity (DMC) is assessed and supported in adults with aphasia, and outlines the clinical, ethical, and medico-legal implications for consent procedures. The review followed PRISMA-ScR guidelines. A systematic search of biomedical and legal databases was conducted without time restrictions. Studies addressing informed consent or DMC in adults with aphasia were included and analyzed using a qualitative thematic approach. Out of 519 records, 9 studies (2010–2024) from Australia, Canada, the United Kingdom, and Ireland met inclusion criteria. These studies often referenced national legislation and rights-based frameworks to define clinical responsibilities. Three main themes emerged: (1) DMC assessments rely heavily on language, with limited involvement of speech–language pathologists (SLPs), despite their role in reducing bias; (2) supported communication strategies—such as simplified language, visual aids, alternative response formats, and structured tools—can uncover “hidden competence”; and (3) structural barriers, including time constraints, insufficient training, and limited access to aphasia services, restrict implementation. Current evidence remains limited, largely qualitative, and insufficient to support definitive clinical recommendations. Incorporating supported communication, multidisciplinary assessment, and thorough documentation may enhance fairness and legal robustness. Future research should focus on validating aphasia-sensitive tools and evaluating their impact on outcomes and medico-legal risk. Full article

This perspective outlines the ongoing necessity for an HIV vaccine and immune-based prevention strategies in an era of availability of multiple behavioral and pharmacological HIV prevention interventions, including safe and highly effective pre-exposure prophylaxis (PrEP). We describe the approach of the National Institute of Allergy and Infectious Diseases (NIAID), Division of AIDS (DAIDS), based on key scientific progress, critical steps, and persistent challenges in achieving broad and durable immune protection against HIV. We highlight DAIDS coordinated infrastructure, clinical trial networks, and partnerships that enable iterative development and de-risk innovation for these interventions. Finally, we consider implications for trial design and priorities for advancing scalable HIV immune-based prevention. Full article

Hurricanes cause severe impacts on lives, livelihoods, and essential systems. Hurricane Melissa impacted Jamaica as a Category 5 cyclone, resulting in estimated losses of approximately 41% of national GDP (US$8.8 billion) and eliciting widespread damage to housing, healthcare, agriculture, and urban infrastructure. Agriculture sustained heavy losses, with 41,000 hectares of damaged farmland and the loss of more than 1 million livestock animals. These impacts resulted in exposed animal closures with biological hazards. Using systems thinking, the PESTHEEL framework, and a One Health lens, we argue for viewing Hurricane Melissa as series of cascading inter-related One Health threats of waterborne and vector-borne diseases, zoonoses, antimicrobial resistance, degraded indoor and outdoor air quality, chemical pollution, and shifting migration and border dynamics. These each unfold at different timings. A structured synthesis for Jamaica and other Caribbean Small Island Developing States is provided by integrating systems thinking, One Health, and the PESTHEEL framework. Immediate and lagged risk pathways are identified, and practical risk reduction actions are proposed to support anticipatory, multisectoral recovery: enhanced syndromic, laboratory, wastewater, vector, and rodent surveillance; resilient WASH and shelter systems; non-insecticidal and integrated vector management; biosecure aid and border protocols; environmental toxicology monitoring; and climate–health intelligence. Full article

Background/Objectives: Prosthetic joint infection following total knee arthroplasty remains a significant public health challenge. Automated surveillance systems are increasingly used for national monitoring of surgical site infections after arthroplasty. This study assessed the performance of the French ISO-ORTHO automated surveillance indicator after primary total knee arthroplasty by comparing automated surveillance data with exhaustive clinical follow-up. It also reported the incidence of surgical site infections during the initial years of activity of a tertiary care university hospital. Methods: A retrospective cohort analysis of primary total knee arthroplasties performed between January 2016 and December 2018 was conducted using exhaustive clinical chart review and the French ISO-ORTHO automated surveillance system. Prosthetic joint infections were diagnosed according to the 2018 International Consensus Meeting criteria. The local ISO-ORTHO results were compared with the national ISO-ORTHO rates. Results: Clinical chart review identified 1138 primary total knee arthroplasties and five prosthetic joint infections. Prosthetic joint infection incidence was 0.44% with a mean follow-up of 40.5 months. ISO-ORTHO was not yet implemented in 2016. Between 2017 and 2018, ISO-ORTHO identified 519 procedures and one prosthetic joint infection, compared with 807 procedures and three infections identified by clinical review. Conclusions: The French ISO-ORTHO surveillance indicator aided local and national monitoring of surgical site infections after total knee arthroplasty, but discrepancies with clinical chart review highlighted important limitations of automated monitoring and the importance of prolonged clinical follow-up. Future surveillance strategies could integrate these complementary approaches to improve prosthetic joint infection detection. Full article

Accurate evapotranspiration (ET) estimation is critical for sustainable water management in arid environments. This study estimates actual ET over the Al-Hofuf region, Al-Ahsa Oasis, Saudi Arabia, during 2024 using a cloud-based remote sensing approach. Landsat 9 Level-2 imagery was combined with ERA5-Land meteorological data to quantify spatial and temporal ET variations across a 25 km buffer. Vegetation dynamics were characterized using the Normalized Difference Vegetation Index (NDVI) to derive crop coefficients (Kc) within a Kc–ET₀ framework, where reference ET (ET₀) was obtained from ERA5-Land potential evaporation. All processing utilized Python (Version 3.14) on Google Colab and Google Earth Engine for scalable computation. Eighty-eight cloud-free Landsat 9 scenes were processed following cloud and shadow masking. Mean NDVI, Kc, and daily ET values were compiled into a comprehensive time-series dataset. Model performance was evaluated through cross-validation with MODIS MOD16A2 and internal consistency checks, demonstrating strong statistical agreement (R² = 0.82, NSE = 0.71, PBIAS = +8.3%). Results revealed pronounced seasonal variability closely linked to vegetation activity and atmospheric demand, with peak ET occurring during summer months (June–July: 7.2–7.5 mm day⁻¹) and minima in winter (January–February: 2.0–2.6 mm day⁻¹). Findings demonstrate that cloud-based techniques provide reliable, cost-effective ET monitoring in data-scarce, groundwater-dependent regions. Validation confirms Kc-ET₀ estimates reliably capture spatial and temporal patterns, supporting practical irrigation management applications. This approach aids precision irrigation and long-term water sustainability planning in Al-Hofuf, contributing significantly to national water conservation objectives under Saudi Arabia’s Vision 2030 and National Water Strategy. Full article

Global crises often force a pivotal choice between protecting human legacy and ensuring financial survival, yet the psychological drivers behind these trade-offs remain poorly understood. While family firms are traditionally viewed as inherently resilient, the unique emotional attachments of their owners may constrain their ability to adapt to unprecedented shocks. This study examines the behavioral underpinnings of crisis management across 11 European nations during the COVID-19 pandemic, challenging the traditional stewardship paradigm. Findings reveal a significant tension between preserving socioemotional wealth and economic survival. While family-managed firms prioritized personnel retention and financial autonomy, thus avoiding the psychological stigma of government aid, these non-financial priorities often proved detrimental to liquidity and business survival. This suggests that high emotional endowment can induce behavioral rigidity and an escalation of commitment, hindering strategic pivots. Furthermore, the results highlight a trend toward mimetic isomorphism, where extreme uncertainty forced a convergence of crisis responses across diverse organizational structures. Overall, the contribution of this study is to challenge the resilience myth, illustrating that acute shocks often override the distinctive behavioral archetype of family firms, forcing a shift toward institutional conformity and standardized mandates. Full article

South Korea’s official development assistance to the energy sector has increased steadily over the past decade, reaching USD 232.20 million in 2024. Yet public willingness to pay for renewable energy official development assistance remains largely unknown. This study uses a discrete choice experiment with 1000 nationally representative South Korean respondents and a mixed logit model to estimate marginal willingness to pay for key project attributes, including electrification, greenhouse gas reduction, firm expansion, expert training, and reputation enhancement. The results show that greenhouse gas reduction and expert training receive the highest willingness to pay, followed by firm expansion. Electrification and reputation enhancement receive relatively low support. The findings also reveal substantial preference heterogeneity, with younger and nationally oriented respondents placing greater value on economic returns. These results provide new donor country evidence on public preferences for renewable energy official development assistance and offer policy implications for designing a more climate-focused and socially supported green aid portfolio. Full article

The prevalence of plastics in the environment raises concerns about their complex and poorly understood effects on human health. Research continues to uncover more sources of exposure and wider ranges of plastics within the body. Adverse health effects have been observed in animals, but their relevance to humans remains unclear. To address the growing need for reliable toxicity assessment resources and tools to aid in the synthesis of findings and the identification of data gaps and needs, we have developed a data visualization tool to provide streamlined access to the evaluated data on the chemical impacts of plastics on human health. The Plastics-Related Toxicology Profiles Tool uses Tableau Public to organize the extracted chemical-specific information from ATSDR Toxicological Profiles, the United Nations Environmental Program’s 2023 Chemicals in Plastics Technical Report, and a literature review of relevant research in Google Scholar and PubMed. The tool organizes extracted data from 98 ATSDR Toxicological Profiles representing over 476 substances related to plastics production in 16 tabulated health outcome categories associated with plastics exposure. The chemicals are organized into four categories based on their role in plastics manufacturing. The top four health endpoints impacted by all listed substance profiles are respiratory, neurologic, hepatic, and developmental effects. More than 30% of the substance profiles affected these systems as well as other non-cancer endpoints involving the immunological, renal, and reproductive systems, as well as increased cancer risk in respiratory and hepatic systems. Most monomers negatively impact development and the respiratory system, and most metal additives affect the respiratory system. We explain how this data visualization tool combined with ATSDR’s framework for assessing health impacts from multiple chemicals could be applied to identify the target organs impacted by components of the common plastic polyvinyl chloride. Hazard quotients and index show low toxicity and health risk of components in the cured product. This data provide a valuable resource for prioritizing health risk assessments. Use of this interactive tool can enhance the ability of public health professionals to navigate the expanding literature, synthesize findings, and identify future health risk assessment and research priorities. Full article