Search Results (2,891)

To meet national and global air quality and climate ceilings, it is essential to provide farm-level decision support tools for mitigating gaseous emissions from agriculture. A major challenge is to develop reliable tools that can be adapted to country-specific conditions, particularly in countries where such tools are currently lacking, and support farmers in assessing emission mitigation measures. To address this challenge, a Prototype Decision Support Tool (PDST) for estimating and mitigating gaseous emissions at the livestock farm scale was developed based on the FarmAC whole-farm model. The PDST supports livestock farm-level assessment of carbon emissions, including CH₄ and CO₂, and nitrogen-related emissions, including N₂O and NH₃. Emissions were estimated using the IPCC 2006 Guidelines, their 2019 Refinement, and the EMEP/EEA 2023 methodology. The PDST was applied to two intensive pig farms in Greece, both with fully slatted housing and outdoor slurry tank storage, and two intensive dairy cattle farms, one in Greece and one in Poland, both using deep-litter housing with solid manure storage. For these farms, the PDST estimated total annual emissions of 1.58 and 1.54 kg CO₂eq per kg of pig live weight and 0.80 and 0.66 kg CO₂-eq per kg of raw milk, respectively. These estimates were consistent with values reported in the literature for comparable production systems and emission sources, supporting the preliminary consistency of the PDST outputs. The PDST can form the software basis to support stakeholders in choosing farm-level practices that specifically reduce emissions. Full article

Background/Objectives: As population ageing accelerates, integrated care has become an important strategy for addressing the complex care needs of older adults. Although gerontological nurse specialists (GNSs) are expected to contribute to integrated care, their roles remain inconsistently defined and insufficiently synthesized across healthcare systems and professional role titles. This scoping review aims to systematically map the roles of GNSs in supporting integrated care for older adults within hospital-based settings. Methods: This scoping review protocol will follow the JBI methodology for scoping reviews and will be reported in accordance with the PRISMA-ScR guidelines. Searches will be conducted in PubMed, CINAHL, Web of Science, China National Knowledge Infrastructure, and Ichushi-Web, with no date restrictions. Studies published in English, Chinese, and Japanese will be included. The review will consider studies involving nurses with recognized specialist or advanced nursing practice competence in gerontological or older-adult care and will focus on their roles in supporting integrated care for older adults within hospital-based settings and hospital-linked transitional care services. Two independent reviewers will conduct study selection and data extraction. The findings will be synthesized descriptively and presented using tabular, narrative, and diagrammatic formats. Conclusions: This review is expected to contribute to a clearer understanding of the roles of GNSs in integrated care for older adults and provide evidence to inform future nursing practice, workforce development, education, and research in gerontological integrated care. Registration: This protocol was registered within the OSF database on 19 May 2026. Full article

Water quality analysis plays an essential role in maintaining the health and sustainability of river ecosystems, especially in semi-arid regions like the Arroyo Colorado Watershed in South Texas. Since the river is a vital source of water supply for local communities, agriculture, and wildlife, it faces significant challenges and pollution from land use changes, climate variation, and agricultural runoff. Continuous monitoring and assessment of water quality parameters and their temporal variability are essential to ensure the drinking water supply and aquatic ecosystem health. However, comprehensive laboratory-based water quality investigations are often constrained by higher costs, logistical complexity, and limited manpower. As a result, monitoring datasets are often not available for all water quality parameters, or the datasets may be incomplete. To address such challenges, the objective of this study was to evaluate the potential of water quality index (WQI)-based assessment supported by machine learning algorithms as an alternative decision-support tool for water quality evaluation. The analysis compared four monitoring stations in the Austin and Arroyo Colorado Watersheds, with particular emphasis on one gauging station at Port Harlingen. Datasets were collected from the Texas Commission of Environmental Quality (TCEQ). A complete exploratory data analysis (EDA) was performed to understand the TCEQ water quality datasets containing sixteen parameters, and seven water quality parameters were selected based on multicollinearity checks. It was observed that seven independent water quality parameters (dissolved oxygen, ammonia, nitrate, phosphorus, temperature, fecal coliform, and residual non-filterable material concentrations) were identified as sufficient to define the WQI of the Austin monitoring stations. Moreover, U.S. Environmental Protection Agency (EPA)-based guidelines were utilized to scale individual parameters to a range of 0–100 to remove their magnitude and correlation-based bias. These parameters were further analyzed using machine learning techniques, i.e., principal component analysis, K-means, and one-class support vector machine, to compute the relative importance based on their fluctuation within the temporal dataset. Finally, the mean WQI model was developed for Port Harlingen and achieved a strong agreement with the National Sanitation Foundation (NSF) WQI (R² = 0.91). These findings demonstrate the applicability of the proposed data-driven WQI framework for regional water quality assessment and comparative analysis across watersheds. 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

Tuberculosis (TB) continues to be a significant public health challenge in Europe, despite a sustained decline in disease incidence over recent decades. This narrative review briefly traces the historical development of TB diagnosis and focuses on the evolution of TB control protocols from the early twentieth century to the present across Europe, through a longitudinal comparative analysis of its geographical regions. A literature search was conducted using publications, guidelines, and surveillance reports from the World Health Organization (WHO), the European Centre for Disease Prevention and Control (ECDC), and national public health authorities. The analysis follows a geographical framework encompassing Eastern, Western, Northern, and Southern Europe, reflecting historical, socioeconomic, and healthcare system differences. This study presents the transition from traditional diagnostic approaches based on clinical assessment, chest radiography, and smear microscopy to modern molecular and immunological techniques, including Xpert MTB/RIF assays and interferon-gamma release assays (IGRAs). Similarly, treatment strategies have evolved from sanatorium-based supportive care to standardized, evidence-based short-course regimens employing first- and second-line anti-TB drugs. However, marked regional differences remain in the implementation of contemporary protocols. Western and Northern European countries have largely adopted advanced diagnostic technologies and comprehensive surveillance systems and are approaching TB elimination targets. In contrast, Eastern Europe continues to bear a disproportionate disease burden, driven by multidrug-resistant TB, HIV co-infection, and socioeconomic disparities. TB control protocols in Southern Europe are progressively converging with those of Western Europe through the adoption of modern diagnostic approaches, standardized treatment regimens, and WHO-endorsed guidelines. The findings of this study underscore the need for greater harmonization of TB control protocols across Europe through an initiative coordinated by the ECDC/WHO. Accelerating progress toward TB elimination in the European Region will depend on expanding access to modern diagnostic technologies, implementing targeted interventions in high-burden settings, and strengthening cross-border collaboration through coordinated public health policies. Full article

Background: Although cervical cancer is a highly preventable malignancy, Romania continues to report critical mortality rates. This paradox is largely attributable to the suboptimal implementation of clinical guidelines and a passive, “opt-in” administrative framework. This cross-sectional study investigates the cognitive and behavioural determinants—specifically, human papillomavirus (HPV) knowledge, institutional trust in healthcare systems, and digital misinformation exposure—that modulate female attitudes toward HPV immunisation. Methods: An observational cross-sectional study was conducted between December 2025 and March 2026 across four obstetrics and gynaecology clinics. Data were collected via digital questionnaires administered to adult female patients aged 18 to 65 years. The assessment tool evaluated four primary domains: HPV knowledge, perceived vaccine safety, immunisation intention, and the degree of exposure to social media misinformation. Results: The cohort demonstrated a substantially low vaccination rate (28.6%). Statistical analysis elucidated significant positive correlations between HPV knowledge, trust in health authorities, and vaccination intention. Furthermore, reliance on official information sources strongly correlated with perceived vaccine safety. Conversely, exposure to negative online content exhibited a weak negative association with knowledge levels, yet it did not directly influence vaccination intention. Conclusions: Health literacy and institutional trust emerge as fundamental pillars for HPV vaccine acceptance. To overcome patient vaccine hesitancy, the national healthcare system must initiate a strategic paradigm shift, prioritising the neutralization of digital misinformation and transitioning from a passive model to a proactive, “opt-out” infrastructure. Full article

Emerging contaminants (ECs) represent a growing environmental problem due to their presence in various environmental matrices. In Mexico, research on ECs remains limited. This scoping review, conducted in accordance with the PRISMA-ScR guidelines, analyzes their environmental fate during the period 2004–2025, considering their distribution in surface and groundwater, sediments, and influents and effluents from wastewater treatment plants (WWTPs). The reviewed studies demonstrate the presence of pharmaceutically active compounds (PhACs), endocrine-disrupting compounds (EDCs), personal care products, phthalates, bisphenols, pesticides, illicit drugs, xanthines, perfluoroalkyl and polyfluoroalkyl substances (PFAS), metabolites, and industrial compounds. The Apatlaco, Cuautla, and Santa Catarina rivers exhibit the greatest diversity of ECs, while groundwater shows evidence of infiltration of PhACs, phthalates, bisphenols, and triclosan, associated with urban, industrial, and tourist discharges. In sediments, PhACs and EDCs accumulate at concentrations in the ng/g range, while phthalates reach concentrations of thousands of ng/g, indicating their affinity for the solid phase. At Mexican wastewater treatment plants, conventional treatment methods do not completely remove ECs, allowing residual amounts to be discharged into receiving bodies of water. Overall, national monitoring should be expanded to include metabolites, transformation products, and advanced treatment assessment. Full article

Background: Postoperative complications after staging surgery for endometrial cancer often occur after discharge, and 30-day unplanned readmission is an important post-discharge outcome. Existing models lack same-day usability at discharge and sufficient validation, limiting discharge-time risk stratification and transitional care planning. This study aimed to develop and validate a discharge-time risk prediction model based on administrative data for 30-day unplanned hospital readmission among patients undergoing staging surgery for endometrial cancer. Methods: This retrospective cohort study was conducted in accordance with the TRIPOD reporting guidelines. We constructed a nationally representative adult cohort using the Healthcare Cost and Utilization Project Nationwide Readmissions Database (HCUP-NRD) from 2016 to 2022, including index hospitalizations discharged between January and November to ensure complete 30-day follow-up. Variables available at discharge (demographics, payer/income, presentation, inpatient course, discharge disposition, hospital characteristics, Elixhauser index) were included; age and length of stay were modeled with restricted cubic splines. Complex survey-weighted multivariable logistic regression was used for model development with 1000 bootstrap internal validations. Temporal validation within the NRD was performed using 2020–2021 and 2022 data. Decision curve analysis, subgroup, and sensitivity analyses were conducted. Results: A total of 89,627 hospitalizations were included; development and validation cohorts had balanced baselines. Internal validation showed moderate discrimination (AUC 0.719) and good calibration (Brier 0.045; intercept 0.014; slope 0.955). Discharge to home health or institutional care, non-elective or emergency admission, and a higher Elixhauser readmission index (a measure of comorbidity burden) were associated with increased risk. Age and length of stay showed nonlinear associations. Temporal validation yielded a similar performance (AUC 0.708–0.713; Brier 0.043–0.046), and decision curves indicated positive net clinical benefit. Conclusions: The model demonstrated stable discrimination and maintained good calibration after temporal validation and recalibration. It represents a candidate discharge-time decision-support tool, based on administrative data, for identifying patients at higher risk of 30-day unplanned readmission, and may support nurse-led transitional care planning. External validation and local recalibration are required before application in other healthcare settings. Full article

Indigenous Knowledge (IK) is the traditional wisdom used to manage and sustain ecosystem services (ES). This review paper presents the integration of ES and IK for sustainable natural resource management and policy in Ethiopia, suggesting that despite increased research in recent years, there is a lack of uptake at the policy and program implementation levels. A total of 75 studies published between 2015 and 2025 were systematically reviewed, covering an 11-year sequential scope following PRISMA 2020 guidelines and including articles from the Web of Science, Scopus, Google Scholar, African Journal Online and Indigenous Knowledge Documentation Centre (IKDC) databases. The findings show that provisioning services dominate the literature (67.4%), followed by regulating (18.3%), cultural (9.2%), and supporting services (5.1%). IK documented across 22 ethnic groups demonstrated important contributions to biodiversity conservation, sustainable agriculture, forest management, and water resource management. However, only 26.8% of the reviewed studies successfully integrated IK into ES frameworks. Policy content analysis tool (PCAT) of 23 national documents showed weak institutional support for IK integration, with an average integration score of only 5.8 out of 20. Major barriers include limited policy implementation, institutional fragmentation, and negative perceptions toward IK. Successful integration cases were strongly associated with community ownership, participatory monitoring, legal recognition, and long-term funding support. This review is important because it systematically shows that IK delivers confirmed environmental and livelihood benefits over this 11-year time frame. It highlights the urgent need for stronger policy frameworks, inclusive governance, and recognition of IK to improve ecosystem conservation and sustainable resource management in Ethiopia. Full article

Personal health and safety are significant concerns across agricultural education, specifically agricultural mechanics. While hearing safety has been discussed for numerous years as a shortcoming in overall safety actions, it has been identified that attitudes and perceptions of sound and noise within agricultural settings are not aligned. This research continues work to focus on students’ understanding of and application of safety culture within an agricultural mechanics environment. Through direct and indirect exposure to noise levels, students reflected on and identified their use and intended use of hearing personal protective equipment (PPE). Pre- and post-instructional data aided in establishing students’ thresholds to use proper personal protective equipment and identify their perceptions of the decibel (dB) outputs for commonly used power tools in an agricultural laboratory setting. Course reflections alarmingly show a disconnect between intention and practice as many students do not utilize hearing PPE. While indicated threshold values and tool-specific PPE use align with the National Institute for Occupational Safety and Health’s recommended hearing PPE guidelines, the self-reported hearing PPE use results are concerning. While knowledge and application gaps still need to be addressed, based on this exploratory study, bounded in a single instructional context, continued exposure through direct and indirect instruction leads to increased knowledge of sound levels. Full article

Background: Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease and end-stage renal disease worldwide. Despite robust evidence-based guidelines, real-world adherence to recommended preventive care remains inadequate. Most prior evaluations have focused on individual care components rather than comprehensive composite care delivery. Methods: A retrospective cross-sectional study of 1010 adult patients with diabetes attending outpatient clinics at King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNGHA), Jeddah, Saudi Arabia. Full guideline-concordant care (GCC) was defined as composite completion of HbA1c monitoring, albuminuria screening using the urine albumin-to-creatinine ratio (ACR), and renin–angiotensin–aldosterone system inhibitor (RAASi) use among patients with detected albuminuria. Multivariable logistic regression (n = 1007) identified independent predictors of full GCC. Results: Only 22.7% (95% CI: 20.1–25.3%) of patients achieved full GCC. Partial care was the most common pattern (46.2%), followed by no care (20.7%) and near-complete care (10.4%). HbA1c testing was performed in 55.0% and albuminuria screening in 49.3% of patients. Among those with detected albuminuria, RAASi therapy was prescribed in 78.9%. Primary care management (OR 4.79, 95% CI 3.45–6.66; p < 0.001) and hypertension (OR 2.00, 95% CI 1.33–3.00; p = 0.001) were independently associated with full GCC. Age, gender, kidney function, and cardiac disease were not significant predictors. Conclusions: Substantial gaps exist in guideline-recommended DKD care, driven primarily by screening deficiencies rather than treatment failures. Care delivery is influenced more by healthcare setting than by patient characteristics, highlighting the need for system-level interventions targeting detection infrastructure across all care settings. Full article

Animal transport connects farms with slaughterhouses, breeding units and production sites, but remains one of the most debated animal welfare issues of recent decades. These debates also touch on the EU–Mercosur agreement in the areas of agribusiness and animal farming. The aim of this article is to examine the legislation of Brazil and Germany and the European Union (EU) regarding animal transport, using specific examples to identify differences and similarities that may form the basis for joint discussions on this area of animal welfare. The EU Transport Regulation for the Protection of Farm Animals applies in all EU member states (Council Regulation (EC) No 1/2005). In Germany, the Animal Welfare Transport Ordinance transposes EU law into national law. The transport times depend on vehicle type and equipment and vary according to the animal species to be transported. The basic maximum travel time is 8 h for commercial transport and distances longer than 65 km. In Brazil, there exists a wide range of laws, regulations, decrees and guidelines governing the protection of animals during transport in the different Brazilian states, mostly coordinated by the Brazilian Ministry of Agriculture and Livestock (MAPA). Allowed transport times in Brazil vary largely from 4 to 12 h between single state regulations and are less regulated in detail. Maximum Transport durations can be repeated several times after appropriate stops for animal feeding and watering. Similarly to Germany/EU, only animals “fit for travel” are allowed to be transported and the responsibility for the transported animals ends once the last animal has been unloaded at its place of destination. Temperatures in Germany/EU are generally moderate, whereas Brazil and South America have tropical and subtropical climates. Furthermore, the distances between farms and abattoirs in Brazil are generally greater, and transport vehicles often have to travel on unpaved (gravel) roads, e.g., to reach the farms. The key to animal-friendly transport lies in loading healthy, “transport-fit” animals on suitable vehicles with sufficient space and necessary equipment, and licensed and committed drivers. This has to be supported by appropriate legal provisions. Animal welfare laws in both Brazil and Germany/EU aim to ensure the best possible welfare of animals during transit under the given circumstances of transport, in order to prevent pain, suffering and injury. This shared commitment to animal welfare provides a substantiated basis for mutual understanding and cooperation in livestock farming, which may prove helpful in the discussions on the agricultural chapter of the EU–Mercosur Agreement. Full article

Background: The rising incidence of knee osteoarthritis in Oman has increased the demand for total knee replacement (TKR) surgeries, highlighting the critical role of evidence-based postoperative physiotherapy. However, no prior study has systematically assessed physiotherapy practices post-TKR in Oman. This study aimed to fill this gap by assessing current physiotherapy practices post-TKR in Oman, evaluating adherence to international guidelines, and identifying barriers to optimal care. Methods: A cross-sectional study was conducted between January and March 2025 using a self-administered, structured questionnaire distributed to 189 physiotherapists in governmental hospitals. Data were analyzed using descriptive statistics with SPSS version 26. Results: High adoption rates were found for preoperative education (94.2%) and strengthening exercises (95.3%). In acute-stage rehabilitation, functional training (96.35%) and early mobilization (94.27%) were prevalent. However, utilization of standardized outcome measures (e.g., WOMAC) was low (74.47%) and variability existed in discharge criteria. Major barriers included a shortage of physiotherapists (91.66% agreement), limited resources (92.18%), and patient-related challenges (94.79%). Conclusion: While foundational rehabilitation practices are implemented effectively in Oman, significant gaps remain in standardized assessments and adherence to specific international protocols. Addressing workforce shortages, resource limitations, and implementing unified national guidelines are essential for optimizing post-TKR rehabilitation outcomes. Full article

Background/Objectives: Antipsychotic drug utilization has changed substantially over recent decades, reflecting evolving prescribing practices, drug availability, and treatment guidelines. Methods: This study analyzed national antipsychotic consumption in Serbia from 2006 to 2024 using official data from the Medicines and Medical Devices Agency of Serbia. Utilization was expressed as defined daily doses per 1000 inhabitants per day, and trends were assessed using linear and joinpoint regression analyses. Results: Total antipsychotic utilization increased from 4.35 to 14.42 DDD/1000 inhabitants/day, representing a 231.5% increase. This growth was predominantly driven by atypical antipsychotics, whose utilization increased from 1.16 to 10.91 DDD/1000 inhabitants/day (+840.2%). In contrast, typical antipsychotic utilization remained relatively stable in absolute terms. The share of atypical antipsychotics increased from 26.7% in 2006 to 75.6% in 2024, while the atypical: typical utilization ratio increased from 0.36 to 3.10. Atypical antipsychotics surpassed typical agents in 2013. Marked increases were observed for olanzapine, quetiapine, aripiprazole, paliperidone, risperidone, and clozapine, while chlorpromazine and fluphenazine declined. Conclusions: These findings demonstrate a substantial increase in overall antipsychotic utilization in Serbia and a pronounced structural shift toward atypical agents, highlighting the need for continued monitoring of prescribing trends, safety outcomes, and population-level treatment patterns. Full article

Endometriosis is a chronic gynecological disease affecting about 10% of reproductive age women, with a significant impact on socio-economic sphere and quality of life. It is a multifactorial phenomenon, in which genetic predisposition, immunologic malfunction, hormone imbalance, and environmental insult play an important role in disease development and progression. The aim of this review is to report the current evidence from the literature related to the association between endometriosis and endocrine disruptors. This study was designed as a systematic review and meta-analysis investigating the association between exposure to endocrine disruptors and the risk of endometriosis. The review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The systematic search identified 428 records from national and international scientific databases. The included studies were published between 2001 and 2020, with most studies classified as fair-to-good quality. The overall random-effects meta-analysis demonstrated a statistically significant association between exposure to endocrine-disrupting chemicals and endometriosis. This systematic review and meta-analysis provides evidence of a significant association between exposure to endocrine-disrupting chemicals and endometriosis, with the strongest and most consistent association observed for polychlorinated biphenyls. Full article