Search Results (1,292)

Cell-free biosensors harness the selectivity of cellular machinery without living cells’ constraints, offering advantages in environmental monitoring, medical diagnostics, and biotechnological applications. This review examines recent advances in cell-free biosensor development, highlighting their ability to detect diverse analytes including heavy metals, organic pollutants, pathogens, and clinical biomarkers with high sensitivity and specificity. We analyze technological innovations in cell-free protein synthesis optimization, preservation strategies, and field deployment methods that have enhanced sensitivity, and practical applicability. The integration of synthetic biology approaches has enabled complex signal processing, multiplexed detection, and novel sensor designs including riboswitches, split reporter systems, and metabolic sensing modules. Emerging materials such as supported lipid bilayers, hydrogels, and artificial cells are expanding biosensor capabilities through microcompartmentalization and electronic integration. Despite significant progress, challenges remain in standardization, sample interference mitigation, and cost reduction. Future opportunities include smartphone integration, enhanced preservation methods, and hybrid sensing platforms. Cell-free biosensors hold particular promise for point-of-care diagnostics in resource-limited settings, environmental monitoring applications, and food safety testing, representing essential tools for addressing global challenges in healthcare, environmental protection, and biosecurity. 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

Background/Objectives: In Thailand, the transition of primary care units (PCUs) to Local Administrative Organizations (LAOs) has raised concerns regarding the potential impact on healthcare service delivery. This study aimed to compare health services between PCUs that have been transferred to LAOs and those that have not. Methods: A total of 15 transferred PCUs (T-PCUs) and 45 non-transferred PCUs (NT-PCUs), matched by population within the same provinces, were purposively sampled. The study population consisted of the cumulative number of diabetes (DM) and hypertension (HTN) screenings retrieved from the National Health Security Office (NHSO) database from 2017 to 2023. The impact of the LAO transfer policy on health service delivery was assessed using generalized estimating equation (GEE) models. All analyses were performed using Stata version 15. Results: The result showed no significant difference in the population and size of PCUs. DM screening was non-significantly lower by 18.9% (AdjRR: 0.811), and HTN screening was lower by 18.6% (AdjRR: 0.814), when comparing T-PCU with NT-PCU. Similarly, the DM and HTN screening in T-PCU was non-significantly lower than NT-PCU when interacting with time. Both T-PCU and NT-PCU show decreases over time; however, the decrease was not statistically significant. Conclusions: Our results show a non-significant difference in DM and HTN screening between T-PCU and NT-PCU. Therefore, decentralization did not clearly demonstrate a negative impact on the delivery of these health services. Further research is needed to consider other confounding and covariate factors for DM and HTN screening. Full article

Pseudo-persistent organic pollutants, such as pharmaceuticals, personal care products (PPCPs), and organic dyes, are a major issue in current environmental engineering. Considering the limitations of traditional wastewater treatment plant methods and degradation technologies for organic pollutants, the search for new technologies more suitable for treating these new types of pollutants has become a research hotspot in recent years. Membrane filtration, adsorption, advanced oxidation, and electrochemical advanced oxidation technologies can effectively treat new organic pollutants. The electro-advanced oxidation process based on sulfate radicals is renowned for its non-selectivity, high efficiency, and environmental friendliness, and it can improve the dewatering performance of sludge after wastewater treatment. Therefore, in this study, octyl methoxycinnamate (OMC) was selected as the target pollutant. A new type of electrochemical filtration device based on the advanced oxidation process of sulfate radicals was designed, and a new type of modified carbon nanotube material electrode was synthesized to enhance its degradation effect. In a mixed system of water and acetonitrile, the efficiency of the electrochemical filtration device loaded with the modified electrode for degrading OMC is 1.54 times that at room temperature. The experimental results confirmed the superiority and application prospects of the self-designed treatment scheme for organic pollutants, providing experience and a reference for the future treatment of PPCP pollution. Full article

Oral health during pregnancy is essential for maternal and child well-being, as hormonal and physiological changes increase women’s susceptibility to oral diseases. Despite the recognized importance of prenatal dental care, adherence to dental services remains a challenge in the public health context. This study aimed to analyze oral health and the use of dental services during pregnancy through the perception of pregnant women. It represents the qualitative phase of a mixed-method study conducted with 25 pregnant women (with and without dental care) receiving prenatal care in the Brazilian Unified Health System (SUS). Participants were selected through saturation sampling, and data were collected via semi-structured interviews, followed by content analysis. The findings revealed four major themes: barriers and facilitators to dental care, changes during pregnancy and oral health. Discomfort from oral changes was a common concern. Barriers included misinformation, fear, cultural beliefs, and service organization. In contrast, facilitating factors were identified, such as care prioritization, support from healthcare teams, health education, and access through SUS. This study concludes that emotional, cultural, and contextual aspects shape the use of dental services during pregnancy. Access through SUS is perceived as an important facilitator, which simultaneously presents organizational weaknesses that need to be addressed. Full article

The development of severe SARS-CoV-2 pneumonia is characterized by extensive lung inflammation, which, in turn, leads to respiratory distress and a decline in blood oxygen levels. Hospital admission, along with intensive care or ventilator usage, becomes necessary because this condition leads to serious respiratory problems. This review aims to provide a comprehensive overview of the pathophysiological mechanisms, diagnostic methods, and current therapeutic options for pneumonia caused by the SARS-CoV-2 virus. The pathophysiological process of severe pneumonia due to SARS-CoV-2 infection is characterized by direct lung damage from viral replication, an excessive immune system response, inflammation, impaired gas exchange, and multi-organ failure. The coexistence of various medical conditions leads to substantial lung impairment, resulting in hypoxia and respiratory failure, which can ultimately lead to fatal outcomes. The diagnosis of severe SARS-CoV-2 pneumonia is made through a combination of clinical, radiologic, and laboratory findings. A multifaceted approach integrating antiviral therapy, corticosteroids, oxygen supplementation, ventilatory management, and immunomodulation is imperative to control inflammation and enhance clinical outcomes. Early intervention, meticulous monitoring, and personalized care are paramount for enhancing survival and mitigating complications in critically ill patients with COVID-19 pneumonia. Full article

Lung transplantation remains the standard of care for end-stage lung disease, yet a persistent gap exists between donor lung availability and growing clinical demand. Expanding the donor pool and optimising donor lung management are therefore critical priorities. However, no universally accepted management protocols are currently in place. This narrative review examines evidence-based strategies to improve lung utilisation across three donor categories: donors after brain death (DBD), controlled donors after circulatory death (cDCD), and uncontrolled donors after circulatory death (uDCD). A systematic literature search was conducted to identify interventions targeting lung preservation and function, including protective ventilation, recruitment manoeuvres, fluid and hormonal management, and ex vivo lung perfusion (EVLP). Distinct pathophysiological mechanisms—sympathetic storm and systemic inflammation in DBD, ischaemia–reperfusion injury in cDCD, and prolonged warm ischaemia in uDCD—necessitate tailored approaches to lung preservation. In DBD donors, early application of protective ventilation, bronchoscopy, and infection surveillance is essential. cDCD donors benefit from optimised pre- and post-withdrawal management to mitigate lung injury. uDCD donor lungs, uniquely vulnerable to ischaemia, require meticulous post-mortem evaluation and preservation using EVLP. Implementing structured, evidence-based lung management strategies can significantly enhance donor lung utilisation and expand the transplantable organ pool. The integration of such practices into clinical protocols is vital to addressing the global shortage of suitable lungs for transplantation. Full article

As a crucial reactive oxygen species, hydrogen peroxide (H₂O₂) serves as both a physiological regulator and a pathological indicator in human systems. Its urinary concentration has emerged as a valuable biomarker for assessing metabolic disorders and renal function. While conventional colorimetric determination methods predominantly employ enzymatic or nanozyme catalysts, we present an innovative non-catalytic approach utilizing the redox-responsive properties of organic neutral radicals. Specifically, we designed and synthesized a novel radical TTM-DMODPA based on the tris (2,4,6-trichlorophenyl) methyl (TTM) scaffold, which exhibits remarkable optical tunability and oxidative sensitivity. This system enables dual-mode H₂O₂ quantification: (1) UV-vis spectrophotometry (linear range: 2.5–250 μmol/L, LOD: 1.275 μmol/L) and (2) smartphone-based visual analysis (linear range: 2.5–250 μmol/L, LOD: 3.633 μmol/L), the latter being particularly suitable for point-of-care testing. Validation studies using urine samples demonstrated excellent recovery rates (96–104%), confirming the method’s reliability for real-sample applications. Our work establishes a portable, instrument-free platform for urinary H₂O₂ determination, with significant potential in clinical diagnostics and environmental monitoring. Full article

Background/Objectives: Respectful maternity care involves privacy, dignity, and informed choice within the process of delivery as stipulated by the World Health Organization (WHO). Informed consent is a cornerstone of patient-centered care, representing not just a formal document, but an ongoing ethical and clinical process through which women are offered objective, understandable information to support autonomous, informed decision-making. Methods: This narrative review critically examines the literature on informed consent in maternity care, with particular attention to both obstetric-led and midwifery-led models of care. In addition to identifying institutional, cultural, and systemic obstacles to its successful implementation, the review examines the definition and application of informed consent in perinatal settings and evaluates its effects on women’s autonomy and satisfaction with care. Results: Important conclusions emphasize that improving women’s experiences and minimizing needless interventions require active decision-making participation, a positive provider–patient relationship, and ongoing support from medical professionals. However, significant gaps persist between legal mandates and actual practice due to provider attitudes, systemic constraints, and sociocultural influences. Women’s experiences of consent can be more effectively understood through the use of instruments such as the Mothers’ Respect (MOR) Index and the Mothers’ Autonomy in Decision Making (MADM) Scale. Conclusions: To promote genuinely informed and considerate maternity care, this review emphasizes the necessity of legislative reform and improved provider education in order to close the gap between policy and practice. Full article

Healthcare Information Systems (HISs) are essential for improving care quality, managing chronic diseases, and supporting clinical decision-making. Despite significant investments, HIS implementations often fail due to the complexity of healthcare environments. Maturity Models (MMs) have emerged as tools to guide organizational improvement by assessing readiness, process efficiency, technology adoption, and interoperability. This study presents a comprehensive literature review identifying 45 Maturity Models used across various healthcare domains, including telemedicine, analytics, business intelligence, and electronic medical records. These models, often based on Capability Maturity Model Integration (CMMI), vary in structure, scope, and maturity stages. The findings demonstrate that structured maturity assessments help healthcare organizations plan, implement, and optimize HIS more effectively, leading to enhanced clinical and operational performance. This review contributes to an understanding of how different MMs can support healthcare digital transformation and provides a resource for selecting appropriate models based on specific organizational goals and technological contexts. Full article

Fluid resuscitation after thermal injury is paramount to avoid burn shock and restore organ perfusion. Both over- and under-resuscitation can lead to unintended consequences affecting patient outcomes. While many studies have examined systemic effects, limited data exist on how fluid resuscitation impacts burn wound progression in the acute period. Furthermore, the mechanisms underlying burn wound progression remain not fully understood. This study used a swine model to investigate how varying resuscitation levels affect peri-burn wound dynamics. Twenty-seven female Yorkshire pigs were anesthetized, subjected to 40% total body surface area burn and 15% hemorrhage, then randomized (n = 9) to receive decision-support-driven (adequate, 2–4 mL/kg/%TBSA), fluid-withholding (under, <1 mL/kg/%TBSA), or high-constant-rate (over, >>4 mL/kg/%TBSA) resuscitation. Pigs were monitored for 24 h in an intensive care setting prior to necropsy. Laser Doppler Imaging (LDI) was conducted pre-burn and at 2, 6, 12, and 24 h post burn to assess perfusion. Biopsies were taken from burn, peri-burn (within 2 cm), and normal skin. RNA was isolated at 24 h for the qRT-PCR analysis of IL-6, CXCL8, and IFN-γ. At hour 2, LDI revealed increased peri-burn perfusion in over-resuscitated animals vs. under-resuscitated animals (p = 0.0499). At hour 24, IL-6 (p = 0.0220) and IFN-γ (p = 0.0253) were elevated in over-resuscitated peri-burn skin. CXCL8 showed no significant change. TUNEL staining revealed increased apoptosis in over- and under-resuscitated peri-burn skin. Differences in perfusion and cytokine expression based on resuscitation strategy suggest that fluid levels may influence burn wound progression. Full article

Background/Objective: Early-onset neonatal sepsis (EOS), defined as infection occurring within the first 72 h after birth, remains a major contributor to neonatal morbidity and mortality worldwide. Although advances in perinatal care have improved overall outcomes, the diagnosis of EOS continues to be challenging. Clinical presentations are often nonspecific, laboratory confirmation is often delayed, and immune responses vary considerably among neonates. Expanding our understanding of the molecular mechanisms underlying EOS is essential in enhancing early detection, refining risk stratification, and guiding therapeutic strategies. This systematic review aims to synthesize the available information on the molecular pathways involved in EOS, focusing on pathogen-induced inflammation, systemic immune responses, sterile inflammatory processes, interactions between infectious and non-infectious pathways, as well as emerging molecular diagnostic approaches. Methods: A comprehensive review of original research articles and reviews published between January 2015 and January 2025 was conducted; studies were included based on their focus on human neonates and their analysis of molecular or immunological mechanisms relevant to EOS pathogenesis, immune dysregulation, or novel diagnostic strategies. Results: Pathogen-driven inflammation typically involves the activation of Toll-like receptors (TLRs), the recruitment of neutrophils, and the release of pro-inflammatory cytokines such as IL-6, IL-1β, and TNF-α, particularly in response to vertical transmission of organisms like Escherichia coli and Streptococcus agalactiae. Systemic inflammatory responses are marked by cytokine dysregulation, contributing to multi-organ dysfunction. Sterile inflammation, often initiated by hypoxia–reperfusion injury or intrauterine stress, amplifies susceptibility to sepsis. Interactions between immune, metabolic, and endothelial pathways further exacerbate tissue injury. Recent advances, including transcriptomic profiling, microRNA-based biomarkers, and immune checkpoint studies, offer promising strategies for earlier diagnosis and individualized therapeutic options. Conclusions: EOS arises from a complex interplay of infectious and sterile inflammatory mechanisms. A deeper molecular understanding holds promise for advancing correct diagnostics and targeted therapies, aiming to improve neonatal outcomes. Full article

Patient involvement in health technology assessment (HTA) processes is increasingly recognized as pivotal for informed, equitable, and patient-relevant health care decision-making. With the implementation of Joint Scientific Consultations (JSCs) and Joint Clinical Assessments (JCAs) under Regulation (EU) 2021/2282, the European Union has a unique opportunity to design harmonized mechanisms that reflect best practices from established HTA systems. This article, drawing on the Acute Leukemia Advocates Network (ALAN)’s comparative analysis of HTA practices across seven countries (Canada, England, Scotland, France, Germany, Spain, and Italy), examines how current patient involvement processes can inform the JCA framework. It identifies opportunities to replicate effective practices and proposes strategies to embed patient voices meaningfully into the JCA process. By prioritizing robust and inclusive patient involvement, the EU can establish a global benchmark for impactful and consistent HTA processes. By leveraging lessons from international HTA systems and prioritizing clear frameworks, early involvement, and capacity building, the EU can set a global standard for meaningful patient participation in HTA processes. ALAN is an independent global network of patient organizations dedicated to improving outcomes for patients with acute leukemia. Full article

Objective: Given the critical workforce challenges in home care settings and the limited understanding of empowerment mechanisms in isolated work environments, this study aimed to examine how structural empowerment influences psychological empowerment among home care workers in South Korea through the mediating pathways of thriving at work and caregiver reciprocity. Based on Kanter’s empowerment theory, we specifically investigated the serial mediation effects to understand the complex processes through which organizational support structures translate into enhanced worker empowerment. Methods: A cross-sectional survey was conducted with 192 home care workers. Data were analyzed using descriptive statistics, correlation analysis, and serial multiple mediation analysis using SPSS Process Macro Model 6. Results: Structural empowerment demonstrated significant positive correlations with thriving at work (r = 0.445, p < 0.001), caregiver reciprocity (r = 0.490, p < 0.001), and psychological empowerment (r = 0.337, p < 0.001). Thriving at work significantly influenced both caregiver reciprocity (β = 0.3968, p < 0.001) and psychological empowerment (β = 0.1685, p < 0.001). The serial mediation analysis revealed that the indirect effect of structural empowerment on psychological empowerment through thriving at work and caregiver reciprocity was statistically significant (indirect effect = 0.1327, 95% CI [0.0713, 0.1929]), with the model explaining 58% of the variance in psychological empowerment. Conclusions: Structural empowerment significantly enhances psychological empowerment among home care workers through the sequential mediation of thriving at work and caregiver reciprocity. Healthcare organizations should prioritize strengthening structural empowerment through comprehensive support systems and conducive work environments to optimize care quality and worker well-being. Full article

The continued migration of physicians from independent practice to affiliation with larger entities has garnered significant scrutiny. These affiliation models include hospitals and health systems, payers and corporate entities, and management services organizations, which may or may not be private equity (PE)-backed. Data on the impact of different physician affiliation models on cost of care is limited. We examined the relationship between provider affiliation model, site of care (SOC), and cost of care for certain high-volume procedures in procedure-intensive specialties for both Medicare and commercial insurance. We found that hospital-affiliated physicians are least likely—and PE-affiliated physicians are most likely—to provide care in lower-cost settings. For both Medicare and commercial insurance, SOC contributes meaningfully to procedure unit price, which is consistently greater in hospital-based settings. These findings suggest that the physician affiliation model and associated SOC cost differentials contribute materially to healthcare expenditures. As the Medicare cost differentials are set by statute and regulations, strategies such as site-neutral payments are needed to mitigate the monetary impact of historical and future physician practice migration. Full article