Search Results (131,832)

Farmworkers experience disproportionate risks of pesticide exposure, yet only two U.S. states, California and Washington, currently mandate routine cholinesterase biomonitoring programs for agricultural workers. Although regulatory and resource limitations influence implementation of worker protection programs, operational barriers also complicate repeated biomonitoring among highly mobile and underserved farmworker populations. The objective of this preliminary study was to evaluate the operational feasibility of recruiting, retaining, and repeatedly monitoring farmworkers using a novel, rapid, portable cholinesterase analysis device under routine agricultural field conditions. Guided by an evidence-based feasibility framework, a multidisciplinary team administered surveys and collected blood samples from 25 farmworkers in rural North Carolina at three time points during a single agricultural season. Participation and visit completion rates were high, although worker mobility, changing job assignments, environmental conditions, and temperature-sensitive samples created logistical challenges. Experienced bilingual promotoras de salud played a critical role in coordination, communication, scheduling, and retention. Findings provide preliminary evidence that repeated field-based cholinesterase biomonitoring protocols are feasible and acceptable when supported by community-based outreach organizations with Spanish speaking health workers, structured logistics, and culturally responsive engagement strategies. Evaluation of the analytical performance is beyond the scope of this report, however, these results provide practical insights for strengthening occupational health surveillance and future implementation studies designed to protect agricultural workers. Full article

Neuropeptide Y [NPY; encoded by the NPY gene] is a widely expressed 36-amino-acid neuropeptide that regulates neuronal function, vascular regulation, and immune regulation; its role in glioblastoma [GBM] remains incompletely characterized. We performed an integrative in silico multi-scale transcriptomic analysis combining bulk RNA-sequencing of IDH-wildtype GBM [n = 169] and lower-grade glioma [n = 510] surgical resections from TCGA, normal cortical tissue from GTEx [n = 207], and four independent GEO validation cohorts of surgical GBM and non-tumor brain specimens [GSE4290, GSE50161, GSE131928 scRNA-seq of ~20,426 cells from 28 patients, and GSE194329 10X Visium spatial transcriptomics from five patients], along with survival modeling, pathway enrichment, single-cell RNA sequencing, spatial transcriptomics, and cell–cell communication analysis. NPY and its principal receptor, NPY1R, were significantly downregulated in GBM, while genes associated with hypoxia, angiogenesis, invasion, and immune suppression were upregulated. Single-cell analysis showed that NPY-axis transcript expression was elevated in neural progenitor-like populations. In contrast, hypoxia and metabolic programs were concentrated in mesenchymal tumors and stromal compartments, indicating distinct cellular contexts. Spatial analysis revealed a weak and heterogeneous relationship between NPY and hypoxia signatures, with substantial inter-patient variability and no significant global spatial cross-correlation. These findings indicate that loss of NPY signaling is a consistent feature of GBM and is associated with hypoxia-driven tumor states, while the spatial relationship between NPY and hypoxia appears weak, heterogeneous, and patient-specific. Full article

With the widespread integration of renewable energy, microgrid environmental economic dispatch (EED) faces challenges such as uncertainties in wind and solar power outputs and multi-objective conflicts. This paper proposes a stochastic expected dispatch framework based on an improved multi-objective dung beetle optimization algorithm (MO-CLDBO). First, considering both wind–solar uncertainties and demand response, a Gaussian Copula function is employed to characterize the 24-h temporal correlations among wind speed, solar irradiance, and load, and typical scenarios are generated via Monte Carlo sampling and simultaneous backward reduction; a time-of-use demand response model is also introduced. Second, taking expected operational cost and environmental emission as dual objectives, three improvements are proposed to address the issues of uneven initial population, easy local convergence, and Pareto front collapse in the standard dung beetle algorithm: a Folded Two-Dimensional Modified Coupled Logistic-Sine Map (Folded 2D-MCLSM) is used to initialize a high-quality population, a non-dominated sorting mechanism is introduced, and a dynamic lens imaging backward learning strategy is designed. Finally, the proposed algorithm is compared with several classical algorithms in the mathematical model of microgrid optimal dispatch through 50 independent runs. Experimental results show that the improved dung beetle optimization algorithm achieves not only the lowest average operating cost, but also the best hypervolume (HV) indicator, demonstrating excellent comprehensive performance in multi-objective search convergence and solution set diversity. Full article

Growing up without parental care may negatively affect adolescents’ behavioral and emotional development, particularly among adolescents in conflict with the law. In a selected secure care center in the Vhembe District, limited research has explored the lived experiences and behavioral impact of growing up without parents. This study aimed to explore and describe the behavioral and emotional impact of growing up without parents among adolescents in conflict with the law in a child and adolescent secure care center in Limpopo Province. A qualitative, explorative, descriptive, and contextual research design was employed. Purposive sampling was used to recruit twelve (12) adolescents aged 15–17 years admitted to a secure care center in the Vhembe District. Data was collected through individual semi-structured interviews conducted in Xitsonga or Tshivenda, depending on participants’ preferred language. Interviews were audio-recorded, transcribed, translated into English, and analyzed using Tesch’s eight steps of data analysis. Ethical considerations and measures to ensure trustworthiness were observed throughout the study. The findings revealed that adolescents experienced low self-esteem, diminished self-confidence, early initiation of substance use, poor educational engagement, survival-oriented delinquent behavior, and feelings of neglect. These findings highlight the need for an integrated intervention approach to ensure coordinated psychosocial, educational, behavioral, and socio-economic support for this population. Full article

Parental involvement in applied behavior analysis (ABA) interventions for children with autism spectrum disorder (ASD) is essential for treatment success, yet caregiver engagement remains inconsistent across clinical contexts. This qualitative study employs reflexive thematic analysis to explore the lived experiences of eight mothers receiving ABA services through a single South Florida provider. We identified barriers (time constraints, insufficient family support, communication gaps) and facilitators (observed child progress, economic support, intrinsic motivation) to parental involvement. Interpreted through a family systems lens, findings suggest that parental engagement is better understood as a dynamic, context-dependent process shaped by systemic and relational factors rather than as a matter of individual motivation alone. This modest, single-site account contributes contextually to understanding how service-design factors shape caregiver participation within one ABA program and aligns with existing literature on barriers to service engagement among underserved families. Clinical implications point to concrete service adaptations including flexible scheduling, enhanced communication protocols, family-centered psychoeducation, and evaluation of caregiver-recommended practices such as relaxation techniques and family therapy. While this study cannot generalize broadly, its findings offer specific recommendations for improving practice in community-based ABA settings serving diverse populations. Full article

Background: Pre-travel health consultations require individualised risk assessment across itinerary, destination, traveller characteristics, vaccine and medication history, comorbidities, pregnancy and immune status, activities, and access to care. Artificial intelligence (AI), particularly large language models (LLMs), may support pre-consultation education, structured history collection, guideline retrieval, multilingual communication and post-consultation reinforcement, but unsafe use may introduce hallucinated, outdated or insufficiently personalised recommendations. Objectives: This scoping review maps the current evidence on AI tools relevant to pre-travel health consultations, characterises implementation gaps, identifies patient-safety risks and proposes a supervised implementation model for travel medicine clinics. Original contribution: Unlike previous reviews of clinical AI, patient-education LLMs or chatbots in chronic illness, this is the first scoping review focused specifically on AI in pre-travel consultations. It uniquely combines a five-tier evidence hierarchy that separates direct travel-medicine AI evidence from indirect clinical-AI safety and equity evidence, and provides a travel-medicine-specific clinical safety risk taxonomy and a supervised implementation framework anchored to authoritative travel-medicine guidance and current AI regulatory regimes. Methods: A scoping review was conducted following PRISMA-ScR reporting, using a Population–Concept–Context eligibility framework and a targeted retrieval in May 2026 covering January 2017 to May 2026. Sources were screened and charted by a single reviewer using a structured eligibility checklist. Quality and applicability were appraised conceptually using MMAT, AMSTAR 2 and JBI text-and-opinion criteria, with GRADE-informed certainty. Results: Of 70 records identified, 11 were included: four direct pre-travel AI sources, one adjacent travel-related decision-support study, four guideline and context sources and two clinical LLM safety sources. The only patient-level implementation involved 26 travellers using a GPT-4 Travel Clinic Assistant in Singapore, where physicians and travellers reported acceptability and workflow benefit but objective effectiveness outcomes were not measured. Broader clinical LLM evidence indicates heterogeneous evaluation methods, vulnerability to hallucinated guidelines, and accuracy that varies widely across model versions and specialties. Conclusions: Current evidence supports supervised AI augmentation of pre-travel consultations but does not support autonomous AI-led vaccine selection, malaria prophylaxis, contraindication screening or individualised travel-risk clearance. Near-term deployment should be restricted to clinician-supervised education, structured intake, source-grounded guideline retrieval, after-visit reinforcement and escalation-triggered workflow support. Priority research includes travel-medicine-specific hallucination audits; equity testing in visiting-friends-and-relatives, migrant, older-adult, First Nations Australian, and Pacific Islander travellers; and prospective trials reported under CONSORT-AI, SPIRIT-AI and TRIPOD + AI. Full article

White-nose syndrome (WNS), caused by the psychrophilic fungus Pseudogymnoascus destructans, poses a severe threat to wild bat populations. Caves serve as unique microecosystems. Exploring antagonistic microorganisms and their volatile antifungal compounds within these native environments has emerged as a promising ecological control strategy. In this study, we isolated four antagonistic bacterial strains from bat cave soil that completely inhibit P. destructans. Additionally, we identified benzaldehyde (BzH) and 2,5-dimethylpyrazine (2,5-DMP) as their primary antifungal volatile organic compounds (VOCs). Combined physiological, biochemical, and multi-omics analyses revealed that these two VOCs disrupt the structural integrity of the fungal cell wall and membrane. This disruption triggers abnormal energy metabolism and compensatory ATP accumulation, leading to a significant intracellular burst of reactive oxygen species and the impairment of primary antioxidant defenses. This sustained oxidative stress causes irreversible DNA damage, endoplasmic reticulum stress, and basal metabolic dysfunction. Consequently, this cascade induces apoptosis and significantly downregulates the expression of essential virulence genes. In conclusion, this study systematically elucidates the molecular network through which VOCs released by cave soil microorganisms antagonize P. destructans. These findings provide a theoretical foundation and candidate intervention molecules for the contactless biocontrol of WNS. Full article

Background/Objective: Dysthyroid Optic Neuropathy (DON) is a severe complication of Thyroid Eye Disease (TED) leading to irreversible visual impairment. Its pathogenesis remains unclear, and early predictive tools are lacking. The study aims to investigate peripheral immune characteristics associated with DON, focusing on the IL-2⁺Th1/CD4⁺Tregs axis. Methods: A retrospective study was conducted in 37 TED patients, including DON (n = 22) and non-DON (n = 15) groups. Peripheral blood immune cell subsets were quantified using flow cytometry. Clinical data and peripheral blood immune indicators including T cell subsets, B cell subsets, T helper (Th) cell subsets, and regulatory T (Treg) cells populations were analyzed. Correlation and logistic regression analyses were applied to evaluate associations between immune indicators and DON. Receiver operating characteristic (ROC) analysis was used to assess the discriminatory performance of candidate variables and exploratory combined models. Results: Patients with DON showed higher IL-2⁺Th1 levels and lower CD4⁺Tregs levels compared with non-DON patients, along with an increased IL-2⁺Th1/CD4⁺Tregs ratio. Age and clinical activity score also differed significantly between groups. The IL-2⁺Th1/CD4⁺Tregs axis showed significant alterations associated with DON. The exploratory logistic regression model combining immune and clinical indicators showed potential discriminatory ability in differentiating DON from non-DON patients. Conclusions: This study identifies an imbalance between IL-2⁺Th1 and CD4⁺Tregs as a potential immune signature associated with DON. Integration of immune and clinical features may provide an exploratory framework for risk stratification in TED. Further prospective studies with larger cohorts are warranted to validate these findings. Full article

Leptomeningeal metastasis (LM) is a severe and increasingly recognized complication of advanced non-small-cell lung cancer (NSCLC), particularly in patients with actionable genomic alterations. Although LM has historically been associated with poor outcomes, molecularly targeted systemic therapies with improved central nervous system (CNS) activity are reshaping its therapeutic landscape. This review summarizes current concepts in the pathogenesis, diagnosis, and risk stratification of LM, focusing on systemic treatment strategies for NSCLC harboring actionable driver alterations. We highlight the rationale and emerging evidence for next-generation tyrosine kinase inhibitors targeting EGFR, ALK, and other oncogenic drivers, and discuss their role as the cornerstone of LM management. Intrathecal chemotherapy, immunotherapy, and radiotherapy are also reviewed within a risk-adapted treatment framework. An individualized approach integrating molecular profiling, neurological status, and disease distribution is essential to optimize outcomes. Prospective studies are needed to refine systemic treatment strategies and establish evidence-based algorithms for this high-risk population. Full article

Feline panleukopenia virus (FPV) causes severe enteric and systemic disease in cats, with particular importance in shelter environments where susceptible kittens, high population turnover, environmental contamination, and variable vaccination histories increase infection pressure. Recent virome and microbiome studies suggest that FPV-associated enteritis may occur within a broader context of viral co-detection and intestinal microbial disturbance, but direct FPV-specific bacteriome evidence remains limited. This review aims to synthesize current evidence on FPV-associated enteritis in shelter cats by integrating viral pathogenesis, diagnostic interpretation, enteric virome co-detection, gut dysbiosis, recovery dynamics, and intervention-related ecological effects. The literature was organized using an evidence-tier framework that distinguishes direct FPV/feline panleukopenia evidence from feline enteric microbiome proxy evidence and broader comparative or mechanistic microbiome studies. This approach was used to define the limits of inference and to separate evidence-supported conclusions from hypothesis-generating ecological models. Feline panleukopenia in shelter cats should be interpreted not only as an individual viral infection, but also as an ecological process shaped by host susceptibility, shelter exposure, diagnostic complexity, viral co-detection, and microbial community disturbance. Current evidence supports a cautious framework in which virome co-detection and dysbiosis-associated patterns are not treated as direct proof of causation. Future longitudinal, context-controlled, and multi-layer studies integrating validated FPV diagnostics, virome and bacteriome profiling, clinical metadata, treatment records, and functional endpoints are needed to clarify the biological and clinical significance of gut ecosystem disruption in feline panleukopenia. Full article

Frequent extreme climate events pose severe threats to human health. Existing studies mainly focused on summer thermal environments, while few compared summer and winter extreme climate risks from the perspective of urban functional zones (UFZs). This study classified more precise UFZs using the machine-learning method and constructed heat and cold exposure indicators. GeoDetector was adopted to analyze driving factors and interactions of both types of exposure across UFZs. The results showed that UFZ classification achieved an overall accuracy of 81.8% and a Kappa coefficient of 0.75. High heat exposure concentrated in core public, residential, and commercial zones, while high cold exposure occurred in peripheral industrial and greenspace zones. Dual high exposure zones lay between the 3rd and 5th Ring Roads. Industrial zones positively contributed to both exposures, while commercial, public, and residential zones showed positive heat but negative cold exposure contributions, and greenspace zones presented opposite effects. Vulnerable population ratios had a strong explanatory power. Heat exposure interactions were dominated by vulnerable populations, building morphology, and landscape patterns, while cold exposure was also affected by the degree of facility agglomeration and human activities with varied mechanisms across UFZs. This study advanced single-season thermal research to multi-season exposure and zoned governance for climate-adaptive renewal. Full article

Escalating healthcare costs and persistent disparities in outcomes have been linked to delayed engagement in preventive care and the ongoing influence of social determinants of health (SDoH). Current care models often assume that individuals can effectively manage their health and seek care at appropriate times, despite evidence that contextual constraints limit this capacity. This perspective proposes that oral health may serve as a practical and scalable entry point for earlier engagement in preventive care. Oral health problems are highly prevalent, behaviorally influenced, clinically observable, and associated with systemic health conditions. We present a six-pillar conceptual framework linking consumer-reported behaviors with clinician-observed oral health status to support risk identification, engagement, and population health strategies. The framework integrates behavioral science, predictive modeling, social risk factors, digital health infrastructure, and policy innovation. We outline a research agenda, identify implementation challenges, and discuss equity considerations. While oral–systemic relationships are well-documented as associations, further prospective and interventional studies are needed to establish causality and population-level impact. Full article

Introduction and objectives: Acute heart failure (AHF) is the leading cardiovascular cause of hospitalization and remains associated with high mortality and rehospitalization rates. Contemporary real-world data from cardiology departments are scarce. We aimed to identify admission characteristics associated with one-year outcomes in patients hospitalized with AHF. Methods: RECYLICA is a prospective, multicentre, regional registry including consecutive patients admitted with AHF to cardiology departments across 10 hospitals over a one-year period. Patients were followed for 12 months. The primary endpoint was the composite of all-cause mortality or heart failure (HF) rehospitalization. Results: A total of 602 patients were included (37.0% women; mean age 72.6 ± 12.0 years), of whom 47.4% had heart failure with reduced left ventricular ejection fraction (HFrEF). During follow-up, 83 patients (13.8%) died and 105 (17.4%) were rehospitalized because of HF. Independent predictors of the primary endpoint were elevated admission N-terminal pro-B-type natriuretic peptide (NT-proBNP), atrial fibrillation (AF), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), previous HF, prior implantable cardioverter-defibrillator (ICD) implantation, and higher left ventricular ejection fraction (LVEF). Among patients with HFrEF, less comprehensive implementation of guideline-directed medical therapy (GDMT) at discharge was associated with significantly worse outcomes. Conclusions: In patients hospitalized with AHF, prognosis is primarily determined by comorbidity burden, admission NT-proBNP levels, previous HF, and LVEF. Among patients with HFrEF, more comprehensive implementation of GDMT at discharge was associated with improved clinical outcomes, supporting early optimization of evidence-based therapy during hospitalization. Full article

Assessing the sustainability of urban development, including road changes, is increasing from year to year and requires clear indicators for robust decision-making tools to gain knowledge across regions. This study conducts the selection of transportation routes over a longer period as an example to evaluate the sustainability of historical official routes in achieving economically cost-efficient operation and maintenance. Official ways in the Qiantang River Basin connected the Jiangnan region, the economic center of China, with surrounding provinces were assessed. During the past six hundred years, the official road network in this area gradually simplified, evolving from valley roads to river banks, which covered longer distances. However, this transformation lacks a systematic explanation. By applying the analytic hierarchy process (AHP) with geographic information system (GIS), quantitative analysis was gained and the results are as follows: (1) Among the influencing factors, the weights of transportation cost and population related to economic needs are 39.54% and 29.52% respectively, with a combined total of 69.06%. (2) The official road network is often designed for governing the people, but in places such as the Qiantang River Basin, economic logic superseded political imperatives, becoming the dominant factor in reshaping the official ways. (3) In the pre-industrial era characterized by limited technological capacity, the physical environment had a greater impact on economic costs, ultimately reshaping the spatial configuration of official route networks. Overall, the evolution of official routes reflects the decline in their military-political function, driven by sustained peace and long-term decline in strategic position. The evolution of the official ways in the Qiantang River Basin reveals the importance of economic benefits in road selection. Full article

Background: Nutritional deterioration and systemic inflammation frequently accompany gastrointestinal cancers and may negatively affect treatment tolerance, quality of life, and clinical outcomes. This study aimed to evaluate nutritional status, dietary behaviors, inflammatory biomarkers, and multidimensional nutritional–inflammatory profiles in patients with gastrointestinal cancers within the context of tertiary prevention. Methods: A cross-sectional study was conducted among 150 patients with gastrointestinal cancers. Nutritional status was assessed using the Mini Nutritional Assessment (MNA), while dietary behaviors were evaluated using an original questionnaire. Biochemical markers, including albumin, hemoglobin, C-reactive protein (CRP), fibrinogen, and neutrophil-to-lymphocyte ratio (NLR), were evaluated in participants with available laboratory data. Exploratory hierarchical clustering analysis was performed to identify multidimensional nutritional–inflammatory profiles. Results: According to the MNA classification, 79.3% of participants were at risk of malnutrition and 2.0% were malnourished despite predominantly normal or excessive body weight. Nutritional risk was identified in 91.4% of patients with normal BMI and in 79.5% of overweight patients. Only 32.0% of patients reported receiving dietary counseling during treatment, while oral nutritional supplements and therapeutic diets were used by 40.7% and 41.3% of participants, respectively. Biochemical analyses revealed elevated inflammatory markers accompanied by reduced albumin concentration and anemia-related abnormalities. Exploratory clustering analysis suggested three distinct nutritional–inflammatory profiles (Stable/Supported, Hidden Malnutrition, and Inflammatory Deterioration), highlighting metabolic heterogeneity within the study population. Conclusions: Patients with gastrointestinal cancers frequently present nutritional risk accompanied by inflammatory activation despite preserved or excessive body weight. A multidimensional assessment integrating nutritional screening, dietary evaluation, inflammatory biomarkers, and exploratory profile-based clustering may improve understanding of nutritional heterogeneity in gastrointestinal cancer patients and may support future research on individualized nutritional assessment and supportive care. Full article