Search Results (16,775)

The sustainability of rural areas depends on effective wastewater management to reduce human impact on the environment, including the risk of pollution to surface water, groundwater, and soil from human waste. However, organized sanitation systems, which include pipeline networks and wastewater treatment plants in rural communities with low population densities, often have very low profitability and cost-efficiency, which greatly reduces their acceptance and residents’ willingness to pay. This study examines the economic profitability and cost-efficiency of selected on-site household sewage collection and treatment systems operating under real economic conditions in Poland. An evaluation was conducted on seven contemporary models of individual bioreactors, as well as a standard anaerobic septic tank equipped with drainage filters. Additionally, all options were tested on permeable and poorly permeable soils. For each variant, investment costs, as well as operation and maintenance expenses, were calculated. Financial evaluation utilized indicators of economic profitability and cost-efficiency, including the Payback Period, Net Present Value, Benefits–Cost Ratio, and Dynamic Generation Costs. The potential financial benefits included savings from avoiding the use of holding septic tanks and sewage transport by slurry wagons. All the studied designs of on-site sanitary sewage management showed significant economic feasibility and cost-efficiency. Full article

The global water crisis, intensified by climate change and population growth, underscores the critical need for sustainable water production. Desalination is a pivotal solution, but its energy-intensive nature demands a transition from fossil fuels to renewable sources. However, the inherent intermittency of solar and wind power poses a fundamental challenge to the stable operation of desalination plants. This review provides a comprehensive analysis of a specifically tailored solution: hybrid energy storage systems (HESS) that synergistically combine batteries and hydrogen fuel cells (FC). Moving beyond a general description of hybridization, this study delves into the strategic complementarity of this pairing, where the high-power density and rapid response of lithium-ion batteries manage short-term fluctuations, while the high-energy density and steady output of fuel cells ensure long-duration, stable baseload power. This operational synergy is crucial for maintaining consistent pressure in processes like reverse osmosis (RO), thereby reducing membrane stress and improving system uptime. A central focus of this review is the critical role of advanced energy management systems (EMS). We synthesize findings on how intelligent control strategies, from fuzzy logic to metaheuristic optimization algorithms, are essential for managing the power split between components. These sophisticated EMS strategies do not merely ensure reliability, they actively optimize the system to minimize hydrogen consumption, reduce operational costs, and extend the lifespan of the hybrid energy storage components. The analysis confirms that a lithium-ion battery-fuel cell HESS, governed by an advanced EMS, effectively mitigates renewable intermittency to significantly enhance freshwater yield and overall system reliability. By integrating component-specific hybridization with smart control, this review establishes a framework for researchers and engineers to achieve significant levels of energy efficiency, economic viability, and sustainability in renewable-powered desalination. Full article

Background/Objectives: Coronary artery disease (CAD) is a leading cause of global mortality, necessitating effective risk stratification tools for optimal patient management. The electrical risk score (ERS) is a multi-parametric index incorporating various electrocardiographic (ECG) parameters, previously shown to predict unfavorable cardiovascular outcomes. However, the relationship between ERS and the presence and severity of CAD remains unclear. This study aimed to investigate the association of ERS with the presence and extent of CAD as assessed by coronary angiography. Methods: This retrospective study included 314 consecutive patients who underwent coronary angiography. ERS was calculated using six ECG parameters: heart rate > 75 bpm, left ventricular hypertrophy, delayed QRS transition zone, frontal QRS-T angle > 90°, prolonged QTc interval, and extended T peak to T end interval. Results: Of the study population (mean age 57.8 ± 11.4, 61.5% male), 158 were diagnosed with CAD, and 156 constituted the control group. The mean ERS was significantly higher in the CAD group than the control group (2.34 ± 1.35 vs. 1.78 ± 1.12, p = 0.006). Among ERS components, delayed QRS transition (p = 0.023), prolonged QTc (p = 0.004), and extended T peak to T end interval (p = 0.001) were notably more prevalent in the CAD group. ERS was independently associated with the presence of CAD on multivariate logistic regression analysis (p < 0.05). Conclusions: ERS is significantly associated with the presence and severity of CAD in stable patients. Elevated ERS, particularly due to delayed QRS transition, prolonged QTc, and extended T peak to T end interval, may serve as a valuable, non-invasive marker for prediction and early identification of CAD. Full article

Background: Non-melanoma skin cancer (NMSC) is the most frequent cancer in fair-skinned populations and represents a growing public health concern due to its impact in terms of morbidity and treatment costs. While some meta-analyses have investigated cigarette smoking as a risk factor for NMSC, less is known about its prognostic implications in patients with NMSC. This systematic review and meta-analysis aims to fill this gap by assessing the association between smoking habits and survival in patients with NMSC. Methods: A systematic search was conducted in PubMed and EMBASE up to 25 February 2025, to identify prospective studies of patients with histologically confirmed NMSC that evaluated the association between smoking habits and survival. Study-specific hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were pooled using random effects meta-analysis models. Results: A total of five studies published between 2015 and 2022 were included. The meta-analysis revealed that being a current or ever smoker at diagnosis was associated with a worse overall survival (summary HR 2.42, 95% CI 1.91–3.06). A similar result was observed when smoking exposure was assessed in terms of pack-years or number of cigarettes per day (summary HR 2.44, 95% CI 2.02–2.93). Conclusions: Our findings indicate that cigarette smoking is a negative prognostic factor in these patients, despite the generally excellent prognosis of NMSC. It is reasonable to assume that this unfavourable effect is largely due to the increased risk of developing other life-threatening conditions, in which smoking plays a causal role. These results underscore the clinical relevance of systematically integrating smoking cessation counselling into the routine management of patients with NMSC. Full article

Background/Objectives: Infective endocarditis (IE) remains a rare but increasingly complex condition, posing significant challenges for cardiologists and cardiac surgeons. Blood groups from the ABO/Rh system have been associated with susceptibility to various diseases, including infections and bacterial colonization tendencies. However, data on the distribution of ABO/Rh blood types among IE patients are lacking. We hypothesized that the prevalence of ABO/Rh blood types among IE patients differs from their frequency in the general population. This study aimed to assess the distribution of ABO/Rh blood types in the LODZ-ENDO database in comparison to general populations. Methods: LODZ-ENDO is a single-center retrospective study conducted in a tertiary cardiology and cardiac surgery facility serving 2.35 million residents. All consecutive patients with confirmed IE hospitalized between 1 January 2015 and 1 October 2025 were included. Clinical data and ABO/Rh blood types were collected and compared with national population data using Fisher’s exact and chi-square tests. Results: A total of 329 patients with IE were analyzed (median age 61 [41–68] years; 69% men), of whom 227 underwent cardiac surgery. Overall ABO/Rh distribution differed significantly from the general population (p = 0.033), driven by a tendency to an overrepresentation of B− (LODZ-ENDO 5.2% vs. Poland 2%; OR 2.88; 95% CI 1.17–7.29; p = 0.03; power 0.89; p(adj) = 0.23). Considering regional demographics and blood use (≈3 units per surgery), this represents an excess annual use of 1.9 B− units, equal to 0.23% of regional B− reserves, with additional indirect depletion of O− blood. Based on WHO data, if this overrepresentation exists elsewhere, IE-related surgeries could consume 0.2–1.3% of national B− stocks in smaller European countries such as Malta, Iceland, Luxembourg, Cyprus, Estonia, Lithuania, Latvia, and Slovenia. Conclusions: This, probably the first report of B− blood type overrepresentation in IE indicates disproportionate use of a rare blood group, highlighting the need for targeted blood management strategies, especially near specialized cardiac surgery centers. Full article

Ground-borne vibrations caused by railway traffic represent a significant environmental concern, particularly in densely populated or vibration-sensitive urban areas. These phenomena can lead to discomfort and annoyance among residents, interfere with the operation of sensitive equipment, and even threaten the integrity of heritage sites or structurally vulnerable buildings and infrastructures. Building on these concerns, this paper presents a comprehensive review of the current state of knowledge on the subject. It begins by examining the impacts of ground-borne vibrations on both people and structures, followed by an overview of the regulatory frameworks implemented in different countries to manage these effects, with a focus on four examples from Europe and North America. The review then systematically explores the key factors associated with the generation and propagation of ground-borne noise and vibrations. Furthermore, prediction methodologies are categorised into four groups—analytical and semi-analytical, numerical, empirical and AI-based models—and critically assessed. Finally, the paper reviews mitigation strategies applied at the source, along the propagation path, and at the receiver, assessing their effectiveness in reducing the identified impacts. Full article

Sleep deprivation is a common issue among college students, critically impairing their well-being and academic performance. This study specifically investigated the impact of sleep duration on concentration among online college students, a population with unique living situations and often irregular sleep patterns. Furthermore, it explored how this relationship is mediated by subjective physical and mental fatigue, providing a clearer understanding of the underlying process. An online survey assessed these variables using the Demographics and Background Questionnaire for sleep duration, the Student Mental Fatigue Survey (SMFS) for mental fatigue, and two subscales from the Checklist Individual Strength (CIS) for subjective physical fatigue and concentration. Path analysis revealed that both subjective physical and mental fatigue significantly and negatively predicted concentration, and that sleep duration positively influenced concentration indirectly by reducing both types of fatigue. The findings highlight the essential function of sleep in improving concentration. The results provide valuable guidance for developing targeted interventions to improve sleep quality and manage fatigue, which can directly promote mental and physical health, and academic success of this growing, often overlooked, online college student population. Full article

Accurate prediction of urban grid-scale population inflow is crucial for smart city management and emergency response. However, existing methods struggle to model spatial heterogeneity and quantify prediction uncertainty, limiting their accuracy and decision-support capabilities. This paper proposes PDCDM (POI-enhanced Dual-Dimensional Conditional Diffusion Model), which integrates urban functional semantic awareness with conditional diffusion modeling. The model captures urban functional attributes through multi-scale Point of Interest (POI) feature representations and incorporates them into the diffusion generation process. A dual-dimensional Transformer architecture is employed to decouple the modeling of temporal dependencies and inter-grid interactions, enabling adaptive fusion of grid-level features with dynamic temporal patterns. Building upon this dual-dimensional modeling framework, the conditional diffusion mechanism generates probabilistic predictions with explicit uncertainty quantification. Real-world urban dataset validation demonstrates that PDCDM significantly outperforms existing state-of-the-art methods in prediction accuracy and uncertainty quantification. Comprehensive ablation studies validate the effectiveness of each component and confirm the model’s practicality in complex urban scenarios. Full article

Vitamin D (VD), due to its hormonal action, plays a crucial role in calcium homeostasis and bone metabolism, and its deficiency has been associated with musculoskeletal disorders such as osteoporosis, fractures, and osteomalacia, as well as a growing attention of chronic conditions and certain cancers. Despite its physiological relevance and widespread prevalence, particularly among older individuals, patients with chronic diseases, institutionalized populations and pregnant or lactating women, clinical approaches to diagnosing and managing vitamin D deficiency (VDD) remain heterogeneous across guidelines and healthcare settings. This reflects a lack of consensus regarding the benefits and limitations of universal versus selective screening, the definition of adequate serum concentrations, and the clinical indications for supplementation across different patient profiles. This narrative review explores key controversies in the clinical management of VDD, including current perspectives on screening strategies and target populations, indications for empirical supplementation, criteria for biochemical monitoring, and therapeutic goals in bone-related outcomes. In particular, the review discusses the rationale for adopting a 30 ng/mL (75 nmol/L) threshold for adequate serum 25(OH) concentrations in skeletal health, the role of vitamin D and calcium in osteoporosis treatment, and the pharmacological advantages of cholecalciferol compared to other vitamin D compounds. Through a synthesis of available evidence and expert consensus, the review aims to support clinical decision-making in the prevention and treatment of VDD and to identify areas that require further clarification or research. This review aims to support evidence-based clinical decision-making. Full article

Circulating tumor DNA (ctDNA) profiling offers non-invasive insights for personalized prostate cancer management. This systematic review provides the first comprehensive appraisal of ctDNA assay methods, genomic targets, and their clinical correlations and proposes practical recommendations to guide future standardization and validation. We searched PubMed, ScienceDirect, Scopus, and the Cochrane Library starting December 2024 following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. From 229 records, 44 studies (10,631 patients) met the inclusion criteria. Plasma ctDNA analyzed by NGS predominantly profiled TP53 (72.7%), AR (70.4%), BRCA1/2 (61.3%), ATM (50%), RB1 (47.7%), and PTEN (41%). ctDNA positivity and specific key alterations correlated with poorer overall and progression-free survival. BRCA1/2-mutant patients benefited from Olaparib plus Abiraterone, while persistent alterations predicted early progression. Beyond synthesizing existing evidence, we identify key gaps, such as inconsistent reporting of variant allele fractions, limited diversity in study populations, and underexplored rare alterations. We recommend unified reporting standards (e.g., variant allele frequency thresholds and panel composition) and prioritized prospective trials to validate high-impact targets. These steps will accelerate the integration of ctDNA into routine precision oncology practice worldwide. Full article

Defect-rate uncertainty creates cascading operational challenges in multi-stage production, often driving inefficiency and misallocation of labor, materials, and capacity. To confront this, we develop a multi-stage Production Integrated Decision (MsPID) framework that unifies quality inspection and shop-floor decision-making within a single computational model. The framework couples a two-stage sampling inspection policy—used to statistically learn and control defect-rate uncertainty via estimation and rejection rules—with a multi-process, multi-part production decision model. Optimization is carried out with an Improved Grey Wolf Optimizer (IGWO) enhanced with Latin hypercube sampling (LHS) for uniformly diverse initialization; an evolutionary factor mechanism that blends simulated binary crossover (SBX) among three leadership-guided parents (Alpha, Beta, Delta) to strengthen global exploration in early iterations and focus exploitation later; and a greedy, mutation-assisted opposition learning step applied to the lowest-performing quartile of the population to effect leader-informed local refinement and accept only fitness-improving moves. Experiments show the method identifies minimum-cost policies across six single-stage benchmark cases and yields a total profit of 43,800 units in a representative multi-stage scenario, demonstrating strong performance in uncertain environments. Sensitivity analysis further clarifies how recommended decisions adapt to shifts in estimated defect rates, finished product prices, and swap/changeover losses. These results highlight how bio-inspired intelligence can enable adaptive, efficient, and resilient integrated production management at scale. Full article

Background/Objectives: Colorectal cancer (CRC) accounts for nearly 10% of global cancer cases and is the second leading cause of cancer-related mortality. While age and genetics are non-modifiable risk factors, nutrition and its impact on gut microbiota are emerging as key determinants in CRC prevention and management. We aimed to systematically evaluate recent evidence on the role of diet and microbiota-targeted interventions—including probiotics, prebiotics, synbiotics, and postbiotics—in modulating CRC risk and therapeutic outcomes. Methods: A structured literature search was performed in PubMed, ResearchGate, Scopus, and ScienceDirect up to July of 2025. Reference lists of relevant reviews and clinical trials were also screened. A total of 36 studies were selected according to PRISMA guidelines. Data were extracted on dietary exposures, microbiota modulation, metabolite profiles, and CRC-related outcomes. Evidence quality was assessed using appropriate appraisal tools for observational and interventional designs. Results: Western-type diets were consistently associated with microbiota dysbiosis, the enrichment of pro-inflammatory and genotoxic taxa, and elevated CRC risk. Diets rich in fiber and polyphenols enhanced commensals producing short-chain fatty acids (e.g., butyrate), with anti-inflammatory and antineoplastic effects. Probiotics, prebiotics, and postbiotics demonstrated potential to restore microbial balance, improve epithelial integrity, and enhance tolerance to conventional therapies. Conclusions: Current evidence supports a complex interplay between nutrition, the gut microbiota, and CRC, with strong translational potential. Microbiota-modulating nutritional strategies, particularly fiber-rich diets and synbiotics, show the most consistent microbiota-related benefits in CRC prevention and represent promising adjuncts to standard therapies. However, much of the available research is still based on preclinical models. Therefore, there is a pressing need for well-designed clinical studies in human populations to validate these findings and inform evidence-based guidelines. Full article

The prevalence of atrial fibrillation (AF) is increasing and often coexists with frailty. The management of anticoagulation therapy in frail older adults with AF is especially challenging due to the high risk of bleeding complications. The aim of this narrative review is to provide a comprehensive overview of current evidence about the management of anticoagulation in frail older adults with non-valvular AF. First, frailty itself should not be considered a contraindication. A comprehensive geriatric assessment is recommended to identify and potentially address conditions that may increase the risk of bleeding, such as inappropriately prescribed medications or malnutrition. Overall, the net clinical benefit remains in favour of oral anticoagulation in frail older adults, even if it decreases with increasing frailty severity. Direct Oral Anticoagulants (DOACs) show a better effectiveness and safety profile compared with Vitamin K antagonists (VKAs) in this population. Among DOACs, apixaban seems to be the safest. Also, edoxaban at a very low dosage (15 mg/day) could be an effective therapy in patients for whom the standard anticoagulation is contraindicated. Moreover, switching from VKAs to DOACs in frail older adults is a complex decision and should be personalized according to the stability of the ongoing anticoagulant therapy, the bleeding risk profile, and the severity of frailty. Finally, although further studies are required to confirm their effectiveness, factor XIa inhibitors are emerging as new promising alternative therapies because they have been associated with a lower bleeding risk compared with DOACs. Full article

Objectives: To investigate the association between Type-D personality and pain-related outcomes in patients undergoing spine surgery, and to discuss implications for the management of chronic pain conditions. Methods: A prospective cohort of 200 patients scheduled for elective spine surgery was assessed for Type-D personality using the DS14 scale. Postoperative outcomes including pain intensity (VAS), functional recovery (ODI), complication rates, and patient satisfaction (PSI) were measured preoperatively and at 3, 6, and 12 months. Multivariate regression analyses adjusted for age, sex, surgical approach, comorbidities, and baseline health status. Results: Type-D personality was identified in 30% of patients. These individuals reported significantly higher postoperative pain, slower functional recovery, higher complication rates, and lower overall satisfaction compared to non-Type-D patients. Compared with non-Type-D patients, Type-D patients reported higher pain and slower functional recovery at 12 months (VAS β = 0.34, 95% CI 0.18–0.52, p = 0.004, Cohen’s d = 0.61; ODI β = 0.31, 95% CI 0.12–0.48, p = 0.006, d = 0.58), and lower satisfaction (PSI β = −0.36, 95% CI −0.49 to −0.20, p < 0.001, d = 0.66). Conclusions: Type-D personality is associated with worse postoperative pain and recovery. Preoperative psychological assessment and tailored interventions may improve outcomes. These findings highlight the importance of integrating psychosocial screening into pain management strategies for both spine surgery and chronic pain populations. Full article

As urban areas in developing countries, including South Africa, continue to grapple with the adverse challenges of climate change and rapid population growth, there is an increasing call for nature-inspired solutions. This is because nature-based solutions (NbSs) can significantly enhance urban resilience by managing stormwater, reducing flooding and creating livable spaces within urban centers. One such NbS is permeable pavement, which has gained attention for its ability to allow water to infiltrate rather than run off. However, while its use is growing in developed nations, the story is not the same in South Africa, where the literature is silent on its usage and issues of flooding and other associated disasters have persisted. Therefore, this study adopts a post-positivist approach to investigate the application and challenges of permeable pavements as an NbS in South African urban areas. The study reveals a low level of permeable pavement use, albeit an encouraging level of awareness among built environment professionals. Covariance-based structural equation modelling further revealed the significant causes of this poor application. The findings provide valuable insights for policymakers to create incentives and frameworks that promote permeable pavement adoption in urban areas facing environmental challenges. Moreover, this research contributes to the limited literature on NbSs in South Africa, offering a foundation for future studies and addressing the pressing need for innovative solutions to flooding and urban resilience. Full article