Search Results (11,040)

Background/Objectives: Management of cervical esophageal cancer after induction therapy remains unsettled. Definitive chemoradiotherapy is the guideline default, but a subset of patients with residual but resectable disease may still benefit from surgery. No validated multidisciplinary selection framework exists for this subsite. Methods: We conducted a systematic review registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420261369102) and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement, using searches of PubMed/MEDLINE, Web of Science, Scopus, and the Cochrane Library from inception through 14 April 2026. We identified 1779 records, removed 873 duplicates, and screened 906 records; 87 full-text reports were assessed, of which 67 were excluded at the full-text stage (66 on population grounds—disease not cervical esophageal; and 1 because cervical-direct outcomes were not separable within a mixed cervical/thoracic cohort), leaving 20 cervical-direct studies included in the primary synthesis. Thoracic and meta-analytic sources are cited for indirect comparison and biological rationale but are not counted in the included set. Included studies were evaluated using the Newcastle–Ottawa Scale (NOS) and Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I); certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. Formal meta-analysis was not performed because study design, treatment approach, and outcome reporting were too heterogeneous. Results: Cervical-specific evidence is predominantly retrospective but consistent in direction. Available cervical-specific observational data suggest benefit mainly in patients with biopsy-confirmed incomplete response, resectable residual disease, preserved performance status, and access to experienced centers. Larynx-preserving resection is feasible in 90% of T1–2 tumors and 54% of T3–4 responders. In thoracic esophageal squamous cell carcinoma, neoadjuvant chemoimmunotherapy yields pathologic complete response rates of approximately 29–48%; in cervical disease, the SCENIC trial has reported interim clinical response of approximately 50% in 28 patients, but pathology-confirmed response is not yet available. We present a proposed multidisciplinary selection framework integrating response depth, post-induction stage, laryngeal preservation feasibility, sarcopenia, circulating tumor DNA dynamics, and programmed death-ligand 1 (PD-L1) expression. The framework has not been prospectively validated and is presented as a hypothesis-generating, conceptual tool for multidisciplinary discussion rather than a clinically validated instrument. Adjuvant nivolumab is recommended for residual pathologic disease after margin-negative (R0) resection when surgery follows preoperative chemoradiotherapy; after PD-1-based induction, adjuvant checkpoint inhibition remains investigational. Conclusions: The available cervical-direct evidence is predominantly retrospective and selection-prone, and several inputs supporting the framework are extrapolated from thoracic ESCC cohorts; conclusions about the survival benefit of surgery should therefore be read as associations rather than causal claims. Surgery has a role after induction therapy in carefully selected incomplete responders. The proposed framework is designed for multidisciplinary use and requires prospective validation before routine clinical application. Full article

The use of artificial intelligence (AI) in the radiological field has been extensively investigated from the radiologists’ perspective. Existing studies have primarily focused on AI’s contribution to diagnostic processes and on how its introduction has transformed—and continues to transform—radiologists’ professional practice. The perspectives of radiographers remain underrepresented in the literature, despite their central role in image acquisition and their position as the primary “on-the-ground” operators and managers of imaging technologies. The objective of this study was to analyze the perceptions, attitudes, and expectations of Italian radiographers regarding the introduction of AI, and to provide insights to inform professional training and organizational strategies within healthcare systems. A cross-sectional survey study with qualitative enhancement was adopted as the study design. A survey was administered to a convenience sample, comprising 222 respondents. The findings reveal a high level of familiarity with AI in everyday life, accompanied by an almost complete absence of cultural resistance, suggesting a workforce that is both receptive and ready to evolve. Nevertheless, this individual readiness is contrasted with a substantial institutional and operational gap, characterized by the lack of standardized protocols, regulatory uncertainty, and an uneven distribution of technological resources. The effective integration of AI therefore requires a comprehensive and coordinated approach. Educational reform is necessary to integrate AI and radiomics into university curricula and continuing professional development programs, encompassing not only technical competencies but also ethical, deontological and communication skills. Finally, national and European regulatory frameworks must evolve to clearly define radiographers’ responsibilities within AI-assisted workflows, to establish robust guidelines for data governance and the management of algorithmic outputs. Full article

Community-Based Fire Management (CBFiM) integrates local governance and ecological stewardship, yet the social drivers shaping its effectiveness remain poorly understood. This study examines the relationships among leadership perception, community participation, and surface fuel conditions in two community forests in Lampang Province, northern Thailand: Ban Pong and Ban Rong Ta. Forest floor fuel data were collected through destructive fuel sampling during the 2025 dry season, and social data were gathered through structured questionnaires measuring leadership perception using the Crew Member Perceived Leadership Scale and participation across seven fire management activities. Ban Rong Ta showed lower fuel loads but higher fire occurrence (nine fire detections recorded in 9 of 10 study years), lower leadership perception across all dimensions, and reduced participation in activities. The brigade–community participation gap reflects patterns documented across Southeast Asian community forestry programs, pointing to a structural challenge in fire governance. These findings suggest that awareness and informational participation alone do not reduce wildfire risk, and that integrating social and ecological indicators is essential for designing effective community-based fire governance systems. Full article

This review examines Bacillus thuringiensis subsp. israelensis (Bti) as both a highly selective microbial larvicide and a biological platform for protein storage and delivery, enabled by the structural features of its prokaryotic insect larvicidal organelle (PILO). Bti remains the most widely deployed biological agent for mosquito control. Decades of operational use demonstrate substantial public health benefits and only limited, manageable ecological tradeoffs within integrated vector management programs (IVMP). Its narrow host range underlies an excellent safety record for humans and other vertebrates. Moreover, laboratory and field studies consistently show that collateral effects are minimal, context dependent, reversible, and largely restricted to closely related non-target aquatic dipterans. These attributes have established Bti as a cornerstone of environmentally sustainable IVMP worldwide. Here, we synthesize current knowledge on Bti biology, ecological selectivity, field performance, and the resistance-management properties embedded in the molecular architecture of the PILO. Finally, we assess emerging opportunities and technical constraints in repurposing the PILO as an in vivo microbial factory for packaging heterologous proteins with potential pharmaceutical and industrial applications. Full article

Background: With the rapid aging of populations worldwide, strengthening the professional capacity of long-term care (LTC) workers has become a critical priority for health systems. While competency-based training frameworks are widely implemented, it remains unclear which domains of competency are most closely associated with ethical professionalism in daily care practice. Methods: A cross-sectional survey was conducted with 268 LTC workers across home-based, community-based, and institutional settings in Taiwan. Multiple linear regression analyses were performed to examine the associations between core competency domains and perceived ethical professionalism. Results: Participants reported relatively high levels of overall competency and ethical professionalism. Among the competency domains, interpersonal communication (β = 0.345, p < 0.001), psychological support (β = 0.184, p = 0.020), and teamwork (β = 0.111, p = 0.045) were significantly associated with ethical professionalism. In contrast, technical competencies, including physical care, daily living care, and emergency management, were not significantly associated (p > 0.05). Conclusions: The findings suggest that ethical professionalism in LTC practice is more strongly associated with relational and psychosocial competencies than with technical skills. These results highlight the importance of incorporating communication, emotional support, and teamwork training into workforce development programs. Prioritizing these competencies in training frameworks may be associated with improved care quality, workforce sustainability, and person-centered care delivery in aging societies. Full article

As emerging global environmental contaminants, organic ultraviolet absorbers (OUVAs) are widely used in personal care formulations and exhibit environmental persistence and potential bioaccumulation. Among these compounds, 2-ethylhexyl salicylate (EHS) and homosalate (HMS) are the most frequently used salicylate-type UV filters in cosmetic formulations. Although an increasing number of studies have demonstrated their environmental hazards, little is known about the molecular mechanisms underlying their cytotoxicity in mammalian systems, a fundamental knowledge gap for both human health protection and the development of more environmentally friendly consumer goods. In this study, we used mouse embryonic fibroblasts (MEFs, 3T6) and zebrafish as models to assess the toxicological phenotypes of EHS and HMS in vitro and in vivo, respectively. We found that both EHS and HMS induced cellular damage characterized by oxidative stress, disrupted intracellular calcium homeostasis, mitochondrial impairment, and DNA damage. Importantly, molecular analyses further suggested the concurrent activation of two distinct regulated cell death programs: pyroptosis, as suggested by Caspase-11-mediated GSDMD cleavage, and necroptosis, as suggested by ZBP1-RIPK3-Caspase-8-mediated MLKL phosphorylation. The in vitro data have been partially validated at the level of gene expression and in developmental toxicity in the zebrafish model, providing some in vivo phenotypic and molecular correlates. While the upstream events were experimentally verified, the causal links among them remain to be further elucidated. Taken together, this work suggested that OUVA-induced toxicity is not limited to isolated oxidative damage, but may also involve the activation of two different cell death programs. These findings provide important molecular clues to understanding the potential health and ecological risks of widely used UV filters and offer a scientific basis for their more environmentally friendly safety evaluation and regulatory management, which are crucial for advancing more sustainable chemistry and safer consumer goods. Full article

The increasing presence of pharmaceutical compounds in aquatic environments poses a significant challenge for wastewater treatment systems worldwide. Among these emerging contaminants, bicyclic non-steroidal anti-inflammatory drugs (NSAIDs) are particularly concerning due to their high consumption, partial metabolism, and long-lasting persistence in wastewater. This review was prepared critically based on popular databases such as PubMed and the Google Scholar website, and using the modern Nested Knowledge platform. The bibliometric analysis was performed using the VosViewer program with the keywords co-occurrence method. The review aims to systematically compile and synthesize current knowledge on the impact of bicyclic non-steroidal anti-inflammatory drugs (NSAIDs) on biological wastewater treatment systems, with particular emphasis on activated sludge. It discusses how these compounds influence microbial community composition, metabolic activity, sludge structure, and overall treatment performance. Furthermore, the distribution of these contaminants in the environment and their degradation efficiency were analyzed. By integrating evidence from both laboratory and industrial studies, this article provides a comprehensive perspective on the environmental risks posed by bicyclic NSAIDs. Our findings also underscore the urgent need for systematic monitoring and adaptive management to mitigate the ecological impact of these widely used pharmaceuticals in the future. Full article

Urban regeneration processes are increasingly intertwined with participatory practices aimed at integrating local knowledge and civic engagement into design and planning decisions. However, public participation often fails to influence decision-making meaningfully or to anticipate the unintended consequences of proposed interventions. This paper presents a methodological framework developed during a participatory process for the restoration of Piazza Umberto I, a historic urban square in Bari, Southern Italy. The process was structured around seven online workshops held between March and May 2021, involving 45 registered participants and an average attendance of about 30 participants per session, including residents, civic associations, students, professionals, economic actors, and municipal representatives. Through a sequential funnel—problems, opportunities, visions, solutions, methodological principles, validation, and proposal—the process elicited and organized participants’ knowledge across five analytical domains and eight long-term vision categories: History, Nature, Education, Culture, Economy, Society, Experience, and Democracy. The validated workshop outputs were then translated into a fuzzy cognitive map and explored through cross-impact analysis to identify intended impacts, unintended effects, leverage points, and trade-offs among proposed solutions. Link weights were assigned through a semi-quantitative scale representing the direction and relative strength of influence, and a ±20% sensitivity analysis was conducted to test the robustness of the main ranking patterns. The results show that some proposals, such as ecological restoration, public art programming, and cultural or educational activation, operate as broad-spectrum leverage points, while others generate more selective effects or latent tensions, particularly between ecological preservation, economic activation, accessibility, and civic use. This paper does not propose a predictive or statistically inferential model; rather, it demonstrates how participatory knowledge can be operationalized into a transparent, exploratory, and semi-quantitative decision-support framework. By linking deliberation with systems-oriented reasoning, the study contributes to urban planning debates on participatory governance, anticipatory decision-making, and the management of unintended consequences in public-space regeneration. Full article

Heart failure (HF) remains associated with high morbidity and mortality, with heart failure with preserved ejection fraction (HFpEF) becoming increasingly prevalent and therapeutically challenging despite advances in pharmacological and rehabilitative care. Beyond their glucose-lowering effects, glucagon-like peptide-1 receptor agonists (GLP-1RAs) confer cardiometabolic benefits and may serve as effective adjuncts to cardiac rehabilitation (CR), particularly in obese patients with HFpEF. Obesity plays a central role in the pathophysiology of HFpEF, and GLP-1RAs promote weight loss, reduce insulin resistance and leptin signaling, and improve hemodynamic and metabolic abnormalities associated with HFpEF. Accumulating evidence suggests that the benefits of GLP-1RAs are phenotype-specific and more pronounced in patients with HFpEF than in patients with HF with reduced ejection fraction. Current clinical guidelines recommend GLP-1RAs for patients who have type 2 diabetes mellitus and established cardiovascular (CV) disease or are at high CV risk, with recent updates recognizing their potential benefits in patients with HFpEF and obesity. Cardiac rehabilitation, delivered through multidisciplinary programs, remains a cornerstone of HF management. Although caloric restriction and aerobic exercise can be beneficial in patients with HFpEF and obesity, these interventions alone are often insufficient. Sarcopenia is common in older patients with HFpEF and contributes to adverse outcomes, underscoring the importance of incorporating resistance training into CR programs. The most frequent adverse effects of GLP-1RAs are gastrointestinal events, which are generally mild to moderate but may lead to treatment discontinuation in some patients. Future studies should investigate the potential synergistic effects of GLP-1RAs and CR, clarify their long-term safety and efficacy in HF populations, and define their role beyond obese HFpEF phenotypes. Full article

As global industrialization and energy demands rise, excessive reliance on fossil fuels escalates carbon emissions, making clean energy alternatives an urgent priority for sustainable development. As a key transition pathway, wind and solar power can be converted into hydrogen via electrolyzers for electricity generation, thermal supply, or natural gas synthesis. This enables flexible multi-energy coordination and improves overall renewable energy utilization efficiency. However, conventional electrolyzer scheduling approaches typically assume fixed hydrogen production efficiency, failing to account for dynamic variations in operating conditions, efficiency attenuation, and lifetime degradation under fluctuating renewable inputs. This inadequacy compromises the long-term sustainability of green hydrogen systems. To address these challenges, this paper proposes a hybrid AEL-PEM electrolyzer power allocation and operating condition array rotation strategy. Piecewise linear models are established to characterize the efficiency and full life cycle degradation of both electrolyzer types across normal operation, overload, and start–stop transitions. A mixed-integer linear programming (MILP) model is formulated with an objective function incorporating energy purchase costs, start–stop penalty costs, and electrolyzer lifetime degradation costs, and is solved using the Gurobi solver. Simulation validation is conducted using a 24 h typical summer day dataset with a 15 min resolution. Three comparative schemes are evaluated to verify the strategy’s effectiveness in minimizing total system operation costs and enhancing renewable energy utilization efficiency through optimized operating condition management. Results demonstrate that the proposed strategy reduces total system costs by 23%, entirely eliminates renewable energy curtailment, and balances electrolyzer lifespan degradation across all units, collectively advancing the economic efficiency, asset sustainability, and long-term operational reliability of green hydrogen systems. Full article

The rapid integration of artificial intelligence in higher education positively affects student satisfaction, engagement, and learning outcomes. However, students frequently report ethical unease, guilt, and concerns about dependency. The current literature offers a limited explanation for their coexistence, as both have been treated as parallel or independent outcomes. Hence, this review extends and integrates existing theories by reconceptualising cognitive and moral dissonance as a central psychological process that explains how student satisfaction with AI-mediated learning is produced, negotiated, and sustained. Following PRISMA 2020 guidelines, we adopted a two-layer explanatory review design, synthesising 40 Scopus-indexed studies (Layer 1 = 15 studies; Layer 2 = 25 studies) from 2016 to 2025. Layer 1 studies explicitly define dissonance-related explanatory mechanisms that influence satisfaction and continued AI use across contexts such as dissertation writing, programming education, and problem-based learning. Layer 2 encompasses satisfaction-based studies that report ethical or affective concerns in parallel without theorising their interaction. The findings suggest a recurring satisfaction–dissonance paradox, in which students often experience genuine or conditional satisfaction from performance gains while simultaneously managing their psychological discomfort through one or more regulation mechanisms. Further, persistent and escalated dissonance leads to withdrawal or full or partial adaptive behaviour. We propose these dynamics as a testable Dual-Process Satisfaction–Dissonance Framework (DPSDF), which includes five dissonance triggers, five regulation strategies, three feedback loops, and four behavioural outcomes. Further, five domain experts’ suggestions have been taken to provide specific practical implications. This framework extends understanding of AI-mediated learning and provides foundations for future theory and policy development in higher education. Full article

The two-spotted spider mite, Tetranychus urticae, poses significant agricultural challenges due to its rapid population growth and high capacity for developing chemical resistance. This study evaluated the acaricidal activity of bacterial strain TAM1, isolated from naturally deceased mites in Taiwan. In bioassays, TAM1 caused over 90% adult mite mortality within 48 h. Infected mites showed symptoms of body darkening and deformation of the ventral abdominal crest lines. Enzymatic analysis confirmed significant chitinase and gelatinase activities. Whole genome sequence of TAM1 was acquired with a 5,066,903 bp circular chromosome (CP120954) and a 164,574 bp circular plasmid (CP120955). Refined functional profiling identified a sophisticated enzymatic arsenal including core chitin-active families (GH18, GH20, AA10) and 157 proteases, with a high prevalence of metallopeptidases that correlate with the detected gelatinase activities. Secretome analysis predicted 42 extracytoplasmic proteases primarily utilizing the Sec-dependent pathway, while the presence of multiple CBM50 modules suggests a potential for targeted substrate anchoring. These genomic insights provide a plausible molecular basis for the observed enzymatic potential and the localized ultrastructural disruption of the T. urticae cuticle. The alignment between phenotypic observations, microscopic evidence, enzymatic activities, and genomic data suggests that TAM1 utilizes synergistic, multi-target mechanisms to exert its acaricidal effects. Based on analyses of whole-genome sequence and 16S rRNA gene sequence, TAM1 was tentatively designated as a strain of Kosakonia sacchari. The bacterial strain reported here represents a promising microbial agent for integrated pest management (IPM) programs. Full article

In recent years, there has been an unprecedented upsurge in opioid prescriptions for pain management. Consequently, the widespread availability of these medicines has led to an increase in misuse and abuse. This has led to a greater number of overdose-related deaths. The high prevalence of drug misuse was born of multiple and complex societal factors. However, from a medical perspective, critical contributors to the dire consequences of the crisis have been the need for chronic pain relief, as well as mental health issues within communities. Chronic pain coupled with psychological distress exacerbates patients’ predicaments and thus further fuels the crisis. Anxiety and depression have bidirectional and complex relationships with pain. The somatic symptoms associated with anxiety potentially worsen pain, whilst pain emanating from a chronic condition worsens anxiety. The same relational dynamic applies to depression and pain. Thus, these psychopathological states may be major contributors to the opioid abuse epidemic. Thus, psychosocial management as a first-line treatment instead of starting with drug treatments seems an enlightened approach to this problem. Cognitive behavioral therapy (CBT) has been proven to be effective in managing specific symptoms associated with chronic pain. Similarly, patient education has been shown to be a viable alternative to drugs for certain aspects of chronic pain treatment. We consider that the opioid crisis could be addressed with a greater reliance and emphasis on non-pharmacological approaches to managing chronic pain patients. This mini-review examines non-pharmaceutical and monitoring-based interventions to reduce opioid misuse risk among adults prescribed opioids for chronic non-cancer pain. Studies were identified through PubMed/MEDLINE, Scopus, and Google Scholar using terms related to chronic pain, prescription opioid misuse, opioid use disorder, cognitive behavioral therapy, patient education, prescription drug monitoring programs, digital health, telehealth, and non-pharmacological interventions. Studies were included if they focused on adults with chronic pain who were prescribed opioids or at risk of misuse, and evaluated interventions aimed at reducing unsafe opioid use, misuse risk, or opioid-related harm. Evidence was synthesized narratively to identify key intervention approaches, limitations, and clinical implications. Full article

This study examines the integration of generative Artificial Intelligence (AI) tools within a Flipped Classroom model to enhance active learning and feedback processes in an English as a Foreign Language (EFL) teaching program. The participants were 242 pre-service EFL teachers enrolled in upper-level courses at a private university in southern Ecuador. Adopting a mixed-methods, design-based research approach, the study incorporated a diagnostic survey, written reflections, post-intervention survey, and focus groups. These instruments explored students’ prior knowledge, perceptions, and experiences regarding AI-supported learning. Findings showed that AI tools such as ChatGPT, Gemini, and Copilot strengthened students’ linguistic accuracy, writing performance, self-regulation, and understanding of pedagogical concepts. AI-generated feedback complemented teacher feedback by providing immediate and clear guidance, promoting iterative revision and deeper engagement with course content. Participants reported increased autonomy, improved time management, and greater readiness to integrate AI into future teaching practices. The results indicate that AI-supported flipped instruction fosters meaningful learning, enhances feedback quality, and develops both linguistic and pedagogical competencies. Full article

Diabetes disproportionately affects rural populations in the United States where prevalence and associated complications remain among the highest in the nation. Access to diabetes education and support services is often limited by geography, socioeconomic barriers, and workforce shortages. This study qualitatively explored participant experiences in a telehealth-based Diabetes Self-Management Education and Support (DSMES) program. This study uses interview techniques and takes a phenomenological approach to exploring the lived experiences of 27 program participants. Transcripts were analyzed through three cycles of coding to identify shared themes. Four themes emerged: (1) structural benefits of the program, (2) knowledge gained, (3) lifestyle changes implemented, and (4) improved quality of life. Participants consistently emphasized the value of personalized coaching, emotional encouragement, and practical nutrition education. Findings suggest that individualized telehealth coaching plays an important role in diabetes self-management, particularly in rural and underserved populations. By combining personalization with education and encouragement, programs can improve patient engagement, enhance self-efficacy, and support meaningful behavior change. Full article