Search Results (28,324)

This study develops an integrated mathematical model to investigate the interaction between tuberculosis (TB) transmission and childhood stunting, which is aligned with the United Nations Sustainable Development Goals (SDG 3). The population is structured into two age groups (0–5 years and ≥5 years), with stunting explicitly incorporated into the pediatric population to capture its potential influence on TB dynamics. The model is formulated as a system of ordinary differential equations and analyzed using equilibrium and stability analysis, with the basic reproduction number, R₀. The disease-free equilibrium is locally asymptotically stable when R₀ < 1, while an endemic equilibrium exists when R₀ > 1. Sensitivity analysis indicates that the transmission rate (β), progression rate from latent to active infection (σ), and recovery rate (γ) are the most influential parameters affecting R₀. These parameters are therefore selected as control variables in an optimal control framework to design effective intervention strategies. Numerical simulations show that the combined control strategy significantly reduces TB transmission, resulting in a reduction of more than 80% in active TB cases within a relatively short intervention period. The results suggest that integrated interventions targeting transmission, disease progression, and recovery are substantially more effective than single-measure strategies. This study provides a quantitative framework to support integrated public health policies addressing TB and childhood stunting simultaneously. Full article

Background: The treatment of perianal fistulas remains challenging, with low healing and high recurrence rates. Autologous adipose-derived regenerative therapies and platelet-rich plasma (PRP) have emerged as adjuncts to surgical intervention for cryptoglandular and Crohn’s disease (CD)-related perianal fistulas (PAF). This systematic review evaluates the outcomes of these therapies as an add-on to surgical intervention. Methods: A systematic search was conducted in several online databases up to December 2025. Studies with ≥10 patients reporting on the use of intraoperative autologous adipose-derived therapies and/or PRP for the treatment of cryptoglandular or CD-related PAF, and clinical healing rates, were included. Other outcomes comprised radiologic healing (as defined in the study), recurrence rates and complications. The study quality was assessed with the Effective Public Health Practice Tool. Results: In total, 28 studies on individual cases were included (n = 1017 patients, range 10–219) (17 in cryptoglandular PAF, 8 in CD-related PAF and 3 in both entities). A total of 57% of the studies were rated low quality. In cryptoglandular PAF, reported healing rates with adipose-derived therapies ranged from 50% to 90% across studies of low to good methodological quality. For PRP, three of the four randomized trials demonstrated no superiority over standard care. In CD-related PAF, healing rates after treatment with adipose-derived therapies ranged from 40% to 80%. For PRP, three studies, of which two were low quality, reported highly variable healing rates (33–80%). Radiologic healing, reported in 10 studies, ranged from 38 to 76% in cryptoglandular and 33–75% in CD-related PAF. Recurrence rates remained <17% for adipose-derived therapies and <31% following treatment with PRP. Major complications occurred in <15% of the patients. Conclusions: High heterogeneity with regard to fistula complexities, outcome definitions and surgical method was observed in the available studies on autologous add-on therapies. This hinders an overall effectiveness analysis. The promising healing rates, low recurrence rates after healing and low complication rates warrant high-quality trials. Full article

Background and Objectives: Despite critically low levels of chronic kidney disease (CKD) awareness worldwide, there is no psychometrically validated instrument to comprehensively assess CKD awareness across socioecological levels. This study aimed to develop, psychometrically evaluate and validate a multidimensional awareness scale grounded in socioecological theory for patients with stage 3–4 CKD. Materials and Methods: This methodological study enrolled 908 stage 3–4 CKD patients. Scale development proceeded through systematic stages: comprehensive literature review, qualitative interviews (n = 15), expert panel evaluation (n = 25), and pilot testing. The initial 72-item pool was refined to 41 items (Content Validity Index = 0.912). The sample was randomly split for exploratory factor analysis (EFA; n = 454) and confirmatory factor analysis (CFA; n = 454). Psychometric evaluation encompassed internal consistency (Cronbach’s α, McDonald’s ω), test–retest reliability (n = 30; 4-week interval), convergent validity (average variance extracted [AVE], composite reliability [CR]), discriminant validity (Fornell–Larcker criterion), and criterion validity (correlation with Turkish Health Literacy Scale-32 [TSOY-32]). Results: EFA revealed a seven-factor structure with an acceptable explained variance of 43.8%. Following iterative item elimination based on communalities (h² < 0.20) and factor loadings (λ < 0.30), CFA confirmed the final 34-item model with good fit (CFI = 0.972; RMSEA = 0.070 [90% CI: 0.067–0.074]). The factor structure captured awareness across core socioecological levels (Individual, Interpersonal/Institutional, Community, and Systemic), complemented by Treatment Adherence and Social Impact dimensions. Internal consistency coefficients were α = 0.884 and ω = 0.889 for the total scale. Test–retest reliability yielded an ICC of 0.954 (95% CI: 0.907–0.978). Convergent and discriminant validity were confirmed via composite reliability (CR: 0.740–0.953) and the Fornell–Larcker criterion. Criterion validity analysis revealed a significant correlation with TSOY-32 (r = 0.810, p < 0.001). Conclusions: The CKD Awareness Scale (CKD-AS-34) represents a novel, psychometrically validated, multidimensional awareness instrument for CKD. This scale enables clinicians to identify awareness deficits spanning individual to systemic levels, facilitating personalised patient education and targeted public health interventions. Full article

Purpose: Anemia remains a major public health concern among vulnerable rural adolescent girls in many countries, including India. This study aimed to assess the prevalence of anemia, nutritional status, and anemia-related knowledge, attitudes, and practices (KAP) among school-going rural adolescent girls, along with predictors of KAP score, complemented by stakeholder perspectives. Methods: A mixed-methods cross-sectional study was conducted among 553 school-going adolescent girls aged 14–19, selected through a multi-stage stratified random sampling technique from three rural districts of Andhra Pradesh, India. Quantitative data were collected using a structured questionnaire assessing KAP, anthropometric measurements to collect Body Mass Index (BMI) and middle upper arm circumference (MUAC), dietary assessments using a dietary diversity score, and hemoglobin estimation using standardized procedures. Qualitative insights were obtained through focus group discussions (FGDs) with teachers, parents, frontline health workers, and community leaders and analyzed thematically. Logistic regression analysis was performed to identify predictors of KAP. Results: The prevalence of anemia among the participants was 55.3%, and 30.7% were underweight. Although over half of the girls demonstrated adequate knowledge of anemia, only 39.6% reported good anemia-preventive practices, indicating a significant gap between knowledge and practice. Dietary scores indicated micronutrient-deficient diet consumption by participants (36.2%), which might be contributing to anemia. Multivariable analysis revealed that maternal education, hemoglobin status, diet patterns, and type of school attended were significantly associated with KAP scores. Qualitative findings highlighted challenges related to health-seeking behavior, cultural misconceptions, gaps in awareness and implementation of existing adolescent health programs. Conclusions: Anemia remains highly prevalent among rural school-going adolescent girls in Andhra Pradesh, with suboptimal anemia-preventive practices despite moderate levels of knowledge. Strengthening school-based nutritional education, improving dietary diversity, and enhancing the reach and effectiveness of adolescent health programs through community engagement may help combat anemia. Full article

This study examines accessibility barriers experienced by individuals with disabilities in urban public transportation and analyzes how these barriers influence their travel behavior. Survey data were collected from 450 participants with different disability types in Alanya, Turkey, a tourism-oriented city characterized by pronounced seasonal mobility fluctuations. To ensure internal consistency and analytical robustness, the Analytic Hierarchy Process (AHP) was applied to prioritize seven accessibility criteria, and the consistency of pairwise comparisons was verified prior to analysis. Based on the AHP-derived weights, a composite accessibility-based Problem Severity Index (PSI) was constructed and integrated into regression models to quantify behavioral effects. The results show that the Problem Severity Index (PSI) is strongly associated with satisfaction (R² = 0.895), frequency of public transport use (R² = 0.924), and perceived travel difficulty (R² = 0.924), reflecting constrained mobility conditions and limited modal alternatives rather than improved service quality. Deficiencies in bus stop design and vehicle accessibility equipment were identified as the most influential barriers affecting public transport experience. Beyond the case study context, the proposed AHP–regression framework provides a structured analytical approach for evaluating accessibility performance and generating empirical evidence to inform inclusive and sustainable urban mobility planning. The findings offer empirical evidence on the relative importance of accessibility barriers and highlight critical infrastructure and service deficiencies. Rather than constituting a decision-support tool themselves, these results provide structured information that, when appropriately contextualized, can inform and guide transport authorities and urban planners in prioritizing accessibility improvements and enhancing inclusive public transport performance over time. Full article

Background/Objectives: This study evaluates the efficacy of hypoglossal nerve stimulation as an alternative intervention for pediatric patients with obstructive sleep apnea (OSA) unresponsive to standard therapies and examines the uniformity of therapeutic outcomes across different patient cohorts. Methods: An extensive systematic search was performed across four principal databases (PubMed, EMBASE, Cochrane Library, and Web of Science) utilizing keywords associated with pediatric OSA and hypoglossal nerve stimulation, encompassing studies up to July 2025 that provided objective polysomnographic metrics (e.g., apnea-hypopnea index [AHI] values) to enable the quantitative assessment of pre- and post-intervention effects in children. The primary outcome measured was the ratio of means (ROM), determined from pre–post data in single-group studies, with summary estimates obtained using the fixed-effects model. Results: The systematic review included nine eligible studies with a total of 140 pediatric subjects, the majority of whom were adolescents with Down syndrome. AHI meta-analysis outcomes indicated a marked improvement in OSA severity, yielding an overall ROM of 0.57 [95% confidence interval: 0.49–0.65]. The therapeutic benefit demonstrated a high degree of uniformity across cohorts, as indicated by minimal statistical heterogeneity (I² = 16%, p = 0.30). Funnel plot assessment showed no statistically significant evidence of systematic publication bias. Conclusions: Current evidence suggests that hypoglossal nerve stimulation therapy is a safe, effective, and valuable alternative for pediatric OSA patients who do not respond to conventional therapies. Full article

This paper investigates how climate shelter initiatives implemented in European cities interact with National Adaptation Strategies (NAS) and National Adaptation Plans (NAP), assessing the degree of vertical integration between local practices and national climate adaptation frameworks. As urban heat increasingly threatens public health and exacerbates socio-spatial inequalities, climate shelters, conceived as networks of safe, accessible public spaces providing thermal comfort and social support, have emerged as innovative adaptation tools; however, their recognition within national policy architectures remains uneven across the EU. This study adopts a qualitative–comparative design structured in three phases: (i) a systematic review of NAS and NAP in the 27 EU Member States through keyword screening and classification of references as explicit, implicit, or absent; (ii) a mapping of climate shelter initiatives across 244 NUTS-2 capital cities; and (iii) an integrative cross-analysis of national frameworks and local implementation patterns. According to our results, only 4 Member States explicitly refer to climate shelters, 11 include implicit references, and 12 show no recognition, while 88 cities implement 97 initiatives, predominantly based on Nature-based Solutions and schoolyard transformations; 5 recurring governance configurations reveal bottom-up, top-down, and hybrid dynamics, demonstrating that local experimentation can anticipate, complement, and potentially reshape national adaptation policies. Full article

The use of effect size estimates to complement visual analysis has become increasingly emphasized in single-case research design (SCRD) studies in special education. This review examined trends in SCRD publication and ES reporting practices across three major special education journals (i.e., Journal of Special Education, Exceptional Children, and Remedial and Special Education) from 2001 to 2025. A total of 1969 articles were screened, yielding 194 SCRD intervention studies and 124 SCRD systematic reviews/meta-analyses. Results indicated a sustained increase in the publication of SCRD studies over time, accompanied by a marked rise in ES reporting. Overall, 42.27% (n = 82) of SCRD intervention studies and 55.65% (n = 69) of SCRD systematic reviews reported at least one effect size estimate, with the highest rates observed in the most recent publication period (2001–2025). Across both intervention studies and systematic reviews, Percentage of Nonoverlapping Data and Tau-U were the most frequently reported ES metrics, although reliance on Percentage of Nonoverlapping Data declined over time while use of Tau-U increased. Findings highlight evolving effect size reporting practices and have implications for evidence synthesis and methodological standards in special education research. Full article

Wireless medical sensor networks (WMSNs) enable continuous patient monitoring by transmitting sensitive physiological data over open wireless links. Given the resource-constrained nature and large-scale deployment of such networks, authentication mechanisms must be both lightweight and privacy-preserving. Moreover, due to the frequent turnover of patients and devices in hospital environments, timely member revocation is crucial to prevent discharged or compromised entities from injecting forged reports that could mislead medical diagnosis. Although existing pairing-free certificateless aggregate authentication schemes are efficient, they often suffer from critical security and privacy vulnerabilities. Recently, an efficient certificateless authentication scheme with revocation has been proposed. However, our analysis reveals that the scheme presents the following security vulnerabilities: (i) member witnesses can be recovered from public information, (ii) revocation checks can be bypassed via identity grafting attack, and (iii) user identities can be linked due to the long-term use of static pseudonyms. To address these issues, we propose a security-enhanced certificateless aggregate authentication protocol with revocation for WMSNs. Our design enforces strong identity–membership binding to resist grafting attacks, employs a non-interactive zero-knowledge membership proof to preserve witness secrecy, and adopts dynamic pseudonym rotation to achieve unlinkability. We provide formal security proofs and comprehensive performance comparisons. The results indicate that, at the same security level, our protocol achieves more efficient signature verification while maintaining communication overhead comparable to existing schemes. In addition, the overhead introduced by our revocation mechanism remains constant, making it well suited for large-scale WMSNs deployments with frequent membership changes. Full article

Microcystin (MC) contamination of surface waters threatens ecosystems and public health. Nature-based solutions such as Multi-Soil-Layering (MSL) systems have been used for MC remediation. However, the biological mechanisms controlling MC degradation remain unclear. The present study investigates microbial community responses in two MSL systems with different clay contents (8% and 54%) exposed to MC-contaminated inputs (well water and eutrophied lake water). Samples were analysed before and after treatment using quantitative PCR (qPCR) to quantify the mlrA gene (encoding microcystinase) and its bacterial hosts. Next-generation sequencing (NGS) was used to assess microbial diversity, while the FAPROTAX database was used to predict functional characteristics. Results showed that MC was mainly adsorbed in pozzolan layers, while mlrA gene abundance and MC-degrading bacteria were higher in soil mixture layers. The presence of mlrA and associated bacteria was most pronounced in lake inflow samples, indicating intrinsic MC Biodegradation potential. Taxonomic analysis revealed dominant phyla including Proteobacteria, Actinobacteriota, Firmicutes, Chloroflexi and Bacteroidota. Functional analysis identified dominant traits such as chemoheterotrophy and aerobic metabolism. These findings provide new insights into microbial interactions in MSL systems and contribute to the optimisation of water treatment strategies for MC-contaminated environments. Full article

Since the inception of utility-scale wind turbines, there has been a continual increase in the size of the devices used. One drawback of turbine size increase is that the weight of the rotor blades has grown dramatically. Technological advancements have allowed for the creation of light blades to overcome this issue. These lighter rotors are also less stiff than their predecessors and prone to experiencing aeroelastic vibrations that can lead to fatigue damage. Aerodynamic damping occurring during blade vibration has the potential to mitigate those oscillations; thus, understanding its underlying physics provides an extremely useful tool for future blade design. In a series of previous publications, the authors presented a novel reduced-order characterization technique for the oscillatory response of wind turbines, which allows for the analysis of rotor vibrations when excited by wind gust pulses. In this paper, the authors will apply the same gust pulse technique to analyze the physics of blade’s aerodynamic damping, identifying two physical mechanisms. The first acts either as a damper, or as an energy feeder, depending on operational conditions. The second operates in a purely dissipative manner. Results of numerical experiments on several operational scenarios illustrating these behavioral responses will be presented and discussed. Full article

Background: Sialylation, a key terminal glycosylation modification, plays a pivotal role in tumor progression and immune evasion. The sialyltransferase ST3GAL4 is implicated in individual cancers, but its pan-cancer landscape and systemic associations remain undefined. Methods: We performed an integrated multi-omics analysis using transcriptomic, proteomic, genomic, DNA methylation, and tumor microenvironment datasets from TCGA, CPTAC, GTEx, and other public resources. Immune associations were evaluated via TIMER2.0 and TISIDB. Experimental validation included immunofluorescence staining for ST3GAL4 protein in human tumor specimens. Results: ST3GAL4 exhibited pervasive, lineage-specific dysregulation across cancers. Elevated expression correlated with adverse prognosis, genomic instability, and specific RNA modification patterns. Tumor microenvironment analyses revealed significant associations: ST3GAL4 expression positively correlated with cancer-associated fibroblast and endothelial cell infiltration but was inversely associated with cytotoxic T-cell abundance. Functional enrichment implicated ST3GAL4 within glycosphingolipid metabolism and glycan biosynthetic pathways. In experimental models, its expression demonstrated context-dependent modulation following cytokine stimulation and immunotherapy. Immunofluorescence confirmed tumor-specific protein expression and its spatial co-occurrence with stromal and immune cell markers. Conclusion: This multi-omics study delineates a comprehensive pan-cancer atlas of ST3GAL4, establishing its association with aggressive tumor behavior, an immunosuppressive microenvironment, and core glycosylation pathways. These findings position ST3GAL4 as a potential cross-tumor node linking sialylation to immune evasion, providing a rationale for future mechanistic and therapeutic exploration. Full article

Uneven urbanization can lead to significant quantities of vacant and abandoned land while exacerbating urban heat island (UHI) effects and simultaneously adversely affecting socioeconomically disadvantaged communities. This study examines the correlation between land surface temperature (LST) and urban vacant and abandoned land in socially vulnerable neighborhoods in Houston, TX, USA, where extreme heat can present significant environmental and public health challenges. Six critical study locations exhibiting a social vulnerability index (SVI) over 0.7 and average land surface temperature (LST) values surpassing 82 °F (27.8 °C) are analyzed through spatial analytics and drone footage. Findings indicate that vegetated vacant spaces help mitigate urban heat by decreasing land surface temperature, but abandoned structures exacerbate temperatures due to heat retention from non-permeable surfaces. Findings suggest that elevated socioeconomic vulnerability correlates with increased land surface temperature, exacerbating heat-related hazards in at-risk communities. In this six-site sample, the abandonment rate exhibited a positive correlation with the site mean land surface temperature (exploratory linear fit: +2.42 °F [0.74, 4.11]/+1.35 °C [0.41, 2.28] per +1% increase in abandonment; to be interpreted as exploratory and potentially confounded). Results provide critical insights for climate resilience planning and urban heat reduction through high-resolution thermal and geographical analysis, highlighting the impact of vacant and abandoned land on LST. Such findings endorse certain urban cooling techniques, including land reutilization and green infrastructure, to enhance environmental equality and adaptation. Full article

With the acceleration of digital transformation in education, this paper examines how blockchain is being framed as a governance solution for trust, transparency, and decentralization. Using a hybrid bibliometric and thematic analysis of 93 Web of Science and Scopus publications, the study maps publication trends, leading outlets, author networks, and conceptual clusters. We analyze co-authorship networks, keyword co-occurrence patterns, and conceptual structures using VOSviewer version 1.6.19 and the R-based Bibliometrix package. Then, we apply qualitative coding to offer a more profound interpretation of governance stories. Findings show that blockchain in educational governance is predominantly positioned through techno-managerial lenses—focusing on secure credentials, tamper-proof records, and efficiency—while critical perspectives on power, equity, and participation remain limited. Global North institutions and computer science–oriented venues dominate the field, with little engagement from Global South contexts or educational leadership scholarship. The paper concludes by proposing a research agenda that reimagines blockchain not as a neutral tool, but as a socio-technical assemblage that must be interrogated through equity-, ethics-, and community-centered frameworks. Full article

This study examines the efficiency and productivity of public education expenditure in 20 countries using Data Envelopment Analysis (DEA) and the Malmquist Productivity Index over the period 2011–2023. Focusing on science and mathematics performance at the primary and lower-secondary levels, the results show that higher public spending does not necessarily lead to better educational outcomes, highlighting the importance of efficient resource allocation. The DEA estimates reveal substantial cross-country heterogeneity in efficiency, while the Malmquist results indicate positive total factor productivity growth across all countries, driven mainly by technical progress rather than efficiency catch-up. Countries such as Morocco, Japan, Turkey, and Iran exhibit sustained productivity improvements, particularly in 2019–2023. Persistent disparities in efficiency and productivity are closely associated with differences in education policies, governance, and socio-economic contexts. Overall, the findings stress the need for efficiency-oriented education reforms to enhance performance and promote sustainable growth. Full article