Search Results (706)

Tuberculosis (TB) remains a leading cause of death in Bangladesh, disproportionately affecting low socio-economic status (SES) populations. This review, guided by the WHO Social Determinants of Health framework and Rockefeller-Lancet Planetary Health Report, examined how social, economic, and ecological factors link SES to TB burden. The first literature search identified 28 articles focused on SES-TB relationships in Bangladesh. A second search through snowballing and conceptual mapping yielded 55 more papers of diverse source types and disciplines. Low-SES groups face elevated TB risk due to smoking, biomass fuel use, malnutrition, limited education, stigma, financial barriers, and hazardous housing or workplaces. These factors delay care-seeking, worsen outcomes, and fuel transmission, especially among women. High-SES groups more often face comorbidities like diabetes, which increase TB risk. Broader contextual drivers include urbanisation, weak labour protections, cultural norms, and poor governance. Recommendations include housing and labour reform, gender parity in education, and integrating private providers into TB programmes. These align with the WHO End TB Strategy, UN SDGs and Planetary Health Quadruple Aims, which expand the traditional Triple Aim for health system design by integrating environmental sustainability alongside improved patient outcomes, population health, and cost efficiency. Future research should explore trust in frontline workers, reasons for consulting informal carers, links between makeshift housing and TB, and integrating ecological determinants into existing frameworks. Full article

Background: There has been a reduction in successful H. pylori eradication rates recently, which is largely attributed to increasing antibiotic resistance. In areas of high dual clarithromycin and metronidazole resistance such as ours, Maastricht VI/Florence guidelines recommend bismuth quadruple therapy (BQT) as first line of therapy; however, the availability of bismuth was poor in Ireland until recently. Similarly, tetracycline, a component of BQT, is restricted locally, with doxycycline (D) being approved and reimbursed for most indications. Aims: To assess the efficacy of BQT-D therapy for H. pylori eradication in an Irish cohort. Methods: All patients testing positive for H. pylori in three Irish referral centres by urea breath test, stool antigen, or histology were treated prospectively with BQT-D (bismuth subcitrate 120 mg QDS, metronidazole 400 mg TDS, doxycycline 100 mg BD and esomeprazole 40 mg BD) for 14 days. Eradication was evaluated with a urea breath test (UBT) >4 weeks after therapy cessation or by stool antigen testing, as available. Outcomes were recorded and analysed according to demographics and H. pylori treatment history of the patients. Results: 217 patients completed post-eradication testing. Of which, 124 (57%) were female, with a mean age 52 years. 180 patients (83%) were treatment-naïve. A total of 165/180 (92%) of the treatment-naïve patients had successful eradication. There was no association between eradication and gender or age in this cohort (p = 0.3091, p = 0.962 respectively). A total of 29 patients received this therapy as second-line therapy, of which 22 (76%) had successful eradication. Eight patients received the regimen as rescue therapy, with seven (88%) having successful eradication. No serious adverse events were reported. Eleven individuals (6.5%) commented on the complicated nature of the regimen, with 11 tablets being taken at five intervals daily. Conclusions: BQT-D as first-line therapy for H. pylori infection is highly effective in a high dual-resistance population, achieving >90% eradication. BQT-D as a second-line treatment performed less well. Our data support BQT-D as a first-line treatment. Full article

In the landslide chain from pre-disaster conditions to landslide mitigation and recovery, time is an important factor in understanding the geological hazards process and managing landsides. Static knowledge graphs are unable to capture the temporal dynamics of landslide events. To address this limitation, we propose a systematic framework for constructing a multi-temporal knowledge graph of landslides that integrates multi-source temporal data, enabling the dynamic tracking of landslide processes. Our approach comprises three key steps. First, we summarize domain knowledge and develop a temporal ontology model based on the disaster chain management system. Second, we map heterogeneous datasets (both tabular and textual data) into triples/quadruples and represent them based on the RDF (Resource Description Framework) and quadruple approaches. Finally, we validate the utility of multi-temporal knowledge graphs through multidimensional queries and develop a web interface that allows users to input landslide names to retrieve location and time-axis information. A case study of the Zhangjiawan landslide in the Three Gorges Reservoir Area demonstrates the multi-temporal knowledge graph’s capability to track temporal updates effectively. The query results show that multi-temporal knowledge graphs effectively support multi-temporal queries. This study advances landslide research by combining static knowledge representation with the dynamic evolution of landslides, laying the foundation for hazard forecasting and intelligent early-warning systems. Full article

Background: Fenestrated stentgrafting has become a first-line treatment for juxtarenal aneurysms, and the incorporation of all renovisceral vessels with fenestrations has become common to increase the proximal sealing zone. This increases the complexity of the repair compared to using fewer fenestrations, and stenting of the celiac artery (CA), in particular, can be technically challenging. Objective: This study evaluates the mid-term outcomes of leaving the celiac artery unstented during quadruple fenestrated stentgrafting for complex aortic aneurysms. Additionally, it explores the clinical and anatomical factors that influence the decision to not stent the celiac artery. Methods: A retrospective review was conducted of patients with complex aortic aneurysms who underwent elective fenestrated endovascular aneurysm repair (FEVAR) between 2018 and 2023. Custom Cook Zenith grafts were used, and all patients underwent preoperative computed tomography angiography (CTA) as well as follow-up CTA to assess the celiac artery. This study evaluated celiac artery anatomic factors, such as proximal and distal diameter; presence of stenosis (<50% or >50%) and patency; length of any CA stenosis; CA takeoff angulation, CA tortuosity, early CA division; calcification; and presence of CA aneurysm or ectasia anatomical abnormalities. Recorded outcomes of CA instability included any stent stenosis, target vessel occlusion, reintervention, or endoleak (types 1C and 3). Results: A total of 101 patients underwent FEVAR, with 72 receiving a stent in the celiac artery and 29 not receiving it. Rates of technical success (96.5% vs. 100%), intervention times (256 min vs. 237 min), and lengths of hospital stay (5.1 vs. 4.7 days) were similar between unstented vs. stented groups. At one year, no significant difference in celiac artery instability was noted (17.2 vs. 5.5%; p = 0.06). Risk factors for CA occlusion on univariate analysis included a steep takeoff angle (≥140°), length of stenosis >6.5 mm, proximal diameter ≤6.5 mm, preoperative stenosis ≥50%, and celiac artery tortuosity. Conclusions: Anatomical features of the CA impact the ability to achieve routine CA stenting during FEVAR. Selectively not stenting the celiac artery during FEVAR might simplify the procedure without compromising patient safety and mid-term outcomes. Full article

It is projected that the world population will quadruple over the next century, and to meet future food demands, agricultural production will need to increase by 70%. Therefore, there has been a transition from traditional farming methods to autonomous modern agriculture. One such modern technique is aeroponic farming, in which plants are grown without soil under controlled and hygienic conditions. In aeroponic farming, plants are significantly less affected by climatic conditions, infectious diseases, and biotic and abiotic stresses, such as pest infestations. Additionally, this method can reduce water, nutrient, and pesticide usage by 98%, 60%, and 100%, respectively, while increasing the yield by 45–75% compared to traditional farming. In this study, a three-dimensional industrial design of an innovative aeroponic plant growth chamber was presented for use by individuals, researchers, and professional growers. The proposed chamber design is modular and open to further innovation. Unlike existing chambers, it includes load cells that enable real-time monitoring of the fresh weight of the plant. Furthermore, cameras were integrated into the chamber to track plant growth and changes over time and weight. Additionally, RGB power LEDs were placed on the inner ceiling of the chamber to provide an optimal lighting intensity and spectrum based on the cultivated plant species. A customizable chamber design was introduced, allowing users to determine the growing tray and nutrient nozzles according to the type and quantity of plants. Finally, system models were developed for temperature control of the chamber. Temperature control was implemented using a proportional-integral-derivative controller optimized with particle swarm optimization, radial movement optimization, differential evolution, and mayfly optimization algorithms for the gain parameters. The simulation results indicate that the temperatures of the growing and feeding chambers in the cabinet reached a steady state within 260 s, with an offset error of no more than 0.5 °C. This result demonstrates the accuracy of the derived model and the effectiveness of the optimized controllers. Full article

Instead of measuring the distance between two points with a positive real number, determining the degree to which the distance between these two points is close, not close, or uncertain allows for more detailed measurement. Recently, researchers have overcome this grading problem by using probability distribution functions, along with fuzzy, intuitionistic fuzzy, and neutrosophic sets. This study pioneers neutrosophic quadruple metric spaces as a powerful new tool for quantifying distances under complex, multi-dimensional uncertainty. It provides a comprehensive mathematical structure, including topology, convergence theory, and completeness, and handles both symmetric and asymmetric cases, generalising previous neutrosophic metric results. For this purpose, neutrosophic quadruple metric spaces were derived from neutrosophic metric spaces in order to better model situations involving uncertainty. Also, we generalised the findings obtained with the neutrosophic metric to the quadruple neutrosophic metric. Full article

Background: Although improving the patient experience with care is being framed as part of value-based care, the economic and provider well-being impact of interventions for improving the patient experience has not been established. We aimed to synthesize the contemporary (2015–2024) empirical literature on the economic (e.g., costs, revenue) and other value-based impacts (e.g., provider well-being) of patient-experience improvement interventions. Methods: Systematic review using six databases of scientific literature (PubMed, EconLit, CINAHL, PsycINFO, DOAJ, and Scopus) supplemented by journal-specific and snowball searches following a registered study protocol (PROSPERO: CRD42022358337). Two independent reviewers performed eligibility decisions and quality appraisals of the study methods and economic assessments, when applicable; the latter was conducted using the Joanna Briggs Institute’s checklist for economic evaluations. Results: Out of 1317 unique references, nine were included. Four studies assessed the effectiveness of patient experience improvement interventions (e.g., provider communication training, discharge or transitional support) coupled with economic evaluations; these found statistically significant positive outcomes for both patient experience and economic dimensions—including reduced costs, improved revenue, or additional costs offset by increased revenue. Three additional studies on provider communication training also found statistically significant positive impacts on provider well-being (i.e., reduced burnout) and patient experience improvements. Conclusion: These findings shed light on the overall synergistic value of and business case for investments into developing patient experience improvement programs or activities. However, there is room for strengthening this body of knowledge in scope, volume, and method quality, including the need to study the impact on patient experience, provider well-being, health outcomes, and costs (i.e., the quadruple aim) in tandem. Full article

Background: Local audits of Helicobacter pylori (H. pylori) prescriptions and outcomes are necessary to assess guideline awareness among clinicians and treatment effectiveness. Aims: The aims were to investigate first-line prescriptions and effectiveness over a 10-year period in Ireland and evaluate the influence of the 2017 Irish consensus guidelines on these trends. Methods: Data were collected at e-CRF AEG-REDCap from the European Registry on H. pylori management (Hp-EuReg) and quality reviewed from 2013 to 2022. All treatment-naïve cases were assessed for effectiveness by modified intention-to-treat (mITT) analysis. Multivariate analysis was also performed. Results: Data from 1000 patients (mean age 50 ± 15 years; 54% female) were analyzed. Clarithromycin (C) and amoxicillin (A) triple therapy represented 88% of treatments, followed by sequential C, A, and metronidazole (M) therapy (4.3%) and triple C + M (2.7%). Bismuth quadruple therapy was prescribed in 1.7% of cases. Treatment durations of 14, 10, and 7 days accounted for 87%, 4.5%, and 8.5% of prescriptions, respectively. High-, standard-, and low-dose proton pump inhibitors (PPIs; 80 mg, 40 mg, and 20 mg omeprazole equivalent b.i.d.) were used in 86%, 0.9%, and 13% of cases, respectively. The overall eradication rate was 80%, while it was 81% for triple C + A. Good compliance and high-dose PPI were associated with higher overall mITT eradication rates (OR 4.5 and OR 1.9, respectively) and triple C + A eradication rates (OR 4.2 and OR 1.9, respectively). Overall eradication rates increased from 74% pre-2017 to 82% (p < 0.05) by the end of 2022. Similarly, the triple C + A eradication rates increased from 76% to 83% (p < 0.05). Conclusions: While first-line treatment effectiveness improved in clinical practice over time, cure rates remain below 90%. Alternative first-line strategies are required in Ireland. Full article

Background: Although the difficulty level of figure skating programs has increased in the last two decades, particularly at the junior level, trends in performance have not been reported. This retrospective observational study investigated performance development trends among the top five junior figure skaters competing at international levels in both the ladies’ and men’s singles disciplines from 2005 to 2020. Data from 160 junior single ladies and 160 junior single men were analyzed. The focus was on the progression of technical elements—particularly jumps—and their potential correlation with injury risk. It was hypothesized that younger athletes are increasingly performing jumps with more revolutions, thereby enhancing overall competition standards. Materials and Methods: Using data from the Junior World Championships and Junior Grand Prix Finals, linear regression analysis and one-way ANOVA were conducted to track the frequency of double, triple, and quadruple jumps, as well as trends in age development among athletes in the singles categories from 2005 to 2020. Results: The results indicate a significant increase in the execution of higher-revolution jumps among junior athletes. Between 2005 and 2012, the frequency of double jumps declined across all events, with the most pronounced reductions observed in the Ladies’ Junior World Championships (Δ = 0.216, p = 0.004, d = 1.64) and the Men’s Junior World Championships (Δ = 0.500, p = 0.001, d = 1.82). From 2005 to 2011, the frequencies of triple and quadruple jumps increased, while double jumps remained stable or showed only slight increases. Triple jumps showed slight downward trends (e.g., R² = 0.0202 at the Men’s Junior World Championships). Although still rare, the frequency of quadruple jumps has shown a consistent upward trend across multiple competitions. Between 2000 and 2009, all four events exhibited declining age trends, with decreases ranging from −0.029 to −0.078 years of age per year. In the subsequent decade (2010–2020), when averaged across all events, the observed difference slope (Δ = 0.014) indicated a continued decline in athlete age. Conclusions: In summary, increases in more difficult jumps were found, with simultaneous decreases in less difficult jumps. As jump complexity rises, a parallel increase in sport-specific injury incidence can be anticipated, highlighting the need for proactive strategies for injury prevention and athlete well-being. Full article

Background and Objectives: Bisphosphonates (BP) like zoledronic acid (ZA) and alendronic acid (AA) are used for osteoporosis (OP) or other bone-related conditions as well as to prevent the spread of metastases and in rheumatoid arthritis treatment. However, they have been associated with an increased risk of osteonecrosis of the jaw (ONJ). This systematic review aimed to assess the incidence and risk of ONJ in osteoporotic patients treated with ZA or AA and evaluate the impact of treatment duration. Material and Methods: The systematic literature review was conducted following PRISMA guidelines. The keywords “Zoledronic acid,” “Alendronic acid,” “Osteoporosis,” and “Osteonecrosis” were searched in PubMed and ScienceDirect databases. Selection criteria included studies on humans written in English, published from 2014. The systematic review protocol was registered in the PROSPERO register under the following number: CRD42024587046. Results: A total of 7 studies with 98,717 osteoporotic patients met the criteria, showing a higher ONJ incidence with ZA than AA. Six studies linked longer BP use to increased ONJ risk, which quadrupled after 5 years of AA use. A positive correlation was found between BP use (≥3 years) and ONJ in OP patients, primarily affecting females over 60. ONJ appeared after 1 year with AA, increasing over time, while ZA-related ONJ emerged as early as 5 months with a higher overall incidence. Conclusions: ZA poses a higher ONJ risk and incidence and earlier onset than AA, occurring within 5 months versus 1 year for AA. These findings emphasize the need for careful monitoring, especially in long-term BP therapy with additional risk factors. Full article

Lung involvement is the most common extraglandular manifestation of primary Sjögren’s Disease (pSjD). There is an increasing interest in finding the clinical/serological risk predictors of this feature. A cross-sectional study evaluating anti-SSA/Ro antibodies, anti-SSB/La antibodies, rheumatoid factor, antinuclear antibodies, and the diffusing capacity of the lungs for carbon monoxide (DLCO) in 26 pSjD patients who presented interstitial changes on the chest CT scan was performed. The titres and positivity rates for anti-SSA/Ro (p = 0.02, p = 0.02) and anti-SSB/La antibodies (p = 0.01, p = 0.001) proved to be significantly increased in patients with abnormal DLCO. Anti-SSB/La antibodies’ titres seemed to be the best predictor for decreased DLCO–AUC 0.791 (0.587–0.994), p = 0.016. A close-to-significance decrease was found in the titres (p = 0.07) and positivity rates—p = 0.09 and OR of 0.15 (0.01–1.63)—of anti-SSB/La antibodies in patients with usual interstitial pneumonia (UIP), indicating their possible protective role against UIP. The lymphocytic interstitial pneumonitis (LIP) pattern on lung CT scan was significantly associated with the simultaneous positivity of the four examined serological markers (p = 0.03). The increase in anti-SSB/La antibody positivity rate in patients with LIP patterns was situated close to the significance level (p = 0.09). Quadruple positivity, as well as isolated anti-SSB/La positivity, could be risk factors for developing LIP in pSjD patients. Thus, anti-SSB/La antibodies might represent a marker of lung involvement in pSjD patients. Full article

India’s revised nationally determined contribution at COP26 set a net-zero target for 2070, but the role of carbon dioxide removal (CDR) in achieving this goal remains unclear. This study quantifies the contribution of land-based CDR—bioenergy carbon capture and storage, biochar, and afforestation—in achieving India’s net-zero goal. Additionally, a stylised scenario explores an accelerated net-zero target by 2050 in India`s climate target. The global emission target is modelled to follow India’s climate ambition in both stylised scenarios. The results show that the ambitious 2050 net-zero pathway requires 56 GtCO₂ of cumulative novel CDR across the century, compared to 47 GtCO₂ under the 2070 scenario, with both requiring around 1 GtCO₂/year at net-zero. A higher ambitious pathway leads to increased economic costs, with a mid-century carbon price of USD 938, compared to USD 174 in the 2070 scenario. Without novel CDR methods, the cost of achieving net zero by 2050 quadruple. The accelerated 2050 net-zero pathway also intensifies land and water trade-offs, reducing land for crop production while increasing water demand for electricity and biomass. Despite these challenges, it limits end-of-century warming to 1.46 °C, compared to 1.79 °C under the 2070 scenario. These findings highlight the importance of clearly defined climate targets, scalable CDR strategies, and integrated resource management to balance climate ambition with sustainable development. Full article

Background/Objectives: We sought to demonstrate the versatility and economy of physician-modified endograft (PMEG) fenestrated endovascular aortic repair (FEVAR) based on the Treo (Terumo Aortic) platform for patients referred for custom-made device (CMD) FEVAR due to a complex abdominal aortic aneurysm (CAAA). Endovascular planning was performed utilizing a standardized design incorporating all visceral arteries with a low supra-celiac landing zone. The pure cost of the aortic components was compared between the PMEG and CMD designs. Methods: A total of 39 consecutive patients treated with CMD FEVAR due to a CAAA between September 2018 and December 2023 were recruited at a tertiary vascular center for a retrospective evaluation. Endovascular planning was performed on readily available computed tomography angiography (CTA) datasets using 3Mensio Vascular (Pie Medical Imaging) software. The actual cost of the major components was compared between the implanted CMD platform produced by Cook and the planned Treo-based PMEG repair. Results: A total of 155 fenestrations were planned on 3 triple-, 34 quadruple-, and two quintuple-fenestrated devices. The 90 mm distance between the proximal edge and the flow divider of the 120 mm long main body of the Treo graft allowed for the placement of all necessary fenestrations of the target arteries without the need to reduce the 3 cm supra-celiac landing zone while also preserving a safety distance of >1 cm to the flow divider. The costs of the components were EUR 33896 for CMD and EUR 8878 for a PMEG. Conclusions: This retrospective study suggests that a quadruple-fenestrated PMEG based on the Treo bifurcation is a highly versatile alternative with a significant price advantage over custom-made devices for the treatment of complex abdominal aortic aneurysms. Full article

Helicobacter pylori antibiotic resistance data in Oman are limited yet crucial for effective treatment selection. The genetic diversity within H. pylori influences its pathogenicity and clinical outcomes. This study evaluates resistance patterns and genetic determinants to guide treatment strategies. This study assessed antibiotic susceptibility in 15 H. pylori isolates (from 169 clinical samples) from naïve and treatment-failed patients. Resistance to clarithromycin (CLA), amoxicillin (AMX), metronidazole (MTZ), tetracycline, rifampicin (RIF), and levofloxacin (LEV) was tested alongside genetic analysis of virulence and resistance-associated mutations by whole-genome sequencing (WGS). Among the 15 resistant isolates, 20% were resistant to one antibiotic, 33.3% to two, 20% to three, and 26.6% to four antibiotics. MTZ resistance was universal among single-drug resistant isolates (100%). AMX-MTZ dual resistance was present in 60%, while triple resistance (CLA-AMX-MTZ) was present in 66.7%. Quadruple resistance (CLA-AMX-MTZ-RIF) was present in 75%. WGS revealed 23S rRNA mutations in 33.3% of CLA-resistant strains and pbp-1 mutations in 66.6% of AMX-resistant strains. MTZ resistance was linked to rdxA/frxA mutations, while RIF and LEV resistance correlated with rpoB (65.7%) and gyrA (20%) mutations, respectively. The genotype–phenotype agreement was insignificant (p = 1). High mutation heterogeneity, virulence factors, and environmental influences contribute to resistance. Further studies on host–pathogen interactions are needed to understand resistance mechanisms. Full article

Background/Objectives: The corneal epithelium plays a vital role in maintaining corneal transparency and ocular surface integrity. Chronic topical use of antiglaucoma medications may induce epithelial changes, especially with the concurrent use of multiple agents. This study aimed to evaluate the association between the number and class of antiglaucoma medications and central corneal epithelial thickness (CET), measured using a spectral-domain optical coherence tomography (SD-OCT) device. Methods: This cross-sectional study included 456 eyes from 242 adults (median age 72 years), grouped by the number of antiglaucoma agents used (0–4 medications). All pharmacologically treated participants had received the same regimen for ≥6 months. CET was measured using SD-OCT (SOLIX, Optovue). Generalized estimating equations (GEEs) accounted for inter-eye correlation. Two models were constructed: one evaluating specific medication effects and another assessing CET reduction per additional drug used. Age and sex were included as covariates. Results: CET progressively decreased with the number of medications, ranging from 53 µm in controls to 48 µm with quadruple therapy. Multivariable GEE analysis confirmed a cumulative thinning effect, with each additional medication associated with further CET reduction (β = −2.83 to −9.17 µm, p < 0.001). Latanoprost exerted the most pronounced single-drug effect (β = −3.01 µm, p < 0.001). Age was a modest negative predictor, while sex showed no significant effect. Conclusions: The cumulative number and specific class of antiglaucoma medications have a significant impact on corneal epithelial thickness. These results emphasize the need for vigilant ocular surface evaluation in patients on multi-drug regimens and propose CET as a surrogate marker for the burden of topical therapy. Full article