Search Results (6,631)

Understanding how atmospheric pollutants interact with soil pollution is essential for assessing long-term environmental and human health risks. This study compares concentrations of polycyclic aromatic hydrocarbons (PAHs) and potentially toxic elements (PTEs) in PM₁₀ and surface soil near air quality monitoring stations in Zagreb, Croatia. While previous work identified primary emission sources affecting PM₁₀ composition in the area, this study extends the analysis to investigate potential pollutant transfer and accumulation in soils. Multivariate statistical tools, including correlation analysis and principal component analysis (PCA), were employed to gain a deeper understanding of the sources and behavior of pollutants. Results reveal significant correlations between air and soil concentrations for several PTEs and PAHs, particularly when air pollutant data are averaged over extended periods (up to 6 months), indicating cumulative deposition effects. Σ11PAH concentrations in soils ranged from 1.2 to 524 µg/g, while mean BaP in PM₁₀ was 2.2 ng/m³ at traffic-affected stations. Strong positive air–soil correlations were found for Pb and Cu, whereas PAH associations strengthened at longer averaging windows (3–6 months), especially at 10 cm depth. Seasonal variations were observed, with stronger associations in autumn, reflecting intensified emissions and atmospheric conditions that facilitate pollutant transfer. PCA identified similar pollutant groupings in both air and soil matrices, suggesting familiar sources such as traffic emissions, industrial activities, and residential heating. The integrated PCA approach, which jointly analyzed air and soil pollutants, showed coherent behaviour for heavier PAHs and several PTEs (e.g., Pb, Cu), as well as divergence in more volatile or mobile species (e.g., Flu, Zn). Spatial differences among monitoring sites show localized influences on pollutant accumulation. Furthermore, this work demonstrates the value of coordinated air–soil monitoring in urban environments and provides an understanding of pollutant distributions across different components of the environment. Full article

This study presents a comprehensive Quantitative Microbial Risk Assessment (QMRA) for Escherichia coli in northeastern Greece’s riverine and deltaic aquatic systems, evaluating potential human health risks from recreational water exposure. The analysis integrates seasonal microbiological monitoring data—E. coli, total coliforms, enterococci, Salmonella spp., Clostridium perfringens (spores and vegetative forms), and physicochemical parameters (e.g., pH, temperature, BOD₅)—across multiple sites. A beta-Poisson dose–response model within a Monte Carlo simulation framework (10,000 iterations) was applied to five exposure scenarios, simulating varying ingestion volumes for different population groups. Median annual infection risks ranged from negligible to high, with several locations (e.g., Mandra River, Konsynthos South, and Delta Evros) surpassing the World Health Organization (WHO)’s benchmark of 10⁻⁴ infections per person per year. A Gradient Boosting Regressor (GBR) model was developed to enhance predictive capacity, demonstrating superior accuracy metrics. Permutation Importance analysis identified enterococci, total coliforms, BOD₅, temperature, pH, and seasons as critical predictors of E. coli concentrations. Additionally, sensitivity analysis highlighted the dominant role of ingestion volume and E. coli levels across all scenarios and sites. These findings support the integration of ML-based tools and probabilistic modelling in water quality risk governance, enabling proactive public health strategies in vulnerable or high-use recreational zones. Full article

Background/Objectives: To assess the effectiveness of the most commonly used swallowing manoeuvres, exercises, and postural strategies as standalone interventions in the behavioural management of oropharyngeal dysphagia in adults. Methods: Systematic searches of two electronic databases, Embase and PubMed, were conducted in accordance with PRISMA guidelines to identify studies with comparison groups, including (pseudo) randomised controlled trials, comparative studies with concurrent controls, and within-subject or crossover study designs. The methodological quality of the included studies was assessed using the standard quality assessment tool (QualSyst). Results: Seventeen studies met the eligibility criteria, evaluating the effects of chin tuck, effortful swallow, the Mendelsohn manoeuvre, the modified jaw opening exercise, the volitional laryngeal vestibule closure manoeuvre, and the Shaker exercise. Most studies reported positive treatment outcomes, supporting the benefits of both compensatory and rehabilitative interventions across diverse populations, mainly derived from mixed groups and individuals post stroke. However, due to the limited number and significant heterogeneity of studies, a meta-analysis was only performed for the chin tuck, which showed a moderate positive effect. Overall, the evidence is preliminary and should be interpreted with caution. Conclusions: While current findings support the benefits of standalone behavioural interventions in oropharyngeal dysphagia, future research should focus on high-quality study designs with larger populations. Such studies need to consider variability in patient characteristics, intervention protocols, and outcome measures, with the use of advanced statistical methods enabling more definitive conclusions about the effectiveness of these interventions. Full article

Sugarcane is a key crop for sugar, biofuels, and bioenergy, with Brazil as the world’s largest producer. Intensive cultivation demands pesticides like tebuthiuron and thiamethoxam, while fertigation with vinasse may alter their environmental behavior. Sustainable approaches, such as phytoremediation, are needed to mitigate negative impacts on soil quality. This study assessed the phytoremediation potential of Canavalia ensiformis and Mucuna pruriens in soils contaminated with tebuthiuron, thiamethoxam, and vinasse under greenhouse conditions. Experiments used a completely randomized design (five replicates, 4 × 2 factorial). Plant development impacts on the sentinel species Crotalaria juncea, and ecotoxicity via Lactuca sativa bioassays were evaluated. Tebuthiuron strongly inhibited C. ensiformis, while thiamethoxam showed mild stimulatory effects. M. pruriens maintained better growth in the presence of contaminants. Bioassays revealed greater residual toxicity in tebuthiuron treatments. Overall, M. pruriens demonstrated superior biomass production and capacity to lessen soil toxicity, underscoring its potential as a sustainable tool for phytoremediation of pesticide-impacted soils. Full article

Background: Hepatopancreatobiliary (HPB) surgery is among the most complex domains in oncologic care, where decisions entail significant risk–benefit considerations. Artificial intelligence (AI) has emerged as a promising tool for improving individualized decision-making through enhanced risk stratification, complication prediction, and survival modeling. However, its role in HPB oncologic surgery has not been comprehensively assessed. Methods: This systematic review was conducted in accordance with PRISMA guidelines and registered with PROSPERO ID: CRD420251114173. A comprehensive search across six databases was performed through 30 May 2025. Eligible studies evaluated AI applications in risk–benefit assessment in HPB cancer surgery. Inclusion criteria encompassed peer-reviewed, English-language studies involving human s ubjects. Two independent reviewers conducted study selection, data extraction, and quality appraisal. Results: Thirteen studies published between 2020 and 2024 met the inclusion criteria. Most studies employed retrospective designs with sample sizes ranging from small institutional cohorts to large national databases. AI models were developed for cancer risk prediction (n = 9), postoperative complication modeling (n = 4), and survival prediction (n = 3). Common algorithms included Random Forest, XGBoost, Decision Trees, Artificial Neural Networks, and Transformer-based models. While internal performance metrics were generally favorable, external validation was reported in only five studies, and calibration metrics were often lacking. Integration into clinical workflows was described in just two studies. No study addressed cost-effectiveness or patient perspectives. Overall risk of bias was moderate to high, primarily due to retrospective designs and incomplete reporting. Conclusions: AI demonstrates early promise in augmenting risk–benefit assessment for HPB oncologic surgery, particularly in predictive modeling. However, its clinical utility remains limited by methodological weaknesses and a lack of real-world integration. Future research should focus on prospective, multicenter validation, standardized reporting, clinical implementation, cost-effectiveness analysis, and the incorporation of patient-centered outcomes. Full article

Background/Objectives: Depression is common in young doctors. Religion/spirituality, vocation, and family might protect against it. The objective of this study was to evaluate mental health, spirituality, and flourishing (a multi-dimensional assessment of well-being) in new medical residents. We also evaluated the associations of baseline characteristics with flourishing. Methods: We conducted a cross-sectional survey in 743 new medical residents who responded to (1) a questionnaire addressing mental health, vocation, spirituality, family, and religion and (2) the “Secure Flourish Index”, which assesses happiness/life satisfaction, physical/mental health, meaning/purpose, character/virtue, social relationships, and financial/material stability. Results: The mean age was 25.7 ± 4.0, and 526 (70.8%) were females, 157 (21.1%) had felt depressed, and 22 (3.0%) had suicidal ideation. The mean values for assessments of vocation and family were very high (>9.2), while religion and spirituality had intermediate values (5.2–6.5). Participants with depression or suicidal ideation had lower assessments in all four of the aforementioned domains, although differences were only significant for depression–religion (p = 0.03). The average “Secure Flourish Index” was 8.2 ± 0.9. There were lower levels of flourishing in males and in those with depression or suicidal ideation, with p-values < 0.001. Flourishing had a correlation with vocation and family (with r-values of 0.3–0.4) and with spirituality and religion (with r-values of 0.25–0.27), with p-values ≤ 0.001. Conclusions: Resident well-being is critical for physicians and healthcare quality. Spirituality and religion may serve as a protective resource, enhancing flourishing. Our study shows that new medical residents seem to have high value assessments for vocation and family importance and intermediate values for religion and spirituality. The mean flourishing scores were high, but were lower in males and in those with depression. Flourishing seems to be correlated with vocation, family, spirituality, and religion, but these associations need to be confirmed with validated screening tools. Full article

Background/Objectives: Schizophrenia is associated with cognitive deficits that may compromise everyday functioning, including driving. This review systematically examined recent original research (2015–2025) on driving performance in individuals with schizophrenia with a focus on neuropsychological factors, applying a narrative synthesis given the heterogeneity of designs and outcomes, while no quantitative meta-analysis was feasible. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a structured search of PubMed and Scopus was conducted on 4 May 2025. The inclusion criteria were original studies involving individuals diagnosed with schizophrenia, published between 2015 and 2025. Studies on animals, other psychiatric or neurological conditions, and healthy populations were also excluded. Critical appraisal was performed using the Joanna Briggs Institute (JBI) tools. Extracted data included sample demographics, cognitive deficits, neuropsychological assessments, brain imaging, and the main findings. A narrative synthesis was then performed. Results: Six high-quality studies met the inclusion criteria. Findings were grouped into three categories: (1) driving behavior: fitness to drive varied widely across individuals, (2) cognitive deficits and brain activity: poorer driving-related performance was consistently associated with specific impairments in cognition and brain structure, and (3) medication effects: individuals taking certain atypical antipsychotics demonstrated better driving performance compared to those on other types of medication, while extrapyramidal symptoms negatively influenced driving fitness. Conclusions: Driving in schizophrenia is shaped by cognitive, clinical, and pharmacological factors. These findings highlight the clinical relevance of individualized evaluations, integration into personalized care and targeted rehabilitation to promote driving autonomy and community inclusion. This area remains under-researched, as only six studies met the inclusion criteria, which restricts the robustness and generalizability of the conclusions. Funding: This review received no funding from any external sources. Registration: The review protocol was submitted to PROSPERO (International Prospective Register of Systematic Reviews) under registration number CRD420251060580. Full article

Background/Objectives: The aim of this study was to evaluate the correlation between the visual curve (ViC) and Area of the Curve (AoC) indices and the subjective perception of vision-related quality of life in patients who had undergone pseudophakic presbyopia correction. The central hypothesis was that AoC indices would show stronger correlations with vision-specific quality-of-life measures than single-point visual acuity (VA) assessments. Methods: A total of 100 patients who underwent bilateral pseudophakic presbyopia correction at the University Hospital of Alexandroupolis, Greece, were included in the study. Six months following surgery, visual acuity was assessed at nine distances using the DDART tool. The AoC was calculated using VA data from four, five, six, and nine distances, and further categorized into Near Vision AoC (AoCN) and Distance Vision AoC (AoCD). Participants also completed the NEI-VFQ-25 questionnaire to evaluate their subjective vision-related quality of life. Results: Statistically significant correlations were observed between AoC values and NEI-VFQ-25 total scores (r = 0.668–0.682, p < 0.001), near activity subscale scores (r = 0.656–0.686, p < 0.001), and distance activity subscale scores (r = 0.733–0.758, p < 0.001). In all analyses, the AoC indices derived from ViC demonstrated stronger correlations with quality-of-life scores than those observed with AoC-derived DCT and single VA measurements, even when the AoC was computed using only four measurement points. Conclusions: The AoC metric is a superior indicator of vision-specific quality of life compared to isolated VA measurements. AoC effectively captures the multifaceted nature of functional vision following presbyopia correction. Full article

Background/Objectives: Shift work among nurses is associated with adverse outcomes, such as low job satisfaction, reduced quality of life, and high turnover intention. A pattern-based shift system has recently been introduced to provide more predictable and regular schedules. However, empirical research directly comparing the pattern-based shift system with traditional rotating shifts is lacking. Therefore, this study compared job satisfaction, quality of life, and turnover intention between nurses working under a pattern-based shift system and those working under a traditional rotating shift system. Methods: In total, 112 nurses (56 on a rotating shift and 56 on a pattern-based shift) were surveyed in this cross-sectional study. Job satisfaction was assessed using the Job Satisfaction Scale for Clinical Nurses, specifically developed for Korean nurses. Quality of life was measured using the Scale for Korean Adults’ Quality of Life. The Turnover Intention Measurement Tool, developed for Korean nurses, was used to evaluate turnover intention. Results: Nurses working under a pattern-based shift system reported significantly higher job satisfaction and quality of life than those in a traditional rotating shift system. No significant difference in turnover intention was observed between the two groups. Conclusions: Pattern-based shift systems were associated with higher job satisfaction and quality of life than traditional rotating shift systems; however, their impact on turnover intention was not significant. These findings highlight the need for comprehensive strategies in scheduling reform, as schedule predictability may improve nurses’ job satisfaction and quality of life but appears insufficient to reduce turnover intention, which is likely shaped by broader organizational and psychosocial factors. Full article

This study aims to investigate the impact of digital transformation on corporate tax avoidance. In fact, this revolution has pervasively affected firms in different aspects and represents a significant opportunity to modernize their internal processes, bringing alongside a set of challenges that they must overcome. One hypothesis posits that digitalization enhances information transparency and internal control, reducing tax avoidance, while the other one suggests that the increase in digitalization leads to more complex and opaque transactions, leaving avenues for more aggressive tax strategies. This paper uses data of listed firms in the Casablanca Stock Exchange from 2020 to 2024, excluding the financial sector due to its specific tax regulation, leaving a final sample of 56 companies and 272 firm-year observations. It applies an OLS regression to assess the relation between the two variables, controlling for a set of firm and governance characteristics. The aim of the article is to address the scholarly debate by providing insights into an emerging economy where there is little research on the subject. The findings reveal that digital transformation contributes to the decrease in corporate tax avoidance in conjunction with governance variables like the presence of independent directors on the board and the duality of a CEO position, strongly supporting the first hypothesis. Notably, the OLS regression results show that an increase in digitalization by 1 point is associated with a decrease of 40.4755 in the book-tax differences, significant at the 5% level. The results provide high support for firms to invest in technologies in order to optimize their internal processes and improve their data quality; it also calls for tax authorities to strengthen their digital audit capacities and integrate data-driven tools to detect and interpret signals of potential tax-aggressive strategies. Full article

Background: Deep infiltrating endometriosis (DIE) frequently affects the posterior pelvic compartment, where accurate non-invasive imaging is essential for diagnosis and surgical planning. Aim: This systematic review evaluates the diagnostic performance of transvaginal ultrasound (TVUS) in detecting posterior compartment DIE, specifically rectosigmoid lesions, uterosacral ligament involvement, and pouch of Douglas obliteration. Material and Methods: A comprehensive literature search of PubMed, Scopus, and Web of Science was performed for studies published between 2015 and 2025. Eligible studies assessed the accuracy of TVUS for posterior compartment DIE using laparoscopy and histology as reference standards. Data on sensitivity, specificity, and overall diagnostic accuracy were extracted or derived. The study’s quality was evaluated using the QUADAS-2 tool. Results: Thirty eligible studies were included. The mean sensitivities and specificities reported in the included studies reached 83.05% and 90.53% for rectosigmoid disease, 78.07% and 90.49% for uterosacral ligament involvement, and 79.58% and 89.75% for pouch of Douglas obliteration, respectively. Adjunctive techniques such as gel sonovaginography, rectal water contrast, or saline instillation into the pouch of Douglas were described, but their use was inconsistent. Marked heterogeneity in patient preparation, scanning protocols, and reporting limited comparability across studies. Despite this, TVUS demonstrated diagnostic performance within a similar range to that reported for MRI in prior systematic reviews, with the advantages of lower cost, accessibility, and integration into routine gynecological practice. Conclusions: TVUS is consistently reported as a reliable and cost-effective imaging modality and, in line with international guidelines, should be considered the first-line option for posterior compartment DIE, though further standardization of scanning and reporting protocols is needed to optimize reproducibility and clinical utility. Full article

Hyaluronic acid (HA) fillers and botulinum toxin remain among the most frequently requested non-surgical esthetic procedures, due to their favorable safety profile and ability to restore volume and improve skin quality. However, variability in product performance and the lack of objective measurement tools remain challenges in clinical practice. This prospective, single-arm, non-randomized pilot study aimed to assess the esthetic efficacy, tolerability, and duration of effect of Sofiderm^® HA fillers in Caucasian patients with signs of facial aging, and to explore the correlation between subjective visual grading and instrumental imaging outcomes. Five patients with Griffiths photoaging scores ranging from 4 to 8 were treated with different Sofiderm^® formulations. Standardized evaluations were performed at baseline, 2 months, and 9 months using VISIA-CR and PRIMOS 3D optical profilometry. All subjects experienced measurable improvements, with an average 2-point reduction in Griffiths scores at 2 months, maintained at 9 months in most cases. Objective imaging data confirmed enhancements in volume, texture, and surface regularity. No serious adverse events occurred. These findings suggest that Sofiderm^® fillers may offer sustained esthetic benefits with a favorable safety profile and demonstrate how integrated digital imaging can enhance treatment evaluation in esthetic dermatology. Full article

Background & Aim: Malnutrition and frailty are prevalent among older adults following discharge from acute care, including emergency departments. This transition period presents a critical window for targeted nutrition interventions. This systematic review synthesises evidence on the effectiveness of nutrition interventions for malnourished, frail older adults and incorporates analyses of stakeholders’ perspectives, including those of patients, caregivers, and healthcare professionals. By integrating clinical outcomes with stakeholder experiences, the review aims to identify strategies that can optimise nutritional care and support recovery in the post-acute setting. Methods: Searches were conducted in Scopus, CINAHL, EBSCO, EMBASE, and PubMed for randomised controlled trials (RCTs) of nutrition interventions in participants ≥65 years living with frailty and identified as malnourished on discharge from acute care. The primary outcome was assessing the effects of nutrition interventions on malnutrition, nutrition status, physical function and frailty, food intake, and quality of life. Secondary outcomes were hospital readmission and mortality. The quality of studies was assessed using the Cochrane Risk of Bias Tool (V2). Results: Five RCTs with 551 participants were included. Nutrition interventions, including counselling, oral nutrition supplements, and multidisciplinary strategies, improved dietary intake, weight, frailty, physical function, BMI, and quality of life in older adults post-discharge. Some studies also reported reduced hospital stays, readmissions, and mortality. However, none explored stakeholder perspectives, highlighting a gap in person-centred transitional care design. Conclusion: This systematic review highlights a critical gap in evidence for nutrition interventions targeting frail older adults at hospital discharge. While short-term benefits were observed, long-term sustainability and real-world feasibility remain uncertain. The absence of stakeholder involvement further limits person-centred design. These findings underscore the need for integrated nutrition care pathways that embed effective interventions into transitional care models. Full article

The accurate calibration of radiochromic films is critical for high dose rate (HDR) brachytherapy dosimetry. Conventional workflows frequently rely on manually determined regions of interest (ROIs), which might increase operator variability. In this investigation, Gafchromic EBT3 films were irradiated under clinical settings at nominal doses of 0–10 Gy and evaluated using a MATLAB (R2024b)-based tool that allows for both manual and automated ROI selection. The calibration curves were modeled with a second-order polynomial and rational model, and performance was assessed using statistical measures. The study found that the rational model fits better than the polynomial model. Additionally, the automatic ROI approach outperformed the manual method in both models, resulting in higher calibration accuracy and reproducibility (R² = 0.999, RMSE = 0.118 Gy, MAE = 0.103 Gy vs. R² = 0.986, RMSE = 0.448 Gy, MAE = 0.388 Gy). Although manual ROI occasionally produced greater dose–response slopes at higher doses, it was more susceptible to operator bias and film non-uniformity. In contrast, automatic ROI reduced variability by consistently picking homogeneous sections, resulting in steady curve fitting across the entire dose range. Furthermore, a companion module transformed calibrated films into 2D false-color maps and 3D dosage surfaces, allowing for visual assessment of dose uniformity, detection of scanner-related aberrations, and quantitative verification for quality assurance. These findings demonstrate that automated ROI selection provides a more stable and reproducible foundation for film calibration in HDR brachytherapy, minimizing operator dependency while facilitating routine clinical quality assurance. Full article

Objectives: Chronic pain corresponds to hypersensitivity to painful stimuli; however, its relation to acute pain sensitivity in children is poorly understood. We explored this relationship by comparing acute and chronic pain measures, along with related factors, in children with chronic pain syndromes versus controls, before and after therapeutic intervention. Methods: This prospective controlled cohort study involved 57 children with chronic pain undergoing intensive interdisciplinary pain treatment in a hospital-based pain rehabilitation program and 50 controls. Participants, aged 7–18, were tested using a cold pressor task (CPT) at admission, discharge, and first follow-up visit. Data on sleep, anxiety, psychological distress, functional impairment, and pain were collected. Results: Significant differences were found between control and treatment groups in average pain threshold (p < 0.001), pain tolerance (p = 0.035), sleep visual analog scale (VAS) (p < 0.001), functional disability inventory (p < 0.001), patient reported outcomes information system anxiety assessment tool (p < 0.001), general anxiety disorder 7-item scale (p < 0.001), pain VAS (p < 0.001) and total brief symptom inventory (BSI) (p < 0.001) scores at admission with children with chronic pain scoring worse on all measures save the pain VAS during the CPT. After treatment and at follow-up, function and mental health measures improved but not acute pain threshold. Conclusions: At treatment completion, function and mental health significantly improved but acute pain threshold and sleep quality were unchanged. These findings suggest that while chronic pain treatment improves overall function and mental health, acute pain thresholds may not be a suitable indicator for evaluating the efficacy of interventions. Full article