Search Results (9,305)

Waste pollution is becoming a major health issue in many developing nations. Waste-reduction options have been investigated and proposed, but environmental culture-based initiatives have not. This study explores and advances Vietnamese families’ environmental culture related to waste management, using the Culture Tower framework and a contingent valuation method coupled with a Bayesian model (CVBM). Specifically, descriptive statistics measure environmental literacy, while CVBM determines household willingness-to-pay (WTP) and estimates WTP for waste treatment services (WTP4WTS). Based on our survey of 487 households across 11 communes and wards in Hai Phong City, local waste pollution has decreased over time, although the respondents remain concerned. Over 13% of households were dissatisfied with waste treatment services (WTSs), while approximately 50% were neutral. Most respondents (79.26%) were willing to pay for improved WTSs, with an average WTP of 60,200 VND (US$2.32) per household per month. Behavioral and perceptual factors, such as the desire for improved waste services, current perceived waste pollution, and the perception that pollution has worsened, were found to significantly influence this willingness. Our study makes three major contributions. First, it develops a novel CVBM framework that links environmental culture and an economic valuation method, strengthening green economy micro-behavioral research. Second, it advances the circular economy literature by highlighting household engagement and willingness-to-pay as key drivers of sustainable waste financing and resource-loop closure. Third, it provides empirical evidence to inform and refine Vietnam’s revised Law on Environmental Protection (2020), particularly in implementing the “polluter pays” principle, promoting waste classification at the source, and designing socially acceptable environmental financing mechanisms. Full article

Cosmology is living through fascinating times, where new observations from ground and space telescopes are questioning the established paradigm, the so-called $\mathsf{\Lambda }$ Cold Dark Matter model. The particle nature of Dark Matter is severely constrained by underground experiments, while recent observations by galaxy surveys indicate that the cosmological constant ($\mathsf{\Lambda }$) may not be constant after all. Furthermore, observations at high redshift of fully formed galaxies with massive black holes at their centers by the James Webb Space Telescope, as well as black holes with unexpected properties observed by the LIGO-Virgo gravitational wave detectors, are driving an in-depth revision of our assumptions in models of structure formation and the evolution of the Universe. I propose exploring two new paradigms to account for Dark Matter and Dark Energy, based on known physics, without introducing new particles into the Standard Model of Particle Physics. I will extend the primordial spectrum of fluctuations to small scales with new statistical properties to provide a viable Primordial Black Hole scenario for Dark Matter, and will include non-equilibrium thermodynamics in the expanding Universe, in the form of General Relativistic Entropic Acceleration, to explain Dark Energy. My proposal could provide a unified explanation for a plethora of interrelated multi-epoch, multi-scale, and multi-probe observations from present and future Gravitational Wave detectors, Large Scale Structure observatories, and Cosmic Microwave Background experiments. It emphasizes the need to develop new theoretical ideas hand-in-hand with observations to acquire a deeper understanding of our universe. If these ideas are correct, they will open a new window into the early universe and a new fundamental understanding of gravity in the late universe. Full article

Large infrastructure projects frequently experience schedule slippage and cost escalation; however, time–cost planning still relies on expert-assigned activity parameters that fail to reflect the variability induced by construction modes, resource supply, and on-site conditions. This study focuses on activity-level multi-mode time–cost trade-off planning and its dynamic correction during project execution. The proposed methodology is intended for project-level short-term operational scheduling and rolling re-scheduling within a finite project execution horizon, rather than long-term strategic or portfolio-level scheduling. A predict–optimize–update framework is proposed, where light gradient boosting machine (LightGBM) is employed to predict the duration and direct cost of activity–mode pairs using unified features extracted from BIM/IFC records, schedule-resource ledgers, and cost-settlement data, covering engineering quantities, mode and resource decisions, and contextual factors. These predicted parameters are then fed into a time-indexed bi-objective mixed-integer linear program (MILP), which minimizes both project makespan and total cost (including indirect cost) to generate an interpretable Pareto frontier via a weighted-sum approach. Meanwhile, real-time monitoring updates refresh the predictors and re-solve the remaining project network to ensure dynamic adaptability. Validated on a desensitized proprietary enterprise multi-source dataset comprising 25 completed infrastructure projects and 5258 activity–mode samples, the proposed method achieves a mean absolute error (MAE) of 2.7 days and a coefficient of determination (R²) of 0.89 for duration prediction, as well as an MAE of 7.4 × 10⁴ CNY and an R² of 0.91 for direct-cost prediction. The generated Pareto set exhibits a diminishing return trend: as the project duration is relaxed from 101 to 146 days, the total cost decreases from 45.10 to 40.27 million CNY. A weather-triggered update case demonstrates that the completion forecast is revised from 133 to 128 days, with the total cost reduced from 53.05 to 52.75 million CNY. This framework enables explainable schedule–cost co-control, thereby effectively aiding decision-making for the planning and control of large infrastructure projects. Full article

Background: Disseminated coccidioidomycosis (DCM) often requires prolonged antifungal therapy (AFT). Real-world data on AFT duration in DCM are limited. We evaluated time to AFT discontinuation among patients with DCM in the United States clinical practice. Methods: This retrospective, longitudinal study used STATinMED data (2016–2024). Patients had ≥1 International Classification of Diseases, Tenth Revision (ICD-10) code for DCM (B38.3, B38.4, B38.7, B38.81) during January 2017–December 2023, ≥1 claim for a triazole or amphotericin B within 21 days of the DCM diagnosis (index date), and continuous medical/pharmacy coverage during the 6-month baseline period. Discontinuation was defined as a ≥21-day gap without AFT. Antifungal agent/formulation switches were not considered discontinuations unless accompanied by a qualifying gap. The Kaplan–Meier methods were used to estimate time to discontinuation. Results: We identified 991 patients with DCM. Median age was 52 years (IQR 36, 65); 60.0% were men. Most resided in California (42.8%) or Arizona (33.6%). Initial AFT consisted predominantly of triazoles (96.8%), primarily fluconazole (83.2%). Discontinuation occurred in 27.6%, 40.0%, 54.2%, and 68.0% of patients by 3, 6, 12, and 36 months. Median AFT duration was 9.9 months. Conclusions: In a large US claims cohort, there was substantial variability in AFT duration in routine practice. Many patients had AFT durations under the lower limit of guideline recommendations for DCM, suggesting potential under-treatment, though appropriate clinical justifications may have existed. Full article

Background: Achondroplasia, the most common genetic dwarfism caused by the FGFR3 mutation (autosomal dominant, 80% de novo), results in a disproportionately short stature. Thoracolumbar kyphosis (TLK), combined with characteristic spinal canal stenosis, increases the risk of symptomatic compression, yet the literature lacks clear thresholds for symptom onset or progressive deformity angles. Methods: A 16-year-old female with achondroplasia presented with rapidly progressive kyphosis despite conservative management (bracing and therapy). Over six months, she developed neurogenic claudication; bilateral leg pain; weakness; and paresthesia that worsened with standing/walking, which was relieved by flexion/sitting. Imaging demonstrated surgical-threshold kyphosis with progressive spinal misalignment. Her symptoms indicated compressive myeloradiculopathy from lumbar stenosis, critical given achondroplasia’s congenitally narrowed canal and heightened neurologic vulnerability. Results: Staged surgery planned: Posterior fusion T6-L4 with pedicle screws and then extensive decompression (laminectomy/foraminotomy T11-L3), L1 corpectomy with expandable titanium cage, and Ponte osteotomies. Intraoperative complications included a malpositioned left T10 screw breaching the anterior/lateral cortex near the aorta, requiring urgent revision. Postoperatively: Neurogenic bladder, wound leakage, and E. coli urinary tract infection (UTI) with fever (treated with IV antibiotics). After infection resolution, definitive surgery removed the malpositioned screw and completed decompression, corpectomy, cage placement, bone grafting, and osteotomies, successfully resolving neurological symptoms. However, 13 cm trunk lengthening caused severe functional impairment—disproportionately short arms prevented independent toileting and dressing. Left arm lengthening via external fixation restored partial function. At 2.5-year follow-up, there was solid fusion, no neurological deficits, and improved quality of life. Conclusions: Surgery addresses severe TLK, vertebral wedging, and neurogenic claudication in achondroplasia. Vertebral column resection effectively corrects TLK and neurological deficits but carries a high complication risk. This should be reserved for severe TLK with hypoplastic vertebrae, performed by experienced surgeons. Critically, correction magnitude must preserve limb–trunk proportions to prevent functional disability, as excessive lengthening may necessitate additional limb procedures for independence restoration. Full article

Common bunt of wheat (Tilletia spp.) remains a significant threat to wheat production in low-input and organic farming systems, where chemical seed treatments are restricted or avoided. Host resistance represents a key component of sustainable disease control, but its effective deployment requires detailed knowledge of race-specific virulence and the genetic basis of resistance. In this study, we analysed the reaction of a large and diverse wheat germplasm collection to current European populations of common bunt and mapped the underlying resistance genes using SNP-based approaches. A total of 2731 wheat accessions were phenotyped from 2012 to 2025 using up to 42 purified bunt races with well-defined virulence profiles. Based on phenotypic responses to race-specific resistance patterns, accessions were grouped and compared with established differential lines. A total of 1504 selected accessions were genotyped using Illumina 26k SNP arrays, and resistance loci were identified by genome-wide association studies followed by fine mapping using recombination analysis. All classical Bt resistance genes from Bt1 to Bt10 and Bt13 and BtZ were mapped to defined physical intervals, and the genomic positions of 18 additional race-specific resistance genes were identified in a panel of germplasm. Our results confirm that several historically defined Bt genes, including Bt11 and Bt12, represent multi-gene resistance complexes rather than single loci. Also, genes established as separate genes may possibly be identical, including Bt4 being identical to Bt6, Bt10 being identical to BtZ, and Bt9 possibly being identical to one of the genes in the Bt11 complex. These findings highlight the need for a revised nomenclature of genes and a differential set of varieties. The identified resistance haplotypes provide an improved tool for marker-assisted selection and support the development of wheat cultivars with durable resistance to common bunt. Full article

Background: Rome IV criteria promote a symptom-based (“positive”) diagnosis of pediatric disorders of gut–brain interaction (DGBIs). In clinical practice, however, organic gastrointestinal diseases may mimic DGBIs and lead to diagnostic revision after further evaluation. We aimed to quantify the diagnostic stability of an initial Rome IV-oriented functional diagnosis in a tertiary pediatric outpatient setting and to identify symptom phenotypes associated with a higher likelihood of later organic reclassification. Methods: We performed a single-center retrospective cohort study (2014–14 May 2021) based on outpatient chart review. Eligible patients were children and adolescents aged 0–18 years with an initial Rome IV-oriented functional diagnosis. Diagnostic reassessment was based on follow-up data, available laboratory and instrumental investigations, and/or response to exclusion therapies. Final diagnoses after reassessment were categorized as functional only, organic, or mixed. Groups were compared using Pearson’s chi-square test. Results: The cohort included 220 males (50.0%) and 220 females (50.0%), with a mean age of 8.86 ± 4.65 years. After reassessment, 343/440 (77.95%) remained functional, 73/440 (16.59%) were reclassified as organic, and 24/440 (5.45%) were classified as mixed. Final diagnosis differed by GI tract involvement (p = 0.001) and by symptom cluster (p = 0.001). Upper GI/dyspepsia-spectrum presentations showed the highest organic yield (27.03%), followed by lower abdominal pain/IBS-spectrum presentations (19.61%). Diarrhea and vomiting/cyclic vomiting each showed 16.67% organic diagnoses (mixed: 10.0% and 7.14%, respectively), whereas constipation showed the greatest diagnostic stability (98.89% functional; 1.11% organic). Functional confirmation rates were similar before and during the pandemic (77.71% vs. 78.70%; p = 0.756). Monthly case volume was higher in 2020–2021 (6.29 vs. 4.61 cases/month). Conclusions: In this tertiary cohort, about one in six children initially diagnosed with a functional disorder were later found to have an organic disease, and an additional 5% had mixed organic–functional presentations. Diagnostic revision was associated with presenting phenotype, with the highest organic yield observed in dyspepsia/upper GI presentations and the lowest in constipation. These findings support symptom-stratified evaluation and follow-up alongside Rome IV criteria. Full article

Background: Total hip arthroplasty (THA) for the late sequelae of childhood septic hip arthritis is technically demanding, and infection-related risk remains incompletely defined. This systematic review and meta-analysis address the research question: “In adults undergoing THA after childhood septic arthritis of the hip, what is the incidence of post-THA infection, revision, and mechanical/neurologic complications?” We systematically reviewed and meta-analyzed outcomes after THA in patients with septic hip arthritis diagnosed at ≤18 years. Methods: PubMed, Web of Science, Scopus, and the Cochrane Library were searched from inception to 31 December 2025 (PRISMA). Eligible studies reported THA outcomes after childhood septic arthritis and met a Methodological Index for Non-Randomized Studies (MINORS) threshold (≥9). A random-effects meta-analysis of events per hip was performed. Results: Nine studies were included; eight contributed to the quantitative synthesis (343 hips). The pooled incidence of any post-THA infection was 1.55% (95% CI 0.38–3.48; I² = 23.8%; 5/343); when microbiology was available, no relapse due to the index organism was reported and events were classified as new infections. The pooled incidence of revision for any cause was 4.99% (95% CI 2.27–8.70; I² = 43.4%; 15/334). Non-infectious complications were clinically relevant, including intraoperative fracture (6.95%) and nerve palsy (4.84%). Evidence was limited by retrospective designs and heterogeneous reporting. Conclusions: THA after childhood septic hip arthritis demonstrates a low risk of postoperative infection, with relapse of the original pathogen appearing rare in carefully selected quiescent cases, but a clinically meaningful burden of mechanical and neurologic complications. These findings underscore the importance of careful preoperative assessment, meticulous surgical technique, and highlight the limitations of the current evidence. The protocol was registered in PROSPERO (ID: CRD420261298181). No external funding was received. Full article

A homologous classification for vespid venoms is missing. This study compared Polistes dominula and Vespula spp. venoms to evaluate their homology level. P. dominula and Vespula spp. extracts, including V. germanica, V. maculifrons, V. pensylvanica, V. alascensis, and V. squamosa in equal proportions, were generated from venom sacs and were subjected to sodium dodecyl sulfate–polyacrylamide gel electrophoresis (SDS-PAGE) and Western blot using Vespula-positive sera. Bands described as allergenic were excised and sequenced through Liquid Chromatography–Mass Spectrometry tandem analysis (LC-MS/MS) to confirm their identity. Phospholipase (group 1) and hyaluronidase (group 2) enzymatic activities were measured. Group 1 and 5 3-D structures and sequence identity were analyzed in silico. The results showed that the P. dominula and Vespula spp. venom extracts exhibit similar protein profiles and comparable allergen composition, with phospholipase and hyaluronidase activities. The structures of Pol d 1 and Ves v 1 and Pol d 5 and Ves v 5 were highly similar, and the identity levels were high across and within the Polistes and Vespula genera (≥50%). These results suggest the inclusion of venoms from Polistes and Vespula genera as candidates to create a new homologous group for wasp venoms and indicate that the currently described homologous groups require revision. Full article

The reconstruction of complex orbitomaxillary defects requires biomaterials that can simultaneously provide structural stability, biocompatibility, and accurate restoration of facial volume and contour. While rigid polymers such as polyetheretherketone (PEEK) offer reliable mechanical support, they do not adequately replicate the viscoelastic behavior of soft tissues. This report presents a translational revision case employing a personalized hybrid biomaterial approach that combines a 3D-printed PEEK implant for structural orbital floor support with a patient-specific polydimethylsiloxane (PDMS) implant for malar volumetric augmentation. Reconstruction was planned using CT segmentation and contralateral mirroring. Patient-specific implants were subsequently designed using CAD/CAM techniques, combining a rigid PEEK implant for structural orbital support with a flexible PDMS implant for malar volumetric augmentation with complementary mechanical properties. Revision surgery included the removal of inadequately positioned titanium hardware, the release of incarcerated extraocular muscles, and the restoration of orbital anatomy and facial symmetry. Postoperative imaging demonstrated stable implant positioning and sustained orbitomaxillary stability. Despite successful anatomical reconstruction, residual functional sequelae, including strabismus related to the severity of the initial orbital trauma, persisted and were addressed separately in a staged manner, resulting in satisfactory ocular alignment and resolution of diplopia in primary gaze. This case underscores the complementary functional roles of rigid and elastic polymers and highlights the translational potential of PDMS as a permanent, patient-specific implant material for volumetric and contour restoration in craniofacial reconstruction. Full article

Background/Objectives: Nipple-sparing mastectomy with immediate reconstruction is a preferred option for selected patients undergoing prophylactic or therapeutic mastectomy. Optimizing postoperative wound care is essential to support healing, preserve the nipple–areola complex, and prevent delays in oncologic treatments. This retrospective observational study aimed to evaluate the clinical outcomes associated with the use of the NovoX^® Cup medical device in post-NSM surgical wound management, assessing clinical–surgical outcomes and quality of life (QoL). Methods: We conducted a retrospective observational study on 54 patients who underwent NSM with immediate reconstruction at AOUI Verona between January 2025 and January 2026; Novox^® Cup was applied intraoperatively and changed every 48 h according to protocol. Surgeon-reported outcomes were assessed by the skin flap viability scale and the complications by Clavien–Dindo classification. Patient-reported outcomes were assessed via the Wound-QoL17 questionnaire at 7, 30, and 90 days. Clinical outcomes were supported by photographic documentation. Results: Mean age was 51.5 years; BMI averaged 23.9 kg/m². Local complications occurred in 30.4% of cases (infections 12%, dehiscence 10%, seromas 4%). Mean healing time was 15 days, with 87.4% of patients having drains removed by day 14. One patient required surgical revision, and one (1.8%) experienced delayed adjuvant therapy. Wound-QoL17 responses showed minimal discomfort and high satisfaction. Clinical evaluation revealed favorable wound appearance and preserved NAC perfusion within 48 h. Conclusions: Novox^® Cup appears effective in supporting wound healing and NAC preservation after NSM, with high patient satisfaction and minimal treatment delays. Its integration into postoperative care may enhance outcomes and maintain oncologic timelines. Full article

Water scarcity and pollution from anthropogenic activities are major challenges, increasing the need for sustainable wastewater treatment solutions. Constructed wetlands mimic natural wetland ecosystems using macrophytes and substrates, representing a possible nature-based solution aligned with circular economy principles and the United Nations Sustainable Development Goals. So, this revision integrates recent literature, providing an overview of natural wetlands and examining the design and operation of constructed wetland systems. Also, incorporates a case study that focuses on a constructed wetland implemented at an eco-friendly dog shelter in Portugal—a unique example globally—demonstrating practical wastewater treatment and small-scale water reuse, and offering insights for sustainable management. Performance assessment based on previous work indicates that the system effectively reduces most water quality parameters to levels compliant with national and European irrigation standards. Removal efficiencies exceeded 97% for chemical oxygen demand, total suspended solids, and turbidity, while maintaining low energy consumption and minimal maintenance. Overall, constructed wetlands emerge as a sustainable alternative to conventional wastewater treatment systems; however, several challenges remain to be addressed. Future research should focus on improved aeration strategies, optimized substrate–macrophyte combinations, and long-term monitoring under climate variability, with floating wetlands offering promising opportunities to further enhance treatment efficiency. Full article

Background: Family caregivers remain closely involved in communication, care planning, and shared decision-making in long-term care (LTC) facilities. In this context, the quality of the relationship between family caregivers and professional staff may influence trust, collaboration, and satisfaction with care. However, few instruments have been specifically adapted to assess caregiver–staff relationship quality in Taiwanese LTC settings. Objectives: This study aimed to culturally adapt and preliminarily validate the Family Caregiver Relationship Quality (FCRQ) Scale for use in Taiwanese LTC facilities. Methods: A cross-sectional psychometric validation study was conducted with 205 primary family caregivers recruited from 20 LTC facilities in Taiwan. The original Relationship Quality Scale was adapted to the LTC context through contextual revision, expert review, bilingual verification, and pilot testing. Psychometric evaluation included confirmatory factor analysis, internal consistency assessment, convergent validity, and structural equation modelling with Bollen–Stine bootstrap correction to address potential non-normality. Results: The initial 16-item model required refinement, and three items with low standardized factor loadings were removed. The revised 13-item model met the prespecified fit criteria and showed acceptable internal consistency and convergent validity. The retained items reflected three conceptually related domains of relationship quality: trust, commitment, and satisfaction. Overall, the findings provided preliminary psychometric support for the adapted scale in Taiwanese LTC settings. Conclusions: The adapted FCRQ Scale may be a useful tool for assessing caregiver–staff relationship quality in Taiwanese long-term care facilities, particularly in the context of shared decision-making and family-centred care. Nevertheless, the findings should be interpreted as preliminary, and further validation in larger and more diverse samples is needed before broader clinical or research application. Full article

This study investigated the effects of computer-assisted writing on the written language production of secondary school students with Specific Learning Difficulties (SLD), particularly dyslexia. Writing is a complex cognitive process requiring the coordination of spelling, lexical retrieval, syntactic organization, transcription, and revision, areas in which students with SLD often experience persistent difficulties. The study compared handwritten and computer-based texts produced by 40 students with SLD and 20 students without learning difficulties using a counterbalanced design, with an interval of approximately two weeks between the two writing sessions. In the handwriting condition, students used printed reference materials, whereas in the computer-based condition they had access to general-purpose digital tools, including spell-checkers, electronic dictionaries, online resources, and word-processing software. Written texts were evaluated using the Spelling Accuracy Index and holistic scores assigned by independent raters. Data were analyzed using descriptive statistics and non-parametric tests (Mann–Whitney U and Wilcoxon signed-rank tests). The findings revealed statistically significant improvements in favor of computer-based writing for both groups, with particularly strong gains among students with SLD. Computer-written texts demonstrated higher spelling accuracy and received higher evaluation scores, indicating improved performance in the assessed writing outcomes. The findings suggest that computer-assisted writing may support written language production in secondary school students with SLD, particularly in relation to spelling accuracy and overall text evaluation, and may offer a useful avenue for more inclusive writing instruction. Full article

Staff retention and functional teamwork are major challenges in Early Childhood Education and Care (ECEC), where leadership is increasingly viewed as a shared team-level process. This study investigates how team leadership (TL), conceptualised as the functions through which teams meet their needs, is enacted among Swedish ECEC staff and how it supports collaborative work under current policy conditions. Using a revised version of the Team Leadership Taxonomy. 122 ECEC professionals completed a survey with both quantitative items and open-ended responses. The results show patterns of strong strategic alignment, high awareness of pedagogical goals, and robust relational support within teams, but substantial variability in operational clarity, task distribution, problem-solving responsibility, and psychological safety. Participants described challenges linked to shifting team compositions, unequal pedagogical competence, and inconsistent organisational support from principals, which often constrained their ability to enact both positional and distributed leadership. Overall, the findings suggest that ECEC teams possess considerable capacity for collaborative leadership, yet uneven organisational conditions limit the consistency of TL functions. Strengthening role clarity, planning structures, and reflective routines may enhance team functioning and contribute to a more sustainable ECEC workforce. Full article