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25 pages, 523 KB  
Article
Artificial Intelligence Leadership and the Decoupling of Human Agency: Evidence of Misaligned Innovation in Agentic AI Systems
by Aleksandar Ignjatović Pertini and Aleksandra Vujko
Adm. Sci. 2026, 16(5), 239; https://doi.org/10.3390/admsci16050239 - 19 May 2026
Abstract
This study examines how artificial intelligence (AI) leadership reconfigures the relationship between technological systems, human capabilities, and innovation activity, focusing on the emergence of innovation processes that operate independently of human agency. Moving beyond dominant efficiency-oriented perspectives, it demonstrates that AI-driven leadership enables [...] Read more.
This study examines how artificial intelligence (AI) leadership reconfigures the relationship between technological systems, human capabilities, and innovation activity, focusing on the emergence of innovation processes that operate independently of human agency. Moving beyond dominant efficiency-oriented perspectives, it demonstrates that AI-driven leadership enables the decoupling of innovation from human capabilities, thereby generating governance risks in agentic AI environments. Drawing on a survey of 3079 respondents across industries and regions, the study employs exploratory and confirmatory factor analysis and structural equation modeling. The results show that AI leadership is associated with increased innovation activity while exerting a significant negative effect on human capabilities, with no significant relationship between human capabilities and innovation outcomes. The absence of mediation suggests that innovation outputs emerge independently of human input, reflecting structural misalignment rather than system-level efficiency gains. These findings indicate structural decoupling between human agency and innovation outcomes, with AI-enabled systems increasingly substituting for human capabilities, while human capabilities are progressively marginalized. The study reframes AI-driven innovation as a governance problem and introduces the AI–Human Alignment Diagnostic Scale (AI-HADS) as a structured approach to assessing misalignment. Full article
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11 pages, 1693 KB  
Case Report
Critical Role of Molecular-Based Stratification in Low-Risk Myelodysplastic Syndrome with Direct Progression to Acute Myeloid Leukemia: A Case Report
by Stejara Nicoleta Mihai, Denisa Dragu, Cristina Mambet, Anca Botezatu, Petruta Gurban, Laura G. Necula, Lilia Matei, Ana Iulia Neagu, Ioana Pitica, Marius Ataman, Saviana Nedeianu, Mihaela Chivu-Economescu, Coralia Bleotu, Catalina Roxana Grosu-Ferea, Cristina Ciufu, Carmen C. Diaconu and Ana Maria Vladareanu
Int. J. Mol. Sci. 2026, 27(10), 4557; https://doi.org/10.3390/ijms27104557 - 19 May 2026
Abstract
The genomic landscape of myelodysplastic syndromes/neoplasms (MDS), a heterogeneous group of myeloid malignancies defined by bone marrow cell dysplasia with ineffective hematopoiesis, includes somatic and, less frequently, germline mutations in hematopoietic stem and progenitor cells, along with chromosomal abnormalities. The latest World Health [...] Read more.
The genomic landscape of myelodysplastic syndromes/neoplasms (MDS), a heterogeneous group of myeloid malignancies defined by bone marrow cell dysplasia with ineffective hematopoiesis, includes somatic and, less frequently, germline mutations in hematopoietic stem and progenitor cells, along with chromosomal abnormalities. The latest World Health Organization 2022 classification of myeloid neoplasms, as well as stratification in lower-risk (LR) and higher-risk (HR) MDS using either the Revised International Prognostic Scoring System (IPSS-R) or the Molecular International Prognostic Scoring System (IPSS-M), guide prognostic assessment and risk-adjusted therapy. We report the case of an 81-year-old patient diagnosed with LR-MDS according to IPSS-R that exhibited direct progression to acute myeloid leukemia. The retrospective analysis of paired DNA samples from MDS and leukemic phases, obtained four months apart, using both targeted next-generation sequencing and single nucleotide polymorphism array, indicated swift alterations in the genomic profile, being suggested that the leukemic clone emerged from the clone harboring homozygous TET2 and heterozygous SRSF2 variants that acquired RUNX1, BCOR, BCORL1 likely pathogenic mutations and trisomy 13. By employing IPSS-M for prognostic evaluation at the MDS phase, the patient would have been assigned to the HR-MDS category with a possible benefit from hypomethylating agent therapy. Risk stratification is of pivotal importance in a patient-centered approach to MDS treatment being significantly improved by incorporating the molecular genetic findings. Full article
(This article belongs to the Special Issue Advances in Molecular Target and Anti-Cancer Therapies)
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32 pages, 11312 KB  
Article
Quantitative Analysis of NDVI Temporal Data Using Artificial Neural Networks: A Decision-Making Approach for Precision Agriculture
by Constantin Ilie, Margareta Ilie, Kamer Ainur Aivaz, Cristina Duhnea and Silvia Ghiță-Mitrescu
Mathematics 2026, 14(10), 1741; https://doi.org/10.3390/math14101741 - 19 May 2026
Abstract
The integration of quantitative mathematical methods and artificial intelligence into agricultural monitoring systems represents a critical pathway toward data-driven decision-making in the contemporary precision agriculture economy. This study applies mathematical modeling and quantitative analysis to temporal NDVI (Normalized Difference Vegetation Index) raster datasets [...] Read more.
The integration of quantitative mathematical methods and artificial intelligence into agricultural monitoring systems represents a critical pathway toward data-driven decision-making in the contemporary precision agriculture economy. This study applies mathematical modeling and quantitative analysis to temporal NDVI (Normalized Difference Vegetation Index) raster datasets from six agricultural parcels in the Dobrogea region of Romania (2017 growing season), with the objective of supporting agronomic performance evaluation and operational decision-making. Higher-order statistical descriptors—variance, kurtosis, and skewness—were extracted from XML raster files and subjected to comprehensive visual analytics using kernel density estimation, three-dimensional surface modeling, and polynomial regression in Python. A feedforward Artificial Neural Network (ANN) with a 4-15-9-3-1 architecture was trained under four activation function and solver combinations (tanh/ReLU × Adam/SGD) to classify satellite sensing-date authenticity (is_sensing_date), a key data-quality indicator for operational crop monitoring workflows. Permutation-based feature importance analysis confirmed that variance is the dominant mathematical predictor (~35.8%), followed by kurtosis (~31.5%) and skewness (~26.6%), while the temporal month variable contributed least (~6.1%). The tanh–SGD configuration yielded the best training–test error balance for most individual datasets, while tanh–Adam performed optimally on the combined dataset. The inverse mathematical relationship between variance and kurtosis, and the direct co-variation between kurtosis and skewness, were consistent across all parcels, demonstrating the universality of these quantitative patterns in agricultural remote sensing data. These findings establish a replicable mathematical modeling framework applicable to predictive analytics, risk assessment of data quality, and performance evaluation in agricultural decision-making systems, with direct relevance to digital transformation strategies in the agri-economy sector. Full article
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25 pages, 34945 KB  
Article
6PPDQ Exposure Exacerbates Seizure-Induced Neuronal Damage via the TP53/Nrf2 Axis: An Integrated Strategy Combining Network Toxicology and Experimental Validation
by Ruijin Xie, Wei Xiao, Hua Xu, Yufan Luo, Xue Xiao, Qiyang Pan, Shengjie Xu, Li Liu, Chenyu Sun and Yueying Liu
Toxics 2026, 14(5), 443; https://doi.org/10.3390/toxics14050443 - 19 May 2026
Abstract
As an emerging tire wear-derived environmental contaminant, 6PPD-quinone (6PPDQ) has raised significant concerns regarding its neurotoxic potential, particularly for children exposed to recycled tire crumb rubber in playgrounds. However, the molecular mechanisms by which 6PPDQ influences neurological disorders such as epilepsy remain poorly [...] Read more.
As an emerging tire wear-derived environmental contaminant, 6PPD-quinone (6PPDQ) has raised significant concerns regarding its neurotoxic potential, particularly for children exposed to recycled tire crumb rubber in playgrounds. However, the molecular mechanisms by which 6PPDQ influences neurological disorders such as epilepsy remain poorly understood. In this study, we employed an integrative framework combining network toxicology, bulk analysis of human epileptic brain tissues, Mendelian randomization, and molecular dynamics simulations to elucidate these mechanisms. Our findings, validated through CETSA-WB and SPR, identify 6PPDQ as a direct ligand that binds to and stabilizes neuronal TP53. Through a synergistic double-hit mechanism, 6PPDQ directly engages the TP53 pathway while simultaneously triggering microglial interleukin-6 secretion. These converging pathways lead to the suppression of the master antioxidant regulator Nrf2, resulting in glutathione depletion, excessive reactive oxygen species accumulation, and exacerbated neuronal damage under excitotoxic stress. Experimental validation using glutamate-induced HT22 cell models and microglia–neuron crosstalk systems confirmed that targeting the TP53/Nrf2 axis or scavenging ROS significantly attenuates 6PPDQ-induced neurotoxicity. Our findings highlight critical risks to pediatric neurological health posed by tire-derived contaminants and identify the TP53/Nrf2 axis as a promising therapeutic target. Furthermore, this work provides a robust scientific basis for refining risk assessment frameworks and developing regulatory strategies to mitigate environmental exposure to 6PPDQ. Full article
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17 pages, 1105 KB  
Article
Clinical and Operational Outcomes Associated with the Adoption of a Digital Wound Care Solution in Home Health Settings
by Heba Tallah Mohammed, Robert D. J. Fraser, Tameka McCabe and Amy Cassata
Healthcare 2026, 14(10), 1387; https://doi.org/10.3390/healthcare14101387 - 19 May 2026
Abstract
Introduction: Wounds increase the risk of hospitalization in home health (HH) settings by up to 52%. They also consume a notable portion of HH budgets due to frequent nursing visits for wound assessment and care. To address these challenges, a U.S.-based HH enterprise [...] Read more.
Introduction: Wounds increase the risk of hospitalization in home health (HH) settings by up to 52%. They also consume a notable portion of HH budgets due to frequent nursing visits for wound assessment and care. To address these challenges, a U.S.-based HH enterprise adopted a Digital Wound Care Solution (DWCS) to enhance wound management and operational efficiency. This study examines the impact of integrating the DWCS into practice, focusing on clinical and operational indicators and potential cost savings. Methods: This study employed a quasi-experimental pre–post design to evaluate the impact of the DWCS on clinical and operational outcomes. Data were extracted from the DWCS and EMR databases, encompassing pre-adoption (2022) and post-adoption (2023) periods. The analysis included wound data from 16,276 patients in 2023 and 19,252 patients in 2022, covering an 8-month period (March–October) across 11 branches. The key performance indicators included skilled nursing (SN) visits per episode (VPE), time to complete SN visits, hospitalization rates, and staff optimization. Results: The adoption of the DWCS was associated with clinical and operational improvements. SN VPE decreased by 7.5%, resulting in an estimated annual savings of $1.3 million. A directional change in wound-related hospitalization rates was observed at 30 days (20.7% to 20.3%) and 60 days (32.4% to 31.5%); however, these changes did not reach statistical significance and should be interpreted as trends. The projected prevention of 200 hospitalizations with estimated annual cost savings of $3.4 million to the health system represents modeled projections based on observed directional trends rather than realized savings. A 1.9% shift in staff roles increased the utilization of licensed practical nurses with no adverse indicators identified within the scope of this analysis, saving $112,748 annually. Conclusions: The adoption of the DWCS was associated with fewer and shorter SN visits and a shift toward more LPN utilization, with anticipated reductions in costs Wound-related admissions showed downward trends but did not reach statistically significant levels. This pre–post design precludes causal attribution, and findings should be interpreted as associations rather than definitive effects of the intervention. These findings support further investigation of wound care models integrating AI within a value-based home health setting. Full article
(This article belongs to the Section Digital Health Technologies)
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17 pages, 422 KB  
Article
A Multidisciplinary Healthy Aging Program in Comprehensive HIV Care: Multidomain Screening, Clinical Interventions, and Cardiometabolic Risk Management
by Steven Y. Hong, Deborah Woodley, Megan Pao, Holly Goetz, Alejandro Alvarez, Max White, Bruce Hirsch, Edith Burns and Joseph P. McGowan
Viruses 2026, 18(5), 572; https://doi.org/10.3390/v18050572 (registering DOI) - 19 May 2026
Abstract
Background: People living with HIV (PLWH) are increasingly reaching older ages due to the success of antiretroviral therapy. However, aging with HIV is associated with increased risk of multimorbidity, neurocognitive impairment, frailty, psychosocial stress, and functional decline. Multidomain geriatric screening framed within an [...] Read more.
Background: People living with HIV (PLWH) are increasingly reaching older ages due to the success of antiretroviral therapy. However, aging with HIV is associated with increased risk of multimorbidity, neurocognitive impairment, frailty, psychosocial stress, and functional decline. Multidomain geriatric screening framed within an Age-Friendly 4Ms Framework (Mentation, Medication, Mobility, What Matters Most) and consideration of multi-complexity may help identify aging-related vulnerabilities and guide multidisciplinary care with greater impact on patient outcomes. However, real-world implementation of such programs within HIV clinical settings remains limited. Methods: We conducted a retrospective analysis of adults aged ≥50 years enrolled in a multidisciplinary Healthy Aging Program within a large, integrated HIV care system. Multidomain screening assessments included cognitive evaluation (Montreal Cognitive Assessment), mental health screening (PHQ-2, GAD-2), functional assessment (Katz ADL, Lawton IADL), frailty screening (Edmonton Frail Scale), and intrinsic capacity domains using the WHO Integrated Care for Older People (ICOPE) framework. Screening results, referrals, clinical interventions, and cardiometabolic risk management measures were extracted from clinical program databases and electronic medical records. Results: A total of 317 adults aged ≥50 years completed multidomain screening. Participants had well-controlled HIV infection, with viral suppression in 96.2% and a median CD4 count of 660 cells/mm3. Despite this, aging-related vulnerabilities were common. Overall, 78.4% of participants had at least one abnormal screening domain. Cognitive impairment was identified in nearly half of individuals screened, including mild impairment in 39.8% and moderate impairment in 8.7%. Functional limitations were identified in 10.1% of participants, while anxiety symptoms were present in 9.5%. Sensory impairments were common, including vision impairment in 36.5% of participants. Polypharmacy was prevalent, with 33.2% of participants prescribed five or more chronic medications. Screening frequently generated multidisciplinary referrals, including behavioral health services (42.3%), social work support (42.9%), and pharmacist-led cardiometabolic risk review (56.8%). Age-stratified analyses demonstrated similar prevalence of screening abnormalities across age groups, including individuals aged 50–59 years. Modest improvements in cardiometabolic preventive care were observed during follow-up. Statin utilization increased from 65.6% at baseline to 70.0% at 12 months, and LDL cholesterol declined modestly during the observation period. Conclusions: Multidomain screening integrated into routine HIV care identified a high prevalence of aging-related vulnerabilities among PLWH aged ≥50 years despite excellent virologic control. These findings suggest that aging-related risk in HIV is not adequately captured by chronological age alone and support early, universal implementation of multidomain screening within HIV care models. Full article
(This article belongs to the Special Issue HIV and Aging)
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29 pages, 10834 KB  
Article
Assessing Cropland Water Deficit and Productivity-Loss Risk Through the Standardized Crop Water Deficit Index and Copula Analysis in the Huang–Huai–Hai Plain, China
by Yuhan Zhao, Chun Dong and Yan Yang
Land 2026, 15(5), 872; https://doi.org/10.3390/land15050872 (registering DOI) - 19 May 2026
Abstract
The Huang–Huai–Hai Plain supports one of China’s most important grain production systems, but crop production there is persistently constrained by limited water availability and recurrent drought. Common regional drought indicators are useful for monitoring dry conditions, yet they do not explicitly represent crop [...] Read more.
The Huang–Huai–Hai Plain supports one of China’s most important grain production systems, but crop production there is persistently constrained by limited water availability and recurrent drought. Common regional drought indicators are useful for monitoring dry conditions, yet they do not explicitly represent crop water demand and irrigation input, which reduces their suitability for agricultural risk assessment. In this study, a crop-oriented framework was developed for winter wheat and summer maize by linking crop water requirement, effective rainfall, irrigation supply, drought-event detection, and productivity-risk estimation. A standardized crop water deficit index (SCWDI) was developed from crop water balance and integrated with run theory, monthly correlation analysis, and a Copula–Bayesian framework to detect drought events, identify crop-sensitive periods, and quantify the probability and triggering threshold of gross primary productivity (GPP) loss. During 2001–2022, the Huang–Huai–Hai Plain experienced an average of 1.15 drought events per year, with pronounced spatial differences. The main sensitive period was June for summer maize and March–April for winter wheat. Summer maize showed a stronger drought response, with a mean triggering threshold of −1.54, whereas winter wheat required more severe stress to trigger concentrated productivity loss (−2.54). Under extreme drought, the probability of summer-maize GPP loss exceeded 80% in both the Beijing–Tianjin–Hebei region and Henan. These results provide a basis for growth-stage-oriented irrigation prioritization and spatially differentiated drought management under agricultural water scarcity. Full article
(This article belongs to the Section Land, Soil and Water)
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13 pages, 702 KB  
Article
Association of Preoperative Platelet-Activating Factor and Postoperative C-Reactive Protein with Inflammatory Burden and Early Outcomes After Major Cardiac Surgery
by Adrian Stef, Gabriel Cismaru, Aurelia Georgeta Solomonean, Nadina Tintiuc, Tudor-Mihai Magdaș and Alexandru Oprea
Biomedicines 2026, 14(5), 1149; https://doi.org/10.3390/biomedicines14051149 - 19 May 2026
Abstract
Background: Major cardiac surgery with cardiopulmonary bypass (CPB) induces a systemic inflammatory response that contributes to postoperative organ dysfunction and hemodynamic instability. While C-reactive protein (CRP) is a well-established downstream marker of postoperative inflammation, the upstream determinants of interindividual variability in inflammatory burden [...] Read more.
Background: Major cardiac surgery with cardiopulmonary bypass (CPB) induces a systemic inflammatory response that contributes to postoperative organ dysfunction and hemodynamic instability. While C-reactive protein (CRP) is a well-established downstream marker of postoperative inflammation, the upstream determinants of interindividual variability in inflammatory burden are not fully understood. Platelet-activating factor (PAF) is a potent inflammatory mediator implicated in platelet activation, endothelial dysfunction, and vascular dysregulation, but its role in modulating postoperative inflammation and clinical outcomes after cardiac surgery has not been fully characterized. Methods: We conducted a retrospective observational study of 87 patients undergoing major cardiac surgery with CPB. Preoperative plasma PAF levels and postoperative CRP concentrations were measured, and patients were stratified according to postoperative CRP severity. Associations between PAF, inflammatory response, postoperative vasoactive–inotropic requirements, recovery parameters, acute kidney injury, and mortality were assessed using correlation analyses, multivariable regression models, and receiver operating characteristic curve analyses. Results: Preoperative PAF levels increased progressively across postoperative CRP strata (p < 0.001) and were strongly associated with postoperative CRP concentrations in both univariate and multivariable analyses. Specifically, each 1000 pg/mL increase in preoperative PAF was associated with an adjusted increase of 36.0 mg/L in postoperative CRP (β = 36.0; p < 0.001). Each 1000 pg/mL increase in preoperative PAF was associated with an adjusted increase of approximately 36 mg/L in postoperative CRP. Elevated PAF was also associated with increased intermediate postoperative vasoactive–inotropic requirements and a modest increase in hospital length of stay (r = 0.25, p = 0.023). However, neither PAF nor CRP independently predicted AKI or mortality after adjustment for clinical variables. Discriminative performance for mortality was modest for both biomarkers. Conclusions: Preoperative platelet-activating factor was strongly associated with postoperative inflammatory burden and early hemodynamic instability following major cardiac surgery. Although PAF and CRP were not independent predictors of adverse outcomes, they may help identify a biologically vulnerable phenotype characterized by exaggerated inflammatory and vascular responses to surgical stress. These findings support further investigation of platelet-mediated inflammatory pathways as targets for perioperative risk stratification and mechanistic research. Full article
(This article belongs to the Section Molecular and Translational Medicine)
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12 pages, 1102 KB  
Systematic Review
Epidemiology and Outcomes of Ventilator-Associated Pneumonia in Saudi Arabian Intensive Care Units: A Systematic Review and Meta-Analysis
by Abdullah A. Alshehri, Jehad A. Aldali, Ghina M. Alhuwaymani, Farah M. Alanazi, Yara K. Alsarhan, Shahad A. Almutairi and Abrar A. Altayeb
Microorganisms 2026, 14(5), 1145; https://doi.org/10.3390/microorganisms14051145 - 19 May 2026
Abstract
Ventilator-associated pneumonia (VAP) remains a major healthcare-associated infection in intensive care units (ICUs) and is associated with prolonged hospitalization, increased antimicrobial use, and high mortality. In Saudi Arabia, evidence on VAP epidemiology, microbiology, and outcomes is fragmented across settings. This study aimed to [...] Read more.
Ventilator-associated pneumonia (VAP) remains a major healthcare-associated infection in intensive care units (ICUs) and is associated with prolonged hospitalization, increased antimicrobial use, and high mortality. In Saudi Arabia, evidence on VAP epidemiology, microbiology, and outcomes is fragmented across settings. This study aimed to systematically review and synthesise the available evidence on VAP in Saudi Arabian ICUs. This study followed PRISMA guidelines and was prospectively registered in PROSPERO (CRD420261332740). A systematic search of PubMed, MEDLINE, Embase, and Web of Science was conducted for studies published between 2015 and 2025. Studies from Saudi Arabia reporting VAP incidence in ICUs were included. A random-effects model was used to pool incidence per 1000 ventilator-days. Risk of bias was assessed using Joanna Briggs Institute tools. Analyses were performed using R. Seven studies involving a total of 15,844 patients, representing multicentre studies, national surveillance data, and single-centre cohorts across diverse ICU settings. The pooled incidence of VAP was 8.50 episodes per 1000 ventilator-days (95% CI: 3.23–13.78), with substantial heterogeneity (I2 = 97%). Subgroup analysis showed higher incidence during baseline phases (12.46 per 1000 ventilator-days) compared with intervention phases (8.06 per 1000 ventilator-days), while surveillance estimates were lower. Gram-negative pathogens predominated, particularly Acinetobacter baumannii, often exhibiting multidrug resistance. VAP was associated with prolonged ICU stay, delayed extubation, and high mortality. Implementation of infection prevention bundles was associated with reductions in VAP incidence. Ventilator-associated pneumonia remains a significant burden in Saudi Arabian ICUs, characterised by substantial variability in incidence and a predominance of multidrug-resistant pathogens. Strengthening infection prevention measures, enhancing antimicrobial stewardship, and improving national surveillance systems are essential to reduce VAP burden and improve patient outcomes. Full article
(This article belongs to the Section Medical Microbiology)
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33 pages, 622 KB  
Systematic Review
Counterfactual, Longitudinal, and Multimodal Explainable AI for MRI-Based Alzheimer’s Diagnosis: A Structured Review
by Ramisa Farha, Blessing Ojeme, Fahmi Khalifa and Md Mahmudur Rahman
J. Dement. Alzheimer's Dis. 2026, 3(2), 26; https://doi.org/10.3390/jdad3020026 - 19 May 2026
Abstract
Background/Objectives: Alzheimer’s disease (AD) is a progressive neurodegenerative disorder for which MRI-based AI systems are increasingly used for diagnosis and prognosis. However, many published approaches remain misaligned with the requirements of trustworthy clinical use. Predicted risks are often poorly calibrated, explanations are frequently [...] Read more.
Background/Objectives: Alzheimer’s disease (AD) is a progressive neurodegenerative disorder for which MRI-based AI systems are increasingly used for diagnosis and prognosis. However, many published approaches remain misaligned with the requirements of trustworthy clinical use. Predicted risks are often poorly calibrated, explanations are frequently limited or non-actionable, guideline-aligned reporting is uncommon, and longitudinal prediction is inconsistently evaluated. In this paper, we conduct a PRISMA-guided structured review with scoping-style breadth of MRI-centric AI methods for AD diagnosis. This design supports a theme-based synthesis across heterogeneous study designs and is intended to summarize the current evidence base and derive practical design requirements for next-generation, clinically oriented pipelines that integrate calibrated staging, explainable outputs, and longitudinal risk modeling. Methods: Searches were conducted across Scopus, PubMed/PMC, and arXiv/bioRxiv (2014–2026; English; human AD/MCI imaging) and were supplemented by backward and forward snowballing. These searches yielded 2460 records. After deduplication, screening, and full-text eligibility assessment, 90 papers were included in the final synthesis. The included literature was organized into thematic streams spanning counterfactual reasoning and explainable AI (XAI), vision–language approaches for report and caption generation, longitudinal and survival-style modeling, and multimodal fusion and transformer-based methods combining MRI with clinical variables and other biomarkers. Vision–language methods were considered together with retrieval-augmented paradigms. Results: Key findings are that the field has shifted toward transformer architectures and multimodal fusion and shows increased interest in richer explanation mechanisms. Nevertheless, calibration metrics and robustness checks are inconsistently reported, external site-held-out validation and subgroup analyses remain relatively uncommon, and guideline-aligned structured reporting with explicit numeric provenance is rare. Vision–language and retrieval-augmented reporting methods are far more mature in general radiology than in AD MRI, highlighting a translational opportunity. Conclusions: Based on these findings, we recommend standardized reporting of classification calibration and longitudinal risk calibration, stronger site-held-out validation with subgroup robustness evaluation, clinically meaningful counterfactuals, and guideline-aligned reporting with reproducible numeric provenance embedded within reproducible pipelines. Full article
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18 pages, 745 KB  
Article
Immune-Related Adverse Events of Cemiplimab Therapy in Advanced Cervical Cancer—Data from the Polish–Czech Cervical Cancer Immunotherapy Group (PCCIG-01) with a Review of the Literature
by Radosław Łupkowski, Karolina Górniak, Maja Lisik-Habib, Ewa Burchardt, Radosław Mądry, Monika Szarszewska, Katarzyna Gabalewicz, Dominika Pyszak, Petra Bretova, Beata Maćkowiak-Matejczyk, Wioletta Sawczuk, Monika Łączyńska-Madera, Dagmara Klasa-Mazurkiewicz, Angelika Gawlik-Urban, Magdalena Michalik, Zuzanna Borysiewicz, Ewa Iwańska, Mirosława Puskulluoglu, Paweł Blecharz and Renata Pacholczak-Madej
Antibodies 2026, 15(3), 42; https://doi.org/10.3390/antib15030042 - 18 May 2026
Abstract
Background: Immunotherapy has become an integral part of systemic treatment for cervical cancer (CC). This study assessed the safety profile of cemiplimab and the association between immune-related adverse events (irAEs) and treatment outcomes in patients with persistent, recurrent or metastatic CC. Methods: This [...] Read more.
Background: Immunotherapy has become an integral part of systemic treatment for cervical cancer (CC). This study assessed the safety profile of cemiplimab and the association between immune-related adverse events (irAEs) and treatment outcomes in patients with persistent, recurrent or metastatic CC. Methods: This ambispective, multicenter, real-world cohort study included 101 patients treated in 13 reference oncology centers as part of the PCCIG-01 study. We evaluated the frequency and severity of irAEs and their association with progression-free survival (PFS) and overall survival (OS). Survival outcomes were analyzed using the Kaplan–Meier method and Cox proportional hazards models, with p < 0.05 considered statistically significant. Results: After a median follow-up of 7.5 months, adverse events occurred in 45 patients (44.6%) and were mostly grade (G) 1–2. IrAEs were observed in 34 patients (33.7%). Endocrine toxicities predominated (n = 24, 58.5% of irAEs), followed by hepatic (n = 5, 12.2%) and gastrointestinal events (n = 4, 9.8%). G3 irAEs occurred in 8 patients (7.9%). Median PFS was 3.9 months (95% CI 2.9–5.6) in patients without irAEs and 10.9 months (95% CI 5.7–16.3) in those with irAEs (p = 0.03). Median OS was 15.3 months (95% CI 8.6–25.9) in patients without irAEs and was not reached in those with irAEs (95% CI 11.6-NR; p = 0.11). The development of irAEs was associated with a 54% reduction in the risk of progression (HR 0.46, 95% CI 0.27–0.80), with no statistically significant impact on OS. Conclusions: In exploratory analyses, the occurrence of irAEs was associated with improved PFS in cemiplimab-treated patients with persistent, recurrent or metastatic CC. Cemiplimab showed a manageable safety profile, with most toxicities being G1–G2. Full article
(This article belongs to the Section Antibody-Based Therapeutics)
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50 pages, 1814 KB  
Systematic Review
Effects of Heat Waves on Hospitalizations, Emergency Department Visits, and Outpatient Care in Frail Older Adults: A Systematic Review and Meta-Analysis
by Antonio Pinto, Flavia Pennisi, Stefania Borlini, Emanuele De Ponti, Carlo Signorelli, Andrea Cozza, Vincenzo Baldo and Vincenza Gianfredi
Diseases 2026, 14(5), 176; https://doi.org/10.3390/diseases14050176 - 18 May 2026
Abstract
Background/Objectives: Heat waves are increasingly frequent and intense climate events with significant implications for public health, particularly among frail older adults. While most evidence has focused on mortality and morbidity, healthcare service utilization represents an additional and potentially more sensitive indicator of heat-related [...] Read more.
Background/Objectives: Heat waves are increasingly frequent and intense climate events with significant implications for public health, particularly among frail older adults. While most evidence has focused on mortality and morbidity, healthcare service utilization represents an additional and potentially more sensitive indicator of heat-related health burden. Methods: A systematic review and meta-analysis was conducted following the PRISMA guidelines and prospectively registered in PROSPERO (CRD420251107598). PubMed/MEDLINE, Scopus, and Web of Science were searched up to August 2025. This study aimed to systematically review and quantitatively synthesize the evidence on the association between heat wave exposure and healthcare utilization—including hospitalizations, emergency department (ED) visits, and outpatient care—among frail older adults. Pooled effect estimates (RRs, IRRs, and ORs) were calculated using random-effects models. Heterogeneity was assessed using the I2 statistic, and sensitivity analyses were performed by outcome type, effect measure, and risk of bias. Results: Fifty-five studies met the inclusion criteria. Heat wave exposure was consistently associated with increased healthcare utilization. Both hospitalizations and ED visits showed significant increases during heat wave periods, with results remaining robust across sensitivity analyses. Evidence on outpatient care was limited but suggested a similar pattern. Substantial heterogeneity was observed across studies, reflecting variability in exposure definitions, populations, and study designs. Overall, the methodological quality of the included studies was acceptable, with most presenting a low-to-moderate risk of bias. Conclusions: Heat waves are associated with increased healthcare utilization among frail older adults, indicating a relevant burden on healthcare systems. Healthcare utilization may represent a sensitive indicator of heat wave impact, complementing traditional clinical outcomes. Full article
21 pages, 15430 KB  
Review
Active Pharmaceutical Ingredients in Medical Cannabis: Manufacturer Profiling, Standardization Challenges, and Technological Compatibility
by Liliia Vyshnevska, Maryana Yaromiy, Iryna Pestun, Kaloyan D. Georgiev, Iliya Zhelev Slavov and Oleh Koshovyi
Sci. Pharm. 2026, 94(2), 41; https://doi.org/10.3390/scipharm94020041 - 18 May 2026
Abstract
The pharmaceutical development of cannabis-based medicinal products is challenged by significant variability in the quality, composition, and standardization of plant-derived active pharmaceutical ingredients (APIs). In Ukraine, despite recent legislative liberalization, a substantial shortage of standardized raw materials continues to limit the development of [...] Read more.
The pharmaceutical development of cannabis-based medicinal products is challenged by significant variability in the quality, composition, and standardization of plant-derived active pharmaceutical ingredients (APIs). In Ukraine, despite recent legislative liberalization, a substantial shortage of standardized raw materials continues to limit the development of innovative dosage forms. This study analyses international practices among API manufacturers to identify technological parameters necessary to overcome domestic market barriers and support the implementation of advanced drug delivery systems. Content analysis was conducted on regulatory documentation, professional literature, and manufacturers’ technical specifications. Candidate evaluation followed predefined inclusion and exclusion criteria. The study assessed compliance with Good Manufacturing Practice (GMP) requirements, extraction and purification technologies, the extent of analytical characterization, and batch-to-batch reproducibility. Purposive sampling enabled a comparative analysis of various technological approaches. Marked heterogeneity was observed in API standardization and analytical control indicators among manufacturers. Possession of a GMP certificate was found necessary but may be insufficient to ensure the pharmaceutical equivalence of materials. Differences in extraction methods and purification levels may affect stability profiles, pharmaceutical development strategies, and risk management related to final product quality. The findings demonstrate that manufacturer selection is a critical decision point in pharmaceutical development, with substantiated supplier choice directly influencing dosage form development and regulatory compliance. Full article
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25 pages, 757 KB  
Systematic Review
Emerging Contaminants in Water Resources: Monitoring Gaps, Treatment Limitations and Governance Challenges with Insights from Portugal
by Pedro Esperanço, Teresa Leal, André Almeida, António Canatário Duarte, Luísa Cruz-Lopes, José Manuel Gonçalves and Margarida Oliveira
Sustainability 2026, 18(10), 5086; https://doi.org/10.3390/su18105086 (registering DOI) - 18 May 2026
Abstract
This study provides a comprehensive overview of emerging contaminants in water resources. It includes a global perspective with specific insights from Portugal. Following PRISMA 2020 guidelines, peer-reviewed studies published between 2020 and 2025 were critically assessed to identify patterns of contamination, monitoring gaps [...] Read more.
This study provides a comprehensive overview of emerging contaminants in water resources. It includes a global perspective with specific insights from Portugal. Following PRISMA 2020 guidelines, peer-reviewed studies published between 2020 and 2025 were critically assessed to identify patterns of contamination, monitoring gaps and technological readiness levels. Results indicate frequently detected emerging contaminants including pesticides, antibiotics and antidepressants in surface water, groundwater and wastewater systems. Advanced analytical methods, particularly liquid chromatography coupled with high-resolution mass spectrometry, stands out as the main detection technique, allowing the identification of trace levels of contaminants. These techniques also support the identification of pollution patterns associated with agriculture, urban and industrial effluents. However, significant asymmetries persist between international and Portuguese research. Particularly evident in systematic monitoring networks and integrated risk assessment approaches. Conventional water/wastewater treatment plants show limited removal efficiency, while advanced oxidation processes, adsorption technologies and microalgae-based systems demonstrate promising but variable performance depending on scale and operational maturity. The findings highlight gaps between scientific advances and regulatory implementation, emphasizing the need for strengthened monitoring frameworks and technology scale-up strategies. They also call for improved integration between science, governance, and sustainability policies to ensure resilient water resource management in line with the Sustainable Development Goals. Full article
19 pages, 2213 KB  
Article
Oil–Source Rock Correlation and Migration in the D Subsag, Beibuwan Basin: A Petroleum System Approach
by Fei Yang, Aoxuan Li, Yahao Huang, Jing Luo and Ruyue Wang
Processes 2026, 14(10), 1631; https://doi.org/10.3390/pr14101631 - 18 May 2026
Abstract
This study aims to resolve the genetic origin of crude oils accumulated in the D Subsag and to assess the potential cross-sag hydrocarbon migration from the adjacent Haizhong Sag. The D Subsag, situated on the western margin of the Weixinan Sag in the [...] Read more.
This study aims to resolve the genetic origin of crude oils accumulated in the D Subsag and to assess the potential cross-sag hydrocarbon migration from the adjacent Haizhong Sag. The D Subsag, situated on the western margin of the Weixinan Sag in the Beibuwan Basin, is a significant petroleum province with proven reserves exceeding 10 million tons in the Weizhou Oilfield. However, the origin of these oils and the contribution from the Haizhong Sag source kitchen remain poorly constrained, hindering accurate resource assessment. To address this, we integrated organic geochemical analyses of nine source rock samples from the Haizhong Sag (Well H1) and eight crude oil samples from the D Subsag reservoirs. Bulk geochemical and biomarker signatures reveal distinct organic facies within the Paleogene succession. Type III kerogen, characterized by terrigenous higher plant input (high C19+20 tricyclic terpanes and C29 regular steranes, Pr/Ph > 2.5) deposited under oxic freshwater conditions, dominates source rocks from the third member of the Weizhou Formation (EWZ3). In contrast, the second and third members of the Liushagang Formation (Els2 and Els3) contain mixed Type II2-III kerogen with elevated contributions from lacustrine algae and aquatic organisms (elevated C23 tricyclic terpanes and C27 regular steranes). Thermal maturity assessment (with Tmax of 436 to 448 °C) confirms that all source intervals are within the oil generation window. Two genetically distinct oil groups are identified in the EWZ3 reservoirs. Group 1 oils (Well W4) exhibit a lacustrine algal signature (C27/C29 sterane > 1.15; low Pr/Ph 1.54–1.68) that does not correlate with the analyzed Haizhong Sag source rocks, suggesting localized, intra-sag source contributions. In contrast, Group 2 oils (Wells W6 and W6-2) display strong geochemical affinities with the Els2 and Els3 source rocks, evidenced by mixed terrestrial/aquatic signatures (∑nC21/∑nC22+ < 1.0). These findings confirm that fault systems acted as conduits for long-distance migration from the Haizhong Sag, while also highlighting a previously unrecognized contribution from local source intervals. This refined petroleum system model provides critical constraints for delineating remaining hydrocarbon potential and reducing exploration risk in the Beibuwan Basin. Full article
(This article belongs to the Section Petroleum and Low-Carbon Energy Process Engineering)
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