Search Results (6,784)

This study investigates the rapid, often uncontrolled urban expansion in Khenchela, a medium-sized city in Algeria’s eastern High Plains, and its profound environmental repercussions amid semi-arid fragility. Drawing on sustainable urban development and resilience frameworks, it dissects pressures such as green space reduction (from 45 ha in 1998 to 33 ha in 2023, dropping per capita from 6.1 m² to 3 m² below WHO standards), water scarcity with 35% leakage losses waste mismanagement, informal settlements on hazardous lands, air/soil pollution, and climate vulnerabilities like heat waves and flooding. Employing a mixed-methods approach documentary analysis of (MPLUUP, LUP and MDP) plans, GIS cartography of spatial evolution (2000–2025), statistical demographics, field observations, and institutional critiques, the research exposes governance gaps: fragmented coordination, weak ecological integration, and resource shortages. It reveals socio-spatial disparities across functional zones, underscoring the need for adaptive, participatory strategies that promote polycentric and compact urban forms, enhanced biodiversity, efficient infrastructure, and inclusive governance to strengthen urban resilience. Full article

Background: Behavioural therapy (BT), including Comprehensive Behavioural Intervention for Tics (CBIT), is an evidence-based first-line treatment for patients with tic disorders. However, access remains limited due to a shortage of trained providers, geographical barriers, costs, and high treatment burden for patients and families. Rapid advances in digital health technologies including telemedicine, web-based treatment platforms, and mobile applications offer new opportunities to expand access to BT for individuals with tic disorders across the lifespan. Methods: For the purpose of this narrative review, we conducted a literature search in PubMed, Europe PMC, and the Cochrane Library to identify relevant studies investigating the effectiveness of digital health treatment approaches in tic disorders. Results: A total of 16 original studies were included. Although the available evidence remains limited and heterogeneous, existing studies suggest that emerging technologies for delivering behavioural interventions for tic disorders, including telehealth-based CBIT, digital therapy platforms, and app-supported habit reversal training (HRT), are feasible, cost-effective, user-friendly, flexible, and safe. These approaches also appear effective for symptom monitoring and personalized treatment support in both pediatric and adult populations. Conclusions: Recent technological advances have the potential to reduce the treatment gap in tic disorders, provided that these approaches are implemented within rigorous, evidence-based, and ethically grounded frameworks. Full article

The recycling of waste clay bricks as raw materials for cement-based materials presents an effective solution to ecological pollution and resource shortages. Previous research has separately examined the effects of recycled brick fine aggregate and recycled brick powder on mortar or concrete, but few studies have investigated their combined use. This study aims to clarify the synergistic effect of recycled brick fine aggregate (RBA) and recycled brick powder (RBP) on mortar performance, quantify the influence of the RBP substitution rate on hydration characteristics and microstructural evolution, and determine the optimal mix proportion and curing system for fully recycled brick mortar. Mortar was prepared using 100% RBA and RBP at substitution rates of 0%, 10%, 20%, and 30%. The physical properties, mechanical performance, and durability of the mortar were evaluated, alongside an analysis of its microstructural morphology, mineral composition, and pore structure. The results indicate that adding an appropriate amount of RBP helped maintain the flowability of the mortar. As the RBP substitution rate increased, the mortar strength generally decreased in the early stages, but long-term curing (≥90 days) effectively mitigated this decline. The inclusion of RBP improved chloride ion permeability, with the 20% substitution rate achieving a favorable balance between compressive strength, fluidity, and durability without significantly affecting carbonation resistance. Microstructural analysis revealed that RBP regulated the morphology of hydration products and optimized the pore structure of the mortar, while the mineral composition of hydration products was similar to that of natural mortar. These findings provide a theoretical basis and technical support for the high-value utilization of construction and demolition waste in cement-based materials. Full article

The shortage of qualified teachers across Europe has increased interest in flexible and decentralized pathways into teacher education. This study examines pre-service teachers’ background characteristics and programme-choice priorities when selecting between two study formats at a Norwegian university: a blended learning programme and a face-to-face campus-based programme. Survey data from 108 pre-service teachers revealed significant differences between the groups in age, place of residence, region of origin, prior teaching experience, current teaching employment, and confidence in securing a permanent teaching position. Campus-based students were younger, less experienced, and reported lower confidence in obtaining permanent employment than students in the blended learning programme. Three of fifteen choice-related factors differed significantly between study formats, most notably the importance assigned to programme organization, which was rated higher by blended-learning students. No differences were found for geographic location or for eleven content-related factors. In this sample, blended-learning students were more often from rural areas, and they placed greater value on organizational flexibility, suggesting that flexible formats may be particularly relevant for students balancing work, distance, or other commitments. However, this study is cross-sectional, based on a single institution, and cannot determine broader policy implications or effects on regional teacher supply. Longitudinal and multi-institutional research is needed to assess potential long-term outcomes. Full article

Background: Lay counsellor-delivered psychosocial interventions are increasingly used to address workforce shortages in mental health care. While randomised trials commonly report mean improvements, explicit assessment of clinical deterioration is rare. This secondary analysis evaluated whether a lay counsellor intervention for early psychosis was associated with evidence of deterioration compared with usual care. Methods: Patient-level data from a randomised controlled trial in Thailand (n = 255) were analysed. Deterioration was defined as worsening between baseline and the 6-month follow-up across functional, behavioural, and service utilisation domains. Risk differences were estimated using Newcombe confidence intervals, and risk ratios were calculated using standard methods with the Haldane–Anscombe correction applied, where required. Analyses were conducted for the full sample (UC n = 125; LICM n = 130) and stratified by baseline severity (none/borderline: UC n = 103, LICM n = 103; mild-to-severe: UC n = 22, LICM n = 27). Results: In the full sample, deterioration rates were similar across most domains. A statistically significant reduction in deterioration related to disturbing or aggressive behaviour was observed in the LICM arm (risk difference −14.1%; 95% CI −26.8% to −0.6%; risk ratio 0.45; 95% CI 0.26 to 0.79). No statistically significant excess deterioration was observed in other domains. In severity-stratified analyses, no subgroup showed a statistically significant increase in deterioration attributable to the intervention. However, among participants with mild-to-severe baseline illness, although no statistically significant harm signal was detected, the adverse risk differences and risk ratios observed in socially useful activities, self-care, regular outpatient follow-up visits, and medication adherence among participants with greater baseline severity underscore the importance of careful monitoring in higher-risk subgroups. Conclusions: No statistically significant evidence of excess deterioration was observed in either the full sample or subgroup analyses between the intervention and control arms. However, the adverse absolute difference observed in multiple patient-related domains, among participants with mild-to-severe baseline illness, suggests that lay-counsellor interventions may require a stepped-care approach to safely address the mental health needs of patients with higher levels of severity. Psychosocial trials should routinely report deterioration and subgroup analyses alongside mean improvements. Full article

Rural hospitals are essential access points for healthcare delivery in the United States, yet they continue to experience disproportionate rates of closure and service disruption that threaten community health, economic stability, and equity. This rapid systematic review synthesizes recent peer-reviewed evidence examining rural hospital closures and service disruptions, with emphasis on financial, policy, workforce, and performance-related factors and their downstream impacts. Guided by PRISMA methodology, four databases were searched for U.S.-based studies published between January 2024 and June 2025. Following screening and consensus-based review, 59 articles met inclusion criteria. Across studies, financial vulnerability, characterized by revenue instability, low patient volumes, unfavorable payer mix, and reliance on non-operating revenue, emerged as a dominant precursor to closure and service reductions. Policy context, particularly Medicaid expansion status, telehealth and broadband infrastructure, and reimbursement adequacy, strongly shaped hospital sustainability. Closures and service disruptions were consistently associated with increased travel distances, reduced access to maternal, surgical, mental health, and chronic care services, higher prices at surviving hospitals, and increased strain on remaining providers. Workforce shortages further compounded these challenges. Collectively, findings demonstrate that rural hospital closures reflect interconnected structural weaknesses rather than isolated organizational failure. Coordinated policy action, targeted financial stabilization, workforce development, and technology-enabled care models are necessary to mitigate continued erosion of rural healthcare access. Full article

Background/Objectives: Candidates with cardiometabolic risk are considered for living kidney donation more frequently because of the global organ shortage. The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines introduced individualized risk assessment based on composite donor profiles rather than categorical exclusion, but the long-term implications of accepting donors with potential risk factors require careful evaluation. This review synthesizes current evidence on outcomes of living kidney donors with obesity, prediabetes, hypertension, and smoking. Methods: A literature search was conducted in PubMed/MEDLINE for studies published between 1 January 2000 and 28 February 2026, including cohort studies, registry analyses, meta-analyses, and clinical guidelines evaluating living kidney donors with obesity, smoking, prediabetes, or hypertension. Priority was given to large cohorts with long-term follow-up. Over 70 publications were included in the final synthesis. Findings were synthesized narratively by risk factors and outcomes. Results: Obesity was associated with an 86% increased end-stage kidney disease (ESKD) risk and 32% increased 20-year mortality. Central adiposity measures outperformed body mass index (BMI) for predicting estimated glomerular filtration rate (eGFR) decline. Post-donation weight gain increased the risk for developing hypertension and diabetes. Smoking conferred a 7.5-fold chronic kidney disease (CKD) risk, with impaired compensatory renal adaptation after donation. Prediabetic donors showed comparable outcomes to normoglycemic donors, with 57.8% reverting to normoglycemia at 10 years. Pre-donation hypertension increased 15-year ESKD risk 3-fold, but absolute risk remained low. At 15 years post-donation, over 50% of the donors developed hypertension. Glucagon-like peptide-1 (GLP-1) receptor agonists reduce diabetes progression by 73–94% in at-risk populations, but prospective studies in donors are lacking. Conclusions: Each risk factor carries quantifiable risks for individualized stratification. These risk factors usually coexist and interact. Refinement of risk prediction models, strategies for metabolic optimization and prospective evaluation of emerging pharmacologic therapies are key priorities. Full article

Producing single-cell protein (SCP) from syngas-derived ethanol and acetate offers a sustainable solution to global protein shortages, yet microbial utilization mechanisms for these mixtures remain underexplored. This study establishes a systematic bioconversion strategy using Cyberlindnera jadinii TU389. To mitigate acetaldehyde accumulation during ethanol metabolism, we engineered the strain TU546 to overexpress acylating acetaldehyde dehydrogenase (ADA6). TU546 achieved a maximum biomass of 46.7 g/L and a protein yield of 21.69 g/L, representing enhancements of 28.16% and 23.02% over the wild-type, respectively. Transcriptomic analysis revealed extensive metabolic reprogramming. In the C2 assimilation pathway, upregulated aldehyde dehydrogenase and acetyl-CoA Synthetase 1 accelerated acetate conversion to acetyl-CoA, while downregulated pyruvate decarboxylase and alcohol dehydrogenase minimized carbon flux loss. The upregulation of tricarboxylic acid cycle enzymes, the glyoxylate shunt, and acyl-coA oxidase improved carbon skeleton retention. Moreover, the upregulation of transaminases and N-acetylglutamate synthase, synergized with intensified cell proliferation signaling, redirected amino acid metabolism toward a synthesis-enhanced and degradation-controlled paradigm. This synergistic regulatory network drives the high-efficiency bioconversion of ethanol and acetate into SCP, establishing a molecular mechanistic foundation for the valorization of syngas-derived C2 substrates in biological macromolecule production. Full article

Automated fruit harvesting is crucial for alleviating labor shortages and enhancing agricultural productivity. In this context, it is crucial to obtain information on fruit poses before picking in order to avoid damaging the fruit and/or the plant. However, the complex and unstructured orchard environment poses significant challenges regarding the pose estimation task. In this study, a dragon fruit pose estimation (DFPE) framework using a single RGB image is proposed for dragon fruit automated harvesting, which includes three key components: dataset annotation processing, keypoint detection, and geometric pose estimation. First, a multi-source dataset consisting of 8467 images is constructed to enhance the estimation model’s generalizability. A pseudo four-keypoint annotation strategy is designed to fit the annotation rules of mainstream single-class keypoint detection models and mitigate the inherent limitations of multi-target keypoint detection in agricultural scenarios. This strategy implicitly encodes the fruit’s orientation using bounding box group IDs, while preserving geometric information for pose inference. Then, the fruit body and its two core keypoints (navel and stem) are detected via a real-time keypoint detection model. Notably, the proposed DFPE framework is detector-agnostic: other mainstream keypoint detection models can also be plugged into the subsequent geometric pose inference stage, which guarantees the generality and scalability of the framework. Finally, a dragon fruit pose estimation algorithm based on customized geometric constraints is designed, which takes the detected pose information as the input and outputs the posture of dragon fruit. The results of experiments conducted in natural orchard and laboratory environments demonstrate that the ellipses fitted using the proposed DFPE framework closely aligned with fruit contours, even under foliage occlusion conditions. In the laboratory environment, roll errors reached a maximum of 14.8°, whereas yaw errors peaked at 13.4°. Crucially, all roll and yaw errors remained consistently below 15°, which is well within the tolerance threshold required for non-destructive picking operations using a harvesting robot. In summary, this work presents a low-cost solution for dragon fruit pose estimation from a single RGB image, which can potentially be extended to other ellipsoid crops and is suitable for implementation in harvesting robots operating in orchards. Full article

In ecologically fragile karst regions, surface water leakage and spatial mismatches between supply and demand exacerbate water scarcity and ecosystem degradation. In this context, sustainable water resource allocation is of great significance for achieving the United Nations Sustainable Development Goals (SDGs). This study proposes a Dual-stage Prediction and Optimization Coupled Allocation Model (DPOCAM), which integrates an LSTM–Transformer-based intelligent water demand forecasting model with the NSGA-III multi-objective optimization algorithm. The forecasting model was trained on data from 2001 to 2020 and tested on data from 2021 to 2024, achieving a mean absolute percentage error of 2.89%. The model incorporates ecological water demand as an independent optimization objective, quantified using the Tennant method, aiming to coordinate the relationship between domestic and productive water use with aquatic ecosystem protection. Applied to Sinan County, a typical karst area in Guizhou Province, China, the model projects sectoral water demands for 2035 and conducts water resource allocation based on water network planning. Results show that under the current water network, the comprehensive water shortage rate reaches 17.7%, with ecological deficit accounting for 10.1%, posing dual threats to human water security and ecosystem integrity. Following the planned construction of a water network centered on the Huatanzi Reservoir, the overall shortage rate drops to 0.6%, and the ecological deficit declines to 4.6%, demonstrating significant improvements in both water supply reliability and ecological flow guarantee. The water network construction plays a positive role in reducing water shortage rates and enhancing ecological flow protection, providing a scientific basis and practical reference for sustainable water resource management in karst regions. Full article

Liver transplantation remains the definitive treatment for end-stage liver disease and acute liver failure, yet a critical and persistent shortage of donor organs results in thousands of preventable deaths annually worldwide. Xenotransplantation has emerged as a potential solution to this structural deficit. This narrative review traces the evolution of liver xenotransplantation, from early non-human primate trials in the 1960s through the application of CRISPR/Cas9-driven multi-gene editing platforms in contemporary porcine donors. The immunological barriers that drove the transition from primate to porcine donors are examined, including hyperacute rejection mediated by anti-α-Gal antibodies, coagulation dysregulation and xenograft thrombotic microangiopathy. The genetic engineering strategies underlying current triple-knockout, ten-gene-edited donor pigs are reviewed alongside the preclinical non-human primate evidence establishing biological feasibility. The three pig-to-human liver xenotransplantation studies published between 2025 and 2026 are then analyzed, encompassing heterotopic auxiliary transplantation in a brain-dead decedent, extracorporeal liver cross-circulation and the first auxiliary liver xenotransplantation in a living recipient with a documented 171-day survival. These cases collectively provide preliminary evidence supporting proof-of-concept for porcine hepatic bridging therapy, with current evidence supporting a role for xenogeneic liver support as a temporary bridge to recovery or allotransplantation rather than definitive organ replacement. Xenograft thrombotic microangiopathy is identified as the principal remaining biological barrier, and the substantial translational challenges, including reproducibility, scalability and regulatory readiness that must be resolved before broader clinical application can be considered. Full article

Liver transplantation is the definitive therapy for end-stage liver disease, yet persistent organ shortages result in approximately 10% of recovered livers being discarded, with markedly higher discard rates among marginal grafts from elderly donors, donation after circulatory death (DCD), and those with macrovesicular steatosis. Machine perfusion (MP) has emerged as a paradigm-shifting preservation strategy with the potential to safely expand the usable donor pool. This narrative review examines the current evidence for three MP modalities—hypothermic machine perfusion (HMP), normothermic machine perfusion (NMP), and normothermic regional perfusion (NRP)—across various marginal donor populations, including elderly donors, steatotic grafts, donors with infectious diseases, and split liver transplantation. Current evidence demonstrates that MP significantly increases utilization of steatotic grafts with up to an eightfold rise in usage of severely steatotic organs. HMP consistently reduces non-anastomotic biliary strictures and early allograft dysfunction across donor types, while NMP enables real-time viability assessment and reduces post-reperfusion syndrome in steatotic grafts. NRP shows particular benefit in DCD organs, reducing biliary complications and improving one-year survival. Additionally, MP extends preservation times enabling next-day split liver transplantation and shows promise as a platform for ex situ antiviral therapy. Despite compelling evidence supporting MP in marginal grafts, widespread adoption remains constrained by high costs, logistical complexity, and the absence of standardized protocols. Future progress will require multicenter studies evaluating long-term outcomes alongside consensus-driven implementation frameworks. Full article

Municipal consolidation, a widespread form of local government restructuring, has attracted growing scholarly attention worldwide. The majority of research on municipal consolidation investigates impacts instead of motives. Using prefecture- and county-level data from China, this study comprehensively examines the local drivers of county-to-district conversion (CTD) events during the 2010s, a period marked by a significant wave of CTDs. The results show that cities with a developable land shortage, a single district, or a higher economic ranking within a province are more likely to implement CTD. All else equal, counties in closer proximity to the central city, more lagged behind the city in development, or having a higher fiscal revenue per capita are more likely to be consolidated. Together, these factors explain about 40% of the odds of CTD at both the city and county levels. These findings highlight the importance of local incentives and characteristics in shaping jurisdictional changes and provide guidance for mitigating selection bias in future impact evaluations of municipal consolidation. Full article

In precision apiculture, the portable digital camera is a cost-effective sensor for capturing hive images or videos used to quantify different colony variables. Openly accessible, well-annotated, interoperable cell-level image datasets are still the exception rather than the norm. This shortage constitutes a major barrier to AI-driven approaches aimed at automating image-based comb analysis. In this article, we present FAIRHiveFrames-1K, a publicly available dataset of 1265 annotated hive frame images (1920 × 1080 PNG) designed to facilitate research in AI-intensive image-based comb analysis automation. The dataset, derived from a 2013–2022 U.S. Department of Agriculture–Agricultural Research Service multi-sensor research reservoir, includes 124,669 annotated regions of interest for seven biologically meaningful categories consistent with comb analysis literature and standard hive inspection protocols. FAIRHiveFrames-1K is curated according to FAIR principles (Findable, Accessible, Interoperable, Reusable) and distributed under CC-BY 4.0 with standard annotation formats, fixed training and validation splits, and reproducible benchmarking artifacts. To establish preliminary baseline performance, we iteratively tuned four YOLO architectures (YOLOv8n, YOLOv8s, YOLOv11n, YOLOv11s) under a shared tuning protocol over the period of dataset growth. Full article

The digitization of tourism has made numerous platforms available, but there remains a significant shortage of tools capable of promoting local events and activities. This study hypothesizes that a decentralized digital interface can mitigate over-tourism. We conducted an experiment by deploying a digital platform to assess the synergy between local providers and visitors through the Tourism Open-ended Experimentation Platform (TOEP), a multi-interface solution designed to directly connect tourism activity providers with residents and visitors. The platform integrates a web portal for providers and a mobile app for users, supported by a recommendation system based on individual profiles and preferences. TOEP stands out for its focus on local and sustainable tourism, facilitating the promotion of smaller events and helping to reduce the concentration of tourist flows in already saturated destinations. Initial validation, conducted with a panel of industry experts, highlighted the ease of use and good organization of the interfaces, with scores above average. Preliminary results confirm the relevance of TOEP as a tool for the sustainable and digitized promotion of local tourism, opening prospects for development towards a smart, participatory tourism ecosystem that can be replicated in different territorial contexts. Full article