Search Results (965)

Background/Objectives: Historically, echocardiographic imaging of the right heart has been challenging because its abnormal geometry is not conducive to reproducible anatomical and functional assessment. With the development of advanced echocardiographic techniques, it is now possible to complete an integrated assessment of the right heart that has fewer assumptions, resulting in increased accuracy and precision. Echocardiography continues to be the first-line imaging modality for diagnostic analysis and the management of acute and chronic right heart failure because of its portability, versatility, and affordability compared to cardiac computed tomography, magnetic resonance imaging, nuclear scintigraphy, and positron emission tomography. Virtually all echocardiographic parameters have been well-validated and have demonstrated prognostic significance. The goal of this narrative review of the echocardiographic parameters of the right heart chambers and hemodynamic alterations associated with right ventricular dysfunction is to present information that must be acquired during each examination to deliver a comprehensive assessment of the right heart and to discuss their clinical significance in right heart failure. Methods: Using a literature search in the PubMed database from 1985 to 2025 and the Cochrane database, which included but was not limited to terminology that are descriptive of right heart anatomy and function, disease states involving acute and chronic right heart failure and pulmonary hypertension, and the application of conventional and advanced echocardiographic modalities that strive to elucidate the pathophysiology of right heart failure, we reviewed randomized control trials, observational retrospective and prospective cohort studies, societal guidelines, and systematic review articles. Conclusions: In addition to the conventional 2-dimensional echocardiography and color, spectral, and tissue Doppler measurements, a contemporary echocardiographic assessment of a patient with suspected or proven right heart failure must include 3-dimensional echocardiographic-derived measurements, speckle-tracking echocardiography strain analysis, and hemodynamics parameters to not only characterize the right heart anatomy but to also determine the underlying pathophysiology of right heart failure. Complete and point-of-care echocardiography is available in virtually all clinical settings for routine care, but this imaging tool is particularly indispensable in the emergency department, intensive care units, and operating room, where it can provide an immediate assessment of right ventricular function and associated hemodynamic changes to assist with real-time management decisions. Full article

Since its discovery in the late 19th century, spinal muscular atrophy (SMA) has had a significant medical and societal impact, primarily affecting newborns, toddlers, and young adults. While new pharmaceutical strategies are effective in treating SMA in a particular subset of patients, continued research is necessary to improve the well-being of patients. Treatments are needed for those who do not respond to newly approved drugs and older patients with significantly compromised neuron systems. After summarizing SMA genotypes, phenotypes, and approved pharmacological treatments, this review presents ongoing trials for approved and new molecules, new formulations, and administration methods. Based on the work of our lab, we also discuss nutritional interventions that aim to counteract the oxidative stress present in SMA cells. Finally, we assess rehabilitative interventions, focusing on psychological approaches. Full article

Background/Objectives: Borderline Personality Disorder (BPD) involves emotional dysregulation, interpersonal instability and impulsivity. Although treatments have advanced, evaluating the latest innovations remains essential. This rapid review aimed to (1) identify and classify recent therapeutic innovations for BPD, (2) assess their effects on clinical and functional outcomes, and (3) highlight research gaps to inform future priorities. Methods: Employing a rapid review design, we searched PubMed/MEDLINE, PsycINFO, and Embase for publications from 1 January 2019 to 28 March 2025. Eligible studies addressed adult or adolescent BPD populations and novel interventions—psychotherapies, pharmacological agents, digital tools, and neuromodulation. Two independent reviewers conducted screening, full-text review, and data extraction using a standardised form. Results: Sixty-nine studies—predominantly from Europe and North America—were included. Psychotherapeutic programmes dominated, ranging from entirely novel models to adaptations of established treatments (for example, extended or modified Dialectical Behavior Therapy). Pharmacological research offered fresh insights, particularly into ketamine, while holistic approaches such as adventure therapy and digital interventions also emerged. Most investigations centred on symptom reduction; far fewer examined psychosocial functioning, mortality, or social inclusion. Conclusions: Recent innovations show promise in BPD treatment but underserve the needs of mortality and societal-level outcomes. Future research should adopt inclusive, equity-focused agendas that align with patient-centred and recovery-oriented goals, supported by a coordinated, integrated research strategy. Full article

On 20 April 2024, an extreme rainfall event occurred in Jiangwan Town Shaoguan City, Guangdong Province, China, where a historic 24 h precipitation of 206 mm was recorded. This triggered extensive landslides that destroyed residential buildings, severed roads, and drew significant societal attention. Rapid acquisition of landslide inventories, distribution patterns, and key controlling factors is critical for post-disaster emergency response and reconstruction. Based on high-resolution Planet satellite imagery, landslide areas in Jiangwan Town were automatically extracted using the Normalized Difference Vegetation Index (NDVI) differential method, and a detailed landslide inventory was compiled. Combined with terrain, rainfall, and geological environmental factors, the spatial distribution and causes of landslides were analyzed. Results indicate that the extreme rainfall induced 1426 landslides with a total area of 4.56 km², predominantly small-to-medium scale. Landslides exhibited pronounced clustering and linear distribution along river valleys in a NE–SW orientation. Spatial analysis revealed concentrations on slopes between 200–300 m elevation with gradients of 20–30°. Four machine learning models—Logistic Regression, Support Vector Machine (SVM), Random Forest (RF), and Extreme Gradient Boosting (XGBoost)—were employed to assess landslide susceptibility mapping (LSM) accuracy. RF and XGBoost demonstrated superior performance, identifying high-susceptibility zones primarily on valley-side slopes in Jiangwan Town. Shapley Additive Explanations (SHAP) value analysis quantified key drivers, highlighting elevation, rainfall intensity, profile curvature, and topographic wetness index as dominant controlling factors. This study provides an effective methodology and data support for rapid rainfall-induced landslide identification and deep learning-based susceptibility assessment. Full article

Traffic-related pollutants remain a challenging global issue, with significant policy implications. Within the European Union, Romania has the highest yearly societal cost per capita due to air pollution, which kills 29,000 Romanians every year, whereas the health and economic costs are also significant. In this context, municipal authorities in the country, particularly in high-density areas, should place a strong focus on mitigating air pollution. In particular, the capital city, Bucharest, ranks among the most congested cities in the world while registering the highest pollution index in Romania, with traffic pollution responsible for two-thirds of its air pollution. Consequently, studies that assess and model pollution trends are paramount to inform local policy-making processes and assist pollution-mitigation efforts. In this paper, a generalized additive modeling (GAM) framework is employed to model hourly concentrations of nitrogen dioxide (NO₂), i.e., a relevant traffic-pollution proxy, at a busy urban traffic location in central Bucharest, Romania. All models are developed on a wide, fine-granularity dataset spanning January 2017–December 2022 and include extensive meteorological covariates. Model robustness is assured by switching between the generalized additive model (GAM) framework and the generalized additive mixed model (GAMM) framework when the residual autoregressive process needs to be specifically acknowledged. Results indicate that trend GAMs explain a large amount of the hourly variation in traffic pollution. Furthermore, meteorological factors contribute to increasing the models’ explanation power, with wind direction, relative humidity, and the interaction between wind speed and the atmospheric pressure emerging as important mitigators for NO₂ concentrations in Bucharest. The results of this study can be valuable in assisting local authorities to take proactive measures for traffic pollution control in the capital city of Romania. Full article

Urban areas are at the forefront in addressing global challenges such as climate change and biodiversity loss. Among the key responses are nature-based solutions, which are increasingly being integrated into policy frameworks but which require strong community engagement for their effective implementation. This paper presents the findings of surveys conducted within the Place Lab in Katowice, Poland, an initiative developed as part of an international project and used as a participatory tool for co-creating and implementing green infrastructure. The project applies both place-based and people-centred approaches to support European cities in their transition towards regenerative urbanism. Place Lab activities encourage collaboration between local authorities and residents, enhancing awareness and fostering participation in environmental initiatives. The survey data collected during the project allowed for the evaluation of changes in public attitudes and levels of engagement and for the identification of broader societal phenomena that may influence the implementation of nature-based solutions. The findings revealed, for instance, that more women were interested in supporting the project, that residents tended to be sceptical of governmental actions on climate change, and that views were divided on the trade-off between urban infrastructure such as parking and roads and the presence of green areas. Furthermore, questions of responsibility, awareness, and long-term commitment were frequently raised. Building on the survey results and the existing literature, the study proposes a set of indicators to assess the contribution of citizen participation to the adoption of nature-based solutions. While the effectiveness of nature-based solutions in mitigating climate change impacts can be assessed relatively directly, evaluating civic engagement is more complex. Nevertheless, when conducted transparently and interpreted by experts, indicator-based assessment can offer valuable insights. This study introduces a novel perspective by considering not only drivers of engagement but also the obstacles. The proposed indicators provide a foundation for evaluating community readiness and commitment to nature-based approaches and may be adapted for application in other urban settings and in future research on climate resilience strategies. Full article

Background/Objectives: Given the heterogeneous nature of long COVID, its treatment and management remain challenging. This study aimed to investigate whether poor pre-pandemic sleep quality, its deterioration during the peak of the pandemic, and circadian preference increase the risk of long COVID symptoms. Methods: An online survey was conducted between 9 October and 12 December 2022, with 384 participants who had recovered from COVID-19 at least three months prior to data collection. Participants were categorized based on the presence of at least one long COVID symptom. Logistic regression models assessed associations between sleep-related variables and long COVID symptoms. Results: Participants with long COVID symptoms reported significantly poorer sleep quality, higher perceived stress, greater somatic and cognitive pre-sleep arousal, and elevated levels of post-traumatic stress symptoms, anxiety, depression, and aggression. Fatigue (39.8%) and memory problems (37.0%) were the most common long COVID symptoms. Sleep deterioration during the pandemic peak was reported by 34.6% of respondents. Pre-pandemic poor sleep quality, its deterioration during the pandemic, and poor sleep at the time of the survey were all significantly associated with long COVID. An extreme morning chronotype consistently predicted long COVID symptoms across all models, while an extreme evening chronotype was predictive only when accounting for sleep quality changes during the pandemic. COVID-19 frequency, severity, financial impact, and somatic pre-sleep arousal were significant predictors in all models. Conclusions: Poor sleep quality before the pandemic and its worsening during the pandemic peak are associated with a higher likelihood of long COVID symptoms. These findings underscore the need to monitor sleep health during pandemics and similar global events to help identify at-risk individuals and mitigate long-term health consequences, with important clinical and societal implications. Full article

Intermittent claudication is the most common manifestation of peripheral arterial disease as well as a lifestyle-limiting disease with a favorable prognosis. Despite societal guideline recommendations, most claudicants do not trial optimal medical therapy (OMT) and supervised exercise therapy (SET) or receive a quality-of-life (QoL) assessment prior to intervention. In this review, we discuss the components of OMT and SET and the trials establishing their clear benefits in claudicants. We assess adherence rates to OMT/SET and qualitative and quantitative studies attempting to understand the barriers to adoption. We also review how patient-reported outcome metrics were developed to assess QoL in claudicants and reasons for their underutilization in daily clinical practice. Last, we describe novel initiatives seeking to improve adherence to OMT, SET, and QoL assessment. Full article

Ensuring sustainable food systems is an urgent global priority as populations grow and environmental pressures mount. Technological innovations such as genetic engineering (GE) and nanotechnology (nano) have been promoted as promising pathways for achieving greater sustainability in agriculture and food production. Yet, the sustainability of these technologies is not defined by technical performance alone; it hinges on how they are perceived by key stakeholders and how well they align with broader societal values. This study addresses the critical question of how expert stakeholders evaluate the sustainability of GE and nano-based food and agriculture (agrifood) products. Using a multi-method online platform, we engaged 42 experts across academia, government, industry, and NGOs in the United States to assess six real-world case studies—three using GE and three using nano—across ten different dimensions of sustainability. We show that nano-based products were consistently rated more favorably than their GE counterparts in terms of environmental, economic, and social sustainability, as well as across ethical and societal dimensions. Like prior studies, our results reveal that stakeholders see meaningful distinctions between nanotechnology and biotechnology, likely due to underlying value-based concerns about animal welfare, perceived naturalness, or corporate control of agrifood systems. The fruit coating and flu vaccine—both nano-enabled—received the most positive ratings, while GE mustard greens and salmon were the most polarizing. These results underscore the importance of incorporating stakeholder perspectives in technology assessment and innovation governance. These results also suggest that responsible innovation efforts in agrifood systems should prioritize communication, addressing meaningful societal needs, and the contextual understanding of societal values to build trust and legitimacy. Full article

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, progressive form of pre-capillary pulmonary hypertension characterized by persistent, organized thromboemboli in the pulmonary vasculature, leading to vascular remodeling, elevated pulmonary artery pressures, right heart failure, and significant morbidity and mortality if untreated. Despite advances, CTEPH remains underdiagnosed due to nonspecific symptoms and overlapping features with other forms of pulmonary hypertension. Basic Methodology: This review synthesizes data from large international registries, epidemiologic studies, translational research, and multicenter clinical trials. Key methodologies include analysis of registry data to assess incidence and risk factors, histopathological examination of lung specimens, and molecular studies investigating endothelial dysfunction and inflammatory pathways. Diagnostic modalities and treatment outcomes are evaluated through observational studies and randomized controlled trials. Recent Advances and Affected Population: Research has elucidated that CTEPH arises from incomplete resolution of pulmonary emboli, with subsequent fibrotic transformation mediated by dysregulated TGF-β/TGFBI signaling, endothelial dysfunction, and chronic inflammation. Affected populations are typically older adults, often with prior venous thromboembolism, splenectomy, or prothrombotic conditions, though up to 25% have no history of acute PE. The disease burden is substantial, with delayed diagnosis contributing to worse outcomes and higher societal costs. Microvascular arteriopathy and PAH-like lesions in non-occluded vessels further complicate the clinical picture. Conclusions: CTEPH is now recognized as a treatable disease, with multimodal therapies—surgical endarterectomy, balloon pulmonary angioplasty, and targeted pharmacotherapy—significantly improving survival and quality of life. Ongoing research into molecular mechanisms and biomarker-driven diagnostics promises earlier identification and more personalized management. Multidisciplinary care and continued translational investigation are essential to further reduce mortality and optimize outcomes for this complex patient population. Full article

National parks represent a global initiative for biodiversity conservation and environmentally sustainable societal development, with China having launched its own national park program. The establishment and operation of these parks significantly impact local residents’ livelihoods. Based on DFID’s Sustainable Livelihoods Framework, an assessment tool introduced by the UK Department for International Development (DFID) for evaluating the livelihood standards of residents, this study constructs a structural equation modeling (SEM) framework to analyze how national parks affect residents’ livelihoods, discussing livelihood risk management and feasible capacity-building interventions. Focusing on the Northeast Tiger and Leopard National Park as a case study, the research reveals that indirect wildlife-inflicted damage poses more pronounced negative impacts on local communities than park establishment policies. Both regulatory land-use restrictions and wildlife conflicts disrupt land-based livelihood activities, ultimately affecting residents’ livelihood stability. Mitigation requires comprehensive measures, including retaining essential farmland; providing vocational skill training; offering specialized loans; diversifying employment channels; and improving compensation mechanisms to safeguard residents’ livelihood security. Full article

This position paper proposes a conceptual framework (CF-BIAI-SXT) for integrating blockchain with AI to enhance ethical governance, transparency, and privacy in high-risk AI applications that ensure societal resilience through the mitigation of sexual exploitation. Sextortion is a growing form of digital sexual exploitation, and the role of AI in its mitigation and the ethical issues that arise provide a good case for this paper. Through a combination of systematic and narrative literature reviews, the paper first explores the ethical shortcomings of existing AI systems in sextortion prevention and assesses the capacity of blockchain operations to mitigate these limitations. It then develops CF-BIAI-SXT, a framework operationalized through BPMN-modeled components and structured into a three-layer implementation strategy composed of technical enablement, governance alignment, and continuous oversight. The framework is then situated within real-world regulatory constraints, including GDPR and the EU AI Act. This position paper concludes that a resilient society needs ethical, privacy-first, and socially resilient digital infrastructures, and integrating two core technologies, such as AI and blockchain, creates a viable pathway towards this desideratum. Mitigating high-risk environments, such as sextortion, may be a fundamental first step in this pathway, with the potential expansion to other forms of online threats. Full article

X-linked adrenoleukodystrophy (ALD) is an inherited metabolic disorder that can cause adrenal insufficiency and cerebral ALD (cALD) in childhood. Early detection prevents adverse health outcomes and can be achieved by newborn screening (NBS) followed by monitoring disease progression. However, monitoring is associated with high costs. This study evaluates the cost–effectiveness of NBS for ALD in The Netherlands compared to no screening using a health economic model. A decision tree combined with a Markov model was developed to estimate societal costs, including screening costs, healthcare costs, and productivity losses of parents, and health outcomes over an 18-year time horizon. Model parameters were derived from the literature and expert opinion. A probabilistic sensitivity analysis (PSA) was performed to assess uncertainty. The screening costs of detecting one ALD case by NBS was EUR 40,630. Until the age of 18 years, the total societal cost per ALD case was EUR 120,779 for screening and EUR 62,914 for no screening. Screening gained an average of 1.7 QALYs compared with no screening. This resulted in an incremental cost–effectiveness ratio (ICER) of EUR 34,084 per QALY gained for screening compared to no screening. Although the results are sensitive to uncertainty surrounding costs and effectiveness due to limited data, NBS for ALD is likely to be cost–effective using a willingness-to-pay (WTP) threshold of EUR 50,000– EUR 80,000 per QALY gained. Full article

Evaluating performance is a necessary and specific process across all sectors and organizational levels, shaped by context, indicators, and purpose. Considering global sustainability transitions, understanding financial performance entails a deeper perspective on technical accuracy, conceptual clarity, and systemic integration. This study investigates how financial performance is assessed and interpreted in sustainability-focused research, drawing on a bibliometric analysis of 490 articles indexed in the Web of Science from 2007 to 2023. Using SciMAT, we traced thematic evolutions and revealed a fragmented research landscape marked by competing theoretical, methodological, and practical orientations. To address this conceptual dispersion, we applied the Analytic Hierarchy Process (AHP) to evaluate five key alternatives to financial-performance assessment (quantitative measurement, definition-oriented reasoning, theoretical frameworks, experiential comparison, and integration with sustainability and ethics) against three conceptual criteria (philosophical depth, holistic scope, and multidisciplinary relevance). The results highlight a strong preference for holistic and integrative models of financial performance, with quantitative measurement ranking highest in practical terms, followed by experiential and sustainability-driven approaches. These results underscore the need to align financial evaluation more closely with sustainability values, bridging short-term metrics with long-term societal impact. By combining diachronic thematic mapping with structured decision analysis, this study advances a more reflective and forward-looking framework for performance research. It contributes to sustainability research by identifying underexplored epistemological pathways and supporting the development of financial evaluation models that are inclusive, ethically grounded, and aligned with sustainable development goals. Full article

Geoethics emphasizes responsible human interaction with the Earth, promoting ethical practices in the geosciences to ensure sustainability for current and future generations. UNESCO Global Geoparks (UGGps) are designated areas that support sustainable development by integrating geoconservation, geoeducation, and community engagement, thereby raising awareness of geological heritage. This quantitative study employed an online questionnaire (n = 798) to assess geoethical awareness among residents of all nine Hellenic UGGps, with the aim of profiling environmental engagement and perceptions. The results indicate a generally high level of geoethical awareness, with Sitia UGGp exhibiting the highest average mean score (M⁻ = 8.98, SD⁻ = 1.34), reflecting strong community support and effective outreach efforts. In contrast, Lavreotiki UGGp (M⁻ = 8.48, SD⁻ = 1.15) and Psiloritis UGGp (M⁻ = 8.33, SD⁻ = 1.36) scored lower in areas such as community engagement and geotourism, suggesting opportunities for targeted improvement. Regional differences suggest that management, visibility, and local context significantly influence public perceptions. Cluster analysis identified four respondent profiles: (a) highly engaged environmental stewards (28.7%), (b) supportive but selective advocates (40.5%), (c) moderately indifferent participants (26.9%), and (d) disengaged or critical respondents (3.9%). Demographic factors such as age, residence, prior visits to Hellenic UGGps, and education significantly differentiated these groups. Mapping geoethical awareness provides a valuable tool for assessing societal benefits and enhancing the governance of UGGps. Overall, the findings underscore the need to shift from an anthropocentric to a more geocentric worldview that prioritizes the well-being of both humanity and Earth’s systems. Full article