Search Results (4,360)

Background: Diabetic ketoacidosis (DKA) remains a preventable yet frequent complication at the onset of type 1 diabetes (T1D) in children, driven by delayed symptom recognition, socioeconomic disparities, and inconsistent access to care. Early identification of presymptomatic T1D through autoantibody-based screening, together with emerging disease-modifying therapies, may reduce the incidence of DKA. This review synthesizes evidence on epidemiology, risk determinants, screening strategies, and immunological interventions relevant to DKA prevention. Methods: A narrative review was conducted using PubMed, EMBASE, Scopus, Web of Science, and Google Scholar (2011–2026). Eligible sources included clinical studies, guidelines, systematic reviews, meta-analyses, and prevention trials addressing staging, screening, epidemiology, and disease-modifying treatments in pediatric T1D. Landmark publications outside this timeframe were included when essential. Evidence was integrated to identify determinants of DKA and strategies to reduce its occurrence. Results: DKA risk is influenced by younger age, socioeconomic disadvantage, rural residence, misdiagnosis, and limited access to specialized care. Sustained public awareness and community-based education reduce DKA incidence, whereas short-term campaigns show transient effects. Structured screening programs, including TrialNet and TEDDY, demonstrate near-elimination of DKA among monitored children. Teplizumab delayed progression from stage 2 to stage 3 T1D by a median of approximately 24 months in the original TN-10 trial, with extended follow-up demonstrating a median delay of 32.5 months. It is approved for individuals with stage 2 T1D aged ≥ 1 year and has recently gained approval for selected patients with newly diagnosed T1D, expanding opportunities for early disease modification. Global networks such as INNODIA strengthen prevention through coordinated biomarker-driven research. Conclusions: Reducing DKA at T1D onset requires integrated, sustained strategies combining public awareness, systematic autoantibody screening, structured follow-up, and access to emerging immunotherapies. Coordinated care across primary providers, pediatric endocrinologists, and research networks is essential to advance a proactive, prevention-oriented model of pediatric T1D care. Full article

Dam-break floods pose severe threats to downstream urban areas due to their sudden onset, rapid propagation, and potentially catastrophic socioeconomic consequences. This study develops a multi-indicator fuzzy comprehensive evaluation framework for urban flood risk assessment under dam-break scenarios. The framework integrates hydrodynamic simulation outputs with geographic information system-based spatial analysis to characterize spatial variations in flood risk. It incorporates flood hazard factors (inundation depth, arrival time, and inundation duration) derived from a coupled one-dimensional/two-dimensional hydrodynamic model and socioeconomic vulnerability factors (population density and road network density) derived from spatial statistics. Indicator weights were determined using a combined Analytic Hierarchy Process and entropy-weight method, and risk levels were obtained through membership-function calculation and spatial overlay analysis. The framework was applied to the Dongpu and Dafangying reservoirs in Hefei, China, under a scenario of simultaneous dam failure during a probable maximum flood. Results show that, compared with hazard-only assessment, the comprehensive evaluation substantially reduced the extent of high-risk areas and altered their spatial distribution. Very high-risk zones were concentrated along the upstream main channel, where high-velocity floodwaters coincide with dense population and economic activity. Flood arrival time and population density were identified as the most influential indicators in the proposed risk assessment framework. The proposed framework provides a more comprehensive and spatially refined tool for urban dam-break flood risk management and emergency decision-making. Full article

Climate change and rapid urbanization are reshaping the spatial relationship between flood risk and socioeconomic development, yet basin-scale evidence on where risk pressure and development capacity diverge remains limited. Taking 54 cities in China’s Pearl River Basin as the study area, this study adopts a dual-system evaluation framework integrating game-theory weighting, coupling coordination analysis, and spatial autocorrelation. Flood risk is characterized through hazard, exposure, vulnerability, and Resilience, while socioeconomic development is represented by economic scale, urban construction, and population agglomeration. This design extends previous Pearl River Delta-centered analyses to the entire basin and enables city-scale identification of risk–development imbalance. The results reveal a pronounced downstream–upstream gradient. The Pearl River Delta has the highest flood exposure (mean exposure index = 0.2603, 117% higher than the basin average of 0.1208), but strong Resilience and socioeconomic capacity prevent high exposure from translating into the highest overall risk. By contrast, east-central Guangxi emerges as a critical hotspot where moderate to high hazard overlaps with high vulnerability and weak Resilience. Coupling coordination remains generally low, shifting from basic coordination in parts of the Pearl River Delta to severe imbalance in upstream Guizhou, Guangxi, and Yunnan. The global Moran’s I is 0.4261 and significant at the 1% level, indicating marked spatial clustering, with high-high clusters concentrated in core Pearl River Delta cities and low–low clusters in eastern Yunnan and southwestern Guizhou. By distinguishing high exposure cities from high priority intervention areas, this study provides a potentially transferable framework for differentiated flood governance, infrastructure investment, and Resilience enhancement across large river basins. Full article

Background: Microtia is a congenital anomaly of the external ear that is frequently associated with conductive or mixed hearing impairment and potential developmental consequences. Although genetic factors may contribute to some cases, social and economic conditions can influence access to diagnosis, hearing rehabilitation, and specialized care. This study examined clinical severity, hearing disability, and socioeconomic characteristics among patients with isolated and familial microtia evaluated in Ecuador. Methods: A cross-sectional study was conducted at a tertiary referral center in Quito, Ecuador. A total of 143 patients with microtia were included. Clinical variables included hearing impairment, hearing device use, microtia severity, associated risk factors, and family history. Sociodemographic variables included age, sex, residence, economic level, and healthcare access. Categorical variables were summarized as frequencies and percentages, and continuous variables as medians with interquartile ranges. Group comparisons were performed using the chi-square test and the Mann–Whitney test. Multivariable logistic regression was used to assess factors associated with hearing device use. Statistical significance was set at p < 0.05. Results: Hearing impairment was present in 41.78% of patients, with similar prevalence in isolated and familial cases. Hearing device use was reported by 19.86% of the sample. Familial microtia showed a significantly different distribution of right-ear severity, with higher frequencies of grade 1 and grade 4 anomalies, whereas isolated microtia was more commonly grade 3. Significant differences were also observed in sex distribution and economic level. Isolated cases were more frequent among males, whereas familial cases showed a higher proportion of females. Familial microtia was concentrated mainly in the low-middle economic stratum. In multivariable analysis, no factor was independently associated with hearing device use, and confidence intervals were wide, indicating limited precision. Conclusions: In this tertiary referral sample, microtia-related disability and access to care appeared to reflect the combined influence of clinical vulnerability, familial aggregation, and socioeconomic disadvantage. The low use of hearing devices despite frequent hearing impairment indicates an important gap between clinical need and rehabilitation. Equity-oriented strategies, including early hearing screening, timely referral, financial protection for assistive devices, and improved access to specialized care, may help reduce unmet needs among patients with microtia. Full article

Coal gangue, a major by-product of coal mining, has long posed significant environmental and resource management challenges. With increasing global emphasis on energy transition and environmental sustainability, the comprehensive utilization of coal gangue has emerged as a critical research and policy priority. This review systematically examines the sources, characteristics, environmental impacts, and integrated utilization pathways of coal gangue. First, the formation mechanisms, mineralogical composition, and physicochemical properties of coal gangue are summarized, with particular attention to hazardous constituents and associated environmental risks, including soil and groundwater contamination, atmospheric pollution, and ecological degradation. Subsequently, current technological approaches for coal gangue management and comprehensive utilization are evaluated, including subsidence areas reclamation and underground backfilling, applications in construction materials and energy conversion, extraction of valuable chemical elements and functional materials, ecological soil engineering, and carbon sequestration. The potential contributions of these pathways to waste reduction, resource efficiency, and low-carbon development are critically discussed. Finally, key environmental, technological, and socio-economic considerations influencing sustainable coal gangue utilization are emphasized. This review provides a comprehensive synthesis of existing knowledge and identifies future research directions aimed at advancing environmentally sound, economically viable, and large-scale utilization strategies. The findings are intended to support researchers, policymakers, and industry stakeholders in promoting circular resource systems and sustainable development. Full article

Climate change is increasingly reshaping the distribution and long-term persistence of urban greening tree species, yet national-scale assessments of widely planted species in China remain limited. Salix babylonica is one of the most representative and extensively planted urban greening trees in China, but its future climate vulnerability and redistribution patterns are still poorly understood. In this study, we integrated 425 occurrence records and 16 environmental variables to project the potential distribution of S. babylonica under current and future (2050s, 2070s, and 2090s) climate scenarios across three shared socioeconomic pathways (SSP126, SSP370, and SSP585) using an optimized MaxEnt model. The optimized model demonstrated strong predictive performance and identified annual precipitation (≥309.64 mm), precipitation of the wettest month (≥82.01 mm), elevation (≤2251.24 m), mean temperature of the coldest quarter (≥−10.77 °C), annual mean temperature (≥3.94 °C), and minimum temperature of the coldest month (≥−19.11 °C) as the dominant environmental factors (threshold) constraining species distribution. Under the current climate, suitable habitats of S. babylonica are primarily distributed in East, Central, Southwest, and South China, with highly suitable habitats concentrated in the eastern and central plains. Under future climate scenarios, high suitability areas are projected to contract significantly and become progressively fragmented, with reductions ranging from 2.81% (2070s-SSP126) to 40.01% (2090s-SSP585), whereas medium and low suitability areas are projected to expand substantially, with increases ranging from 6.76% to 48.10%. The overall centroid of suitable habitats exhibits a consistent northward shift across scenarios. These results indicate that climate change will not simply expand the potential distribution of S. babylonica, but will reorganize habitat quality and increase long-term risks for its continued use in urban greening. Our findings provide a spatially explicit basis for climate-adaptive urban forestry planning and support risk-differentiated management, including the conservation of stable core areas, monitoring of declining risk zones, and cautious introduction trials in newly emerging suitable areas. Full article

Gastrointestinal (GI) adverse drug reactions (ADRs) are common among glucagon-like peptide-1 receptor agonist (GLP-1 RA) users and frequently contribute to treatment discontinuation and reduced therapeutic benefit. This retrospective study aimed to develop and validate an explainable artificial intelligence (XAI) model to predict GI ADR risk among GLP-1 RA users using real-world clinical data from the NIH All of Us Research Program. Adults prescribed GLP-1 RAs were identified and classified according to the occurrence of GI ADRs following treatment initiation. Multiple supervised machine learning models, including logistic regression, random forest, extreme gradient boosting (XGBoost), support vector machine, neural network, LightGBM, and CatBoost, were evaluated using demographic, socioeconomic, clinical, medication, and laboratory variables. Model performance was assessed using area under the receiver operating characteristic curve (AUC), accuracy, precision, recall, and F1-score. A total of 8697 participants were included, of whom 59.1% experienced GI ADRs. All models demonstrated reasonable predictive performance, with AUC values ranging from 0.82 to 0.84. The XGBoost achieved discrimination of (AUC: 0.84 ± 0.01). SHapley Additive exPlanations (SHAP) identified gastroesophageal reflux disease, hemorrhoids, and elevated HbA1c as important predictors of GI ADR risk. These findings demonstrate the potential utility of explainable machine learning approaches for predicting the safety of GLP-1 RA therapy. Full article

Wildfires pose increasing environmental and socio-economic risks, particularly in climate-sensitive and tropical regions, necessitating reliable satellite-based monitoring and predictive frameworks. This study presents a comprehensive survey of satellite-derived wildfire indicators and spatiotemporal modeling approaches, covering their historical development, current methodologies, and emerging research directions. We review major active fire and hotspot datasets derived from MODIS, VIIRS, and related platforms, along with key environmental drivers such as vegetation indices, meteorological variables, and land-surface with a specific case study for the Indonesian region. Modeling approaches are synthesized from classical statistical regression and time-series analysis to contemporary machine learning and deep learning architectures, including convolutional neural networks, recurrent neural networks, and transformer-based models. The analysis highlights the transition toward multi-source data integration and spatiotemporal deep learning frameworks capable of capturing complex wildfire dynamics. Finally, we identify future research challenges, including hybrid physical–AI modeling, uncertainty quantification, and scalable real-time wildfire intelligence systems. This survey provides a structured reference for researchers and practitioners seeking to advance satellite-based wildfire monitoring and prediction. Full article

Background: Unplanned paediatric hospital readmissions are key indicators of healthcare quality, often reflecting issues in discharge planning and continuity of care. The COVID-19 pandemic significantly disrupted healthcare delivery and utilisation, yet its impact on paediatric readmission patterns in Australia remains unclear. Methods: A 5-year single-centre retrospective cohort study of 21,262 paediatric admissions and unplanned readmissions at a non-tertiary metropolitan Australian hospital between 21 March 2017 and 20 March 2023 was conducted. Admissions up to 20 March 2020 were classified as pre-pandemic, and those from 21 March 2020 as during the COVID-19 pandemic. We analysed patient characteristics, including gender, age, First Nations status, primary diagnosis, and socio-economic status, to identify UHR trends. Results: During the COVID-19 period, total paediatric admissions declined by nearly 30%, and the readmission rate decreased from 7.5% to 4.6% compared with the pre-pandemic period. Across both cohorts, higher readmission rates were observed among male patients, infants aged 0–12 months, and children from more socio-economically advantaged areas. Readmissions among First Nations children and those with communicable diseases declined during the pandemic period. Conclusions: A higher proportion of males and patients under 12 months of age had higher readmission rates across both periods. These findings highlight the need for targeted early intervention, age-specific discharge planning, and strengthened follow-up care for high-risk groups. Further research should extend the study period beyond the pandemic and include larger cohorts to better characterise long-term trends and improve generalisability. Full article

Resource-based cities in Northwest China face increasing ecological, geotechnical, and socio-economic challenges caused by long-term mining, including subsidence, slope instability, waste rock accumulation, soil erosion, industrial decline, and settlement deterioration. Post-mining land reuse is constrained by geological safety, foundation stability, slope safety, drainage capacity, erosion risk, and waste rock dump stability, yet existing restoration studies often separate engineering remediation from landscape reuse, industrial pathway selection, and long-term governance. Taking a mining area in City A, Gansu Province, as a case study, this paper develops a geotechnical constraint-based ecology–landscape–economy framework for post-mining land reuse and sustainable human settlement improvement. Unlike conventional reclamation approaches that mainly emphasize engineering remediation, vegetation recovery, or single-function land reuse, this study integrates geotechnical constraints, land-unit classification, pathway-specific compatibility assessment, and capital–space coupling into a planning-scale decision-support framework. Post-mining land was classified into five units, and their compatibility with three restoration plus industrial pathways was assessed using five indicators: geological safety, ecological sensitivity, land-use availability, landscape and cultural value, and industrial operation potential. The results indicate that backfilled mining voids and reclaimed platforms are most suitable for modern agriculture, tailings ponds and subsidence waterbodies for cultural tourism and wellness, and waste rock dump platforms and other stable, low-sensitivity open land for new energy development. A capital–space coupling mechanism is further proposed to link restoration, support, and development zones with government funds, corporate capital, social capital, green finance, and industrial income. This framework provides a planning-scale engineering-suitability screening tool for sustainable post-mining land transformation. Full article

Wetlands are the largest natural source of atmospheric methane, but the socioeconomic consequences of future wetland CH₄ emissions remain poorly quantified. We combined projected wetland CH₄ pathways with the PAGE-ICE integrated assessment model to estimate their contributions to atmospheric CH₄ concentration, radiative forcing, warming, and socioeconomic damages under SSP1-2.6, SSP2-4.5, and SSP5-8.5. By 2100, wetland CH₄ emissions increased atmospheric CH₄ concentrations by 782, 868, and 1207 ppb under the three pathways, respectively. The corresponding global warming increments were 0.190, 0.170, and 0.166 °C, showing that larger atmospheric CH₄ contributions do not translate linearly into larger temperature responses. Wetland-attributable annual global damages reached 2.79, 5.91, and 6.49 trillion USD per year⁻¹ by 2100, while discounted cumulative damages over 2020–2100 reached 79.96, 127.24, and 127.33 trillion USD under SSP1-2.6, SSP2-4.5, and SSP5-8.5. Regionally, Africa, the Middle East, and India accounted for the largest absolute damages, whereas Eastern Europe and the former Soviet Union had the highest losses relative to GDP and population. A sensitivity analysis identified transient climate response, damage-function curvature, and the pure time preference rate as the main controls on valuation uncertainty. These results indicate that projected wetland CH₄ emissions can make a measurable marginal contribution to future climate damage and should be incorporated into sustainability assessments, methane-related climate-risk evaluations, and long-term adaptation planning. Full article

Background/Objectives: Glaucoma is one of the leading causes of irreversible blindness worldwide. Open-angle glaucoma (OAG) predominates in East Asian populations, with normal-tension glaucoma accounting for the majority of cases. Although intraocular pressure remains the most established risk factor, non-pressure-dependent mechanisms, including ocular vascular dysregulation, warrant further investigation. Cold extremities, a hallmark of Flammer syndrome reflecting primary vascular dysregulation, and underweight (body mass index [BMI] < 18.5 kg/m²) are each independently associated with OAG; however, their combined effect has not been examined at the population level. Materials and Methods: Using nationally representative data from the Korea National Health and Nutrition Examination Survey 2008–2012 (n = 8135; controls 7418, OAG 717), participants aged ≥ 50 years with measured intraocular pressure within the normal range (5–21 mmHg) at the time of examination were classified into four groups: non-underweight without cold extremities (N-N, reference), cold extremities only (CEO), underweight only (UWO), and underweight with cold extremities (UW+CE). Complex sample logistic regression was adjusted for sex, age, diabetes mellitus, mean arterial pressure, intraocular pressure, and spherical equivalent. Results: UW+CE was associated with significantly higher odds of OAG than N-N (adjusted odds ratio [OR] = 2.10, 95% confidence interval: 1.14–3.88, p = 0.018), whereas neither CEO (OR = 1.10, p = 0.431) nor UWO (OR = 1.54, p = 0.170) was significantly associated individually. This association with UW+CE remained robust across alternative BMI thresholds and after further adjustment for socioeconomic, lifestyle, and cardiometabolic variables. Conclusions: Co-occurring cold extremities and underweight status were associated with a combined hemodynamic risk profile for OAG, suggesting their potential utility as clinically accessible noninvasive markers for the early identification of highly vulnerable individuals and informing proactive glaucoma screening strategies. Full article

Endometriosis is a chronic gynecological disease affecting about 10% of reproductive age women, with a significant impact on socio-economic sphere and quality of life. It is a multifactorial phenomenon, in which genetic predisposition, immunologic malfunction, hormone imbalance, and environmental insult play an important role in disease development and progression. The aim of this review is to report the current evidence from the literature related to the association between endometriosis and endocrine disruptors. This study was designed as a systematic review and meta-analysis investigating the association between exposure to endocrine disruptors and the risk of endometriosis. The review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The systematic search identified 428 records from national and international scientific databases. The included studies were published between 2001 and 2020, with most studies classified as fair-to-good quality. The overall random-effects meta-analysis demonstrated a statistically significant association between exposure to endocrine-disrupting chemicals and endometriosis. This systematic review and meta-analysis provides evidence of a significant association between exposure to endocrine-disrupting chemicals and endometriosis, with the strongest and most consistent association observed for polychlorinated biphenyls. Full article

Background: People living with dementia (PLWD) are at increased risk for medical complications, including urinary tract infections (UTIs), which are often presented atypically with delirium or behavioral changes. These atypical presentations frequently prompt psychiatric consultation and complicated medical management. As the aging population grows, understanding how dementia influences UTI-related outcomes is critical for C-L psychiatrists working at the interface of medicine and psychiatry. Methods: This retrospective cohort study used the 2021 National Inpatient Sample (NIS) to identify adult inpatients with a principal diagnosis of UTI. Patients were stratified by the presence of a comorbid dementia diagnosis. Multivariate logistic and linear regression models adjusted for demographic, clinical, and hospital-level covariates were used to examine associations between dementia and outcomes: in-hospital mortality (primary), length of stay (LOS), hospital charges, and discharge disposition (secondary). Adjusted models included available demographic, socioeconomic, comorbidity, and hospital-level covariates, including age, sex, race/ethnicity, median household income quartile by patient ZIP code, insurance type, Charlson Comorbidity Index, hospital region, urban hospital location, and hospital teaching status. Results: Among 295,494 hospitalizations for UTI, 78,990 (26.7%) involved patients with dementia. Compared to those without dementia, PLWD were significantly older (mean age 82.5 vs. 69.5 years), more likely to be female, and had greater comorbidity burden. Adjusted analyses revealed that dementia was linked to higher odds of in-hospital mortality (aOR: 1.28, 95% CI: 1.03–1.58), longer LOS (+0.93 days, p < 0.01), and increased hospital charges (+$3243.50, p < 0.01). Additionally, PLWD had lower odds of discharge to home (aOR: 0.53) and higher odds of discharge to skilled nursing facilities (aOR: 1.94). Conclusions: Among patients hospitalized with a principal diagnosis of UTI, comorbid dementia was linked with higher in-hospital mortality, longer length of stay, higher hospital charges, and lower likelihood of discharge home. These findings should be interpreted in the context of important limitations of administrative data, including residual confounding and inability to distinguish symptomatic UTI from asymptomatic bacteriuria. Full article

Background: Tuberculosis (TB) remains a leading cause of global morbidity and mortality, yet its impact extends far beyond microbiological cure. Many TB survivors experience persistent structural lung damage or functional impairment consistent with post-TB lung disease, while growing evidence highlights long-term non-respiratory health outcomes. Synthesizing evidence across lung and non- respiratory health outcomes, along with their risk factors, is critical to inform long-term TB care. Methods: We conducted a scoping review including systematic reviews reporting on post-TB long-term health outcomes. A search was performed in PubMed/MEDLINE on 27 July 2025, using terms related to “tuberculosis,” “systematic review,” “meta-analysis,” “sequelae” and “long-term health outcomes,” without language restrictions. Results: Nine systematic reviews met inclusion criteria. Most focused on pulmonary outcomes and consistently demonstrated that TB is associated with chronic airflow obstruction, reduced lung function, and an increased long-term risk of lung cancer, although residual confounding from environmental, clinical, and socioeconomic factors cannot be excluded. While younger adults are more prone to developing COPD after TB in high TB burden settings, older individuals face a higher risk of broader post-TB lung sequelae. Evidence suggested that TB survivors are at increased risk of non-respiratory complications. HIV co-infection, low CD4 counts, older age, pre-existing hepatitis, prior TB treatment, and hypoalbuminemia were associated with post-TB liver injury, while baseline hearing impairment and HIV co-infection increased the likelihood of post-TB hearing loss. TB was also linked to elevated risk of several non-pulmonary cancers, including oesophageal, cervical, hematological, pancreatic, and gastric malignancies, with the highest risk within the first year after TB diagnosis and persisting, though attenuated, in subsequent years. Conclusion: TB should be viewed as a chronic condition with enduring lung and non-respiratory health outcomes. TB survivors face increased risks of COPD, lung cancer, and a range of non-respiratory health outcomes, including hepatic and auditory complications, particularly among high-risk groups, such as those living with HIV infection, along with baseline hearing and hepatic impairment. Public health programmes must extend care beyond microbiological cure to include integrated, post-TB long-term monitoring of lung, hepatic and hearing across all ages, including malignancy surveillance, after baseline assessments to identify high-risk TB survivors. Future research should also elucidate risk factors for post-TB malignancy, and clarify the relationship between neurological, renal, and musculoskeletal sequelae and TB to inform evidence-based TB survivorship care. Full article