Search Results (2,247)

The Xishan–Yongding River cultural belt is a key component of the three major cultural belts of Beijing and its water heritage; as a representative of the intensive distribution of semi-arid climate, analyzing its spatial and temporal distribution characteristics is crucial for the development of systematic conservation strategies. This study is based on a dataset developed from field surveys and historical documentation and has been spatially analyzed using visual analytical methods and using a Geographic Information System (GIS). In this study, kernel density estimation was used to identify areas of high density, standard elliptic deviation was used to assess the distribution of water heritage sites over time, and the mean nearest neighbor index was used to determine the spatial clustering pattern of these sites. Regarding type and quantity, water heritage in the cultural belt is diverse, with non-water heritage sites, such as temples and inscriptions, being the most prevalent. In terms of temporal distribution, water heritage spans a long period, with the largest number dating to the Qing Dynasty. The centers of distribution across different periods exhibit a trend from south to north and from mountainous regions to plains, exhibiting a gradual concentration. Spatially, water heritage within the cultural belt follows a “multi-core, contiguous distribution” pattern, with three high-density zones, two medium-density zones, and six low-density zones. The distribution of water heritage is influenced by a combination of natural factors, such as river systems, settlements, elevation, and slope, alongside human factors, including historical culture and the political environment. The findings of this research offer a detailed analysis of the regional characteristics and underlying mechanisms of the temporal and spatial distribution of water heritage within the Xishan–Yongding River cultural belt. Full article

This paper examines the stock market reaction to company investment decisions with and without a sustainability objective. Abnormal returns are estimated using a standard event study methodology for a sample of 517 investment announcements for listed UK firms for the period 2013 to 2021. Using a sample of 90 sustainable investments and 427 non-sustainable investments, we test whether 90 announcements with a sustainability agenda are more positively viewed by market participants than 427 announcements without a sustainability agenda. This study documents significant positive stock market reactions to both sets of investments, but abnormal returns are higher for investments without a sustainability agenda. The difference in abnormal returns between both sets of investments is not statistically significant. The findings reported in this study suggest that classifying corporate investment decisions according to information content indicative of a sustainability agenda contains price-sensitive information. This has implications for information made available to the market and will therefore promote price discovery, reducing the information asymmetry between informed and uninformed investors and allowing improved market efficiency in categorizing investment decisions according to investment objectives. In a market-based system, the positive valuation of investments associated with sustainability undertakings has implications for allocative efficiency, because firms become more attractive regarding the future allocation of funds to investment projects that address sustainability concerns, indicating that new sustainable investments should be encouraged. Full article

Age-related macular degeneration (AMD) is a leading cause of irreversible blindness, yet current tools for forecasting treatment outcomes remain limited by either the opacity of deep learning or the rigidity of rule-based systems. To address this gap, we propose a hybrid neuro-symbolic and large language model (LLM) framework that combines mechanistic disease knowledge with multimodal ophthalmic data for explainable AMD treatment prognosis. In a pilot cohort of ten surgically managed AMD patients (six men, four women; mean age 67.8 ± 6.3 years), we collected 30 structured clinical documents and 100 paired imaging series (optical coherence tomography, fundus fluorescein angiography, scanning laser ophthalmoscopy, and ocular/superficial B-scan ultrasonography). Texts were semantically annotated and mapped to standardized ontologies, while images underwent rigorous DICOM-based quality control, lesion segmentation, and quantitative biomarker extraction. A domain-specific ophthalmic knowledge graph encoded causal disease and treatment relationships, enabling neuro-symbolic reasoning to constrain and guide neural feature learning. An LLM fine-tuned on ophthalmology literature and electronic health records ingested structured biomarkers and longitudinal clinical narratives through multimodal clinical-profile prompts, producing natural-language risk explanations with explicit evidence citations. On an independent test set, the hybrid model achieved AUROC 0.94 ± 0.03, AUPRC 0.92 ± 0.04, and a Brier score of 0.07, significantly outperforming purely neural and classical Cox regression baselines (p ≤ 0.01). Explainability metrics showed that >85% of predictions were supported by high-confidence knowledge-graph rules, and >90% of generated narratives accurately cited key biomarkers. A detailed case study demonstrated real-time, individualized risk stratification—for example, predicting an >70% probability of requiring three or more anti-VEGF injections within 12 months and a ~45% risk of chronic macular edema if therapy lapsed—with predictions matching the observed clinical course. These results highlight the framework’s ability to integrate multimodal evidence, provide transparent causal reasoning, and support personalized treatment planning. While limited by single-center scope and short-term follow-up, this work establishes a scalable, privacy-aware, and regulator-ready template for explainable, next-generation decision support in AMD management, with potential for expansion to larger, device-diverse cohorts and other complex retinal diseases. Full article

Background/Objectives: This report examines the future of academic studies involving investigational therapeutic radiopharmaceuticals within the framework of Regulation (EU) No. 536/2014. It discusses the impact of Good Manufacturing Practice (GMP) requirements (EudraLex-Volume 4-Good Manufacturing Practice guidelines) on the development of radiopharmaceuticals, based on local experience and analysis. Methods: The report was drafted by analysing multiple factors, including the European regulatory context regarding EMA guidance for investigational medicinal products (IMPs) and GMP requirements for radiopharmaceuticals, as well as position papers from various scientific associations. An analysis of all the relevant changes was conducted by a multidisciplinary team comprising radiopharmacists, nuclear medicine physicians, research experts and technology transfer specialists. They conducted a literature review to examine the clinical implications of the regulatory change and assess the impact of Regulation 536/2014 on academic clinical trials. Results: IRST has around 20 years’ experience in radiopharmaceutical clinical research. From 2008 to 2025, it conducted 16 clinical trials with radiopharmaceuticals under the Directive, and it is currently promoting five studies under the Regulation. During this time, more than 1000 patients were enrolled. The transition was based on staff training in quality documentation, the constitution of a contract research organisation (CRO) to ensure data quality and transfer, careful budget planning, the evaluation of innovative business models and the role of a Contract Development and Manufacturing Organization (CDMO). These integrated approaches enabled IRST to transform regulatory constraints into an opportunity to enhance its organisational model, improve data reliability, and strengthen its position as a centre of excellence for radiopharmaceutical research and production. Conclusions: The implementation of EU Regulation 536/2014 has significantly impacted academic research centres, especially those specialising in radiopharmaceuticals. Adhering to Good Manufacturing Practice (GMP) for therapeutic radiopharmaceuticals requires a considerable investment in infrastructure and personnel. However, the regulation also presents opportunities for research centres to enhance their capabilities. Meeting GMP standards can help institutions improve the quality and reliability of their clinical trials, potentially making them more competitive in the international research arena. Full article

This article presents a qualitative analysis of GAVIN, a Blockchain-based system for educational information management that is fully compliant with the General Data Protection Regulation (GDPR). This system was designed to address the challenges of academic credential verification and recovery in a context where academic certificate issuance and verification is highly fragmented, with institutions operating isolated systems that hinder efficient verification and facilitate the proliferation of fraudulent documents. The GAVIN model introduces a multi-blockchain architecture aimed at recognition of formal, non-formal, and informal learning, guaranteeing compliance with GDPR. After completing the design and development of a functional prototype, this study discusses its qualitative evaluation by means of a validation workshop with diverse stakeholders from the education sector, using pre- and post-workshop questionnaires grounded in the Technology Acceptance Model (TAM). Results indicate a strong perceived usefulness and significant potential to improve current credentialing processes. However, concerns were raised regarding implementation feasibility, associated costs, the need for official standardization, and the importance of establishing robust governance and sustainable business models. This study offers valuable insights into the challenges and opportunities of blockchain adoption in education, providing guidance for future development and policy-making. Full article

Background/Objectives: With increasing survival rates in pediatric oncology, late effects, such as therapy-induced infertility, are becoming more relevant. This study evaluated the management of fertility preservation in children and adolescents with cancer at the Medical University Innsbruck between 2000 and 2018. Methods: In this retrospective monocentric study, 552 patients (0–17 years) receiving chemotherapy were analyzed. Data was extracted from the Clinical Information System and the cryopreservation database. The assessed main variables included pubertal status, sex hormone levels, and use of fertility preservation methods. Results: Fertility preservation was documented in 6.5% of patients, more frequently in males (8.9%) than females (3.2%). Sperm cryopreservation was performed in twenty-eight males, ovarian tissue cryopreservation in six females, and oocyte cryopreservation in three. Pubertal status at diagnosis was recorded in 4.9% of patients and hormone levels in 29.7%. Conclusions: The findings highlight significant gaps in systematic fertility preservation, particularly in female patients. Consistent assessment of pubertal and hormonal parameters at diagnosis is essential to inform decision-making. Standardized procedures and closer interdisciplinary collaboration are needed to ensure equitable access to fertility preservation and safeguard long-term quality of life. Full article

The rising amount of food industry waste has sparked interest in its valorization as a source of bioactive compounds. This study combines bibliometric analysis and a systematic review to map the scientific literature on the recovery of bioactive compounds from food byproducts, focusing on green extraction strategies and their alignment with the principles of the circular economy. A total of 176 documents, published between 2015 and 2025, were analyzed. The analysis shows significant growth after 2020 and highlights bioactive compounds, extraction, and the circular economy as the primary research themes. Italy, Spain, and Brazil emerged as the leading countries in scientific production. The systematic review covers green extraction techniques, including ultrasound-assisted extraction (UAE), microwave-assisted extraction (MAE), pressurized liquid extraction (PLE), supercritical fluid extraction (SFE), enzyme-assisted extraction (EAE), and natural deep eutectic solvent extraction (NADES). UAE- and NADES-based processes were the most frequently applied extraction techniques, mainly targeting phenolic compounds and flavonoids. Significant progress has been observed, particularly in the advancement of extraction technologies, in the recovery of key bioactive compounds, and in their industrial applications. These methods recover phenolics, flavonoids, anthocyanins, and other compounds with antioxidant, antimicrobial, and cardioprotective properties, which have potential applications in functional foods, nutraceuticals, pharmaceuticals, cosmetics, and biodegradable packaging. Nutraceuticals and functional foods represent the main application areas, followed by cosmetics and pharmaceuticals. Despite progress, challenges remain, including scalability, equipment costs, solvent recovery, and process standardization. The green extraction of bioactive compounds from food byproducts shows promise and can support the goals of the 2030 Agenda. Full article

This research presents a detailed Life Cycle Assessment (LCA) of 26 mm Crown cork metal closures used in glass bottle packaging, with the objective of quantifying and comparing their environmental impacts across all life cycle stages. This study adheres to ISO 14040 and ISO 14044 standards and utilizes Microsoft Excel for structuring and documenting input–output data across each phase. The LCA encompasses three primary stages: raw material production (covering iron ore extraction and steel manufacturing), manufacturing processes (including metal sheet printing, forming, and packaging of closures), and the transport phase (distribution to bottling facilities). During the Life Cycle Inventory (LCI), steel production emerged as the most environmentally burdensome phase. It accounted for the highest emissions of carbon dioxide (CO₂), carbon monoxide (CO), nitrogen oxides (NO_x), and sulphur oxides (SO_x), while emissions of heavy metals and volatile organic compounds were found to be negligible. The Life Cycle Impact Assessment (LCIA) was carried out using the Eco-Indicator 99 methodology, which organizes emissions into impact categories related to human health, ecosystem quality, and resource depletion. Final weighting revealed that steel production is the dominant contributor to overall environmental impact, followed by the manufacturing stage. In contrast, transportation exhibited the lowest relative impact. The interpretation phase confirmed these findings and emphasized steel production as the critical stage for environmental optimization. This study highlights the potential for substantial environmental improvements through the adoption of low-emission steel production technologies, particularly Electric Arc Furnace (EAF) processes that incorporate high percentages of recycled steel. Implementing such technologies could reduce CO₂ emissions by up to 68%, positioning steel production as a strategic focus for sustainability initiatives within the packaging sector. Full article

(1) Background: Ground Emergency Medical Services in Hungary are provided by the National Ambulance Service. Paramedics, physicians, and specialists in this service are competent in performing endotracheal intubation (ETI) on patients. The aim of this study is to evaluate the impact of the standardized Rapid Sequence Intubation (RSI) procedure on safety and effectiveness. (2) Methods: A retrospective observational study was conducted concerning the RSI procedure. Patient documentation from a 2-year implementation period was analyzed using a dedicated Case Report Form (CRF), where both RSI and non-RSI methods were used. Our primary endpoint was Definitive Airway Sans Hypoxia and Hypotension on First Attempt (DASH-1A). Our secondary endpoints included success on the first attempt; overall success; and hypoxia, hypotension, and cardiac arrest complications. (3) Results: In total, 6399 intubation cases were studied; non-RSI was used in 3236, and RSI was applied in 3163 cases. DASH-1A was attained in a significantly higher number of cases with RSI than non-RSI (55.0 vs. 68.5%, p < 0.0001). The DASH-1A results of the RSI group were significantly better in the paramedic (54.0 vs. 68.5%, p < 0.0001) and the physician (55.0 vs. 66.7%, p = 0.0017) subgroups. In the specialist subgroup, the difference was not statistically significant (64.5 vs. 69.7%, p = 0.1514). (4) Conclusions: Standardized RSI significantly increased effectiveness and safety in the paramedic and physician subgroups. Full article

Background/Objectives: Focal cartilage defects of the knee are a common cause of pain and functional impairment. While several patient-reported outcome measures (PROMs) and objective scores have been developed to assess clinical knee status and functional impairment, the correlation between subjective PROMs and objective clinical findings after cartilage repair surgery remains unclear. A better understanding of this relationship could enhance the interpretation of registry data and improve clinical decision-making. Methods: This study analyzed 52 patients from the German Cartilage Registry (KnorpelRegister DGOU) who underwent cartilage repair surgery of the knee at a single orthopedic university center in Germany. All patients were re-evaluated in a standardized follow-up examination. PROMs from either the registry or the follow-up examination and objective findings, summarized using a modified objective International Cartilage Repair Society [ICRS] score, derived from the International Knee Documentation Committee (IKDC) 2000 knee examination form, were correlated using Spearman’s rank correlation coefficient. Results: Moderate and statistically significant negative correlations were observed between the objective ICRS score and Knee Injury and Osteoarthritis Outcome Score (KOOS) Symptoms (ρ = −0.420, p = 0.005), KOOS Quality of Life (QoL) (ρ = −0.377, p = 0.013), and the subjective IKDC score (ρ = −0.305, p = 0.028) The subjective IKDC score (IKDC–Subjective Knee Form) was also moderately and significantly correlated with the objective ICRS score (ρ = –0.305, p = 0.028). Other KOOS subscales (Pain, Activities of Daily Living (ADL), Sport) did not show statistically significant correlations with the objective ICRS score. Conclusions: PROMs provide valuable insights into patients’ perceived outcomes after cartilage repair surgery, but do not fully reflect objective functional recovery, underlining the importance of combining them with clinical assessments. Level of Evidence: III. Full article

During the 2022–2023 cholera outbreak in Lebanon, cases were reported through the District Health Information System 2 (DHIS2). We developed automated procedures in R computing language to improve completeness of routinely notified variables, apply case definition criteria, improve geographic accuracy and documentation of laboratory results. We developed R scripts for data cleaning, standardization, and reclassification, plotted epidemic curves and produced maps to display cholera incidence rates and rapid diagnostic test (RDT) coverage by district. We shared the R scripts on GitHub platform for open adaptation and use. Prior to cleaning, missingness reached 99.7% for inpatient status and 17–35% for other key variables. After cleaning, all fields were complete. Initially, 92.8% of cases were notified through DHIS2 as suspected and 7.2% as confirmed. Following reclassification, 40% were classified as suspected, 5.8% as confirmed, and 48.6% with unspecified classification. Laboratory data revealed that 5.8% of cases were culture positive, 2.2% RDT positive, and 65.1% had no documented testing. Among facility-entered cases (n = 5953), 11.4% were reported from a different governorate than the patient’s residence. At the time of the outbreak, the daily maps were generated based on place of residence. Integrating R-based analytics with DHIS2 enhanced data completeness, improved case classification, and enabled more better spatial and laboratory analysis. This combined approach provided a clearer epidemiological picture of the cholera outbreak, supporting data-driven public health decision-making and highlighting the value of integrating analytical tools with routine surveillance systems. Full article

Phytochemicals are plant-derived bioactive compounds with antioxidant, anti-inflammatory, and epigenetic modulatory effects that may contribute to the prevention and management of chronic diseases. This review synthesizes recent evidence on the molecular mechanisms through which phytochemicals influence oxidative stress, inflammatory signaling, and epigenetic regulation. A targeted literature search of the PubMed and Web of Science databases (2015–2025) identified over 400 experimental and review studies investigating phytochemicals with documented antioxidant and epigenetic activities. Eligible articles were selected based on relevance to oxidative stress, inflammation, and DNA or histone modification pathways in chronic diseases. Data were qualitatively analyzed to highlight mechanistic links between redox balance, transcriptional regulation, and disease modulation. The results indicate that several phytochemicals, including hesperidin, phloretin, lycopene, and silybin, modulate signaling cascades—NF-κB, Nrf2, and PI3K/Akt—while also influencing DNA methylation and histone acetylation to restore gene expression homeostasis. Despite strong in vitro and in vivo evidence, translation to clinical practice remains limited by low bioavailability, lack of standardized formulations, and insufficient human trials. Future research should prioritize integrative study designs linking molecular mechanisms to clinical endpoints. Understanding the epigenetic actions of phytochemicals may guide the development of nutraceutical strategies for chronic disease prevention. Full article

This study examines Panama’s 2023 mining restrictions to illuminate persistent legitimacy crises in extractive governance. Employing a qualitative case study, it draws on 25 semi-structured interviews with government officials, industry representatives, Indigenous leaders, local communities, mining critics and other civil society actors, alongside policy and document analysis. Findings suggest that legitimacy reconstruction relies on four interdependent conditions: procedural justice, institutional trust, epistemic legitimacy, and relational governance. Stakeholders consistently emphasized transparency, capacity building, and inclusive engagement as essential for future mining activity, underscoring that technical standards alone are insufficient without credible institutions. Building on—but extending beyond—frameworks such as Social License to Operate (SLO) and Free, Prior and Informed Consent (FPIC), this paper offers Social Legitimacy for Mining (SLM) as a provisional, co-produced framework. Developed through literature synthesis and refined by diverse stakeholder perspectives, SLM is applied in Panama as an illustrative proof of concept that may inform further research and practice, while recognizing the need for additional adaptation across jurisdictions. Full article

Background: Clinical pharmacy services (CPS) have been shown to confer significant advantages in patient care. It remains to be clarified how CPS resources are allocated across routine care settings. It remains to be clarified which recommendations are made to resolve the drug-related problems (DRP) identified by CPS and which adverse drug reactions (ADR) actually arise from the identified DRP. Methods: Following positive ethical approval, patient chart analyses, evaluation of pharmacy documentation on CPS and pharmacist interviews were performed to characterize CPS at all medical departments of the Bundeswehr Hospital Hamburg. We developed and pre-tested instruments for standardization: A Standard Operating Procedure (SOP) for the practical exercise and documentation of CPS by the pharmacists performing them, a standardized form (checklist) for retrospective data collection as part of this study, and a standardized questionnaire for conducting the pharmacist interviews including a risk assessment according to the NCC-MERP score. Results: In total, 1000 CPS were documented in 504 patients (mean age: 69.95 years; 229 female) on 16,705 treatment days. A total of 66.87% CPS was initiated when pharmacists participated in ward rounds. In all CPS, “Indications” was the topic addressed most frequently (37.70%). “Agents for obstructive respiratory diseases” was the most frequently involved drug class (11.32%). The most frequent processing time per CPS was 16–30 min (48.61%). The number of CPS ranged from 0.36/100 treatment days in dermatology to 12.47 in oncology. Severity of 358 DRP was classified “very severe” (5.03%), “severe” (42.74%), “moderate” (34.36%), “low” (15.08%), “very low” (1.40%), or “without impact” (1.40%). The probability of DRP occurrence was classified as “high” in 13.13% and “very high” in 3.35%. In 15.36% of the DRP, an ADR actually occurred. In 504 patients, 932 specific recommendations were forwarded to solve the DRP identified during CPS. Of those, 53.97% were implemented. Conclusions: In almost all CPS, a considerable number of DRP with serious clinical consequences were identified. Half of the forwarded recommendations were implemented. Full article

Background/Objectives: The Commission d’examen des troubles mentaux (CETM), under Quebec’s Tribunal Administratif du Québec, reviews individuals found not criminally responsible on account of mental disorder (NCRMD). These hearings seek to balance public safety with reintegration, guided largely by treatment team recommendations. Despite the CETM’s central role in forensic psychiatry, limited empirical data exist on how its decisions align with clinical advice and which dynamic risk factors influence outcomes. This study aimed to (1) profile the CETM’s 2023 caseload, (2) evaluate concordance between CETM dispositions and treatment team recommendations, and (3) examine clinical, social, and legal factors associated with decision-making. Methods: We conducted a retrospective review of 1721 judgments issued by the CETM in 2023, retrieved from the publicly accessible Société Québécoise d’information juridique (SOQUIJ) database. Eligible cases included annual NCRMD review hearings, excluding trial fitness assessments and repeated hearings within the same year. A structured coding grid documented sociodemographic, administrative, legal, and clinical information, with emphasis on dynamic risk factors such as treatment adherence, substance use, and recent aggression. Descriptive analyses summarized population characteristics and concordance between clinical recommendations and CETM decisions. Results: The cohort was predominantly male (85%) with a mean age of 41 years. Psychotic disorders were the most frequent primary diagnoses (76%), frequently accompanied by substance use and antisocial traits. Most patients (79.6%) had prior psychiatric hospitalizations, while 25.5% had prior incarcerations. Nearly half displayed recent aggression or non-compliance. Treatment teams most often recommended conditional discharge (55%), followed by detention with conditions (21%) and unconditional release (19%). CETM decisions aligned with recommendations in 83.6% of cases; when divergent, rulings were more restrictive (8.6%) than permissive (4.6%). Conclusions: This study provides the first large-scale profile of Quebec’s CETM. High concordance with clinical teams was observed, but restrictive decisions were more frequent in cases of disagreement. The findings underscore the importance of incorporating standardized risk assessment tools to enhance transparency, consistency, and balance in forensic decision-making. Full article