Search Results (4,175)

Background: Caesarean section (CS) is a critical intervention, yet stark inequities in access persist across low- and middle-income countries (LMICs). Over the last decade, governments have introduced policies to eliminate or subsidize user fees; however, the collective impact of these initiatives on utilization, equity, and financial protection has not been fully synthesized. Methods: We conducted a systematic review in line with PRISMA 2020 guidelines. Searches were conducted in PubMed, Dimensions, Google Scholar, Scopus, Web of Science, and government portals for studies published between 1 January 2009 and 30 May 2025. Eligible studies evaluated government-initiated financing reforms, including full user-fee exemptions, partial subsidies, vouchers, insurance schemes, and provider-payment restructuring. Two reviewers independently applied the PICOS criteria, extracted data using a 15-item template, and assessed the study quality. Given heterogeneity, results were synthesized narratively. Results: Thirty-seven studies from 28 LMICs were included. Most (70%) evaluated fee exemptions. Mixed-methods and cross-sectional designs predominated, while only six studies employed interrupted time series designs. Twenty-two evaluations (59%) reported increased CS uptake, ranging from a 1.4-fold rise in Senegal to a threefold increase in Kano State, Nigeria. Similar surges were also observed in non-African contexts such as Iran and Georgia, where reforms included incentives for vaginal delivery or punitive tariffs to curb overuse. Fourteen of 26 fee-exemption studies documented pro-rich or pro-urban drift, while catastrophic expenditure persisted for 12–43% of households, despite the implementation of “free” policies. Median out-of-pocket costs ranged from USD 14 in Burkina Faso to nearly USD 300 in Dakar’s slums. Only one study linked reforms to a reduction in neonatal mortality (a 30% decrease in Mali/Benin), while none demonstrated an impact on maternal mortality. Qualitative evidence highlighted hidden costs, delayed reimbursements, and weak accountability. At the same time, China and Bangladesh demonstrated how demographic reforms or voucher schemes could inadvertently lead to CS overuse or expose gaps in service readiness. Conclusions: Government-led financing reforms consistently increased CS volumes but fell short of ensuring equity, financial protection, or sustained quality. Effective initiatives combined fee removal with investments in surgical capacity, timely reimbursement, and transparent accountability. Future CS policies must integrate real-time monitoring of equity and quality and adopt robust quasi-experimental designs to enable mid-course correction. Full article

This study examines the impacts of climate change on fisheries and aquaculture in Bangladesh, one of the most climate-vulnerable countries in the world. The fisheries and aquaculture sectors contribute significantly to the national GDP and support the livelihoods of 12% of the total population. Using a Critical Literature Review (CLR) approach, peer-reviewed articles, government reports, and official datasets published between 2006 and 2025 were reviewed across databases such as Scopus, Web of Science, FAO, and the Bangladesh Department of Fisheries (DoF). The analysis identifies major climate drivers, including rising temperature, erratic rainfall, salinity intrusion, sea-level rise, floods, droughts, cyclones, and extreme events, and reviews their differentiated impacts on key components of the sector: inland capture fisheries, marine fisheries, and aquaculture systems. For inland capture fisheries, the review highlights habitat degradation, biodiversity loss, and disrupted fish migration and breeding cycles. In aquaculture, particularly in coastal systems, this study reviews the challenges posed by disease outbreaks, water quality deterioration, and disruptions in seed supply, affecting species such as carp, tilapia, pangasius, and shrimp. Coastal aquaculture is also particularly vulnerable to cyclones, tidal surges, and saline water intrusion, with documented economic losses from events such as Cyclones Yaas, Bulbul, Amphan, and Remal. The study synthesizes key findings related to climate-resilient aquaculture practices, monitoring frameworks, ecosystem-based approaches, and community-based adaptation strategies. It underscores the need for targeted interventions, especially in coastal areas facing increasing salinity levels and frequent storms. This study calls for collective action through policy interventions, research and development, and the promotion of climate-smart technologies to enhance resilience and sustain fisheries and aquaculture in the context of a rapidly changing climate. Full article

Hybrid marine energy platforms that integrate wave energy converters (WECs) and hydrokinetic turbines (HKTs) offer potential to improve energy yield and system stability in marine environments. This study identifies a compatible WEC–HKT integrated system concept through a structured concept selection framework based on multi-criteria decision analysis (MCDA). The framework follows a two-stage process: individual technology assessment using eight criteria (efficiency, TRL, self-starting capability, structural simplicity, integration feasibility, environmental adaptability, installation complexity, and indicative cost) and pairing evaluation using five integration-focused criteria (structural compatibility, PTO feasibility, mooring synergy, co-location feasibility, and control compatibility). Criterion weights were assigned through a four-level importance framework based on expert judgment from 11 specialists, with unequal weights for the individual evaluation and equal weights for the integration stage. Four WEC types (oscillating water column, point absorber, overtopping wave energy converter, and oscillating wave surge converter) and four HKT types (Darrieus, Gorlov, Savonius, and hybrid Savonius–Darrieus rotor) are assessed using literature-derived scoring and weighted ranking. The results show that the oscillating water column achieved the highest weighted score among the WECs with 4.05, slightly ahead of the point absorber, which scored 3.85. For the HKTs, the Savonius rotor led with a score of 4.05, surpassing the hybrid Savonius–Darrieus rotor, which obtained 3.50, by 0.55 points. In the pairing stage, the OWC–Savonius configuration achieved the highest integration score of 4.2, surpassing the PA–Savonius combination, which scored 3.4, by 0.8 points. This combination demonstrates favorable structural layout, PTO independence, and mooring simplicity, making it the most promising option for early-stage hybrid platform development. Full article

Seawater intrusion into coastal river systems poses increasing challenges for freshwater availability and estuarine ecosystem integrity, especially under evolving climatic and anthropogenic pressures. This study presents a multidisciplinary investigation of marine intrusion dynamics within the Magra River estuary (Northwest Italy), integrating field monitoring, isotopic tracing (δ¹⁸O; δD), and multivariate statistical modeling. Over an 18-month period, 11 fixed stations were monitored across six seasonal campaigns, yielding a comprehensive dataset of water electrical conductivity (EC) and stable isotope measurements from fresh water to salty water. EC and oxygen isotopic ratios displayed strong spatial and temporal coherence (R² = 0.99), confirming their combined effectiveness in identifying intrusion patterns. The mass-balance model based on δ¹⁸O revealed that marine water fractions exceeded 50% in the lower estuary for up to eight months annually, reaching as far as 8.5 km inland during dry periods. Complementary δD measurements provided additional insight into water origin and fractionation processes, revealing a slight excess relative to the local meteoric water line (LMWL), indicative of evaporative enrichment during anomalously warm periods. Multivariate regression models (PLS, Ridge, LASSO, and Elastic Net) identified river discharge as the primary limiting factor of intrusion, while wind intensity emerged as a key promoting variable, particularly when aligned with the valley axis. Tidal effects were marginal under standard conditions, except during anomalous events such as tidal surges. The results demonstrate that marine intrusion is governed by complex and interacting environmental drivers. Combined isotopic and machine learning approaches can offer high-resolution insights for environmental monitoring, early-warning systems, and adaptive resource management under climate-change scenarios. Full article

Ilex verticillata (winterberry) is a valuable ornamental shrub increasingly threatened by leaf blight, a disease that compromises its aesthetic and economic value. While fungal pathogens like Alternaria alternata are known to cause leaf blight in horticultural crops, their role in I. verticillata and the host’s defense mechanisms have not been fully characterized. Our study investigated the pathogen-host interaction by identifying the causal agent and examining the physiological and molecular defense mechanisms of I. verticillata. Through morphological and multi-locus molecular analyses (ITS, TEF1-α, G3PDH, RPB2), A. alternata was confirmed as the primary pathogen, fulfilling Koch’s postulates. Pathogenicity assays revealed distinct disease progression stages, from necrotic lesions to tissue degradation. Transcriptomic profiling uncovered dynamic host responses, with early upregulation of pattern recognition receptors (PRRs) and transcripts encoding antioxidant enzymes (SOD, CAT), followed by downregulation of metabolic pathway genes. Phytohormone analysis highlighted intricate crosstalk, with salicylic acid (SA) peaking during mid-infection and jasmonic acid (JA) rebounding later, reflecting a coordinated defense strategy. Additionally, the oxidative stress marker malondialdehyde (MDA), an indicator of membrane lipid peroxidation, surged early, indicating membrane damage, while sustained induction of antioxidant enzymes suggested adaptive responses. The key finding was distinct phytohormone crosstalk, characterized by a mid-infection SA peak followed by a late JA rebound, alongside an early oxidative burst marked by MDA accumulation and sustained antioxidant enzyme activity. These findings provide a framework for understanding I. verticillata’s defense mechanisms and offer insights for developing targeted disease management strategies, such as resistant cultivar breeding or hormone-mediated interventions. Full article

Cannabis sativa L. (2n = 2x = 20) is a widely recognized species within the Cannabaceae family. Despite its utilization for medicinal, recreational, and industrial purposes, alongside its extensive historical background, the number of genetic and biotechnological studies of this plant species has decreased due to legal ramifications and prohibition campaigns associated with its use and cultivation. For many years, the development of novel varieties has been pursued solely by cultivators, as domestic growers have transitioned their work from cultivation to breeding Cannabis lineages. Recently, the application of genomics has facilitated a surge in methodologies aimed at marker-assisted selection, germplasm management, genetic differentiation, authentication of cultivated varieties or cultivars, and forensic applications such as safeguarding intellectual property rights. Nevertheless, the utilization of molecular markers for the advancement of commercial varieties through marker-assisted breeding (MAB) frameworks remains rare. This investigation was designed to evaluate a previously established informative microsatellite (SSR) array for the genotyping of drug-type Cannabis sativa cultivars derived from seeds of European origin. A total of 171 samples from 20 varieties were collected from European distributors and analyzed for genetic uniformity and population structure. The results were then compared with previously analyzed hemp samples and drug-type samples of Canadian origin, revealing the identification capabilities of our SSR genotyping method. Full article

This review article aims to provide an overview of the pathophysiology, diagnosis, and contemporary management of cardiac amyloidosis (CA) as well as identify the knowledge gaps and areas of potential research. CA can be divided into two main groups: transthyretin cardiac amyloidosis (ATTR-CA) and light chain cardiac amyloidosis (AL-CA). The former further separates into wild-type transthyretin (ATTRwt) and hereditary transthyretin (ATTRv). African Americans, males, and people older than 75 are the most common demographics affected by this disease. Thanks to an increased understanding of this disease combined with better diagnostic techniques, there is growing awareness and a surge of clinical trials aimed at improving outcomes of CA. The diagnosis and treatment of CA is multifaceted and complex, relying on multiple imaging modalities and the cooperation of specialists to deliver effective treatments. While some disease-modifying agents have been introduced recently, their extraordinary cost limits their benefit or they are supported by limited evidence. Other agents are currently undergoing phase 3 trials. To date, there is scarce data surrounding optimal diagnostic and treatment strategies, including a potential role for combination therapies. Critically, it is imperative that physicians develop close relationships with the patient that addresses not only their individual health needs but also their unique psychosocial situation. Therefore, more clinical trials, protocols and patient resources are needed to better inform and guide providers managing these complex patient needs. Full article

Wharton’s jelly (WJ), the mucoid connective tissue of the umbilical cord, provides essential protection to the umbilical vessels against mechanical stress. While research into WJ-derived stem cells for regenerative medicine has surged, the clinical significance of its in utero pathologies remains less explored. This review synthesizes the current literature on the pathophysiology of WJ abnormalities and their direct impact on fetal and neonatal outcomes. Pathologies are broadly categorized as quantitative (absence/reduction or excess/edema) and structural (pseudocysts, mucoid degeneration). A reduction or segmental absence of WJ critically compromises cord integrity, leading to vascular compression and is a direct cause of stillbirth, fetal growth restriction (FGR), and intrapartum distress. Conversely, excessive WJ or edema is associated with maternal diabetes and fetal hydrops and can also impair hemodynamics. Umbilical cord pseudocysts, arising from focal WJ degeneration, are significant markers for severe chromosomal abnormalities, particularly Trisomy 18 and 13, and other structural defects, especially when persistent or multiple. Sonographic measurement of WJ area shows promise as a surrogate for placental function, with decreased area correlating with placental pathology and FGR. However, significant diagnostic challenges persist, particularly the prenatal detection of segmental WJ absence, a “silent” pathology often discovered only after a catastrophic event. This review highlights the critical role of WJ integrity in determining perinatal outcomes and underscores the urgent need for improved diagnostic modalities and standardized management protocols to mitigate associated risks. Full article

With the surge in urban logistics demand, traditional surface transportation faces challenges, such as traffic congestion and environmental pollution. Leveraging metro systems in metropolitan areas for both passenger commuting and underground logistics presents a promising solution. The metro-based underground logistics system (M-ULS), characterized by extensive coverage and independent right-of-way, has emerged as a potential approach for optimizing urban freight transport. However, existing studies primarily focus on single-line scenarios, lacking in-depth analyses of multi-tier network coordination and dynamic demand responsiveness. This study proposes an optimization framework based on mixed-integer programming and an improved ICSA to address three key challenges in metro freight network planning: balancing passenger and freight demand, optimizing multi-tier node layout, and enhancing computational efficiency for large-scale problem solving. By integrating E-TOPSIS for demand assessment and an adaptive mutation mechanism based on a normal distribution, the solution space is reduced from five to three dimensions, significantly improving algorithm convergence and global search capability. Using the Nanjing metro network as a case study, this research compares the optimization performance of independent line and transshipment-enabled network scenarios. The results indicate that the networked scenario (daily cost: CNY 1.743 million) outperforms the independent line scenario (daily cost: CNY 1.960 million) in terms of freight volume (3.214 million parcels/day) and road traffic alleviation rate (89.19%). However, it also requires a more complex node configuration. This study provides both theoretical and empirical support for planning high-density urban underground logistics systems, demonstrating the potential of multimodal transport networks and intelligent optimization algorithms. Full article

The increasing adoption of digital technologies, robotic systems, and IoT applications in sectors such as medicine, agriculture, and industry drives a surge in data generation and necessitates secure and efficient encryption. For resource-constrained systems, lightweight yet robust cryptographic algorithms are critical. This study addresses the security demands of IoRT systems by proposing an enhanced chaos-based encryption method. The approach integrates the lightweight structure of NIST-standardized Ascon-AEAD128 with the randomness of the Zaslavsky map. Ascon-AEAD128 is widely used on many hardware platforms; therefore, it must robustly resist both passive and active attacks. To overcome these challenges and enhance Ascon’s security, we integrate into Ascon the keys and nonces generated by the Zaslavsky chaotic map, which is deterministic, nonperiodic, and highly sensitive to initial conditions and parameter variations.This integration yields a chaos-based Ascon variant with a higher encryption security relative to the standard Ascon. In addition, we introduce exploratory variants that inject non-repeating chaotic values into the initialization vectors (IVs), the round constants (RCs), and the linear diffusion constants (LCs), while preserving the core permutation. Real-time tests are conducted using Raspberry Pi 3B devices and ROS 2–based IoRT robots. The algorithm’s performance is evaluated over 100 encryption runs on 12 grayscale/color images and variable-length text transmitted via MQTT. Statistical and differential analyses—including histogram, entropy, correlation, chi-square, NPCR, UACI, MSE, MAE, PSNR, and NIST SP 800-22 randomness tests—assess the encryption strength. The results indicate that the proposed method delivers consistent improvements in randomness and uniformity over standard Ascon-AEAD128, while remaining comparable to state-of-the-art chaotic encryption schemes across standard security metrics. These findings suggest that the algorithm is a promising option for resource-constrained IoRT applications. Full article

The global rise of antimicrobial resistance (AMR), exacerbated by the COVID-19 pandemic, has led to a surge in infections caused by multidrug-resistant (MDR) bacteria. A key driver of this phenomenon is co-selection, where exposure to one antimicrobial promotes resistance to others via horizontal gene transfer (HGT) mediated by mobile genetic elements (MGEs). Carbapenem-resistant Enterobacteriaceae, known for their genomic plasticity, are particularly worrisome; yet genomic data from Latin America—especially Ecuador—remain scarce. This study investigated four carbapenem-resistant clinical isolates (two Klebsiella pneumoniae ST1440 and two Serratia marcescens) from tracheal aspirates of three ICU patients during a COVID-19 outbreak at Hospital IESS Quito Sur, Ecuador. Phenotypic profiling and whole-genome sequencing were performed, followed by bioinformatic reconstruction of plasmid content. Nineteen plasmids were identified, carrying 70 resistance-related genes, including antimicrobial resistance genes (ARGs), metal resistance genes (MRGs), integrons, transposons, and insertion sequences. Hierarchical clustering revealed six distinct gene clusters, with several co-localizing ARGs and genes for resistance to disinfectants and heavy metals—suggesting strong co-selective pressure. Conjugative plasmids harboring high-risk elements such as blaKPC-2, qacE, and Tn4401 were found in multiple isolates, indicating potential interspecies dissemination. These findings emphasize the importance of plasmid-mediated resistance during the pandemic and highlight the urgent need to enhance genomic surveillance and infection control, particularly in resource-limited healthcare settings. Full article

Interest in empirical studies of monetary policy has grown over the past decade, and particularly since the post COVID-19 pandemic period characterized by a surge in inflation rates in every corner of the globe. Against this backdrop, central banks’ traditional inflation forecast framework has been challenged, leading to renewed analysis of the monetary policy transmission mechanism. Focusing on Tunisia, an emerging small open economy subjected to external shocks, this study focuses on the role played by the monetary authority in the conduct of Tunisia’s monetary policy over the period from 2000 to 2024. This period is characterized by a deceleration of growth and an increase in inflation and unemployment. This work shows also how a VAR model with long-run restrictions justified by economic theory can be usefully applied in the analysis of monetary policy; the effects of the money market rate and other shocks; the relationship between prices and the nominal effective exchange rate; and the relationship between inflation and the output gap. Full article

Recently, there has been a surge in the popularity of renewable energy systems due to their lucrative and sustainable attributes. Among these, photovoltaic (PV) systems stand out as prominent examples. Nevertheless, it is imperative to ascertain the management of waste produced by these systems in order to mitigate environmental pollution and harness their economic potential. This study aims to assess the present status and forecast the accumulation of waste generated by PV power plants in Chile. Utilizing openly available public data, a database is constructed to track the accumulation of waste. Two scenarios, namely, early-loss and regular-loss scenarios are employed to estimate the projected accumulation of PV waste. The findings indicate that by the years 2035 and 2043, the accumulation of waste is estimated to reach 100,000 tons under the early-loss scenario and regular-loss scenario. The total anticipated waste from solar PV modules is projected to be 284,906 tons, with c-Si PV modules contributing 175,595 tons to this total in Chile. Remarkably, it is determined that more than 235,000 tons of materials from this waste is recoverable, amounting to nearly USD 781 million in economic value. Silver is projected to bring the most economic value, with nearly USD 379 million, while lead, tin, cadmium, and zinc are each valued at less than USD 1 million. This study highlights the importance of promoting the sustainable development of PV systems, particularly in alignment with Sustainable Development Goals 7 (Affordable and Clean Energy) and 13 (Climate Action). Future research is expected to place greater emphasis on eco-design approaches in PV module production. Full article

Surge is a typical aerodynamic instability phenomenon in the compressors of aeroengines. The surge can lead to severe performance degradation and even structural damage to the engine and the air vehicle, making it a longstanding critical concern in the industry. Analyzing and understanding the surge process contributes to enhancing the aerodynamic stability of designed compressors. Previous research in this field often focuses solely on the compressor itself while neglecting the mutual interaction between the compressor and other components in the entire engine system. This study investigates the compressor surge process within an integrated engine environment using a full-engine three-dimensional Unsteady Reynolds-averaged Navier–Stokes (URANS) simulation method for the entire engine system, validated through variable geometry turbine experiments on a small turbojet engine. The result demonstrates that the integrated three-dimensional simulation approach can capture the primary flow characteristics of the compression system during surge within an integrated engine environment. Under the influence of the variable geometry turbine, the studied small turbojet engine enters a state of mild surge. This paper also investigates the changes in aerodynamic forces during surge and reveals the two-regime surge phenomenon that exists during the engine surge. Full article

Recently, the demand for immersive videos has surged with the expansion of virtual reality, augmented reality, and metaverse technologies. As an international standard, moving picture experts group (MPEG) has developed MPEG immersive video (MIV) to efficiently transmit large-volume immersive videos. The MIV encoder generates atlas videos to convert extensive multi-view videos into low-bitrate formats. When these atlas videos are compressed using conventional video codecs, compression artifacts often appear in the reconstructed atlas videos. To address this issue, this study proposes a feature-extraction-based convolutional neural network (FECNN) to reduce the compression artifacts during MIV atlas video transmission. The proposed FECNN uses quantization parameter (QP) maps and depth information as inputs and consists of shallow feature extraction (SFE) blocks and deep feature extraction (DFE) blocks to utilize layered feature characteristics. Compared to the existing MIV, the proposed method improves the Bjontegaard delta bit-rate (BDBR) by −4.12% and −6.96% in the basic and additional views, respectively. Full article