Search Results (2,405)

Background/Objectives: Prompt integration of molecular and clinical data into electronic medical records, with a sustainable workflow that supports clinicians in rendering genomics-guided care, is critical. We sought to expand the implementation of in-house NGS at our community-based academic cancer center to operationalize the utilization of molecular diagnostic studies to optimize cancer care for all patients, including those outside this study, through broader adoption and diffusion. Methods: In this prospective IRB-approved study, the Kellogg Cancer Genomic Initiative (KCGI), patients with advanced cancers underwent in-house NGS, including tumor mutational burden (TMB) and pharmacogenomics. In-house bioinformatics (Flype) was used for structured reporting and served as a molecular knowledgebase. A multidisciplinary molecular tumor board (MTB) was created to provide precision therapy recommendations. Results: In-house NGS, completed within 11 business days on average, was performed in 90% (251) of the 279 patients in the KCGI with advanced cancers. RNA and TMB analyses were successful in 89.2% and 86.5% of patients, respectively. A total of 54.2% of patients were identified as candidates for use of on- or off-label FDA-approved therapies, and 99.6% of patients who underwent pharmacogenomics testing had at least one gene alteration associated with medication dose adjustment/avoidance. An MTB was established to discuss these and other molecularly challenging cases continues to function as a consultative service that provides actionable recommendations. Conclusions: In this real-world trial, the utilization of in-house NGS with an adaptable bioinformatics pipeline and the establishment of an MTB enabled the refinement of institutional processes and created an environment that enhanced clinician interest in genomics and improved genomics-guided care for patients with advanced cancers. Full article

This study investigates how Vision Language Models (VLMs) can be used and methodically configured to extract Environmental, Social, and Governance (ESG) metrics from corporate sustainability reports, addressing the limitations of existing text-only and manual ESG data-extraction approaches. Using the Design Science Research Methodology, we developed an extraction artifact comprising a curated page-level dataset containing greenhouse gas (GHG) emission-reduction targets, an automated evaluation pipeline, model and text-preprocessing comparisons, and iterative prompt and few-shot refinement. Pages from oil and gas sustainability reports were processed directly by VLMs to preserve visual–textual structure, enabling a controlled comparison of text, image, and combined input modalities, with extraction quality assessed at page and attribute level using F1-scores. Among tested models, Mistral Small 3.2 demonstrated the most stable performance and was used to evaluate image, text, and combined modalities. Combined text + image modality performed best (F1 = 0.82), particularly on complex page layouts. The findings demonstrate how to effectively integrate visual and textual cues for ESG metric extraction with VLMs, though challenges remain for visually dense layouts and avoiding inference-based hallucinations. Full article

This study aimed to assess maternal health profiles related to diet, pregnancy, and breastfeeding practices among 437 mothers with children under 24 months in a rural village in Madagascar, and to examine their association with maternal educational attainment using interviews and anthropometric data. Bivariate statistical analyses were performed to explore associations between maternal education level and all studied variables. Multivariate analyses were also conducted but did not yield reliable results and are therefore not presented. The findings showed that higher maternal education was strongly associated with better socioeconomic conditions; improved access to essential resources like food, clean water, and healthcare facilities; and greater dietary diversity. More educated women reported consuming a wider range of foods, reflecting better nutritional quality and potential benefits for maternal health. In contrast, education level did not significantly affect pregnancy-related care or breastfeeding practices as recommended by the WHO. This suggests that while education enhances women’s ability to access and choose nutritious diets, broader cultural or systemic factors may shape maternal care behaviors. Women with higher educational attainment had greater access to diverse and sufficient diets, which may contribute to improved maternal nutritional status. Sustainable interventions aimed at improving women’s education and nutritional literacy are needed to support informed dietary choices and improve maternal and child health outcomes. Full article

Background/Objectives: May–Thurner syndrome (MTS) is a common cause of iliofemoral deep vein thrombosis (DVT). Venous bleeding associated with MTS is extremely rare and has been reported mainly as spontaneous iliac vein rupture (SIVR) with retroperitoneal or iliac hematoma. Additionally, standardized treatment strategies have not yet been established. Herein, we report a case of an iliac hematoma associated with MTS that was successfully treated with endovascular mechanical thrombectomy and bare-metal stenting. Case Presentation: A 69-year-old man presented with acute swelling and pain in the left lower extremity. Computed tomography angiography demonstrated extensive iliofemoral DVT and an iliac hematoma adjacent to the left common iliac vessels, without definite evidence of iliac vein rupture. Initial conservative management with anticoagulation therapy was selected as the patient was hemodynamically stable and showed no active bleeding. However, follow-up imaging one week later revealed persistent DVT with interval enlargement of the hematoma. Pelvic arteriography excluded an arterial bleeding source. Endovascular treatment was performed, including mechanical thrombectomy using the AngioJet system and bare-metal stent placement to restore venous outflow. Follow-up imaging revealed complete thrombus resolution, hematoma regression, and sustained stent patency. Conclusions: Iliac hematomas associated with MTS may occur without definite radiological evidence of iliac vein rupture. In selected hemodynamically stable patients, an individualized endovascular strategy focused on venous outflow restoration using the AngioJet system and bare metal stents may be a feasible treatment option. Full article

There is an urgent demand for sustainable agricultural practices that minimize environmental impacts and reduce the reliance on synthetic pesticides and fertilizers. Endophytes represent a largely untapped resource of beneficial microorganisms with multiple potential applications as natural biocontrol agents and promoters of plant growth and development. This paper aimed at identifying new fungal strains and performing a series of preliminary in vitro screenings to evaluate their potential use for plant-growth promotion and antifungal activity. A total of 102 fungal endophytes were isolated from different plant tissues of seven wild relatives of barley (Brachypodium sylvaticum, Bromus hordeaceus, Bromus sterilis, Elymus farctus, Elymus repens, Leymus arenarius and Lolium perenne) that were sourced from 22 contrasting wild habitats. Fungal endophytes were isolated using standard culture-based methods and identified via DNA barcoding of the nrITS marker. Based on a literature search, a sub-group of endophytes were selected and evaluated for indole-3-acetic acid (IAA) synthesis, ammonia production and phosphorous (P) solubilization. From these, 15 endophytes were also tested for antifungal activity against Ramularia collo-cygni, Pyrenophora teres, and Gaeumannomyces tritici. All the endophytes were positive for ammonia production at variable rates, but no P solubilization nor IAA synthesis without L-tryptophan were observed. On the contrary, five promising isolates (2 Daldinia concentrica, Metapochonia suchlasporia, Chaetomium sp., and Ophiocordyceps sinensis) had mean pathogen growth inhibition rates above 80%, compared to the untreated negative controls. To the best of our knowledge, this study is the first published report that investigates natural antagonism against Ramularia collo-cygni and expands the list of endophytic strains with natural antagonism on the tested cereal pathogens. Results are discussed in the context of endophytes application to barley cultivation within the European regulatory framework. Full article

The rule of law, a foundational value of the European Union as enshrined in Article 2 of the Treaty on European Union, faces challenges in implementation due to historical and political factors that have evolved over the past decade, particularly within Member States in the administrative domain. While institutional backsliding in countries like Hungary and Poland has drawn significant political attention, less emphasis has been placed on the role of public administrations in upholding or undermining the rule of law on a day-to-day basis. This paper argues that the sustainability of the rule of law in the EU requires more than legal compliance mechanisms. These alone do not address the underlying administrative and cultural factors necessary for effective implementation. Instead, it requires closer attention to how rule-of-law principles are embedded in the everyday functioning of public administrations. This argument is informed by the authors’ systematic examination of recent EU monitoring practices and administrative reform instruments. Adopting a mixed conceptual-empirical methodology, the paper draws on primary data from EU Rule of Law Reports (2020–2024), the EU Justice Scoreboard, the Recovery and Resilience Facility (RRF), and the Technical Support Instrument (TSI), complemented by relevant OECD/SIGMA indicators. Several structural obstacles emerge from the analysis. These include symbolic compliance, whereby organisations adopt formal structures without corresponding behavioural change; weak institutional leadership that fails to drive reform momentum; and the absence of integrated performance metrics, which hampers meaningful accountability. Fragmented ownership of reform agendas, in turn, breeds inconsistency in implementation. These challenges point to the limitations of a technocratic or legalistic approach to rule-of-law governance. Strategic leadership and organisational flexibility emerge from the evidence as preconditions—not merely facilitators—of genuine internalisation, though the relationship is context-dependent. Digitalisation can reinforce these dynamics, yet its contribution depends on whether it is embedded within broader integrity-oriented reforms. The paper advocates for a shift from externalized compliance mechanisms to a model that emphasizes administrative ownership through specific strategies such as developing integrity-based leadership programs and embedding governance practices that prioritize transparency and accountability. It proposes concrete institutional reforms, including performance-linked conditionalities that tie funding to measurable outcomes, ethical leadership academies to train future leaders, integrity audits to ensure accountability, and administrative benchmarking to set clear standards, as tools to foster autonomous, value-driven public institutions capable of adapting to evolving governance challenges while maintaining core democratic values. Full article

Environmental, Social, and Governance (ESG) has emerged as a critical paradigm for corporate sustainable development. In the maritime industry, a sector central to global trade, ESG is gaining prominence, driven by regulatory pressures and investor demands. This study conducts a systematic literature review to map the research landscape of ESG in the shipping industry from 2020 to 2024. Employing the PRISMA methodology, we analyze 20 core academic papers from the Web of Science and Scopus databases. Our findings reveal a rapidly growing research interest, with a clear thematic evolution from a singular focus on environmental issues to a more holistic, three-pillar (E, S, and G) framework. Key research hotspots identified include the relationship between ESG performance and financial performance, ESG disclosure, and risk management. While a positive correlation between good ESG practices and corporate financial performance is a recurring theme, significant challenges persist, notably inconsistent disclosure standards, fragmented global research efforts, and a lack of industry-specific evaluation frameworks. This review synthesizes the current state of knowledge, identifies critical research gaps, and proposes a forward-looking agenda focusing on developing industry-specific frameworks, analyzing external institutional impacts, and enhancing data credibility. Our findings provide a foundational reference for academics, policymakers, and industry practitioners to advance the sustainable transformation of the shipping industry. Full article

Background/Objectives: Gestational diabetes (GD) is a well known risk factor for future metabolic diseases. However, the long-term time-dependent risk of non-alcoholic fatty liver disease (NAFLD) remains unexplored. The aim of this meta-analysis was to quantify the long-term risk of NAFLD in women with previous GD and evaluate if the risk persists beyond the postpartum period. Methods: A systematic search was performed in PubMed using appropriate medical subject headings to identify trials evaluating the incidence of NAFLD among women with previous GD compared to those with normal glucose tolerance (NGT). Studies reporting adjusted risk estimates with a follow-up duration beyond pregnancy were included. Data were extracted and analyzed using relevant statistical methods, with the level of significance at p < 0.05. Results: A total of four studies (N = 2873) were included in the meta-analysis. Women with previous GD had a 2.46-fold higher odds of NAFLD compared to those with NGT (95% CI 1.88–3.23, p < 0.001). The slope for years since delivery was not significant (β = 0.001 per year, 95% CI −0.037 to 0.040, p = 0.901), indicating that the likelihood of NAFLD in women with prior GD did not change over time. Conclusions: GD is associated with a substantially increased and sustained risk of NAFLD, persisting decades beyond pregnancy. These findings identified GD as a potential early risk marker of future liver outcomes and highlight the need for long-term metabolic screening and preventive strategies for this high-risk population. Full article

Background: Early childhood caries is closely associated with oral dysbiosis and the proliferation of Streptococcus mutans. Oral probiotics, particularly Lactobacillus reuteri and Lactobacillus rhamnosus, have been proposed as ecological modulators capable of reducing cariogenic microorganisms. Objective: To evaluate the efficacy of orally administered L. reuteri and L. rhamnosus in reducing salivary S. mutans levels in children aged 6 months to 12 years through a systematic review and meta-analysis. Methods: This review followed the PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420251086304). Searches were conducted in MEDLINE/PubMed, CENTRAL, Embase, Scopus and LILACS without language or date restrictions. Randomized controlled trials administering the target probiotic strains for ≥30 days were included. Risk of bias was assessed using RoB 2, and certainty of evidence using GRADE. Random-effects meta-analyses were performed for continuous and dichotomous outcomes. Results: Six randomized controlled trials were included (N = 1362). Only two trials reported continuous outcomes in comparable log₁₀ CFU/mL format and could therefore be pooled for the continuous meta-analysis. This analysis showed a significant reduction in salivary S. mutans levels (MD = −0.65 log₁₀ CFU/mL; 95% CI: −0.97 to −0.34; p < 0.0001; I² = 19%), although the pooled estimate was largely driven by one study and should be interpreted cautiously. Four trials contributed to the dichotomous meta-analysis, which showed a non-significant trend toward risk reduction (OR = 0.73; 95% CI: 0.51–1.06; p = 0.10; I² = 35%). Short-term interventions using high oral-retention formulations demonstrated the most consistent microbiological effects. Conclusions: Oral probiotics may significantly reduce salivary S. mutans in the short-term, especially when delivered through slow-dissolving formulations. However, their effects vary according to strain, vehicle, and intervention duration. Larger, standardized, and longer-term clinical trials are needed to determine the sustainability and clinical relevance of these effects. Full article

Green-synthesized nanomaterials have emerged as promising candidates for environmentally sustainable remediation; however, experimental evidence describing their synthesis routes, physicochemical properties, remediation performance, and sustainability-relevant attributes remains fragmented, inconsistently reported, and difficult to integrate across studies. This work addresses this challenge by proposing an ontology-based semantic framework for the interoperable integration of green-synthesized nanomaterials, contaminants, and remediation processes, incorporating explicit provenance metadata and structured sustainability descriptors. The ontology was developed using the Linked Open Terms (LOT) methodology and implemented in OWL 2 DL, with selective alignment to established vocabularies including eNanoMapper, ChEBI, ENVO, and PROV-O. Adsorption and photocatalysis were instantiated as representative remediation mechanisms to evaluate the framework’s capacity to accommodate structurally distinct processes. Logical reasoning and SHACL-based validation were applied to assess semantic consistency, provenance traceability, and data completeness. The results demonstrate that the proposed ontology effectively integrates heterogeneous experimental data within a unified, FAIR-compliant semantic framework, supports conservative and provenance-aware inference, and enables comparative analysis across mechanistically diverse remediation systems without structural modification. This ontology-based approach provides a robust foundation for sustainability-aware knowledge integration in environmental nanotechnology and establishes the basis for future extensions involving data quality assessment and explainable AI-driven analysis. Full article

This study examines whether corporate climate performance is reflected in firm valuation by synthesising recent empirical evidence, using Tobin’s Q as a forward-looking indicator of market expectations. Employing a random-effects meta-analysis of 30 peer-reviewed studies published between 2020 and 2025 across multiple industries and regions, the findings reveal a modest yet statistically significant positive association between stronger climate performance and higher market valuations, suggesting that investors increasingly incorporate climate-related information into firm pricing. Contrary to prevailing assumptions in the literature, proactive climate strategies, such as emissions-reduction initiatives, do not systematically generate greater valuation benefits than disclosure-oriented approaches; both exhibit comparable positive effects. Similarly, valuation outcomes do not differ materially between self-reported and externally verified climate data. Meta-regression analysis identifies data source as the only statistically significant moderator, although its influence remains nuanced. Overall, the results indicate that climate performance enhances firm valuation in a context-dependent manner, challenging the view that only proactive strategies or externally verified data are uniquely rewarded by financial markets. The study contributes to the sustainable and corporate finance literature by clarifying how capital markets price climate-related corporate behaviour under heterogeneous strategic responses. Full article

Second-generation bioethanol from food industry lignocellulosic residues offers a promising route toward low-carbon, circular bioenergy systems. However, the reported environmental impacts differ markedly across studies, challenging efforts to assess the true sustainability of these waste-derived bioethanol routes. This review synthesizes current knowledge on the production of bioethanol from key agro-industrial wastes including oil palm empty fruit bunches, sugarcane bagasse, brewers’ spent grain, spent coffee grounds, tea waste, citrus residues, and potato peel waste. We outline feedstock characteristics, availability, and prevailing management practices, and map the principal biochemical conversion routes to identify process steps that drive environmental performance. A systematic comparison of life cycle assessments reveals substantial methodological heterogeneity across functional units, system boundaries, allocation procedures, and impact assessment methods. Nonetheless, consistent hotspots emerge, particularly associated with pretreatment severity, enzyme production, thermal energy demand, and co-product handling. The review highlights robust cross-study trends, pinpoints methodological gaps, and proposes recommendations for harmonized LCA practice. By integrating technological and methodological perspectives, this work aims to support the development and policy uptake of sustainable, waste-based bioethanol within circular bioeconomies. Full article

Hepatitis B virus (HBV) infection is a silent epidemic; many infected people are asymptomatic and not aware of the infection. In 2022, it was reported that approximately 254 million people were living with chronic HBV infection globally, majority being in sub-Saharan Africa and Asia. In Kenya, the national HBV prevalence is estimated to be 3.5%. Our study was aimed at identifying key predictors and transmission trends that could inform the development of sustainable prevention models needed to address existing gaps in the national framework towards HBV elimination. We targeted participants seeking health services in Baringo and Kisumu county health facilities and conducted community mass testing in the two counties. Participants were interviewed using a study questionnaire and were tested for hepatitis B surface antigen (HBsAg) using an HBsAg rapid test. Venous blood was collected from participants who tested HBsAg+ for further infection confirmation and linkage to care. Logistic regression was performed to assess factors correlated with HBV infection. Out of 3034 participants, 192 tested positive for HBsAg and the prevalence of HBV infection was 6.3% (95% CI = 0.055–0.072). Intrafamilial infections in Baringo were 15.0%. HBV infection prevalence exceeded 10% among those aged 25–49 years, peaking at 13.1% in the 45–49-year age group and lowest at 1.8% in the 16–19-year age group. Overall, males had a higher prevalence in younger ages, while females above 60 years old were more affected. In multivariable logistic regression, individuals residing in Baringo (aPR = 8.1; 95% CI = 2.2–29.4), users of other injectable drugs (aPR = 6.7; 95% CI = 1.3–204.0), those traditionally circumcised (aPR 1.02; 95% CI = 0.56, 1.88), and staying >5 km from a health care facility (aPR = 10.4; 95% CI = 2.2–49.4) had significantly higher prevalence ratios of being infected with HBV. These different infection predictors underscore the need for different care and prevention approach models. Full article

Solar advanced oxidation processes (AOPs) utilising parabolic trough concentrators (PTCs) present a promising approach for the sustainable removal of recalcitrant contaminants from wastewater. This mini-review critically evaluates 25 peer-reviewed studies employing PTC-AOP systems for the degradation of chemical pollutants and microbial pathogens. Reported applications include photolysis, photo-Fenton and photocatalysis for the treatment of synthetic dyes, contaminants of emerging concern, industrial effluents, heavy metals and pathogenic microorganisms. A performance-oriented comparison based on normalised indicators is introduced. The time required for one order-of-magnitude reduction (corresponding to 90% removal; τ₉₀) reveals a significant mineralisation setback, where parent-compound degradation outpaces total organic carbon removal. The PTC concentration ratio and photon utilisation metrics highlight substantial variability in reactor design (geometry, materials, optical performance), which directly influences the treatment kinetics. Overall, PTC-AOP systems demonstrate strong potential as a polishing step within hybrid wastewater treatment. Future research should prioritise the standardisation of performance metrics, the catalyst design suited for high-photon and -temperature operation, and the integration into scalable and climate-resilient solar wastewater treatment. Full article

Additive manufacturing enables lightweight sandwich structures with complex cellular cores, but the selection of material and process settings typically involves trade-offs among mechanical performance, cost, and sustainability. This study proposes an integrated multi-criteria decision-making framework to identify the most suitable configuration for Fused Filament Fabrication (FFF) sandwich structures featuring a gyroid triply periodic minimal surface (TPMS) core. Eight alternatives are evaluated by combining two materials (PLA and PLA–Flax biocomposite) with two extrusion temperatures (200 °C and 220 °C) and two infill densities (20% and 30%). Mechanical performance is represented by flexural strength obtained from three-point bending tests reported in a previously published experimental campaign, while economic and environmental indicators are quantified through material cost and printing energy consumption, respectively. Criteria weights are derived using the Analytic Hierarchy Process (AHP) based on expert judgment and consistency-ratio verification, and the alternatives are ranked using the TOPSIS method. The results highlight a clear dominance of PLA-based configurations under the adopted weighting scheme, with PLA printed at 200 °C and 20% infill emerging as the best compromise solution. PLA–Flax options are penalized by higher material cost, higher printing-process energy demand, and lower flexural strength in the investigated conditions. The proposed AHP–TOPSIS workflow supports transparent, data-driven selection of AM process–material combinations for gyroid sandwich structures, and it can be readily extended by including additional sustainability metrics (e.g., CO₂-equivalent) and application-specific constraints. A sensitivity analysis under alternative weighting scenarios further confirms the robustness of the obtained ranking. Full article