Search Results (5,967)

Background: Dengue infection is an expanding public health threat in Indonesia, increasingly reported in semi-urban areas undergoing rapid demographic and environmental change, where household-level determinants remain poorly characterised. Methods: We conducted a case–control study in the Deli Serdang district, North Sumatra, evaluating sociodemographic and environmental risk factors for dengue. Patients admitted to the district referral hospital (July–September 2024) were screened via medical records. Laboratory-confirmed dengue cases were compared with non-dengue febrile controls. Housing conditions and sociodemographic characteristics were assessed using a validated electronic questionnaire with photographic documentation. Multivariable logistic regression identified independent risk factors. Results: Of 238 individuals screened, 39 dengue cases and 78 controls were enrolled. Male sex (aOR 6.7, 95% CI 1.3–33.7), student status (aOR 7.8, 95% CI 1.1–56.5), absence of window screens (aOR 12.9, 95% CI 3.1–53.8), and surrounding vegetation (aOR 7.3, 95% CI 1.7–31.9) were independently associated with dengue infection. Rural residence was overrepresented among cases, suggesting expansion beyond traditional urban boundaries. Conclusions: Dengue risk in a transitional setting is shaped by demographic exposure and modifiable structural vulnerabilities. Integrated prevention strategies, including window screening, covered water storage, environmental management, and school-based vector control, are needed in rapidly urbanising districts. Full article

Chronic obstructive pulmonary disease (COPD) extends beyond the respiratory system and is closely linked to an increased risk of cardiovascular complications. Exacerbations represent critical periods of cardiovascular vulnerability, with a marked rise in major adverse cardiovascular events observed in the early post-exacerbation phase. This narrative review synthesizes current evidence on the epidemiology, pathophysiological mechanisms, and therapeutic implications of cardiovascular risk following COPD exacerbations. A structured literature search was conducted to identify relevant studies in this setting. Cardiovascular risk is elevated following exacerbations, particularly within the first weeks, and remains increased for months thereafter. Multiple pathophysiological mechanisms contribute to this vulnerable window. Systemic inflammation, marked by elevated cytokines such as IL-6, IL-8, and CRP, promotes endothelial dysfunction, vascular oxidative stress, and impaired nitric oxide bioavailability. Despite the well-established link, cardiovascular disease remains overlooked and undertreated in patients with COPD, and the use of guideline-directed cardiovascular therapies is suboptimal. A more systematic, integrated approach to cardiovascular assessment and management in patients with COPD is warranted to improve outcomes. Full article

Human-induced climate change has rendered urban areas highly vulnerable to extreme events such as heatwaves, droughts, and floods. This study conducts a scoping review of extreme and compound climate hazards in Iranian urban areas under global warming conditions. Mapping the available literature, 92 authoritative scientific works published between 1999 and 2025 were analyzed. The review synthesizes evidence on the spatiotemporal patterns of heatwaves, drought, torrential rainfall, sea-level rise, and compound hazards across Iran. The results indicate that central, northwestern, eastern, and southern Iran experience the highest heatwave intensity and frequency, with short-duration heatwaves being more common than prolonged ones. Western Iran faces a high risk of torrential rainfall, but urbanization amplifies flood consequences by expanding impervious surfaces and accelerating surface runoff. Coastal areas show high vulnerability to compound flooding due to sea-level rise and storms. The review further reveals that Iran is experiencing hydroclimate whiplash (abrupt transitions between drought and flood) driven by global warming. The study concludes by presenting management suggestions and future research directions for integrated compound hazard management in Iran. Full article

Mediterranean-type forest ecosystems are becoming increasingly vulnerable to intensifying drought, threatening the resilience of even highly adapted ecosystems such as the Northern Jarrah Forest in south-western Australia. This study quantifies multi-decadal dynamics of canopy water stress using a 36-year multispectral satellite archive (1988–2024) and the newly developed Infrared Canopy Dryness Index (ICDI). We combined this spatiotemporal dataset with a MaxEnt-based risk assessment framework to identify the biophysical drivers of drought-induced canopy loss and to delineate high-risk zones under accelerating climate-forcing changes. Our results demonstrate a systematic spatial expansion of canopy dryness, paralleling a deteriorating regional climatic water balance. Hotspot analysis revealed a transition from localized, peripheral stress to widespread, chronic drought conditions across the landscape. The modelling achieved high diagnostic accuracy (AUC = 0.952), significantly outperforming conventional assessment methods. Regolith depth was identified as the primary determinant of drought-induced canopy collapse, followed by ICDI, NDVI, and slope. Crucially, high-biomass stands exhibited disproportionately higher risk of collapse, revealing a density-dependent vulnerability that suggests productive forests are approaching critical hydraulic thresholds. Conversely, lower-stature forests to the east of the study area demonstrated greater stability, likely due to reduced evapotranspirative demand. These findings provide robust spatial evidence for transitioning from reactive monitoring to proactive forest management. We conclude that targeted interventions, such as ecological thinning and prescribed burning in identified high-risk zones, are imperative to protect the forest and preserve the structural integrity of Mediterranean ecosystems in a drying climate. Full article

Background/Objectives: Insomnia is one of the most prevalent and persistent symptoms among patients with breast cancer, yet it remains under-recognized and undertreated in routine clinical practice. Beyond its impact on sleep quality, insomnia is increasingly understood as a multidimensional condition involving neurobiological, psychological, and behavioral mechanisms, closely intertwined with cancer-related stress and psychiatric comorbidities. This narrative review aims to provide a comprehensive and integrative overview of insomnia in breast cancer, focusing on its epidemiology, pathophysiological underpinnings, neuropsychiatric correlates, and clinical implications, while highlighting gaps in current research and management. Methods: A narrative review of the literature was conducted, including studies published in major medical databases (PubMed, Scopus, and Web of Science) up to 2025. Relevant articles addressing insomnia, sleep disturbances, psychiatric symptoms, and neurobiological mechanisms in breast cancer populations were selected and synthesized. Results: Insomnia affects a substantial proportion of breast cancer patients across the disease trajectory, from diagnosis to survivorship. Its etiology is multifactorial, involving dysregulation of the hypothalamic–pituitary–adrenal axis, inflammatory processes, and circadian rhythm, as well as treatment-related factors such as chemotherapy, endocrine therapy, and menopausal symptoms. Insomnia frequently co-occurs with depression, anxiety, fatigue, and pain, forming symptom clusters that significantly impair quality of life and may influence clinical outcomes. Emerging evidence supports a bidirectional relationship between insomnia and psychiatric vulnerability, suggesting a shared neurobiological substrate within the brain–body stress axis. Conclusions: Insomnia in breast cancer should be conceptualized as a neuropsychiatric condition embedded within a broader stress-related symptom network rather than as an isolated sleep disturbance. Improved screening, interdisciplinary management, and the integration of evidence-based interventions such as cognitive behavioral therapy for insomnia are essential. Research should focus on personalized and mechanistically informed approaches to better address this highly prevalent yet insufficiently managed condition. Full article

Objectives: To evaluate associations between social vulnerability and rheumatoid arthritis (RA)-related mortality in the United States, with emphasis on domain-specific effects of the Social Vulnerability Index (SVI). Methods: We conducted a county-level ecological study of RA-related mortality from 2010 to 2019 using age-adjusted mortality rates and the Centers for Disease Control and Prevention SVI. Gamma regression models examined associations between RA mortality and overall SVI and four thematic domains, including socioeconomic status, household composition and disability, minority status and language, housing type and transportation by using both continuous and quartile-based measures. Results: Between 2010 and 2019, 354,280 deaths occurred among individuals with RA, corresponding to a mean age-adjusted mortality rate of 9.7 per 100,000 population. In multivariable analyses adjusting for all SVI domains, household composition and disability vulnerability demonstrated the strongest and most consistent positive association with mortality, with a dose–response relationship across quartiles. Housing type and transportation vulnerability showed a modest positive association. Minority status and language vulnerability was inversely associated with mortality, whereas socioeconomic vulnerability was not significant in continuous models but demonstrated an inverse association with mortality in quartile-based analyses. Conclusions: RA mortality is differentially associated with specific domains of social vulnerability rather than overall vulnerability burden. Household composition and disability represent clinically salient risk factors, demonstrating the relevance of functional status and caregiving context in RA outcomes. Domain-specific assessment of social vulnerability may enhance clinical risk stratification and inform more targeted, patient-centered RA management. Full article

This study evaluates the vulnerability of Siberian larch (Larix sibirica L.) populations to future climate change using a genomic offset (GO) framework that integrates genome-wide SNP data with environmental variables. We analyzed 488 individuals from 37 populations across climatically diverse regions of Russia, genotyped by sequencing at over 20,000 SNP loci using the ddRADseq method. Gene–environment association (GEA) analyses (BayeScEnv, LFMM2, and RDA) identified candidate adaptive loci linked to six key bioclimatic variables. Based on these loci, GO was estimated using three approaches implemented in RONA–RDA, RDA, and Gradient Forest frameworks under multiple climate models (MIROC6, BCC-CSM2-MR, MRI-ESM2-0), scenarios (SSP2-4.5, SSP3-7.0, SSP5-8.5), and time periods (2041–2060, 2061–2080, and 2081–2100). Results revealed consistent spatial patterns of vulnerability, with northern and high-altitude populations, as well as populations from more continental and moisture-limited regions, exhibiting the highest GO and thus the greatest risk of maladaptation. In contrast, several central and southern populations showed relatively low vulnerability. The importance of temperature stability (isothermality) and precipitation of the driest month as key drivers of adaptive variation was highlighted. Despite differences in SNP datasets, population rankings remained highly consistent, supporting the robustness of predictions. Overall, our findings demonstrate substantial heterogeneity in climate vulnerability across the species range and provide a genomic basis for conservation strategies, including assisted gene exchange and climate-adaptive forest management. Full article

Critically ill obese patients with gynecological cancer represent a high-risk population with complex nutritional needs. Although excess adiposity may suggest adequate energy reserves, it often conceals sarcopenia, micronutrient deficiencies, and functional malnutrition, contributing to impaired wound healing, immune dysfunction, prolonged mechanical ventilation, increased susceptibility to infections, and adverse oncologic outcomes. Obesity-associated inflammation, insulin resistance, and tumor-driven catabolism further exacerbate metabolic stress and complicate nutritional management in the intensive care setting. Accurate nutritional assessment requires a multimodal approach incorporating body composition analysis, functional measures, and laboratory parameters, as conventional indices such as body mass index may underestimate nutritional risk. Nutritional support should be individualized and may include early enteral nutrition to preserve gut integrity, supplemental or total parenteral nutrition when gastrointestinal function is compromised, high-protein regimens, and targeted micronutrient replacement. Immunonutrition, including arginine, glutamine, omega-3 fatty acids, and nucleotides, has emerged as a promising strategy to modulate inflammation, enhance immune function, and support tissue repair. This narrative review summarizes current evidence regarding obesity-related metabolic dysfunction, nutritional assessment, enteral and parenteral nutrition, and immunonutrition in obese critically ill patients with gynecological cancer. It highlights the challenges associated with sarcopenic obesity and hidden malnutrition while providing a clinically relevant overview for intensivists, gynecologic oncologists, surgeons, and nutrition specialists. Early recognition of nutritional risk and implementation of individualized multimodal nutritional strategies may improve recovery and clinical outcomes. However, high-quality ICU-specific studies remain limited, and further prospective research is needed to establish evidence-based nutritional protocols and evaluate their impact on survival, treatment tolerance, and quality of life in this vulnerable population. Full article

In past decades, the macroeconomic stability of India has been tested repeatedly by major global disruptions, including oil price shocks, the 2008 global financial crisis and the COVID-19 pandemic. Analysing how macroeconomic variables respond to these shocks is essential for evaluating external vulnerability and policy resilience in emerging economies. Our study provides a comprehensive empirical investigation of the dynamic responses of wholesale price inflation, industrial output, oil prices and exchange rates in India by employing monthly data from January 1993 to December 2024. To examine long-run equilibrium relationships along with short-run adjustment dynamics, the present study employs co-integration analysis within a Vector Error Correction Model (VECM) framework. Further, we applied impulse response functions and forecast error variance decomposition to track volatility spillover mechanisms. Quantile regression and ARCH–GARCH models were further estimated to account for distributional heterogeneity and time-varying volatility. The findings of our study suggested stable long-run linkages among the selected variables, where oil price shocks emerged as a key external source of macroeconomic fluctuations. Short-run dynamics suggested that shocks in oil prices are transmitted primarily through inflation and exchange rate channels and then affect industrial output. Distributional estimates revealed the effects were stronger during stress periods, indicating tail risks that were not captured by the mean-based models. Lastly, volatility analysis confirmed persistent clustering, especially during phases of crisis. Overall, the findings suggest that India’s macroeconomic system remains externally sensitive, with adjustment mechanisms that operate gradually but come under strain during global disruptions. These results underscore the importance of energy risk management and crisis-responsive macroeconomic stabilisation policies. Full article

This study investigates the cross-border consequences of large-scale military attacks on Ukraine’s critical energy infrastructure and their implications for European energy resilience. Unlike prior research focused primarily on national-level disruption, this paper conceptualizes wartime infrastructure destruction as a source of systemic spillover risk within interconnected electricity systems. We develop an analytical framework integrating three dimensions: shock probability, structural vulnerability, and recovery capacity. Using evidence from 2022–2026 and comparative assessment of selected European Network of Transmission System Operators for Electricity (ENTSO-E) countries, we identify substantial asymmetries in exposure and resilience. Moldova appears highly vulnerable due to structural dependence and limited flexibility, whereas Poland demonstrates stronger resilience supported by diversification and institutional capacity. The findings show that shocks originating in Ukraine propagate through electricity trade flows, balancing constraints, and price volatility. The results highlight that large-scale attacks on the energy system threaten not only immediate regional security but also the long-term energy sustainability of the interconnected European network. The paper contributes to the literature by linking war-induced infrastructure damage with sustainable energy governance and by proposing resilience tools such as digital twins and blockchain coordination. The results are relevant for policymakers, transmission operators, and crisis management institutions across Europe. Full article

The increasing adoption of Plant Factories with Artificial Lighting (PFAL) has intensified the reliance on Internet of Things (IoT) technologies for real-time monitoring and control of environmental and operational variables. While IoT-based architectures enable precise resource management and productivity optimization, PFAL systems remain highly vulnerable to component failures, sensor malfunctions, communication faults, and energy disruptions, which may compromise crop integrity and system reliability. These risks are particularly critical in low-cost and small-scale PFAL implementations, where maintenance capacity and redundancy are often limited. Existing IoT-based PFAL monitoring systems typically address either hardware or software redundancy in isolation and rarely incorporate a dedicated maintenance-oriented fault detection layer validated under realistic multi-failure scenarios. This study addresses these challenges by proposing a low-cost redundant system architecture for PFAL applications that simultaneously integrates (1) hardware redundancy through multi-sensor configurations; (2) analytical redundancy based on residual generation and threshold-based fault isolation; and (3) a maintenance-oriented fault detection layer capable of identifying abnormal internal device conditions. Experimental validation was conducted using four hardware configurations—Arduino Nano with Ethernet, ESP32, STM32 with Wi-Fi, and STM32 with Ethernet—evaluated across five fault scenarios: dust accumulation, water exposure, high temperature, fire detection, and physical impact. The STM32 with Ethernet configuration consistently achieved the fastest fault detection response times across all tested scenarios. Future work will focus on the integration of machine learning-based predictive maintenance algorithms, multi-node PFAL network deployments, and long-term field validation. Full article

Direct-seeded industrial tomato (Solanum lycopersicum L.) systems are highly vulnerable to early-season interference, yet the role of seed vigor as a competitive determinant remains under-quantified. This study evaluated the performance of high-vigor (HV; 91% germination) and accelerated-aged low-vigor (LV; 60% germination) tomato seeds against two weeds: green foxtail (Setaria viridis) and jimsonweed (Datura stramonium). While mean emergence timing was statistically comparable between HV and LV cohorts (6.0 vs. 7.2 days), LV seedlings entered the post-emergence phase with a numerical deficit in initial seedling dry weight (7.1 mg vs. 8.5 mg for HV; difference not statistically significant), suggesting a potential early competitive disadvantage. In replacement series experiments, HV tomatoes maintained stable leaf and root biomass within the 0.76–1.24 relative yield (RY) confidence interval when competing with jimsonweed. In contrast, LV plants were significantly suppressed at low weed proportions (25%), where root RY dipped below the 0.76 threshold. Against the aggressive below-ground strategy of S. viridis (which produced ~1200 mg of root mass by 40 DAE), LV tomato root RY collapsed to 0.10–0.15, whereas HV plants maintained significantly higher niche occupancy. Physical separation of above- and below-ground competition confirmed that HV seeds provide a “physiological buffer”; specifically, in below-ground treatments, HV plants achieved a root mass of 0.25 g/plant compared to only 0.15 g/plant for LV plants. These results identify seed vigor as a primary driver of the “priority effect” and suggest that high-vigor lots are essential for Integrated Weed Management (IWM) strategies to mitigate early-season resource pre-emption. These findings suggest that seed vigor assessment should be integrated into seed quality standards for direct-seeded tomato systems as a component of Integrated Weed Management. Future field-based studies are needed to validate these greenhouse findings under variable agronomic conditions. Full article

Vehicle-to-Everything (V2X) communication is a critical enabler of autonomous driving, supporting real-time information exchange among vehicles, roadside infrastructure, pedestrians, and cloud services. However, the security of current V2X systems largely relies on classical cryptographic mechanisms, which are expected to become vulnerable in the presence of large-scale quantum computers. Given the long operational lifespan and stringent safety requirements of autonomous vehicular networks, the transition toward quantum-resistant authentication and key management mechanisms has become increasingly important. This paper presents a comprehensive survey of post-quantum Authentication and Key Agreement (AKA) protocols for secure V2X communications. The survey systematically reviews V2X communication architectures, security and privacy requirements, existing authentication frameworks, and emerging post-quantum cryptographic approaches. Representative AKA schemes and NIST-standardized post-quantum algorithms are comparatively analyzed in terms of security strength, computational complexity, communication overhead, storage requirements, scalability, and deployment suitability for resource-constrained vehicular environments. The survey further examines practical implementation challenges, including latency constraints, bandwidth limitations, signature size expansion, memory consumption, and hardware resource requirements. The analysis reveals that achieving quantum-resistant security in V2X networks requires balancing strong cryptographic protection with the stringent performance demands of safety-critical vehicular applications. While recent post-quantum approaches offer promising security guarantees against quantum adversaries, their practical deployment remains constrained by computational and communication overhead. Finally, this survey identifies key research gaps and outlines future directions for the development of lightweight, scalable, and quantum-resilient AKA frameworks capable of supporting next-generation autonomous transportation systems. The findings provide researchers and practitioners with a structured understanding of the opportunities, limitations, and challenges associated with securing future V2X communications in the quantum era. Full article

To address the environmental evolution and management needs of emerging contaminants in the Yellow River Basin (Henan Section), China, nine typical functional cross-sections, covering industrial outfalls, sewage treatment plant (STP) effluents, human activity-dense areas, and baseline tributaries, were selected to systematically investigate the occurrence, potential sources, and multi-dimensional risks of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) in surface water. The results indicated a 100% detection rate of the target pollutants across all sites, with PFOA (0.45–7.46 ng/L) being the absolute dominant analogue. The spatial distribution exhibited an evident industrial point-source-driven pattern, where the pollution loads at the Jili District industrial outfall (S7) and STP effluent (S5) were significantly higher than those in non-point sources and natural baseline waters. Source apportionment suggested that direct wastewater discharge and secondary release from regional industrial clusters were likely key contributors to PFAS spatial heterogeneity. Multi-dimensional risk assessments revealed that the current ecological risk quotients (RQ < 0.01) for aquatic organisms and the human health risk values (HR < 0.1) via drinking water ingestion for various age groups were well within safe and controllable ranges. However, PFOS contributed significantly more to the ecological risk than PFOA, and children exhibited slightly higher health exposure vulnerability than adults. Although the overall risk is minimal, PFOA concentrations at high-load cross-sections have exceeded the latest stringent maximum contaminant level (4.0 ng/L) mandated by the US EPA in 2024. This study suggests an urgent need to establish a dynamic, life-cycle monitoring network for PFASs in the basin and to prioritize targeted deep-reduction strategies for high-risk industrial point sources. Full article

Across semi-arid and environmentally vulnerable regions, intensifying climate pressures, land degradation, and resource scarcity are placing growing demands on institutions, communities, and land users. However, the knowledge and technical skills required to respond effectively remain uneven and often poorly aligned with local needs. This study presents a comparative skills audit in Kimberley, Upington, and Rietfontein in the Northern Cape, identifying capacity gaps, stakeholder-specific training priorities, and structural barriers in natural resource and sustainable land management. Using questionnaires, semi-structured interviews, participatory site visits, and multi-stakeholder consultations, competencies were assessed across GIS and remote sensing, climate resilience, soil and land restoration, water conservation, sustainable agriculture, and policy literacy. Results show significant disparities in skills proficiency. GIS and remote sensing (0.8) and climate resilience strategies (1.0) were weakest, while policy literacy (1.5) and soil management (2.0) were also limited. Sustainable agriculture (4.0) and water conservation (2.8) showed relatively stronger capacity. Training needs varied by stakeholder, with government prioritizing geospatial tools and governance, and farmers emphasizing climate adaptation and resource management. Key barriers include limited digital infrastructure (83%), insufficient government support (80%), high training costs (78%), and contextual mismatches (50%). Integrated, place-based capacity development is essential to strengthen adaptive governance and long-term resilience. Full article