Although n-3-rich oils are widely used to improve the fatty acid profile of eggs, their susceptibility to oxidation may reduce their nutritional benefits and adversely affect animal health. However, the effects of naturally oxidized n-3 oil sources in laying Japanese quail remain unclear. This study therefore evaluated the effects of naturally oxidized plant and animal oil sources on productive performance, egg quality, egg yolk fatty acid profile, serum biochemical parameters, and liver histopathology. A total of 160 laying Japanese quail (Coturnix coturnix japonica) were assigned to four dietary treatments containing 1.5% non-oxidized sunflower oil, naturally oxidized chia oil, naturally oxidized flaxseed oil, or naturally oxidized salmon oil, designated as the Control, CO, FO, and SO groups, respectively. Each treatment consisted of five replicates of eight birds, and the experiment lasted 6 weeks. Egg production and feed conversion ratio were not affected by dietary treatment. However, feed intake decreased in the FO group, whereas egg weight decreased in the FO and SO groups (P < 0.05). Among the egg quality traits, yolk index increased in the CO group, while albumen index decreased in the FO group (P < 0.05); the remaining traits were unaffected. Egg yolk n-3 fatty acid content and the n-3/n-6 ratio increased significantly in the CO and FO groups (P < 0.01), whereas yolk cholesterol concentration and serum biochemical parameters did not differ among treatments. Liver histology was normal in the Control group, while the oxidized oil groups exhibited histopathological alterations, predominantly steatosis, with severity varying among oil sources. These findings indicate that naturally oxidized chia and flaxseed oils can enhance the n-3 fatty acid profile of egg yolk, but their potential effects on performance and liver health should be considered. Therefore, both oil source and oxidative status are important practical considerations when formulating n-3-enriched diets for laying Japanese quail.
Medical education is globally recognized as a high-stress environment, yet localized data regarding final-year students in Northern Sudan remain scarce. This study investigated the prevalence, independent predictors, and coping mechanisms of stress among final-year medical students at the University of Dongola. A descriptive, cross-sectional study was conducted in (2025) at the University of Dongola, Sudan. The study population comprised 120 final-year medical students. A total of 100 students completed the questionnaire, representing a response rate of 83.3%. Perceived stress was quantified using the Perceived Stress Scale (PSS-10), while a structured 22-item checklist was utilized to identify specific academic/non-academic stressors and coping behaviors. The questionnaire was administered in English to align with the medium of instruction. Data were analyzed using Chi-square tests (X2) and Binary Logistic Regression to identify independent predictors of stress (aOR; 95% CI). A total of 100 students participated (83.3% response rate). The findings revealed that 77% of respondents experienced moderate-to-high stress levels (67% moderate; 10% high), with a mean PSS score of 18.17 ± 6.56. Exam pressure (73%) and academic workload (61%) were the dominant stressors. Multivariable analysis confirmed that exam pressure (aOR = 4.82, 95% CI:} 1.95-11.84, p < 0.001) and academic workload (aOR = 2.54, 95% CI:} 1.12-5.76, p = 0.026) were the primary independent predictors of stress. Regarding coping, prayer (67%) and social interaction (46%) were the most utilized strategies. Notably, physical exercise (aOR = 0.28, p = 0.008) and social support (aOR = 0.35, p = 0.024) were independently associated with a significantly reduced likelihood of high stress. A significant majority of final-year students at the University of Dongola operate under high levels of psychological distress, primarily driven by structural curriculum demands. While religious and social buffers are utilized, the high prevalence of stress suggests that students have surpassed the optimal "eustress" threshold. Institutional interventions, including examination reform and the establishment of formal counseling services, are urgently required to safeguard student well-being and clinical competence.
Ovarian cancer is one of the most common gynecological cancers in women. Its diagnosis and treatment often cause significant psychological distress, mainly reflected in depression and anxiety, which arise from multiple interacting factors. This study, grounded in Lazarus's Stress and Coping Model and from the perspective of set theory, aimed to investigate the correlates and configurational pathways of high and low levels of depression and anxiety symptoms in ovarian cancer patients by integrating stress sources, coping styles, and coping resources. The study recruited ovarian cancer patients from a tertiary general hospital in Shenyang, China. The analysis included 169 ovarian cancer patients. The configurational factors included self-perceived burden (SPB), positive and negative coping styles, self-esteem, and general self-efficacy. Multiple linear regression and fuzzy-set qualitative comparative analysis (fsQCA) were used to explore the factors and configurational pathways related to depression and anxiety symptoms. The fsQCA identified six configurational pathways linked to high and low levels of depression symptoms. Similarly, the fsQCA identified two configurations linked to high anxiety symptoms and four configurations related to low anxiety symptoms. Moreover, the configurations associated with low psychological symptoms did not stand in opposition to those associated with high psychological symptoms. Substitutability and complementarity were observed among the various elements in the configuration. The study generated multiple configurational pathways for depression and anxiety symptoms in ovarian cancer patients by examining the combined effects of stress sources, coping styles, and coping resources. The configuration allows caregivers and medical staff to implement targeted measures to reduce burden perception and negative coping, enhance positive coping and self-esteem considering their substitutability and complementarity.
Soft-tissue reconstruction following oncologic resection of spinal tumors often leaves extensive dead space vulnerable to infection, cerebrospinal fluid leak, and impaired function. En bloc resection with wide margins remains standard for disease control, but closure of these complex defects is challenging. Plastic and reconstructive surgeons (PRS) are often consulted for soft-tissue closure, yet their role in spinal sarcoma care has not been comprehensively reviewed. We aimed to (1) describe indications and timing of PRS consultation, (2) summarize reconstructive options by anatomic site, and (3) report outcome differences where comparative data were available. Following PRISMA-ScR guidelines, we performed a scoping review of Scopus, PubMed, Embase, Web of Science, and CINAHL databases (January 2000-April 2025). Eligible studies reported spinal sarcoma or mixed oncologic spine cohorts with extractable sarcoma data undergoing flap-based or microvascular reconstruction with postoperative outcome data. We included 21 primary studies encompassing 10,854 patients and four secondary sources; two additional narrative reviews published after the original search period were incorporated as contextual sources. PRS teams primarily employed flap-based closure in higher-risk patients, including those with prior irradiation, infection, large posterior defects, or multilevel instrumentation. In comparative observational cohorts, immediate flap-based closure was associated with lower wound complication rates and fewer hardware-related complications. Sacral and chest wall tumors were most anatomically complex, frequently requiring PRS consultation. PRS involvement is preferentially utilized in higher-risk settings and is associated with comparable or lower wound morbidity, supporting early PRS consultation when high-risk features are present. These findings support standardized multidisciplinary consultation pathways and future validation of risk stratification tools in this patient population.
Implementing tools to identify and support palliative care needs remains challenging in hospitals, requiring a clear understanding of implementation determinants. This study defines tools as clinical resources for palliative care identification, needs assessment, and advance care planning support. This scoping review aimed to identify and categorise the barriers and facilitators influencing the implementation of tools in hospital settings. Following the Arksey and O'Malley framework with PRISMA-ScR reporting, we employed a hybrid analysis combining inductive thematic coding with deductive mapping onto the Consolidated Framework for Implementation Research. Studies in English, Danish, Norwegian, or Swedish were considered eligible for inclusion. In May 2024, the databases MEDLINE, Embase, Scopus, CINAHL, SocINDEX, and PsycINFO were searched for studies focusing on tool implementation by healthcare professionals in hospital settings. From 4032 records screened, 25 studies were included. Determinants were identified across all five Consolidated Framework for Implementation Research domains, though primarily concentrated within the Inner Setting and Individuals. Key barriers included time constraints, lack of training, and fragmented communication. Facilitators comprised strong leadership support, clinical champions, multidisciplinary collaboration, and a supportive organisational culture. This scoping review identifies determinants that can inform the selection of implementation strategies for tools in hospitals. Our findings suggest that tool implementation likely requires multi-faceted strategies capable of addressing barriers across multiple levels, from individual training to organisational leadership and culture. Future research should focus on evaluating tailored strategies that account for the unique complexities of different hospital contexts to ensure sustainable adoption.
As a key component for information acquisition, sensors play an irreplaceable role in fields such as healthcare and wearable electronics. However, conventional sensor materials generally suffer from insufficient flexibility and limited environmental adaptability, which restrict their large-scale deployment in digital applications. Therefore, the development of green, stimuli-responsive, and high-performance sensor materials has become a prominent research focus. Cellulose-based aerogels (CAs) serve as promising candidates for next-generation high-performance sensors due to natural abundance, biodegradability, low density, and highly porous three-dimensional network structures. This review provides a detailed overview of the sources and classification of cellulose, followed by a systematic summary of the fabrication techniques for CAs. Particular attention is given to a comparative analysis of three representative drying methods employed during CAs preparation, with an emphasis on their influences on pore architecture, structural integrity, and functional performance. Furthermore, recent applications of CAs in various types of sensors are comprehensively reviewed. Meanwhile, the regulation mechanisms of key performance parameters (such as response speed and operational stability) are critically discussed. Finally, the current challenges in performance optimization, and large-scale application of CAs sensors are highlighted, along with perspectives on their potential in green manufacturing, intelligent integration, and multimodal sensing. This work aims to provide a comprehensive reference and technical roadmap for the research and application of CAs in emerging sensing.
Diabetic foot represents one of the most serious complications of diabetes mellitus. Short videos on diabetic foot are increasingly disseminated through TikTok and Bilibili apps, which have emerged as dominant sources of health-related content. However, the credibility and quality of information in these short videos have not been systematically evaluated. Our study aims to assess the quality and reliability of Chinese short videos on diabetic foot shared on TikTok and Bilibili. A cross-sectional study design was adopted, and a total of 244 short videos related to diabetic foot were collected from two platforms: TikTok and Bilibili. On December 15, 2025, information quality and reliability assessment was conducted using three validated evaluation tools: GQS for quality assessment, and the mDISCERN and JAMA benchmarks for reliability assessment. Meanwhile, user interaction indicators and video characteristics were extracted. Nonparametric tests were applied to compare differences across platforms and uploader types, and Spearman correlation was used to examine relationships among video characteristics, engagement metrics, and quality scores. Compared to Bilibili, TikTok demonstrated significantly higher engagement metrics (all P < 0.001). The quality of short videos was suboptimal on both platforms, with median GQS of 2.00 (1.00,3.00), mDISCERN of 2.00 (1.00,2.00), and JAMA score of 2.00 (2.00,2.00). TikTok videos achieved significantly higher GQS and JAMA scores than Bilibili (both P < 0.001). By uploader type, non-specialists achieved significantly higher GQS scores than specialists (median 3.00 vs. 2.00, P < 0.001). Content distribution was imbalanced: clinical manifestations (48.36%) and treatment (44.26%) were prevalent, whereas epidemiology (7.79%) and diagnosis (14.34%) were underrepresented; 51.23% of videos covered a single theme and 48.77% addressed multiple themes. Video duration was positively correlated with GQS (r = 0.59, P < 0.001) and mDISCERN (r = 0.26, P < 0.001) but not with JAMA, while engagement metrics showed only weak or non-significant correlations with all quality scores. Our study shows that the quality of short videos on diabetic foot is poor on TikTok and Bilibili, with significant content imbalances. Videos uploaded by professionals demonstrated better reliability than those from individual users. Engagement metrics were not reliable indicators of information quality. Thus, medical information short videos on these platforms must be carefully evaluated for scientific soundness, and platforms should strengthen content regulation to ensure accurate diabetic foot education.
Respiratory therapists (RTs) are essential members of multidisciplinary respiratory and critical care teams, yet their contributions to interprofessional education (IPE) and collaborative practice remain less well characterized than those of many other health professions. This narrative review aimed to synthesize current evidence regarding RT-inclusive IPE, educational outcomes, implementation models, and remaining research gaps. # Methods This review followed Ferrari's narrative review framework. Literature searches were conducted in PubMed, ERIC, ProQuest, and supplementary sources from database inception through September 2025. Studies were eligible if they involved RTs or respiratory therapy students and addressed interprofessional education, interprofessional learning, collaborative practice, or team-based healthcare delivery. # Results Seventeen records published between 2013 and 2025 met the inclusion criteria. Most studies originated from North America and were conducted in educational settings. Simulation-based learning was the predominant IPE strategy. RT-inclusive IPE was associated with improvements in teamwork, interprofessional communication, role clarification, collaborative competence, mechanical ventilation knowledge, and clinical preparedness. Clinical reports also described valuable RT contributions in neonatal care, primary care teams, and intensive care recovery clinics. However, RT perspectives remained underrepresented in curriculum development, research priority-setting, and outcome evaluation. Common implementation barriers included scheduling constraints, curricular overload, logistical challenges, and limited faculty resources. # Conclusion Current evidence suggests that RT-inclusive IPE strengthens collaborative competencies and supports team-based respiratory care. Future research should incorporate standardized outcome measures, longitudinal evaluation, RT-specific indicators, and greater involvement of RT educators and clinicians in the design, implementation, and assessment of interprofessional education initiatives.
With alarming demographic and workforce developments in healthcare systems globally, digital health innovations are often heralded as solutions. Despite promises, empirical work points towards the complexity of such endeavours. Various sources of fragmentation complicate scaling up local initiatives and collaborations between different care institutions. In this paper we take fragmentation as ontological reality and conceptual starting point. Mobilizing literature on sociotechnical infrastructures and alignment work, we follow how a hospital-based innovations programme developed a digital care infrastructure in a major urbanized region. Combining these theoretical notions allows us to trace how digital infrastructure is 'done' in practice and continuously 'under construction'. Drawing on longitudinal ethnographic methods (observations, interviews and document analysis) conducted over an extensive period of time (17 months), we examine how various actors involved in a digital innovations programme try to build a digital infrastructure in a healthcare system characterised by fragmentation. We focus on how actors within the programme attempt to align social, technical, organisational and professional elements within the fragmented context. Our approach allowed us to identify five types of alignment work: narrative, internal, organisational, regional, and technical alignment work, and address emerging tensions and interactions between them. We argue that by using this more granular and comprehensive typology, and through conceptualizing infrastructures as moving targets, we can better appreciate the complexity and variety of alignment activities that support 'the' digital transformation in healthcare.
High concentrations of chloric acid (HClO3) have been detected in the sea-ice-covered Arctic atmosphere. While iodic acid (HIO3) is a confirmed key driver of new particle formation (NPF) in the Arctic, and its analogue iodous acid (HIO2) significantly enhances initial nucleation, NPF events are frequently observed even when HIO3 concentrations are insufficient to explain them. Owing to its strong acidity, we propose that HClO3 participates in aerosol nucleation, bridging this observational gap. Here, we systematically investigate the HIO3-HIO2-HClO3 ternary nucleation mechanism. Molecular-level analysis reveals that within the ternary clusters, HIO2 exhibits distinct basicity and preferentially accepts protons. Concurrently, the strong acidity and halogen-bond-inducing effects of HClO3 enable HIO3 to accept protons transferred from HClO3. Thermodynamic and kinetic stability analyses demonstrate that at typical Arctic temperatures (≤278.15 K), HClO3 significantly enhances HIO3-HIO2 nucleation. Specifically, under relevant atmospheric conditions ([HIO3] ≤ 107 cm-3 and [HClO3] ≥ 106 cm-3), the incorporation of HClO3 enhances cluster formation rates by up to an order of magnitude. This synergistic enhancement effectively explains the NPF events observed at Arctic sites (e.g., Ny-Ålesund) under iodine-poor conditions. These results indicate that HIO3-HIO2-HClO3 ternary nucleation is a crucial NPF pathway in marine environments with active halogen chemistry, providing a fundamental theoretical basis for understanding the sources, sinks, and climate impacts of marine chlorine-containing components.
Wastewater generated from industrial and marine activities is considered one of the most pressing global environmental challenges due to the presence of hazardous contaminants, including heavy metals, organic pollutants (such as dyes, phenolic compounds, and pharmaceuticals), and oil-in-water emulsions. At the same time, marine industries generate substantial amounts of crustacean waste that can harm the environment when improperly disposed of. From this valuable marine waste, chitosan, the second most abundant biopolymer after cellulose, can be chemically extracted from crustacean shells such as shrimp, fish, lobster, crab, krill, and squid. The term "extracted, environmentally friendly chitosan" refers to chitosan obtained from marine waste via chemical extraction, which is the primary focus of this review. The biomass-derived chitosan can become a source of several applications, including wastewater treatment, specifically oil-in-water separation, heavy-metal removal, organic contaminant adsorption, and desalination. This review covers marine sources of chitosan, chemical extraction methods, and the application of marine-derived chitosan-based materials in wastewater treatment. Focusing on research published from 2020 to 2025, this review examines marine-derived chitosan-based materials, adsorbents, membranes, and hydrogels, and highlights their application in water treatment. This review not only promotes cleaner water technologies but also fosters the transition towards sustainable valorization of marine waste through chitosan. Overall, this review highlights the significant potential of marine-derived chitosan-based materials as sustainable and efficient solutions for advanced wastewater treatment and marine waste valorization.
Severe Acute Malnutrition (SAM) is a significant contributor to child mortality and morbidity, particularly prevalent in low-resource settings such as Afghanistan. Studies have found various factors that influence the recovery from uncomplicated SAM. However, such associations are yet to be studied in the Afghan context, which has been affected by decades of conflicts and instabilities. This study aims to identify the predictors of recovery from uncomplicated SAM in children aged 6-59 months admitted to an outpatient therapeutic feeding program. A multicentre prospective cohort study enrolled 713 children with uncomplicated SAM between October 2023 and March 2024. Baseline, follow-up, and end data were collected through structured questionnaires and anthropometric measurements, guided by the national guidelines. Recovery from uncomplicated SAM was defined as achieving a mid-upper arm circumference ≥ 125 mm or weight-for-height Z-score ≥ - 2SD, together with the absence of bilateral pitting oedema for two consecutive visits, within three months of treatment. Multivariable logistic regression analyses were conducted to identify predictors of recovery from uncomplicated SAM. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported. Statistical significance was set at p < 0.05. A total of (567, 79.5%) children recovered from uncomplicated SAM. Children with literate mothers (AOR 6.03, 95%CI 1.76-20.57, p = 0.004), those from small family size (AOR 4.05, 95%CI 2.56-6.41, p < 0.001), those with access to an improved water source (AOR 4.24, 95%CI 2.63-6.82, p < 0.001), good adherence to routine antibiotics (AOR 4.28, 95%CI 2.49-7.34, p < 0.001) and caregivers who received nutrition counselling (AOR 2.80, 95%CI 1.72-4.58, p < 0.001) were significantly more likely to recover from uncomplicated SAM. In this study, 79.5% of children recovered from uncomplicated SAM. Factors such as maternal literacy, adherence to routine antibiotics, caregiver nutrition counselling, small family size, and access to improved water sources were linked to better recovery from uncomplicated SAM. These findings highlight the potential importance of educational, behavioural, household, and environmental factors in recovery from uncomplicated SAM and may help inform future research and program planning.
The growing prevalence of antimicrobial resistance and cancer has intensified interest in natural products as sources of biologically active compounds with potential pharmaceutical relevance. In this study, the phytochemical composition of the methanolic extract of Artemisia abyssinica aerial parts (MEAA) was comprehensively characterized using liquid chromatography-tandem mass spectrometry (LC-MS/MS) and gas chromatography-mass spectrometry (GC-MS), and its in vitro antimicrobial, antioxidant, cytotoxic, and molecular docking properties were evaluated. LC-MS/MS analysis revealed a diverse profile dominated by flavonoids and phenolic compounds, including myricetin, quercetin, apigenin derivatives, hispidulin, and taxifolin, while GC-MS analysis tentatively identified several non-polar constituents, with gitoxigenin as a putative major component. MEAA exhibited moderate antibacterial activity against Micrococcus luteus (inhibition zone 15 mm; MIC = 2 mg/mL) and moderate activity against Streptococcus pneumoniae and Escherichia coli. The extract demonstrated weak antioxidant activity in the DPPH assay (IC50 = 268.15 µg/mL) and moderate cytotoxicity against HepG-2 hepatocellular carcinoma cells (IC50 = 59.2 µg/mL) compared with Adriamycin (IC50 = 6.9 µg/mL). Molecular docking was employed to provide supportive structural insights, suggesting that selected flavonoids, particularly myricetin, apigenin, and hispidulin, may interact favorably with DNA gyrase, epidermal growth factor receptor, and urease. Overall, this study provides an analytical and biological profile of MEAA and highlights its phytochemical richness and early-stage bioactivity, supporting its relevance for further pharmaceutical investigation as well as its potential as a natural bioresource for future applications.
The emergence of mecC-carrying Staphylococcus aureus strains is a serious concern in public health. Our study investigated the clonal diversity, genetic characteristics, antimicrobial resistance, virulence determinants, biofilm-forming ability, and molecular epidemiology of mecC-positive Staphylococcus aureus isolates obtained from hospitalized patients in Iran. We analyzed 45 mecC-carrying S. aureus strains isolated from 1,590 S. aureus samples collected from different clinical sources. The characterization included antimicrobial susceptibility tests, assessment of biofilm formation, spa typing, multilocus sequence typing (MLST), and PCR analysis to detect resistance, biofilm-related, and virulence genes. Our results showed that 17.8%, 17.8%, and 64.4% of the isolates were classified as weak, intermediate, and strong biofilm producers, respectively. The prevalence of the ant(4΄)-Ia and tet(M) was found in 80% and 73.3% of the isolates, respectively. MLST revealed that the 45 isolates belonged to four clonal complexes: CC8 (44.4%), CC130 (24.5%), CC121 (17.8%), and CC425 (13.3%). The majority of S. aureus isolates belonged to the CC8/ST239 lineage (44.4%). Also, tst-positive strains belonged to CC121/ST599/t5930 (17.8%) and CC8/ST239/t037 (11.1%), while eta-positive isolates belonged to CC/ST130/t843 (15.6%). Fusidic acid-resistant S. aureus isolates primarily belonged to CC8/ST239/t037 lineage (11.1%), followed by CC8/ST239/t7688 (6.7%), both carrying the fusB gene. Vancomycin-intermediate S. aureus strains were classified into CC/ST599/t5930 (6.7%) and CC/ST130/t843 (4.4%) clones. This study highlights the need for close and continuous monitoring of the genetic diversity and characteristics of the mecC-carrying S. aureus strains. Besides, urgent measures are required to prevent the transmission of these strains and to effectively treat associated infections.
Conservation translocations are widely used to increase population size and redundancy, yet their genetic consequences are often uncertain, particularly for clonal species with unknown rates of sexual reproduction. Propagation through asexual reproduction is frequently employed in these systems, but its effectiveness for preserving genomic diversity remains poorly evaluated. We used genome-wide single nucleotide polymorphism (SNP) data to assess the genetic outcomes of translocation efforts in Pleuropogon oregonus, a critically endangered grass endemic to eastern Oregon, USA. We quantified genetic diversity, relatedness, and population structure across natural and introduced sites and used coalescent simulations to infer the divergence history between disjunct populations. Genetic analyses identified two divergent lineages corresponding to northern and southern regions, with divergence predating the last glacial period and limited subsequent gene flow. Within regions, natural populations exhibited high clonality but retained genetically distinct individuals. Introductions that used vegetative propagules from the northern region maintained heterozygosity and allelic diversity comparable to sources and captured multiple distinct genotypes, including alleles likely originating from an unsampled source, thereby increasing population redundancy. In contrast, the introduction derived from a low-diversity, southern region source reflected similarly limited clonal diversity. Our results demonstrate that vegetative propagation can effectively preserve genomic diversity in clonal species when propagules are sampled representatively, but that evolutionary history may inform sourcing and mixing decisions. More broadly, this study provides an empirical framework for integrating genomic data into conservation translocations, highlighting conditions under which vegetative propagation maintains evolutionary potential and when it may pose risks to long-term persistence.
Conditions for QuEChERS-based extraction assisted by ultrasonic oscillation and ultra-high-performance liquid chromatography-tandem mass spectrometry were established for the rapid and efficient determination of 16 common mycotoxins in wheat samples. The optimal extraction solvent was acetonitrile/water (80/20, v/v) containing 0.3% formic acid, with ultrasonic oscillation for 10 min, followed by analysis within 5 min. Mycotoxin levels were surveyed in wheat grains and flour from both domestic and imported sources, as well as in major commercially available processed wheat-derived products. Deoxynivalenol and T-2 toxin were predominant, whereas nivalenol, 15-acetyldeoxynivalenol, HT-2 toxin, zearalenone, and ochratoxin A were detected only in raw materials. Mycotoxins were present in 94% of raw materials and 67% of processed products; however, all concentrations complied with European Union and Taiwan Food and Drug Administration limits. Since processed products contained low concentrations of deoxynivalenol and T-2 toxin, the estimated dietary intake remained below the tolerable threshold, indicating minimal risk.
In the past, cochlear implantation (CI) was not commonly offered to this population due to concerns about limited auditory rehabilitation outcomes. Recent advancements in CI technology and multidisciplinary rehabilitation have expanded candidacy, but outcomes in deafblind patients remain underexplored. This systematic review and meta-analysis aimed to synthesize available evidence on CI outcomes in deafblind individuals. Data sources included PubMed, Web of Science, Scopus, and Cochrane Library from inception to July 20, 2025. Observational studies included adults or children with confirmed dual sensory impairment after CI. Primary outcomes included speech clarity (Speech Intelligibility Rating [SIR]), verbal communication ability, and telephone communication competence. Secondary outcomes encompassed audiological performance, auditory and cognitive development, educational integration, psychological benefits, and advanced auditory skills. Risk of bias was examined using the NIH Quality Assessment Tool and Newcastle-Ottawa Scale. STATA 18 was used to perform random-effects meta-analyses. Thirty-six studies were analyzed, including 491 patients (mean age 23.68 years; 23% male). The pooled mean SIR score was 3.45 (95% CI: 2.69-4.21), with no significant difference between Usher and non-Usher groups (p = 0. 52). Verbal communication ability was achieved in 70% (95% CI: 0.60-0.79), while telephone communication competence was limited to 51% (95% CI: 0.33-0.69). Cochlear implantation is an effective intervention for deafblind individuals, demonstrating significant improvements in speech intelligibility and verbal communication regardless of the underlying etiology (Usher vs. non-Usher). While verbal communication rates are promising, advanced skills such as telephone competence remain limited, suggesting the need for continued multidisciplinary rehabilitation.
Laser surgical management of human papillomavirus (HPV)-related disease, such as recurrent respiratory papillomatosis (RRP), in the upper aerodigestive tract generates surgical smoke, which may represent a source of occupational viral exposure for laryngeal surgeons, phoniatricians, anesthesia providers and scrub nurses. Despite growing awareness, protective measures remain inconsistently implemented. This study aimed to develop an evidence-informed clinical consensus statement (CCS) to guide occupational HPV risk management in laryngology. A modified Delphi consensus process was conducted under the auspices of the European Laryngological Society (ELS) and the Union of the European Phoniatricians (UEP). A panel of 26 international experts undertook three rounds of voting on 18 statements across five domains: definitions and risk perception, personal protective measures, smoke evacuation and ventilation, preventive vaccination, and areas for further research. All panellists completed all three rounds. Of the 18 statements, one reached strong consensus, seven reached consensus, one reached near consensus and six did not reach consensus. Three statements were merged across rounds. Key areas of consensus included the recognition of surgical smoke as a potential occupational HPV exposure risk, the inadequacy of standard surgical masks, the importance of offering HPV vaccination to healthcare workers with potential occupational exposure, alongside areas for further research. This joint ELS and UEP CCS represents the first internationally coordinated effort to address occupational HPV exposure in laryngology. While consensus was reached in several key areas, the findings underscore the need for targeted research and greater consistency in protective measures, educational provision and regulatory frameworks.
Jakarta, the world's fastest-sinking city, faces complex urban challenges from the complexity of its urban morphology, infrastructure, and environmental conditions. This study presents a descriptor for a multidimensional database of Jakarta, Indonesia, that can be used to analyse the city's subsidence and understand the frequent flooding events throughout the city. The data comprise four different dataset modelled using satellite imagery: (1) land subsidence modelling to quantify subsidence rates in Jakarta based on Sentinel-1 SAR data processed using the open-source package LiCSBAS (2) spectral indices to highlight vegetation and built-up areas, namely the Normalised Difference Vegetation Index (NDVI) and the Normalised Difference Building Index (NDBI) using Landsat 5, Landsat 7, and Landsat 9 imagery, and urban morphology datasets, including (3) impervious surface areas using Sentinel-2 based on adaptation of the Enhanced Normalised Difference Impervious Surface Index (ENDISI) formulation and (4) the proportion of residential areas modelled using K-means clustering. Data processing was performed using Google Earth Engine (GEE) and Python to generate a critical dataset to support analysis and modelling of urban resilience, climate adaptation, and mitigation towards flooding in the context of sinking city. Robust technical validation techniques were performed to ensure data accuracy and validity, with detailed limitations presented. The result presents a series of modelled datasets that can inform further urban analysis and modelling related to flooding events in Jakarta, with a methodology that can be replicated globally, especially in other Global South cities.
Urban water supply systems are increasingly challenged by water scarcity, rising energy consumption, carbon emissions, and water pollution under rapid urbanization and climate change. Existing studies have mainly focused on optimizing individual objectives such as water allocation or energy efficiency, while limited attention has been paid to the coordinated optimization of the Water-Energy-Carbon-Pollution (WECP) nexus under uncertainty. This study develops an integrated multi-objective optimization framework for the WECP nexus using Zhengzhou, China, as a representative case. First, a coupling coordination degree model is established to evaluate the interactions among water conservation, energy saving, carbon reduction, and pollution control. Subsequently, an improved Non-dominated Sorting Genetic Algorithm II (NSGA-II), integrated with interval parameters and dynamic constraints, is employed to optimize multi-source water allocation while balancing economic, social, and environmental objectives. Furthermore, an elastic storage mechanism is introduced to improve system adaptability under uncertain water demand and climate variability.The results indicated that the optimized allocation significantly enhanced system coordination, with the coupling coordination degree increasing from 0.67 to 0.87. Groundwater extraction decreased by 18.5%, reclaimed water utilization increased to 14.7%, and annual carbon emissions were reduced by approximately 57,000 t CO2, while maintaining economic benefits and reducing water shortages. Compared with conventional optimization methods, the proposed framework provided a more balanced trade-off among competing objectives and improved decision-making flexibility through Pareto-optimal solutions. This study demonstrated the potential of integrated WECP optimization for promoting sustainable urban water management and provided practical guidance for low-carbon transformation of water supply systems in Zhengzhou and other water-scarce cities.