Search Results (9,222)

Purpose: Decentralized hearing care models facilitated by community health workers (CHWs) can improve access to care in low-income settings. Preset hearing aids, which offer user-selectable pre-developed amplification programs, may support such models, but little is known about their real-world use and alignment with clinical recommendations. Method: This longitudinal study formed part of a feasibility project implementing the World Health Organization’s (WHO’s) hearing aid service delivery approach in three low-income South African communities. Adults (≥18 years) with confirmed moderate-to-severe bilateral hearing loss were fitted with preset hearing aids by trained CHWs. Devices offered four preset amplification programs. Participant-driven selections were recorded at four distinct time points: fitting and follow-ups at 2 weeks, 2 months, and 6 months post-fitting. Results: In total, 36 participants (mean age = 76 years, SD = 8.9, range 50–96) were fitted with devices. Although over half (right: 52.8%, left: 58.3%) presented with high-frequency loss, only 34% initially selected the corresponding program. Most participants (80.6%, n = 29) changed their selections at least once over the six months. Significant associations between hearing loss configuration and selection occurred at some time points only in the left ear, but agreement with clinically recommended programs declined from 42% at baseline to 28% at six months. Conclusions: CHW-facilitated hearing aid delivery supports user autonomy in low-resource settings. However, frequent changes and divergence from clinically recommended programs suggest reliance on user-driven trial-and-error adjustments rather than audiometric fit, which may limit long-term benefit. Ongoing, person-centred guidance is needed for the effective use of preset hearing aids. Full article

This study examines the effects of the extreme drought and heatwaves that occurred in Romania during the summer of 2024 on the microbiological and mycotoxicological quality of wheat (Triticum aestivum) stored until April 2025, as well as on the quality of wholemeal flour and bread derived from it. Comparative analyses were conducted against the contamination in wheat harvested in 2024. The hot and dry conditions significantly influenced the microbial and mycotoxicological contamination of both freshly harvested and stored wheat, as well as the derived flour and bread, due to their notably reduced moisture content and water activity. Although levels of total fungi, Fusarium-damaged kernels, and mycotoxins deoxynivalenol, aflatoxin B1, and ochratoxin A remained well below regulatory thresholds, higher contamination was observed in Transylvania and Moldavia Moldavia—particularly in the Curvature Carpathians, likely due to their cooler and wetter microclimates. The observed quality changes were strongly associated with alterations in physico-chemical, rheological, and colorimetric parameters, posing potential economic challenges for the milling and baking industries. The study recommends implementing integrated regional strategies to enhance wheat resilience, optimize production systems, and improve contamination control in response to increasing climate stress across Southeastern Europe. Full article

Background: Although surgical antibiotic prophylaxis (SAP) is considered a standard of care for preventing surgical site infections, the rising incidence of antimicrobial resistance (AMR) increases the likelihood of infections caused by multidrug-resistant organisms (MDROs), which may be associated with worse surgical outcomes. Methods: A multidisciplinary working group was convened by the Italian Multidisciplinary Society for the Prevention of Healthcare-Associated Infections (SIMPIOS) to define key measures for optimizing SAP in the era of AMR. Selecting the most appropriate SAP in patients colonized with MDROs is a complex decision that cannot be generalized, as it depends on both host factors and the specific surgical procedure. At present, there is limited evidence of SAP in these patients. Results: This position paper aims to provide practical guidance for optimizing SAP in the context of an AMR era. It is structured in three sections: (1) core principles of surgical antibiotic prophylaxis; (2) the role of screening, decolonization, and targeted prophylaxis for MDROs; and (3) barriers to changing surgeons’ prescribing behaviours. Conclusions: The working group developed 15 recommendation statements based on scientific evidence. Full article

Background: Antimicrobial drugs are used to treat bacterial diseases in livestock production systems, including bovine respiratory disease (BRD) in feedlot cattle. It is recommended that therapeutic antimicrobial use (AMU) in food animals be informed by diagnostic tests to limit the emergence of antimicrobial resistance (AMR) and preserve the effectiveness of available drugs. Recent evidence demonstrates preliminary support for the pen as a prospective target for AMR testing-based interventions in higher-risk cattle. Methods: A previously reported agent-based model (ABM) was modified and then used in this study to investigate the potential for different pen-level sampling and laboratory testing-informed BRD treatment strategies to favorably impact selected antimicrobial stewardship and management outcomes in the western Canadian context. The incorporation of sample testing to guide treatment choice was hypothesized to reduce BRD relapses, subsequent AMU treatments and resultant AMR in sentinel pathogen Mannheimia haemolytica. The ABM was extended to include a discrete event simulation (DES) workflow that models the testing process, including the time at sample collection (0 or 13 days on feed) and the type of AMR diagnostic test (antimicrobial susceptibility testing or long-read metagenomic sequencing). Candidate testing scenarios were simulated for both a test-only control and testing-informed treatment (TI) setting (n = 52 total experiments). Key model outputs were generated for both the pen and feedlot levels and extracted to data repositories. Results: There was no effect of the TI strategy on the stewardship or economic outcomes of interest under baseline ecological and treatment conditions. Changes in the type and number of uses by antimicrobial class were observed when baseline AMR in M. haemolytica was assumed to be higher at feedlot arrival, but there was no corresponding impact on subsequent resistance or morbidity measures. The impacts of sample timing and diagnostic test accuracy on AMR test positivity and other outputs were subsequently explored with a theoretical “extreme” BRD treatment protocol that maximized selection pressure for AMR. Conclusions: The successful implementation of a pen-level sampling and diagnostic strategy would be critically dependent on many interrelated factors, including the BRD treatment protocol, the prevalences of resistance to the treatment classes, the accuracy of available AMR diagnostic tests, and the selected “treatment change” thresholds. This study demonstrates how the hybrid ABM-DES model can be used for future experimentation with interventions proposed to limit AMR risk in the context of BRD management. Full article

Moringa oleifera, renowned for its medicinal potency, was investigated to discern the impact of varying storage temperatures (4 °C, 25 °C, 40 °C) and light conditions (dark and light) on the quality attributes of its leaf powder during a 12-month storage period. The study encompassed comprehensive analyses of phytochemical levels, nutritional properties, microbial contamination, and colour changes in response to these diverse storage environments. The lightness L* colour value changed significantly (40 to 60) from baseline tests when stored at 40 °C in transparent packaging. Results highlighted distinct variations in phytochemical composition and nutritional content based on the interplay between temperature and light conditions. Lower temperatures, particularly 4 °C, in both dark and light environments, demonstrated superior preservation of bioactive compounds, with mean values for quercetin-3-rutinoside of 3.34 µg/g and 3.19 µg/g, respectively; both are significantly higher compared to other treatments (p < 0.05). This trend was also observed for rutin, chlorogenic acid, and quercetin. Conversely, higher temperatures (25 °C, 40 °C) coupled with light exposure hastened degradation, notably impacting phytochemical stability. Microbial proliferation was evident in elevated temperatures, indicating potential safety risks. Further observations unveiled significant colour changes within the leaf powder, notably influenced by storage temperatures and light exposure. Lower temperatures exhibited diminished colour alterations compared to higher temperatures, underscoring their impact on product quality. This study underscores the critical role of controlled storage conditions, especially cooler temperatures and reduced light exposure, in maintaining the potency and quality of M. oleifera leaf powder. Recommendations advocate for stringent temperature control (preferably 4 °C) and light shielding during storage to uphold phytochemical stability and mitigate microbial proliferation. While this study provides valuable insights into temperature-mediated alterations, future research avenues should delve deeper into elucidating the underlying mechanisms of colour changes and long-term temperature effects on phytochemical and nutritional integrity. Full article

Extensive practice has demonstrated that the continuous pursuit of high yields in the black soil region of Northeast China resulted in imbalances in soil nutrients and declines in both soil quality and water use efficiency. Alternate wetting and drying (AWD) irrigation offers a promising solution for increasing rice yield and maintaining soil fertility. However, the success of this irrigation method largely depends on its scheduling. This study examined the threshold effects of AWD on rice growth, yield, and soil nutrient availability in the Sanjiang Plain, a representative black soil region in Northeast China. A two-year trial was conducted from 2023 to 2024 at the Qixing National Agricultural Science and Technology Park. “Longjing 31”, a local cultivar, was selected as the experimental material. The lower limit of soil water content under AWD was set as the experimental factor, with three levels: −10 kPa (LA), −20 kPa (MA), and −30 kPa (SA). The local traditional irrigation practice, continuous flooding, served as the control treatment (CK). Indicators of rice growth and soil nutrient content were measured and analyzed at five growth stages: tillering, jointing, heading, milk ripening, and yellow ripening. The results showed that, compared to CK, AWD had minimal impact on rice plant height and tiller number, with no significant differences (p > 0.05). However, AWD affected leaf area index (LAI), shoot dry matter (SDM), yield, and soil nutrient availability. In 2023, control had little effect on rice plant height and tiller number among the different irrigation treatments. The LAI of LA was 11.1% and 22.5% higher than that of MA and SA, respectively, while SDM in LA was 10.5% and 17.2% higher than in MA and SA. Significant differences were found between LA and MA, as well as between LA and SA, whereas no significant differences were observed between MA and SA. The light treatment is beneficial to the growth and development of rice, while the harsh growth environment caused by the moderate and severe treatments is unfavorable to rice growth. The average contents of nitrate nitrogen (NO₃⁻-N), available phosphorus (AP), and available potassium (AK) in LA were 11.4%, 8.4%, and 9.3% higher than in MA, and 16.7%, 11.5%, and 15.0% higher than in SA, respectively. Significant differences were observed between LA and SA. This is because the light treatment facilitates the release of available nutrients in the soil, while the moderate and severe treatments hinder this process. Although panicle number per unit area and grain number per panicle in LA were 7.5% and 2.3% higher than in MA, and 10.8% and 2.2% higher than in SA, these differences were not statistically significant. Seed setting rate and thousand-grain weight showed little variation across irrigation treatments. The yield of LA was 10,233.3 kg hm⁻², 9.1% and 14.1% higher than that of MA and SA, respectively, with significant differences observed. Compared with the moderate and severe treatments, the light treatment increases indicators such as the number of panicles per unit area, grains per panicle, thousand-grain weight, and seed setting rate, resulting in significant differences among the treatments. Water use efficiency (WUE) decreased as the control level increased. The WUE of all AWD irrigation treatments was significantly higher than that of the control treatment (CK). Compared with CK, AWD reduces evaporation, percolation, and other water losses, leading to a significant decrease in water consumption. Meanwhile, the yield remains basically unchanged or even slightly increases, thus resulting in a higher WUE than CK. The trends in rice growth, soil nutrient indicators, and WUE in 2024 were generally consistent with those observed in 2023. In 2024, the yield of LA was 9832.7 kg hm⁻², 14.9% and 17.3% higher than that of MA and SA, respectively, with significant differences observed. Based on the results, the following conclusions are drawn: (1) AWD irrigation can affect the growth of rice, alter the status of available nutrients in the soil, and thereby cause changes in yield and WUE; (2) LA is the optimal treatment for increasing rice yield, improving the availability of soil available nutrients, and improving WUE; (3) Both MA and SA enhanced WUE; however, these practices negatively impacted rice growth and the concentration of soil available nutrients, leading to a concurrent decline in yield. To increase rice yield and maintain soil fertility, LA, with an irrigation upper limit of 30 mm and a soil water potential threshold of −10 kPa, is recommended for the Sanjiang Plain region. Full article

The hilly and mountainous regions of Nepal provide a suitable environment for the cultivation of large cardamom, a high-value cash crop with significant global market potential. However, climate change poses significant threats to its production and the livelihoods of farmers dependent on this crop. To cope with these challenges, adopting climate-resilient agricultural practices is essential, particularly among smallholder farmers of rural communities. However, the extent of their implementation remains largely unknown. We surveyed 158 households in Ilam and Tehrathum districts to assess the adoption intensity of climate-resilient practices among large cardamom farmers using the Ordered Probit Model. Findings revealed considerable variation in the adoption intensity of climate-resilient practices. Traditional practices like tillering, weeding, and irrigation were highly adopted, while more innovative, knowledge-intensive methods were less adopted. Education was found to have a positive influence on the high adoption intensity of climate-resilient practices. Each additional unit of year of schooling increases the probability of high adoption of practices by 3.4%. Membership in farmers’ groups increases the likelihood of high adoption by 12.9%, while labor availability and regular extension contact rises by 21.9% and 17.8%, respectively. Similarly, age shows a smaller but significant effect, increasing adoption by 0.5% at p-value = 0.08. The use of traditional practices is common; however, the uptake of scientifically recommended practices for climate resilience remains limited. Policy initiatives focusing on farmer education, promoting farmer organizations, addressing labor shortages, and strengthening extension services are important for enhancing resilience in the large cardamom sector of Nepal. Full article

Background/Objectives: Living with a disabled family member has extensive implications for the whole family involved in their care, and there is dependency on healthcare support for maintaining quality of life. This qualitative study, conducted in Northern Ireland, investigated the support needs of different family members living with a severely impaired individual across the lifespan. A key objective was to identify support needs for intervention. Methods: In-depth semi-structured interviews were conducted to obtain data from eight mothers, fathers, sisters and brothers of a profoundly disabled child or sibling. Data was analyzed using Interpretive Phenomenological Analysis, allowing for the application of double hermeneutic in which the researchers derived meaning from the lived experiences of participants. Results: The analysis yielded five themes in total. Three themes were related to gaps in healthcare systems: Support Needs in Childhood, Support in Transition into Adult Services, and Worry for the Future; and two themes were linked with support needs: Associative Disability in Family Members; and Stigma. All family members had caregiving roles, and these had similarities and differences according to the relationship with the care-receiver. Participants recognized their families were survivors, however maintained a family tragedy rather than positive change outlook. Conclusions: Recommendations derived from the findings to alleviate the stressors of the situation for family members include increasing community support and age-related respite facilities. Additionally, improving and enhancing education of disabilities in schools, and immersing and further integrating individuals with disability into society, will alleviate the alienation, isolation and loneliness experienced by family members. Full article

Background/Objectives: The 2-minute walk test (2MWT) is a time-based gait assessment commonly employed for populations with limited walking ability for greater tolerability compared to the longer 6-minute test. The recommended distance to perform the tests is a 30 m straight path, a space requirement that is not always available in non-laboratory contexts. Shorter paths are therefore often adopted, but associated changes in gait patterns are not clear. The aim of the study is therefore to investigate how different walking path lengths affect gait patterns during the 2MWT. Methods: Twenty healthy young adults performed three walking trials on a straight hallway of 5 m, 15 m, and 30 m lengths. Spatiotemporal gait parameters were measured using three inertial measurement units on both distal tibiae and at pelvis level. Results: The 5 m path showed the greatest deviations, specifically in walking distance, walking speed, stride duration, stance time, swing time, single support time, and cadence, if compared to longer distances (p < 0.05). The 15 m path showed differences only in walking distance and walking speed (p < 0.05), if compared to the 30 m path. Conclusions: Shorter path lengths, particularly the 5 m, significantly impact gait patterns and should be considered when interpreting 2MWT results in clinical settings. The 30 m path is recommended as the gold standard, with 15 m as a viable alternative for assessing temporal parameters. Nevertheless, the extent to which each feature would be over/underestimated when walking in limited spaces is also addressed. Full article

Lubricants play a crucial role in improving the reliability of internal combustion engines. The deterioration of engine oil is influenced not only by mileage and usage time but also by subjective factors. Currently, engine oil is replaced in accordance with the manufacturer’s recommendations. At the time of a scheduled oil change, two situations may arise: the degree of lubricant wear may exceed normal levels, in which case the technical systems may also be damaged, with serious consequences for the environment and, implicitly, for human health; or the degree of wear may be low, consistent with normal engine operation, in which case prolonging oil use is recommended, thereby reducing consumption. In this paper, the authors propose a method for diagnosing the engine through periodic analysis of the physico-chemical properties of used engine oil, based on which appropriate vehicle maintenance strategies are issued. Also, recommendations are made for prolonged use of the oil on the condition of its periodic evaluation. Thus, for samples taken from 43 trucks the following physico-chemical properties were analyzed: kinematic viscosity, density, flash point, fuel content, water content, and metal content and their values, for all samples, were within the recommended limits. However, for some samples, more pronounced variations in the values of some properties were found and suitable preventive maintenance recommendations were issued. Full article

Objectives: The study aimed to determine the effect of manganese (Mn) exclusion from the dietary mineral mixture and the dietary replacement of the recommended level of MnCO₃ with Mn₂O₃ nanoparticles (Mn₂O₃NPs) on the Mn biodistribution and the femur histology. Methods: The experiment was conducted on twenty seven Wistar rats divided into three groups (n = 9): a control group receiving the recommended level of Mn (65 mg/kg) in standard form (MnCO₃); a manganese deficient group (Mn deprived from dietary mineral mixture), and a group receiving diet supplemented Mn₂O₃NPs (65 mg/kg) instead of MnCO₃. During the 12-week experiment, a balance test was performed. After the experiment period, blood and femur were collected from sacrificed rats. The content of Mn in water, diet, urine, feces, plasma, and femur was measured. Results: In the Mn-deficient rats, a reduction in Mn intake and excretion, Mn retention index, and blood Mn level, but an increase in Mn digestibility index was noted. In rats supplemented with Mn₂O₃NPs, Mn intake and excretion and blood Mn levels were decreased, while Mn retention and digestibility indexes were increased. In both experimental groups, deterioration of femur morphology was noted, but these changes were more severe in the Mn-deficient group. Conclusions: The obtained research results indicate that manganese deficiency significantly disturbed the biodistribution of this element and led to the deterioration of the architecture and histological parameters of the femur, emphasizing the key role of manganese in maintaining bone homeostasis. It has also been shown that replacing MnCO₃ with Mn₂O₃NPs allows the maintenance of the correct Mn level in the femur but causes unfavorable changes in its morphology. Full article

Background: Adults with cancer who are pre-frail or frail are at risk of poor outcomes. Geriatric assessment (GA) is recommended to assess and manage vulnerability and risk of frailty in older adults with cancer (≥65) and to inform referrals in supportive services, including rehabilitation. Yet, adoption of the GA in community oncology practice lags, and frailty among adults younger than 65 often goes undetected and/or unaddressed. We evaluated the feasibility of a GA-guided rehabilitation care model and assessed changes in patient-reported and performance-based outcomes after rehabilitation. Methods: Adults (≥18 years) starting systemic therapy at a community oncology practice enrolled in the study. The GA was administered online and monthly for one year. Frailty/pre-frailty was identified using a previously validated 44-item index. The oncology team was notified of frail/pre-frail patients and then made referrals to outpatient rehabilitation. Feasibility outcomes (recruitment, retention, fidelity) and participant acceptability [7 items, 0–5 Likert scale] were analyzed descriptively. Patient-reported and performance-based outcomes were examined using the paired t-test. Results: 48% of eligible patients enrolled (N = 141), and 83% completed at least one GA. Frailty/pre-frailty was identified in 40% of the GAs, resulting in 282 referrals to rehabilitation (99% fidelity). Acceptability scores ranged from 3.5 ± 1.7 to 4.7 ± 0.6. Participants who attended rehabilitation (52%) improved significantly in outcomes measuring health-related quality of life, mobility, aerobic capacity, and strength (all p < 0.05). Conclusion: Implementing a GA-guided rehabilitation care model was feasible and acceptable to patients receiving systemic treatment. Those who attended rehabilitation experienced significant improvement in patient-reported and performance-based outcomes. Full article

The transition to a sustainable energy mix is essential to mitigate climate change. Enhanced Oil Recovery (EOR) using low-salinity water (smart water) has emerged as a promising strategy for reducing environmental impacts in the petroleum industry, producing a highly valuable energy source due to both its energy density and market value. This study critically reviews intermediate technological readiness levels (TRL), applying a patent-based approach (TRL 4–5) and a review of articles (TRL 3) to analyze various aspects of smart water for EOR, including its composition. A total of 23 patents from the European Patent Office (Questel Orbit) and 1395 articles from Elsevier’s Scopus database were analyzed, considering annual trends, country distribution, international collaborations, author and applicant affiliations, citation dependencies, and factorial analyses. Both patents and articles show exponential growth; however, international collaboration is more frequent in the scientific literature, while patents remain concentrated in a few countries aligned with their markets. Technologies are focused on wettability, surface complexation, CO₂ interactions, emulsification, aerogels, reinjection water treatment, carbonate reservoirs, effluent treatment, nanofluidics, and ASP fluids. Recent topics include CO₂ associations, permeability, fractured reservoirs, gels, reservoir water, wettability alteration, and reservoir/oil heterogeneity. The findings indicate the need for multivariated development of customized smart waters to address complex interfacial synergistic mechanisms. International Joint Industry Projects and global regulations on the safe use and composition of hybrid injections are recommended to accelerate development, reduce environmental impacts, and enhance the efficient use of existing fields, alleviating the challenges of finding new reservoirs. Full article

The Huangshui River Basin is located in the transition zone between the Loess Plateau and the Qinghai–Tibet Plateau, characterized by a fragile hydrological and ecological environment. Groundwater serves as a vital water source for local economic development and human livelihood. With the acceleration of urbanisation and climate change, groundwater resources face challenges such as pollution and over-exploitation. This study employs an improved DRASTIC model, tailored to the characteristics of the groundwater system in the Huangshui River Valley of the upper Yellow River, to integrate groundwater resources, groundwater environment, and ecological environment systems. Improving the DRASTIC model for groundwater vulnerability assessment. A two-tiered evaluation system with nine indicator parameters was proposed, including six groundwater quality vulnerability indicators and five groundwater quantity vulnerability indicators. Fuzzy analytic hierarchy process and entropy weight method were used to determine the weights, and Geographic Information System (GIS) spatial analysis was employed to evaluate groundwater vulnerability in the Huangshui River basin in 2006 and 2021. The results indicate that the proportion of areas with high groundwater quality vulnerability increased from 10.7% in 2006 to 31.57% in 2021, while the proportion of areas with high groundwater quantity vulnerability decreased from 22.33% to 14.02%. Overall, groundwater quality vulnerability in the Huangshui River basin is increasing, while groundwater quantity vulnerability is decreasing. Based on the evaluation results of water quality and quantity vulnerability, protection zoning maps for water quality and quantity were compiled, and preventive measures and recommendations for water quality and quantity protection zones were proposed. Human activities have a significant impact on groundwater vulnerability, with land use types and groundwater extraction coefficients having the highest weights. This study provides a scientific basis for the protection and sustainable use of groundwater in the Huangshui River basin. Full article

In response to the changing international landscape and the risks associated with China’s supply chain security, conducting policy simulations on semiconductor supply chain security helps clarify the industry’s policies and governance strategies for semiconductor supply chain security in China. It also enables a better understanding of the current state and focus areas of China’s semiconductor supply chain security, which is of great significance for improving the security levels of semiconductor supply chains across provinces and cities and for constructing a secure, efficient, and autonomous semiconductor supply chain system. Firstly, this paper reviews the current research on semiconductor supply chains, supply chain security, and industrial policies. Secondly, based on the industrial policies for semiconductor supply chain security, an evolutionary game model is constructed, involving government departments, chain owner enterprises, and upstream and downstream small and medium-sized enterprises (SMEs) within the supply chain. Finally, the MATLAB R2016b system simulation method is employed to conduct a policy simulation analysis of China’s semiconductor supply chain security and further analyze the industrial policies related to semiconductor supply chain security. The results show that: (1) Supply chain security depends on multi-agent collaborative governance, with government leadership, and chain owner enterprises driving innovation in SMEs, improving digitalization levels, and ensuring supply chain autonomy and control. (2) Increasing government management revenue, raising the responsibility costs for chain owner enterprises, and reducing the innovation costs for SMEs can accelerate the achievement of the ideal governance state. Lastly, policy recommendations are proposed to build an autonomous and controllable supply chain system. Full article