Search Results (6,213)

Neglected tropical diseases (NTDs) remain a significant global health burden, exacerbated by the ongoing climate emergency, which alters disease distribution and increases vulnerability in affected populations. The urgent need for novel therapeutics demands innovative approaches in drug discovery, with heterocyclic compounds serving as versatile scaffolds due to their diverse electronic and structural properties that enable potent biological activity. This review highlights how green chemistry principles have been applied to the construction of bioactive heterocyclic cores relevant to NTD drug development. Key sustainable methodologies are discussed, including microwave-assisted solvent-free and green-solvent reactions, ultrasound-assisted synthesis, mechanochemical one-pot multistep strategies, and the use of ionic liquids and deep eutectic solvents as environmentally benign catalysts and reaction media. By focusing on these approaches, the review emphasizes how green synthetic strategies can accelerate the development of pharmacologically relevant heterocycles while minimizing environmental impact, resource consumption, and hazardous waste generation. Full article

Background: Efficient and accurate clinical data management is crucial for stroke care and research; however, for complex stroke cohorts, manual data entry is often complicated by high human error rates and significant inefficiency. This study addressed this gap by developing and evaluating an automated system for constructing high-quality stroke cohorts from electronic health records (EHRs). Methods: This retrospective cohort study was conducted at a single specialty hospital, comparing manual data entry (January–June 2022) with an automated system (January–June 2024). The system uses C# and secure SQL protocols for direct EHR integration. We developed an automated system using the C# programming language to extract 133 items covering the full hospitalization period (from admission to discharge) from EHRs, aligning with the Korean Stroke Registry, the Registry of Stroke Care Quality, and national quality assessment programs. The system’s effectiveness was evaluated by assessing the data entry time, data error rate, and medical record completion rate and comparing the automated method’s performance against conventional data entry. Results: The automated system significantly reduced the data entry time from 35 min to 19 s per patient. Furthermore, the data error rate decreased from 2.32% to 0.15% (p < 0.001), and the rate of missing medical records decreased from 28.9% to 16.2% (p < 0.001). Conclusions: The proposed clinical data collection and cohort construction system effectively improved data quality and efficiency compared to the manual method. This system provides a reliable and scalable data infrastructure that could facilitate research on stroke and quality improvement initiatives. Full article

Background/Objectives: The Developing and Evaluating a Machine Learning Opioid Prediction & Risk-Stratification E-Platform (DEMONSTRATE) trial aims to assess the usability, acceptability, feasibility, and effectiveness of implementing a machine learning (ML)-based clinical decision support (CDS) tool—the Overdose Prevention Alert—which predicts a patient’s risk of opioid overdose within three months. Methods: This single-arm study uses a pre–post implementation design with mixed-methods evaluation in 13 University of Florida Health, Gainesville, internal medicine and family medicine clinics. Eligible patients are aged ≥18 years, received an opioid prescription within the year prior to their upcoming primary care visit, are not receiving hospice care, do not have a malignant cancer diagnosis, and are identified by the ML algorithm as high risk for overdose. The Overdose Prevention Alert triggers when a primary care provider (PCP) signs an opioid order in electronic health records. We will evaluate effectiveness by comparing pre- and post-implementation outcomes using a composite patient-level measure defined by the presence of any of the following 6 favorable indicators: (1) evidence of naloxone access; (2) absence of opioid overdose diagnoses and naloxone administration; (3) absence of emergency department (ED) visits or hospitalizations due to opioid overdose or opioid use disorder (OUD); (4) absence of overlapping opioid and benzodiazepine use within a 7-day window; (5) absence of opioid use ≥50 morphine milligram equivalent daily average; (6) receipt of referrals to non-pharmacological pain management. Additional quantitative metrics will include alert penetration, usage patterns, and clinical actions taken. Usability and acceptability will be assessed using a 12-item questionnaire for PCPs and semi-structured interviews. Expected Results: The trial will provide insights into real-world ML-driven CDS implementation and inform future strategies to reduce opioid-related harm. Full article

Background: Metabolic syndrome (MetS) comprises a cluster of metabolic abnormalities that increase the risk of type 2 diabetes mellitus (T2DM) and cardiometabolic morbidity. Although widely recognized, evidence on its documentation and follow-up in primary care is limited. This study aimed to evaluate the extent of MetS documentation in electronic medical records (EMRs), examine follow-up patterns and metabolic changes over time, and assess the incidence and predictors of new-onset T2DM according to baseline MetS severity. Methods: A retrospective cohort study was conducted on 8170 adults aged 30–50 years, insured by Clalit Health Services in Southern Israel, who met ATP III criteria for MetS in 2008 and were followed through 2015. MetS severity was classified as mild (three components), moderate (four), or severe (five). Changes in metabolic indices were assessed longitudinally, and predictors of T2DM were analyzed using Kaplan–Meier survival and multivariable Cox regression models. Results: Although all participants met the diagnostic criteria, only 1.6% had a recorded MetS diagnosis. Over the eight years of follow-up, 26% developed T2DM, with incidence increasing from 21% among those with mild MetS to 49% among those with severe MetS (p < 0.0001). Fasting plasma glucose rose significantly (median +13 mg/dL, p < 0.001), BMI remained stable, and modest improvements were observed in blood pressure and lipid levels. Elevated fasting glucose (HR 2.13, p < 0.001), higher BMI (HR 1.33, p = 0.010), and lower HDL (HR 1.26, p = 0.045) independently predicted diabetes onset. Conclusions: MetS remains markedly under-documented and insufficiently integrated into primary care follow-up. Despite regular clinical follow-up, improvements in metabolic indices were limited. These findings highlight the need for structured strategies to enhance MetS recognition and long-term management within routine practice. Full article

Chronic wounds constitute a major global public health challenge, characterized by a high risk of infection, prolonged healing times, and frequent recurrence. Conventional wound assessment methods, which primarily rely on visual clinical inspection and laboratory-based analyses, are limited by inherent subjectivity, delayed feedback, and a lack of capacity for real-time monitoring of the dynamic biochemical changes at the wound site. Significantly, recent advancements in flexible electronics, nanomaterials, and energy harvesting technologies have boosted the rapid development of wearable electrochemical biosensors. These devices have emerged as a transformative platform for the continuous, non-invasive analysis of critical biomarkers within the wound microenvironment, including pH, temperature, inflammatory cytokines, metabolites, and pathogen-derived molecules. This review critically examines the latest progress in wearable electrochemical biosensors for wound monitoring and management. Key discussions include (1) the special requirements for sensor design, targeting the chronic wound’s pathological characteristics; (2) cutting-edge development in self-powered systems, multimodal sensor integration, closed-loop theranostics, and artificial intelligence (AI)-assisted decision-making; and (3) a critical appraisal of challenges in accuracy, stability, biocompatibility, energy management, and clinical translation. Finally, the review explores future trends, such as biodegradable sensors, multi-parameter fusion algorithms, and remote intelligent management systems, with the aim of establishing a foundational framework and providing technical guidance for developing next-generation intelligent wound care solutions. Full article

Background: Cochlear implants (CIs) are a life-changing treatment for individuals with severe to profound hearing loss, yet adult CI uptake remains low despite high clinical and economic effectiveness. This study investigates adult patient experiences, adaptation, and barriers to CI access in Saudi Arabia. Methods: A survey of 89 adult CI recipients was conducted across three major CI centers in Saudi Arabia. The electronic questionnaire explored pre- and post-implant experiences, including referral pathways, device choice, adaptation, and satisfaction. Descriptive statistics, ranked correlations, and inferential tests were used to analyze associations between demographic and clinical variables. Results: The median time between hearing loss diagnosis and implantation was 17 years, with most patients using hearing aids beforehand. Healthcare professionals were the primary source of CI interest for 48% of respondents, though younger recipients were more often influenced by peers. Longer daily device use was linked to faster acclimatization (ρ = −0.26, p < 0.05); however, age, wait time, and initial attitude did not affect adaptation. Outcomes exceeded expectations for 54% of participants. Major barriers included lack of awareness (23%) and fear of surgery (18%). Only 4% learned about CI through social media. Advice for future candidates emphasized confidence and proactive action. Conclusions: Despite expanded CI availability in Saudi Arabia, structural and societal barriers persist. Empowering healthcare professionals and utilizing social media for awareness may enhance adult CI uptake and improve hearing health outcomes. Full article

Background/Objectives: This systematic review summarizes the evidence regarding potential mechanisms underlying the relationship between spiritual practices and cognitive health in adults. The review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Methods: An extensive search of six electronic databases (i.e., PubMed, PsycINFO, Embase, Sociological Abstracts, ATLA, CINAHL) was conducted using keywords related to spiritual practices, religious activities, and cognitive health from 1 January 2000 to December 2025. The quality of the included studies was assessed using the Mixed Methods Appraisal tool aligned with the study design. Results: A total of 34 studies were selected for final inclusion in this review, and a narrative synthesis is provided. The studies were conducted throughout the world, with most studies conducted in North America and Asia. Short- and medium-term effects of spiritual practices on cognitive health were identified across heterogeneous practices ranging from meditation, tai chi and yoga to general spiritual and religious activities. Across the strongest evidence, 73% of the randomized control trials examined reported better cognitive health among the more spiritually active; neurobiological factors of decreased inflammation and improved immune response helped to explain these effects. A total of 5 studies examined mediators, while 29 studies contained only secondary outcomes for determining potential mechanisms. Informed by findings across psychosocial, behavioral, and neurobiological pathways, a conceptual model was created and needs testing. Conclusions: Possible mechanisms for spiritual effects on cognition may be through mental health and neurobiological factors, although more rigorous and long-term studies are needed. Full article

Background: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that causes severe motor, respiratory and communication impairment and imposes a high psychosocial burden on patients and families. Recent evidence shows that integrated neuropalliative care—early collaboration between neurology and palliative services with community support—improves quality of life and reduces avoidable hospitalisations. Yet there are few descriptions of how such integration is operationalised. Objective: This study examines a Community-Integrated Neuropalliative Pathway (CINP) implemented in the province of Modena (Emilia-Romagna, Italy), analysing how neurology, palliative care and emergency services collaborate to provide continuous, person-centred care for people with ALS. Methods: A single, holistic case study was conducted following Yin’s analytical approach. Data sources included ten semi-structured interviews with neurologists, palliative physicians, nurses, home-care professionals and emergency clinicians; ethnographic observations in the ALS outpatient clinic; relevant organisational documents (the regional Clinical Pathway on ALS); and aggregated quantitative data from the palliative care registry (January 2023–December 2024). Thematic analysis with investigator triangulation was used to explore care integration, advance care planning and emergency coordination. Quantitative data were summarised descriptively. Results: Three interrelated themes were identified: (1) Progressive and flexible integration between neurology and palliative care. Neurologists remained longitudinal reference points while palliative teams were activated in response to evolving needs and became more relevant with the progression of the disease. Regular multidisciplinary meetings and shared discharge planning facilitated coordination. (2) The shared culture of advance care planning. Professionals framed advance care planning (ACP) as a relational, iterative process anchored in therapeutic relationships. Shared care plans, once completed, triggered an electronic Emergency Warning (“warning 118”) procedure that notified the emergency service of patient preferences. (3) The integration of palliative and emergency services. The warning system enabled emergency clinicians to respect care plans and avoid aggressive interventions during crises. Quantitative data on 47 ALS patients followed by territorial palliative services showed that 16 had an active Emergency Warning flag; among these, most died at home or in a hospice rather than in hospital. Conclusions: The Modena CINP exemplifies how a public health system can operationalise early neuropalliative integration and connect hospital, community and emergency services. The qualitative findings illustrate the cultural and organisational shifts required for continuous care, while the quantitative data show that the system is correctly used and that patients with the Emergency Warning activation died mostly at home or in a hospice. Lessons from this analytical case study can inform the development of similar pathways in other regions, although further research is needed to assess outcomes in larger populations and such models need to be adapted to local contexts. Full article

Nitrate contamination of water resources poses significant ecological and public health risks. This study developed a cobalt-immobilized microplastic catalyst (Co–MP) capable of activating peroxymonosulfate (PMS) and facilitating formic-acid-assisted catalytic denitrification of nitrate. Characterization via Scanning Electron Microscopy (SEM), Fourier Transform Infrared Spectroscopy (FTIR), Energy-Dispersive X-ray Spectroscopy (EDX), and X-ray diffractometry (XRD) confirmed successful Co deposition, with the surface cobalt content reaching 5.2%. The system’s performance was optimized using Response Surface Methodology (RSM), identifying catalyst dosage and Co(II) concentration as the most significant factors. Under the optimized conditions (pH 5.5, reaction time 120 min, catalyst dosage 1.5 g L⁻¹, and Co(II) concentration 60 mg L⁻¹), the system achieved a nitrate removal efficiency of 90.6%, in excellent agreement with the model prediction (90.93%), along with an 86.7% reduction in total nitrogen, confirming stepwise denitrification to gaseous nitrogen species (N₂). The Co(II)/Co(III) redox cycle, sustained by PMS-assisted regeneration and driven by formic acid as the electron donor, ensured stable performance with minimal cobalt leaching (0.05 mg L⁻¹). This coupled oxidative–reductive system offers a sustainable dual-remediation strategy that simultaneously achieves selective nitrate conversion and valorizes microplastic waste for catalytic environmental applications. Full article

Gastrointestinal (GI) endoscopy is a daily procedure in clinical practice but contributes substantially to healthcare’s environmental footprint. Data on sustainability policies in Switzerland, however, remain scarce. This study aimed to assess the implementation of sustainability practices among members of the Swiss Society of Gastroenterology (SGG-SSG). We conducted a web-based cross-sectional survey between September 2023 and January 2024, targeting all 463 practicing Swiss gastroenterologists listed in the latest SGG-SSG roster. The survey comprised eleven questions covering four domains: respondent demographics; waste and single-use device management and procurement; digitalization; and work–life balance. A total of 161 respondents participated (response rate: 34.8%). Less than half (45.1%) reported waste sorting, while policies for single-use device reduction (23.5%) and waste minimization initiatives (27.8%) were even less common. Nearly half (48.8%) reported including sustainability considerations in procurement policies. In contrast, 52.8% reported having policies to promote work–life balance, and 88.2% reported policies requiring the use of electronic health records, reflecting significant progress in digitalization. While procurement and digitalization efforts are more widely implemented, further coordinated action is needed. Future research should investigate professional attitudes, institutional barriers, and strategies to enhance the adoption of environmentally responsible practices in GI endoscopy. Furthermore, professional societies (particularly SGG-SSG), hospital administrators, and cantonal health authorities must coordinate to establish national standards, integrate sustainability into accreditation, and implement incentives and accountability to reduce the environmental impact of GI endoscopy without compromising quality of care. Full article

The current research presents the synthesis, characterization, and application of a novel gas sensor based on polypyrrole/strontium titanate (PPy/STO) nanocomposites for the selective detection of CO₂. Utilizing chemical oxidative polymerization, PPy and PPy/STO nanocomposites with varying STO (10–50) wt.% were synthesized and characterized. The structural and morphological analysis confirms the formation of spherical structure and well-dispersed PPy nanoparticles with increasing crystallinity and interaction of STO in PPy chain particle compactness as the STO content increases. The integration of perovskite STO within the conducting polymer matrix enhances the electronic structure, porosity, and surface area of the composite, promoting improved gas sensing performance. Electrical impedance spectroscopy reveals that the composites exhibit a frequency-dependent dielectric response and conduction attributed to charge carrier mobility and interfacial polarization effects. PPy/STO 20% exhibits highest conductivity and dielectric constants of 0.03604 Scm⁻¹ and 1.074 × 10⁴, respectively. Real-time CO₂ sensing experiments conducted at 50 °C demonstrate good sensitivity, stability, and rapid response/recovery characteristics, particularly for the PPy/STO 10% and 40% composites. These findings highlight the potential of PPy/STO nanocomposites as flexible, lightweight, and efficient materials for portable CO₂ gas sensors, addressing the growing needs for environmental and health monitoring. Full article

The rapid development of wearable technology has spurred considerable interest in hydrogels, which are hydrophilic three-dimensional polymer networks known for their remarkable flexibility. Nevertheless, their application in flexible electronics has been constrained by inferior mechanical and physical properties. As an emerging flexible material, dual-network hydrogels possess high mechanical strength, self-healing capability, excellent fatigue resistance, and electrical conductivity, showing great potential for use in flexible electronics. This article systematically reviews the design and performance optimization strategies of dual-network hydrogels. It reviews the advancements in their applications in flexible electronic devices, including bodily fluid biomarker sensors, flexible energy storage devices, health monitoring sensors, and physical motion sensors. The potential future challenges and opportunities for dual-network hydrogel materials are also discussed. This review aims to provide a theoretical foundation for developing next-generation dual-network hydrogels for flexible electronics and to promote their practical implementation in this field. Full article

Background/Objectives: Myasthenia gravis (MG) is a rare autoimmune neuromuscular disease. Clinical trials with rigorously collected data provide valuable opportunities for mathematical modeling of patient outcomes over time. However, for rare diseases such as MG, combining data across multiple trials presents challenges due to heterogeneity in outcome measures. This study aims to address these challenges by investigating relationships among commonly used MG outcome measures to support the development of a standardized “Myasthenia Gravis Portrait.” Methods: We integrated three primary data types from multiple clinical studies: (i) laboratory and medication data, (ii) Electronic Health Record (EHR) data (e.g., age, sex, years since diagnosis, BMI), and (iii) disease severity scores. We examined the relationships among several MG-specific scoring systems, including Activities of Daily Living (MG-ADL), Quantitative Myasthenia Gravis (QMG), MG Composite (MG-CE), and MG Quality of Life-15 (MGQOL-15), to evaluate consistency and comparability across studies. Results: Preliminary analyses revealed variable correlations among the different scoring systems, indicating that, while some measures capture overlapping aspects of disease progression, others reflect distinct patient- or clinician-centered perspectives. These findings highlight the need for a harmonized framework that captures both functional and clinical dimensions of MG severity. Conclusions: The proposed “Myasthenia Gravis Portrait” provides a standardized approach for representing patient outcomes across diverse clinical datasets. This framework will facilitate the creation of virtual populations of digital twins, enabling a machine-learning-based modeling of MG progression and prediction of individualized disease trajectories. Full article

Over-the-counter medication electronic health records (OTC-EHRs) play a significant role in users’ self-medication practices. In this study, we consider the potential advantages of wearable smart devices in health management, along with the information processing capabilities of artificial intelligence (AI), and we propose a conceptual design for an AI-assisted wearable OTC-EHR system. Our objective was to systematically explore the relationship between eHealth literacy, users’ attitudes, and willingness to use the proposed system, as well as to discuss AI interventions. Internet users from China participated in an online survey examining eHealth literacy, subjective attitudes, and motivation to use this conceptual design. Descriptive statistical, correlation, difference, and regression analyses were conducted on 372 valid responses to test the research hypotheses. The results showed that the wearable-device-based OTC-EHR system with AI assistance was accepted by most responders and positively associated with eHealth literacy, which was, in turn, associated with decision-making preferences. This study suggests that AI may be perceived as an auxiliary tool for medication-related decision-making and is associated with the degree of eHealth literacy. Individuals with higher eHealth literacy are more likely to make autonomous decisions, whereas those with lower literacy will potentially rely more on AI support and professional guidance. Full article

Background: Multidrug-resistant (MDR) pulmonary infections represent a critical global health challenge, necessitating innovative therapeutic approaches. Green synthesis methodologies offer sustainable alternatives for nanoparticle fabrication while addressing antimicrobial resistance. Methods: Stimuli-responsive chitosan–silver hybrid nanoparticles (CS–Ag HNPs) were biosynthesized using Pseudomonas fluorescens bacterial extracts and loaded with ciprofloxacin for targeted pulmonary delivery. Comprehensive characterization included dynamic light scattering, transmission electron microscopy, UV–visible spectroscopy, and aerodynamic assessment via next-generation impactor. Antimicrobial efficacy was evaluated against MDR Pseudomonas aeruginosa and Klebsiella pneumoniae, including biofilm disruption studies, and biocompatibility was assessed. Molecular docking analysis elucidated binding mechanisms. Cytotoxicity and epithelial barrier integrity were evaluated using Calu-3 cell models. Results: The biosynthesized NPs exhibited optimal physicochemical properties (180 ± 20 nm, PDI 0.21 ± 0.04, ζ-potential + 32.4 ± 3.1 mV) with high encapsulation efficiency (68.2 ± 4.0%). Aerodynamic analysis revealed excellent inhalation characteristics (MMAD 2.6 μm, FPF 65 ± 5%). The hybrid system demonstrated 4-fold enhanced antimicrobial activity against MDR pathogens and significant biofilm disruption (70% for P. aeruginosa, 65% for K. pneumoniae) compared to free ciprofloxacin. Cell viability remained ≥85% at therapeutic concentrations. Molecular docking revealed enhanced drug-target binding affinity (−11.2 vs. −9.3 kcal/mol) and multi-residue interactions. Conclusions: Green-synthesized CS–Ag HNPs represent a promising sustainable platform for combating pulmonary MDR infections through enhanced antimicrobial efficacy and optimal aerodynamic properties. Full article