Search Results (4,135)

The Grain for Green Program (GGP), one of the world’s largest soil and water conservation initiatives, has been implemented in China as a representative payment for environmental service program. This study aims to evaluate the ecosystem service value (ESV) of forests established under the GGP in five representative provinces (Hebei, Liaoning, Hubei, Yunnan, Gansu), using a systematic methodology that integrates ecologic and economic dimensions for large-scale ecological projects. Between 1999 and 2013, a total of 717.67 × 10⁴ ha of forests were established. Barren land served as the primary land source, with ecological forest being the dominant forest type within the program. The ESV assessment encompassed key services, including water conservation, soil conservation, carbon sequestration, nutrient retention, air quality improvements, and biodiversity improvements. Based on our estimates, the total annual ESV of the afforested areas under GGP in the five representative provinces is 3604.99 × 10⁸ Yuan, with water conservation representing the largest share among all ecosystem services. Moreover, the cumulative ESV generated by these forests over the 14-year period exceeded the total payments made by the central government to farmers. To ensure the long-term success and sustainability of the GGP, a more equitable cost–benefit sharing mechanism is recommended. Full article

Objectives: The present study analyzes the effects of a high-intensity interval training (HIIT) program based on the Tabata method on physiological and psychological variables in contemporary dancers (n = 10) and sedentary individuals (n = 8), who performed a 10-week protocol, with sessions of self-loading exercises structured in intervals of 20 s of effort and 10 s of rest three times a week. Methods: Parameters of body composition, muscle strength, aerobic and anaerobic capacity, heart rate variability, as well as perceptions of health, anxiety, stress, sleep quality, and levels of physical activity and sedentary lifestyle were evaluated. Results: The results showed that no significant changes occurred in most body composition variables, except for visceral fat, where group differences were observed (F = 5.66, p = 0.030, η²ₚ = 0.261). In the indicators of strength and power, the dancers improved the height and relative power of the jump (F = 5.996, p = 0.026, η²ₚ = 0.273), while the sedentary ones increased the strength of the handgrip (p = 0.023). In terms of functional performance, both groups significantly increased anaerobic endurance (F = 10.374, p = 0.005, η²ₚ = 0.393), although no changes were recorded in maximal oxygen consumption or heart rate variability (p > 0.05). On a psychological level, improvements in healthy lifestyle habits and a decrease in the trait anxiety variable were evidenced in dancers (p = 0.023), while in sedentary participants no relevant effects were found. Conclusions: In conclusion, the Tabata protocol may represent an efficient and complementary strategy to enhance strength, anaerobic power, and psychological well-being, particularly among dancers. The observed improvements suggest potential benefits related to movement quality, injury prevention, and general physical conditioning. Full article

Background: Zambia, like many low- and middle-income countries, faces a growing burden of antimicrobial resistance (AMR), driven by the misuse of antimicrobials in both human and animal health, a limited diagnostic capacity, and weak regulatory enforcement. To address this challenge, Standard Treatment Guidelines (STGs) were developed for the veterinary sector, which represents a major milestone in the country’s AMR containment strategy. STGs are evidence-based protocols that guide veterinary professionals in consistently and appropriately diagnosing and treating animal diseases. They promote the rational use of veterinary medicines, and can mitigate AMR and improve animal health outcomes. By translating the best evidence into best practices, STGs also provide a practical foundation for antimicrobial stewardship (AMS) programs. Until 2023, Zambia lacked nationally adopted STGs for the veterinary sector. The introduction and standardization of these guidelines are expected to promote prudent antimicrobial use and raise the standard of care delivered to animal patients across the country. Objective: The aim of this paper is to provide a practical reference for future revisions of STGs and outline the successful methodology used to create STGs in the Zambian animal sector. Methods: A situational analysis was conducted to identify priority animal health conditions and existing treatment gaps within the veterinary sector. A multidisciplinary expert committee was then formed, comprising veterinarians, veterinary paraprofessionals, academics, regulatory authorities, and private sector stakeholders, to lead the development of the STGs. The process was guided by the WHO methodology for developing treatment guidelines, including a comprehensive review of the clinical evidence, local disease patterns, antimicrobial resistance data, and existing treatment practices. Draft STGs were developed with clearly defined, species-specific treatment protocols tailored to the Zambian context. For the validation process, the AGREE II instrument was used to assess the quality, clarity, and applicability of the guidelines. Structured stakeholder consultations with practitioners, policy-makers, and technical experts were held to ensure that the guidelines were practical, evidence-based, and aligned with national priorities. The validated drafts were then disseminated and piloted in selected districts. Conclusions: The development of the species-specific STGs represents an essential turning point in the country’s efforts to promote responsible veterinary care and contain AMR. STGs have become a prominent key support in the delivery of quality animal care. Further, the guidelines will assist in the optimization of antimicrobial use in animal health in Zambia. Full article

Drought stress during the reproductive phase substantially reduces seed yield and quality, posing a major challenge to sustainable crop production under climate change. This study investigated the effects of drought stress at the flowering stage on selected biochemical and physiological parameters in 18 carrot accessions. To describe the long-term consequences of drought comprehensively, we examined seed quality parameters. Our analyses revealed that stress responses are highly dependent on the genotype and the parameter examined. Regarding antioxidant responses and potential tissue damage caused by drought, ‘Dolanka’, DC97, DC265, DC359, DC522, DC701, DC704, and DC720 exhibited the highest tolerance. The photosynthetic apparatus and pigments were maintained under stress in DC233, DC522, DC717, and DC728. Germination parameters served as reliable indicators of stress tolerance in DC97, DC359, DC432, DC522, DC701, and DC722 accessions. Based on these findings and detailed discussion of the results, we conclude that tolerance/sensitivity assessment of carrot genotypes should consider the holistic response of the plant rather than individual parameters. Through overall assessment, we recommended DC522 accession as the most drought-tolerant, given its enhanced ROS (Reactive Oxygen Species) scavenging mechanisms, increased chloroplast pigments accumulation, and superior germination parameters under drought conditions. Conversely, DC295 should not be cultivated under water-deficient conditions due to its impaired ability to detoxify ROS, altered photosynthetic activity, and disrupted seed germination under such conditions. These results collectively highlight the potential for selecting drought-tolerant carrot genotypes in breeding programs targeting improved seed performance under water-limited conditions, thereby supporting the development of resilient cultivars adapted to future climate challenges. Full article

Urban blue spaces (UBSs) play a pivotal role in supporting ecological integrity and public health, yet the causal mechanisms connecting the magnitude of water quality improvements to specific health outcomes remain insufficiently explored. The objective of the study is to investigate the effects of two large-scale surface water quality initiatives on the health and physical activity patterns of residents in Qingdao, China: a river pollution clean-up program and a shoreline and estuary monitoring program. Employing a quasi-experimental difference-in-differences (DID) framework with repeated cross-sectional survey data (2017 and 2018; n = 735), we evaluate effects on self-rated health (SRH), happiness, physical activity levels, and body mass index (BMI). Results reveal that both programs significantly enhanced exercise frequency. River pollution clean-up could promote SRH by 0.319 points on the 5-point scale (β = 0.319, p < 0.05), while shoreline quality monitoring program boosted happiness by 0.233 points on the 5-point scale (β = 0.233, p < 0.05). In contrast, both interventions had no significant effect on BMI (p > 0.1). Subgroup analysis revealed that the health and well-being benefits of water quality improvements varied by gender, age, education, and income level. These findings emphasize the importance of prioritizing high-impact UBS interventions in degraded urban areas and integrating them with accessible infrastructure to optimize health gains in a more effective and equitable way. Full article

Background and Clinical Significance: Immune checkpoint inhibitors (ICIs), a revolutionary class of oncology therapeutics that enhance T cell-mediated antitumor immunity, are associated with various immune-related adverse events (IRAEs). While destructive thyroiditis and hypothyroidism are common, ICI-induced Graves’ disease (GD) is exceedingly rare, and the occurrence of concomitant Graves’ ophthalmopathy (GO) is even rarer. Case Presentation: A 57-year-old man with bladder cancer developed GO after receiving the first dose of the programmed death 1 (PD-1) inhibitor pembrolizumab. He presented with severe proptosis, extraocular muscle enlargement, hyperthyroidism, and significantly increased thyroid-stimulating hormone receptor autoantibodies (TRAb). Following the treatment with glucocorticoids and immunosuppressive therapy, his symptoms improved markedly but relapsed upon dosage reduction. To date, we have not identified any previous reports of GO with confirmed positive thyroid-related antibodies induced by pembrolizumab. Conclusions: This case offers valuable insights into the potential IRAEs, underscoring the importance of thorough clinical evaluation and early recognition to improve patient outcomes and quality of life. A literature review of ICI-induced GO was also performed, with further discussion of the potential pathogenic mechanisms, risk factors, and management strategies. Full article

Introduction: Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children. It is believed that children with JIA have lower cardiopulmonary capacity and worse exercise tolerance. The gold standard for assessing physical fitness is aerobic fitness, commonly referred to as the maximum or peak oxygen uptake volume (peakVO₂) measured during a maximum load exercise test. Reduced aerobic fitness may play a key role in predicting the health of JIA patients as it has been associated with cardiovascular diseases and increased adult mortality. Methods: The aim of this study was to assess the oxygen capacity of adolescents with JIA along with other cardiopulmonary parameters in order to determine a group of patients with increased risk of developing cardiovascular diseases in comparison with healthy individuals. Patients were assessed based on parameters such as age, sex, type of JIA, laboratory parameters, physical activity, and treatment. Results: Patients with JIA had lower median values of peakVO₂ (29.05 vs. 38.02 mL/min/kg, p < 0.001), as well as other crucial cardiopulmonary parameters, such as O₂ pulse, minute ventilation, oxygen uptake efficiency slope, and cardiac output than in the healthy control group. The ventilatory anaerobic threshold was achieved earlier and at lower VO₂ values in children with JIA (p = 0.0001). Children with JIA also had lowered respiratory parameters such as maximal voluntary ventilation (p = 0.0031) and tidal volume (p = 0.0002). Patients who were physically active (moderate-intensity physical activity lasting at least 60 min per day) had significantly higher peakVO₂ (p = 0.0099) and ΔVO₂/ΔWR relationship (p = 0.0041) values than JIA patients who were not physically active. Conclusions: Children with JIA show moderate to severe physical impairment. Reduced physical fitness and a low level of activity might be associated with further deterioration of patient’s condition, which might contribute to increased risk of cardiovascular disease, social exclusion and deterioration of quality of life in this group of patients. Exercise programs that improve aerobic fitness and increase muscle strength should be individualized and modified based on the individual needs and capabilities of the patient. Full article

As the global demand for water rises and climate pressures intensify, projections indicate that water scarcity will impact nearly 40% of the world’s population by 2030 and a quarter of all children by 2040. This study reviews the current literature on residential water efficiency, highlighting the most effective strategies for reducing water waste. A systematic literature review—guided by transparent criteria and quality assessments using the Critical Appraisal Skills Program (CASP)—was conducted to extract insights into water distribution management strategies. This study examines current smart water management initiatives aimed at reducing waste, with a particular focus on the policy and regulatory drivers behind global water conservation efforts. Furthermore, it shows innovative smart solutions such as Artificial Intelligence (AI)-powered forecasting, Internet of Things (IoT)-based metering, and predictive leak detection, which have demonstrated reductions in residential water loss by up to 30%, particularly through real-time monitoring and adaptive consumption strategies. The study concludes that innovative technologies must be actively supported and implemented by governments, utilities, and global organizations to proactively reduce water waste, safeguard future generations, and enable data-driven, AI-powered policy and decision-making for improved water use efficiency. Full article

Ensuring the resilience of water distribution networks (WDNs) remains a critical challenge for utilities, as aging infrastructure and inadequate planning can compromise drinking water quality (DWQ) and increase customer dissatisfaction. This study aims to strengthen existing DWQ monitoring schemes utilized by utilities by introducing a GIS-based framework that integrates structured customer feedback into the selection of sampling locations. Using a district metering area in Jūrmala, Latvia, as a case study, consumer-reported complaints were collected through an online survey and geoprocessed to identify problem hotspots. Based on these insights, the sampling program was refined and linked with asset data to improve previously established maintenance routines. Targeted sampling confirmed elevated iron and turbidity levels in several locations, validating the reliability of customer feedback. Embedding spatial context throughout the data pipeline enables systematic evaluation and optimization of sampling locations, enhancing operational awareness and supporting informed decision-making during incidents. The proposed approach can be widely adopted by utilities to develop priority-based monitoring campaigns, particularly in regions with significant seasonal demand fluctuations, such as tourism hubs and vacation destinations. Full article

Super-utilization, defined as frequent and often avoidable use of emergency departments and hospital admissions, has attracted significant policy and research attention due to its impact on healthcare costs. Over the past decade, care management and integrated care interventions have been promoted as solutions to reduce per capita expenditure and service use. However, systematic reviews and primary studies consistently report limited success in shifting utilization patterns or improving care experiences. This narrative review based upon critical systems heuristics explores the conceptual evolution of super-utilization and examines whether current approaches reflect the underlying complexity of the health system and patient needs. The three-phase narrative and complexity-informed review aimed to identify the evolution of Super-utilization as an issue and its key drivers, in relation to the dynamic systems in which it occurs. The findings reveal a predominant emphasis on cost containment and acute care metrics, with minimal incorporation of person-centered outcomes, lived experience, or local system dynamics. Even when addressing social determinants, interventions remain narrowly focused on utilization and/or costs as the key outcome. Super-utilization or High-Need/High-Cost trajectories reflect multi-level dynamics—biological, psychological, social, and political—yet these are rarely integrated into program design or evaluation. Centralized policy frameworks such as the Triple Aim risk reinforce inequities unless they actively address under-resourced populations and the complexity of chronic illness and ageing. Radical transformation of policy is required to make the nature of care of high-cost/high-need super-utilizers central to quality metrics that may improve outcomes rather than inappropriate utilization metrics which make little impact on healthcare costs. This review concludes that super-utilization requires a shift in paradigm toward systems-informed, needs-based approaches that integrate complexity theory and distributive justice to guide future research and interventions. Full article

The Asia-Pacific Network for Sustainable Forest Management and Rehabilitation (APFNet) Fellowship Program, established in 2008, aims to develop future leaders in sustainable forest management (SFM) within the Asia-Pacific region. This study represents the first systematic evaluation of the APFNet Fellowship Program, focusing on its effectiveness in building capacity for forest conservation and management. A mixed-methods approach was employed, combining quantitative pre- and post-program surveys with qualitative interviews and case studies of fellows. Quantitative analysis of survey data from 57 fellows revealed significant improvements in knowledge and skills related to forest conservation and sustainable development. Paired-sample t-tests showed statistically significant increases in the knowledge and abilities of participants, with an average improvement of 23% across key survey domains (t = 5.24, p < 0.05). The analysis also indicated that 95% of participants perceived the program to be highly relevant to their career goals and sustainable development objectives, with 87% reporting strong satisfaction with the quality of learning opportunities. Qualitative data from semi-structured interviews and focus groups revealed that while fellows appreciated the academic rigor and practical training, challenges such as financial limitations, language barriers, and institutional support issues were prevalent. Despite these challenges, fellows expressed strong commitment to applying their training to sustainable forestry practices in their home countries. This study highlights the critical role of the APFNet program in nurturing the next generation of forestry leaders in the Asia-Pacific region. The findings provide a foundation for future evaluations, highlighting the need for continued program refinement to address the identified challenges and maximize the long-term impact on forest conservation. Full article

Background: Scoliosis, a three-dimensional spinal deformity, can impair posture, function, and quality of life. Conservative approaches such as structured physical therapy are widely used, but evidence from long-term, real-world settings remains limited. In this study, “structured” refers to a standardized, supervised program delivered three times per week, incorporating postural correction, Klapp-based positioning, core strengthening, flexibility training, and progressive intensity adjustments rather than ad hoc or unsupervised exercise. Methods: In this 12-month longitudinal study, 240 patients aged 15–19 years with idiopathic scoliosis (Cobb angle 15–25°) were enrolled; 222 completed the program and were included in analyses. All participants were near or beyond skeletal maturity, representing a population with low residual risk of curve progression. Spinal alignment was assessed by Cobb angle at baseline, 6 months, and 12 months, with monthly clinical evaluations to track progress. Outcomes were analyzed by baseline severity, age, sex, and skeletal maturity (Risser stage) using paired-samples t-tests, repeated-measures ANOVA, subgroup analyses, and multivariable regression. Clinically meaningful improvement was defined as a ≥20% reduction in Cobb angle from baseline. Results: Mean Cobb angle decreased from 18.59° at baseline to 14.85° at 12 months (Δ = −3.74°, 20.3% relative reduction; p < 0.001). The largest improvement occurred in the first 6 months (−3.04°, p < 0.001), followed by a smaller gain between months 6 and 12 (−0.70°, p = 0.012). Patients with milder baseline curves improved more than those with greater deviations (4.45° vs. 3.21°, p < 0.001). Monthly clinical follow-ups suggested gradual improvement between radiographic assessments, though detailed statistical analyses were limited to baseline, 6 months, and 12 months. In multivariable regression, baseline severity remained the only significant predictor of improvement (p < 0.001), while age, sex, and Risser stage were not significant (all p > 0.05). Overall, 24.3% of participants achieved clinically meaningful improvement. Conclusions: A structured 12-month physical therapy program produced significant, sustained improvements in spinal alignment across diverse patient groups. Early intervention in milder curves maximized benefit. These findings support physiotherapy exercise programs as an effective conservative option for scoliosis management. Full article

The increasing demand for sustainable construction materials has prompted the recycling of construction and demolition waste in concrete manufacturing. This study investigates the feasibility of utilizing porcelain and brick waste as partial substitutes for natural sand in concrete with the objective of improving sustainability and preserving mechanical and durability characteristics. The experimental program was conducted in three consecutive phases. During the initial phase, natural sand was partially substituted with porcelain waste powder (PWP) and brick waste powder (BWP) in proportions of 25%, 50%, and 75% of the weight of the fine aggregate. During the second phase, polypropylene fibers were mixed at a dosage of 0.5% by volume fraction to enhance tensile and flexural properties. During the third phase, zinc oxide nanoparticles (ZnO-NPs) were utilized as a partial substitute for cement at concentrations of 0.5% and 1% to improve microstructure and strength progression. Concrete samples were tested at curing durations of 7, 28, and 91 days. The assessed qualities encompassed workability, density, water absorption, porosity, compressive strength, flexural strength, and splitting tensile strength. Microstructural characterization was conducted utilizing X-ray diffraction (XRD), scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy (EDS). The findings indicated that porcelain waste powder markedly surpassed brick waste powder in all mechanical and durability-related characteristics, particularly at 25% and 50% sand replacement ratios. The integration of polypropylene fibers enhanced fracture resistance and ductility. Moreover, the incorporation of zinc oxide nanoparticles improved hydration, optimized the pore structure, and resulted in significant enhancements in compressive and tensile strength throughout prolonged curing durations. The best results were obtained with a mix of 50% porcelain sand aggregate, 1% zinc oxide nanoparticles as cement replacement, and 0.5% polypropylene fibers, for which the improvements in compressive strength, flexural strength, and splitting tensile strength were 39.5%, 46.2%, and 60%, respectively, at 28 days. The results confirm the feasibility of using porcelain and brick waste as sand replacements in concrete, as well as polypropylene fiber-reinforced concrete and polypropylene fiber-reinforced concrete mixed with zinc oxide nanoparticles as a sustainable option for construction purposes. Full article

Unmanned Aerial Vehicle-assisted Edge Computing (UAV-EC) leverages UAVs as aerial edge servers to provide computation resources to user equipment (UE) in dynamically changing environments. A critical challenge in UAV-EC lies in making real-time adaptive offloading decisions that determine whether and how UE should offload tasks to UAVs. This problem is typically formulated as Mixed-Integer Nonlinear Programming (MINLP). However, most existing offloading methods sacrifice strategy timeliness, leading to significant performance degradation in UAV-EC systems, especially under varying wireless channel quality and unpredictable UAV mobility. In this paper, we propose a novel framework that enhances offloading strategy timeliness in such dynamic settings. Specifically, we jointly optimize offloading decisions, transmit power of UEs, and computation resource allocation, to maximize system utility encompassing both latency reduction and energy conservation. To tackle this combinational optimization problem and obtain real-time strategy, we design a Quality of Experience (QoE)-aware Online Offloading (QO2) algorithm which could optimally adapt offloading decisions and resources allocations to time-varying wireless channel conditions. Instead of directly solving MIP via traditional methods, QO2 algorithm utilizes a deep neural network to learn binary offloading decisions from experience, greatly improving strategy timeliness. This learning-based operation inherently enhances the robustness of QO2 algorithm. To further strengthen robustness, we design a Priority-Based Proportional Sampling (PPS) strategy that leverages historical optimization patterns. Extensive simulation results demonstrate that QO2 outperforms state-of-the-art baselines in solution quality, consistently achieving near-optimal solutions. More importantly, it exhibits strong adaptability to dynamic network conditions. These characteristics make QO2 a promising solution for dynamic UAV-EC systems. Full article

Objectives: Prolonged opioid use leads to tolerance and hyperalgesia in patients with chronic pain. Apart from an increase in pain, opioid use also leads to several other adverse effects. Nevertheless, the prevalence of opioid use as a treatment for chronic pain remains high, and opioid withdrawal interventions deserve more attention. This study evaluates the effects of a guideline for an opioid withdrawal intervention method that is nested in cognitive behavioral treatment (CBT) and is specifically for patients with a history of long-term opioid use and chronic pain. Methods: We conducted a clinical, exploratory, and mixed-methods study involving pre- and post-measurements on opioid use and health-related quality of life (SF-36), as well as a qualitative analysis of patient experiences (interviews) to evaluate the program. Results: A total of 29 patients were included in the study; 23 of these patients no longer used opioids, and some continued withdrawal under the guidance of their general practitioner. Quality of life improved in all domains, including the amount of pain experienced. No patients reported increased pain levels, and most experienced significantly fewer adverse side effects. Patient satisfaction was high, with no negative long-term side effects of the intervention reported. Conclusions: In light of the results of this study, it is important to address opioid use in patients with chronic pain. There are strong arguments in favor of motivating patients to withdraw from using opioids to treat chronic pain, which can be achieved in combination with CBT. Full article