Search Results (11,621)

Background: Failure to rescue (FTR), defined as death after major postoperative complications, is a critical quality indicator in pancreatic cancer surgery. Despite advances in surgical techniques and perioperative care, FTR rates remain high and vary across institutions. Methods: This systematic review uses a narrative synthesis followed by PRISMA 2020. A PubMed search (1992–2025) identified 83 studies; after screening, 52 studies (2010–2025) were included. Eligible designs were registry-based, multicenter, single-center, or prospective audits. Given substantial heterogeneity in study designs, FTR definitions, and outcome measures, a narrative synthesis was performed; no formal risk-of-bias assessment or meta-analysis was conducted. Results: Definitions of FTR varied (in-hospital, 30-day, 90-day, severity-based, and complication-specific cases). Reported rates differed by definition: average reported rates were 13.2% for 90-day CD ≥ III (G1); 10.3% for in-hospital/30-day CD ≥ III (G3); and 7.4% for 30-day “serious/major” morbidity (G8). Absolute differences were +3.0 and +2.9 percentage points (exploratory, descriptive comparisons). Five domains were consistently associated with lower FTR: (i) centralization to high-volume centers; (ii) safe adoption/refinement of surgical techniques; (iii) optimized perioperative management including early imaging and structured escalation pathways; (iv) patient-level risk stratification and prehabilitation; and (v) non-technical skills (NTSs) such as decision-making, situational awareness, communication, teamwork, and leadership. Among NTS domains, stress and fatigue management were not addressed in any included study. Limitations: Evidence is predominantly observational with substantial heterogeneity in study designs and FTR definitions; the search was limited to PubMed; and no formal risk-of-bias, publication-bias assessment, or meta-analysis was performed. Consequently, estimates and associations are descriptive/associative with limited certainty and generalizability. Conclusions: NTSs were rarely used or measured across the included studies, with validated instruments; quantitative assessment was uncommon, and no study evaluated stress or fatigue management. Reducing the FTR after pancreatic surgery will require standardized, pancreas-specific definitions of FTR, process-level rescue metrics, and deliberate strengthening of NTS. We recommend a pancreas-specific operational definition with an explicit numerator/denominator: numerator = all-cause mortality within 90 days of surgery; denominator = patients who experience major complications (Clavien–Dindo grade III–V, often labeled “CD ≥ 3”). Addressing the gaps in stress and fatigue management and embedding behavioral metrics into quality improvement programs are critical next steps to reduce preventable mortality after complex pancreatic cancer procedures. Full article

The power and electricity (P & E) sector experiences a substantial number of occupational accidents, including in Nigeria. The implementation of a safety management system (SMS) to promote safety performance and mitigate occupational risks in this sector remains underreported. Therefore, we aimed to explore the factors influencing the safety performance of Nigeria’s P & E distribution companies by applying McGrath’s input–process–output model as a theoretical framework. We used SmartPLS 3.0 for structural equation modelling and SPSS Version 23 for preliminary data analysis. We included a sample of 222 organizations and found that management commitment to safety, safety communication, safety champions, and government regulations influence working conditions and safety performance to varying degrees. Employee involvement, safety training, and working conditions were significant factors affecting safety performance. Management commitment, employee involvement, safety communication, safety champions, and government regulations had significant indirect effects on safety performance through their influence on working conditions. Organizational and regulatory elements played a crucial role in shaping safety performance in high-risk environments. The results highlight vital areas to be considered when developing interventions to address P & E occupational accidents. The results can aid stakeholders in developing and implementing measures to improve workplace safety, including examining current SMSs and considering working conditions when implementing safety interventions. Full article

Microplastic pollution is an escalating environmental and public health issue. Defined as plastic particles less than 5 mm in size, microplastics have been found in oceans, rivers, food, drinking water, air, and even human tissues. While scientific research on microplastics has expanded significantly, public understanding and behavioral change remain limited. This literature scan synthesizes global findings on public awareness, perceptions, and responses to microplastics, drawing from surveys, focus groups, and online behavioral data collected by existing studies. It explores the following: (1) general knowledge and perceived environmental and health risks; (2) trust in scientific and governmental sources; (3) willingness to adopt behavioral changes; (4) attitudes toward policy and corporate responsibility. Public concern is high, especially regarding marine life and food safety, but varies across populations based on education, socioeconomic status, and media exposure. Despite growing concern, psychological distance and persistent knowledge gaps hinder meaningful action. Communication strategies such as school programs, media campaigns, and eco-labels show mixed success, while regulatory interventions like plastic bags or microbead bans are more effective when supported by clear public messaging. This literature scan highlights the need for interdisciplinary collaboration to close the knowledge–behavior–policy gap and strengthen public engagement, particularly in urban settings where consumption and waste generation are concentrated. Full article

With the rapid growth of Artificial Intelligence of Things (AIoT), identity management and trusted communication have become critical for system security and reliability. Continuous AI learning and large-scale device connectivity introduce challenges such as permission drift, cross-domain access, and fine-grained API calls. Traditional identity management often fails to balance privacy protection with efficiency, leading to risks of data leakage and misuse. To address these issues, this paper proposes a blockchain-based self-sovereign identity (SSI) management mechanism for AIoT. By integrating SSI with a zero-trust framework, it achieves decentralized identity storage and continuous verification, effectively preventing unauthorized access and misuse of identity data. The mechanism employs selective disclosure (SD) technology, allowing users to submit only necessary attributes, thereby ensuring user control over self-sovereign identity information and guaranteeing the privacy and integrity of undisclosed attributes. This significantly reduces verification overhead. Additionally, this paper designs a context-aware dynamic permission management that generates minimal permission sets in real time based on device requirements and environmental changes. Combined with the zero-trust principles of continuous verification and least privilege, it enhances secure interactions while maintaining flexibility. Performance experiments demonstrate that, compared with conventional approaches, the proposed zero-trust architecture-based SSI management mechanism better mitigates the risk of sensitive attribute leakage, improves identity verification efficiency under SD, and enhances the responsiveness of dynamic permission management, providing robust support for secure and efficient AIoT operations. Full article

Background: Many factors associated with constipation have not been sufficiently investigated. The aim of this study was to assess the factors associated with constipation, defined as low stool frequency, in a community-dwelling adult population. Methods: A cross-sectional study was carried out between 2010 and 2012 among adults who live in the Kielce District of Poland. The participants comprised 11,488 persons aged 37–66 years. Data on depressive symptoms, eating frequency, physical activity and smoking, as well as sociodemographic data, were collected using face-to-face interviews. Constipation was defined as < 3 defecations per week. Dietary patterns (DPs) were identified using a factor analysis. Associations between DPs and the likelihood of constipation were assessed using a logistic regression analysis. Results: The factors associated with constipation were moderate and severe depressive symptoms, regular use of antidepressants, a sedentary lifestyle and past smoking (in women) (all p < 0.05). The likelihood of constipation was significantly decreased by male sex and obesity, as well as by a diet belonging to the highest terciles of the ‘Carbohydrates’, ‘Vegetables and Meat’ and ‘Healthy’ DPs (all p < 0.05). For the ‘Unhealthy’ DP, a high level of physical activity (Q4 vs. Q1 of MVPA) decreased the likelihood of constipation (OR = 0.75; 95%CI: 0.57–0.99). Conclusions: Preventing the onset or reoccurrence of depression by improving one’s mental resistance, reducing the risk factors for depression and promoting a healthy lifestyle, primarily a diet high in vegetables and a limited sitting time, reduces the risk of constipation. Further longitudinal studies are needed to better understand which factors are associated with the occurrence of constipation. Full article

People with Autism Spectrum Disorder (ASD) face significant barriers to accessing and maintaining employment, many of which stem from work environments that fail to accommodate their neurological diversity. This article aims to analyze the occupational risks faced by autistic individuals in the workplace. A total of 39 scientific studies were reviewed, and the results identified nine predominant thematic categories of occupational risks. Particularly prominent were deficient communication, lack of structured support, cognitive overload, and difficulties coping with change. The reported situations were examined in detail, with attention paid to their specific contexts. A clear predominance of psychosocial risks over ergonomic ones was observed. The review also highlights several underexplored yet equally relevant risk factors, such as discontinuity in supported employment programs, difficulties in requesting reasonable accommodations, discrimination, a lack of professional recognition, and the negative effects of digital or remote environments, such as isolation. This study underscores the importance of recognizing unsafe conditions arising from the lack of neurodiversity-informed adjustments as a necessary step toward implementing organizational and social adaptations in the workplace. Full article

This study presents, for the first time, the occurrence and community structure of wild fish inside marine aquaculture cages of gilthead seabream (Sparus aurata), European sea bass (Dicentrarchus labrax), greater amberjack (Seriola dumerili), meagre (Argyrosomus regius), and common dentex (Dentex dentex). Coexistence of farmed and wild fish was observed only in cages of gilthead seabream and European sea bass, with wild fish constituting 0.08% of the total sampled fish biomass. Twelve wild fish species from five families were recorded: Carangidae, Clupeidae, Mugilidae, Moronidae, and Sparidae. Bogue (Boops boops) and jack mackerel (Trachurus sp.) were the most abundant. Multivariate analysis indicated that location significantly influenced the wild fish community composition, while reared species and farming duration, along with their interaction, had no significant effect. Descriptive comparisons suggested potential differences in biometric traits of bogue and jack mackerel between reared species and farming duration. The findings highlight the need for further research on wild fish in cages to better understand the potential health and biosecurity risks they may pose. Full article

Type 1 Diabetes Mellitus (T1D) is an autoimmune disease characterized by the destruction of pancreatic β-cells, predominantly manifesting in childhood or adolescence. The lack of clearly interpretable biological markers in the early stages, combined with the insidious onset of the disease, poses significant challenges to early diagnosis and the implementation of preventive strategies. The applicability of classic T1D biomarkers for understanding the mechanisms of the autoimmune process, preclinical diagnostics and treatment efficiency is limited. Despite advances in next-generation sequencing (NGS) technologies, which have enabled large-scale genome-wide association studies (GWASs) and the identification of polygenic risk scores (PRSs) associated with T1D predisposition, as well as progress in bioinformatics approaches for assessing dysregulated gene expression, no universally accepted risk assessment model or definitive predictive biomarker has been established. Until now, the use of new promising biomarkers for T1D diagnostics is limited by insufficient evidence base. However, they have great potential for the development of diagnostic methods on their basis, which has been shown in single or serial large-scale studies. This critical review covers both well-known biomarkers widely used in clinical practice, such as HLA-haplotype, non-HLA SNPs, islet antigen autoantibodies, C-peptide, and the promising ones, such as cytokines, cfDNA, microRNA, T1D-specific immune cells, islet-TCR, and T1D-specific vibrational bands. Additionally, we highlight new approaches that have been gaining popularity and have already demonstrated their potential: GWAS, single-cell transcriptomics, identification of antigen-specific T cells using scRNA-seq, and FTIR spectroscopy. Although some of the biomarkers, in our opinion, are still limited to a research context or are far from being implemented in clinical diagnostics of T1D, they have the greatest potential of being applied in clinical practice. When integrated with the monitoring of the classical autoimmune diabetes markers, they would increase the sensitivity and specificity during diagnostics of early and preclinical stages of the disease. This critical review aims to evaluate the current landscape of classical and emerging biomarkers in autoimmune diabetes, with a focus on those enabling early detection—prior to extensive destruction of pancreatic islets. Another goal of the review is to focus the attention of the scientific community on the gaps in early T1D diagnostics, and to help in the selection of markers, targets, and methods for scientific studies on creating novel diagnostic panels. Full article

Background/Objectives: This study aimed to evaluate the additive effect of periodontitis and diabetes mellitus on systemic inflammation, measured by high-sensitivity C-reactive protein (hs-CRP), in a nationally representative Korean population. Methods: Data from 3178 adults (≥19 years) in the 2015 Korean National Health and Nutrition Examination Survey were analyzed. Periodontitis was assessed using the Community Periodontal Index (CPI), and diabetes mellitus was defined based on clinical criteria. Participants were classified into four groups according to the presence of periodontitis and diabetes. hs-CRP levels were analyzed by quartiles and ADA/CDC cardiovascular risk categories. ANCOVA and multivariable logistic regression, adjusted for socioeconomic status, oral health and health behaviors, and comorbidities, were used to examine the association between coexisting periodontitis and diabetes and elevated hs-CRP. Results: Mean hs-CRP increased progressively from G1 (1.11 ± 0.49 mg/L) to G4 (2.37 ± 0.38 mg/L). After adjustment, G4 retained the highest concentration (2.31 ± 0.39 mg/L) versus G1 (1.37 ± 0.11 mg/L; p = 0.020). High-risk hs-CRP prevalence (>3.0 mg/L) increased nearly threefold across groups (p < 0.001). Similarly, G4 had increased odds of being in the ADA/CDC high-risk category (>3.0 mg/L) (aOR = 2.73, 95% CI: 1.64–4.54), whereas no significant associations were observed for periodontitis or diabetes alone. Conclusions: The coexistence of periodontitis and diabetes mellitus is significantly associated with elevated systemic inflammation, as measured by hs-CRP, suggesting a synergistic effect beyond the impact of either condition alone. Full article

Background/Objectives: Family physicians are key stakeholders in the implementation of cancer prevention strategies, including risk factor assessment, lifestyle counseling, and early detection. Despite this, integration of personalized prevention into routine practice remains limited. This study aimed to explore family physicians’ perspectives on barriers, training needs, and collaboration opportunities in cancer prevention. Methods: A mixed-methods study was conducted using an exploratory sequential design. The qualitative phase involved semi-structured interviews with 12 family physicians from the North-West Region of Romania. Thematic analysis was employed to identify main challenges and opportunities. Findings informed the development of a structured online survey completed by 50 family physicians. Descriptive and comparative statistical analyses were applied to assess trends and subgroup differences. Results: Interviews and survey data revealed multiple barriers to cancer prevention in primary care: insufficient consultation time, limited access to diagnostic tools, administrative workload, and low patient health literacy. Physicians reported moderate familiarity with personalized prevention but expressed strong interest in further training, particularly through flexible and interactive learning formats. Collaboration with cancer centers was considered suboptimal; participants emphasized the need for streamlined referral pathways and improved communication. Conclusions: The study highlights systemic and educational gaps affecting cancer prevention efforts in family medicine. Tailored training programs, digital integration with cancer centers, and targeted policy adjustments are needed to enhance prevention capacity within primary care. Full article

Crude oil exploration and transportation have led to significant soil contamination in nearby communities, yet seasonal and depth-related variations remain poorly understood. This study assessed physicochemical properties, potentially toxic elements, and polycyclic aromatic hydrocarbons in surface (0–15 cm) and subsurface (15–30 cm) soils from the Ibaa community and its pipeline Right of Way (ROW) in Rivers State, Nigeria. Samples were collected during wet and dry seasons from five locations, and analyses were conducted using standard methods. Results showed that soil temperature ranged from 27.5 to 31.2 °C, reflecting natural environmental conditions, while nitrate concentrations (1.23–3.45 mg/kg) and moisture content (14.3–23.9%) were within acceptable WHO limits. The pH values (4.61–5.72) suggested acidic conditions, particularly in the unremediated areas. Total Organic Carbon exceeded 3%, with a maximum of 6.23% recorded in the wet season, suggesting persistent hydrocarbon contamination. Phosphorus levels (2.65–6.02 mg/kg) were below the 15 mg/kg threshold. Notably, As (4.93 mg/kg) and Cd (1.67 mg/kg) concentrations exceeded the permissible WHO limits. Positive correlations were observed between As–Cd (r = 0.79), Cd–Cu (r = 0.85), and Pb–Cu (r = 0.64). Principal Component Analysis identified four components for physicochemical parameters (81.9% variance) and two for metals (82.6% variance), suggesting crude oil combustion and vehicular emissions as dominant pollution sources. Pb also correlated significantly with total PAHs in the dry season (r = 0.54, p < 0.05). The study highlights the influence of season and depth on contaminant behavior and emphasizes the urgent need for remediation and monitoring to mitigate ecological and public health risks. Full article

Urban community gardens are valued for promoting sustainable food production, yet the accumulation of toxic heavy metals in city soils can present both ecological and public health risks. Therefore, this study was aimed at assessing the environmental and health risks of toxic heavy metals in community gardens soil contaminated by an industrial fire hazard in New Brunswick, Canada. Both top and subsoil soil samples were collected at Carleton community garden. The collected samples were examined for toxic heavy metals using inductively coupled plasma optical emission spectrometry and inductively coupled plasma mass spectrometry. Ecological risks were evaluated through the ecological risk factor and the potential ecological risk index, while human health risks were determined using a standard human health risk assessment approach. The mean concentration of Pb, Zn, Cu, and Sn exceeded permissible limits when compared to the Canadian soil quality guidelines and upper continental crust values. Findings from the ecological risk assessment showed that all metals were associated with low risk, except for nickel, which posed a high ecological risk across both soil layers. PERI results revealed a low overall ecological threat. The human health risk analysis indicated that children could face non-carcinogenic and carcinogenic risks from As exposure, while adults were not at risk from any of the studied metals. These findings identify arsenic as the primary contaminant of concern, with children representing the most vulnerable population, emphasizing the necessity for targeted mitigation strategies and protective measures to reduce their exposure. The results of this study can inform interventions aimed at safeguarding both environmental and public health, while also raising awareness about the presence and risks of toxic heavy metals, ultimately contributing to the protection of human health and the broader ecosystem. Full article

Identifying tobacco smoke exposure in indoor environments is critical for public health, especially in vulnerable populations. In this study, we developed and validated a machine learning model to detect smoking households based on indoor air quality (IAQ) data collected using low-cost sensors. A dataset of 129 homes in Spain and Austria was analyzed, with variables including PM_2.5, PM₁, CO₂, temperature, humidity, and total VOCs. The final model, based on the XGBoost algorithm, achieved near-perfect household-level classification (100% accuracy in the test set and AUC = 0.96 in external validation). Analysis of PM_2.5 temporal profiles in representative households helped interpret model performance and highlighted cases where model predictions revealed inconsistencies in self-reported smoking status. These findings support the use of sensor-based approaches for behavioral inference and exposure assessment in residential settings. The proposed method could be extended to other indoor pollution sources and may contribute to risk communication, health-oriented interventions, and policy development, provided that ethical principles such as transparency and informed consent are upheld. Full article

Anthropogenic barriers fragment Portuguese rivers, threatening endemic freshwater fish communities. This study compiled national inventories and peer-reviewed research (2002–2024) to quantify fishway implementation, evolution and typology, while evaluating fish performance from published research. One hundred fishways built between 1950 and 2024 were recorded, half of which were constructed after the implementation of the Water Framework Directive in Portugal (29 Dec 2005), tripling the annual construction rate. Fishways were found to be associated mainly with weirs (46%) and small hydropower plants (44%), with typology being dominated by the pool-type design (67%), nature-like facilities (18%), fish locks and combined systems (6% each), fish lifts (2%) and a single eel pass. Forty scientific contributions addressed fishway effectiveness; three-quarters dealt with pool-type facilities, while 12.5% and 10% focused on nature-like fishways and lifts, respectively. Experimental and field studies highlighted species-specific hydraulic preferences, the benefits of vertical slot and multislot configurations, and the potential of retrofitting fishways with macro-rugosities (i.e., fixed structural elements placed on the bottom) to improve non-salmonid fish passage. However, low attraction efficiency, limited multi-season monitoring and risks of aiding invasive species remain a concern. Research needs are proposed, including the refinement of species-specific hydrodynamic criteria, and the development of standardized efficiency metrics and of selective passage solutions, to advance fishway performance under Mediterranean hydrological constraints. Full article

Background: Cardiovascular disease disproportionately affects women in the United States. CVD outcomes are closely tied to a multitude of factors including lifestyle habits and socioeconomic status which create a complex interweb of determinants of health that place certain age and racial groups at higher risk over others. Such inequities highlight the need for targeted prevention strategies to address the unique risks faced by different populations. In this study, a state-wide analysis examining the mortality rates among women aged 35 years or older in Florida from 2018 to 2023 was done in order to identify high risk groups to better inform evidence-based public heath interventions that are tailored to the population’s needs. Mortality rates were extracted from the CDC Wonder Database. Age-adjusted and crude mortality rates, per 100,000 women, were calculated and stratified by ten-year age groups, Hispanic origin, race, and major CVD subtypes based on various ICD-10 codes. From the ICD-10 113 Cause List, “The Diseases of the Heart” were the cause of the majority of the deaths; however, “Other Forms of Chronic Ischemic Heart Diseases” was the leading subtype. Crude rates for the “Ischemic Heart Diseases” decreased 110.9 per 100,000 women in 2018 to 101.5 per 100,000 women in 2023. Yet, the most common cause of CVD-related mortality remains ischemic heart disease. Across the study period, non-Hispanic women experienced more than twice the crude mortality rate of Hispanic women. Racial breakdowns showed that White women had the highest CVD mortality, followed by Black women, who had elevated rates of heart failure and heart attacks in comparison to other minority groups. Asian women had the lowest rates across all cardiovascular subtypes. These findings underscore the persistent age and racial differences in cardiovascular outcomes emphasize the urgent need for culturally informed, community-specific preventative interventions to improve cardiovascular care and reduce mortality within high-risk populations. Full article