Browse Articles

Phage therapy for recurrent urinary tract infections: A qualitative study using the theoretical framework of acceptability

Objectives To explore the anticipated acceptability of bacteriophage therapy for recurrent urinary tract infections (rUTIs) among key stakeholders in the United Kingdom, using the Theoretical Framework of Acceptability (TFA). Design Qualitative study using online focus groups, analysed with reflexive thematic analysis, and mapped to the constructs of the TFA. Setting United Kingdom, conducted online via Microsoft Teams. Participants Forty-four participants across three stakeholder groups: individuals with lived experience of rUTIs, doctors involved in UTI management, and other healthcare professionals (HCPs: specialist nurses, pharmacists, and advanced care practitioners). Results Participants demonstrated high enthusiasm for phage therapy, reflecting positive affective attitude and strong perceptions of effectiveness. For patients with lived experience, enthusiasm was often grounded in desperation following repeated treatment failure, raising ethical concerns around vulnerability to poor-quality research or inequitable access. Across groups, opportunity costs were identified as key barriers, centred on financial impact and availability within the NHS. Gaps in understanding about mechanisms, safety, and delivery highlighted the importance of intervention coherence and, for doctors and other HCPs, self-efficacy. Lived experience participants described strong online communities that acted as informal knowledge networks, suggesting a potential channel for dissemination and education. Conclusions Phage therapy was broadly viewed as acceptable, but acceptability is conditional on evidence of safety and effectiveness, equitable access, and clear communication. Application of the TFA demonstrated how enthusiasm, vulnerability, cost, and coherence intersect to shape overall perceptions. These findings emphasise the importance of ethical safeguards, patient-centred education, and integration with community networks to support the responsible adoption of phage therapy.

Comprehensive study of the influence of reinforcements on the deformation mechanism and energy absorption performance of auxetic structure

Abstract The increasing speed of transportation requires outstanding performance of energy absorbers used in passive safety systems. These absorbers must deform at approximately constant force to safely dissipate kinetic energy during a collision. Structured materials exhibit a superior energy-absorption-to-weight ratio compared to bulk materials. Auxetic structures, with a negative Poisson’s ratio due to their unique internal geometry, further improve load redistribution and indentation resistance. However, their absorption capacity remains limited relative to conventional structures. Because no established method exists to systematically enhance the absorption capacity of auxetic structures, this study investigates the use of reinforcements and explains how they influence plastic hinge formation and the resulting energy dissipation mechanisms. Structures represented by reinforced re-entrant honeycomb are manufactured using Laser Powder Bed Fusion additive technology from stainless steel 316L and NiTi alloy. Complex experimental and numerical analyses show that reinforcements in re-entrant honeycomb improve absorption capacity mainly due to contact between deformed reinforcements and horizontal walls, rather than to the formation of new plastic hinges. By optimising the reinforcement placement, the unit cell can absorb three times more energy per unit mass than without reinforcements. Samples from NiTi alloy theoretically outperform those from stainless steel 316L in absorption capacity, but its practical applicability is constrained by LPBF processing challenges. Finally, a new Double Re-entrant Honeycomb structure is designed that can absorb more than 70% of energy per unit mass compared to the reference geometry, while decreasing engineering stress fluctuations by approximately 36%.

Pharmacogenomics knowledge and implementation readiness among community pharmacists in Jordan: A national cross-sectional study

Pharmacogenomics (PGx) offers a powerful strategy to improve medication safety and efficacy, yet its integration into community pharmacy practice remains limited. While an “attitude-knowledge gap” is known to exist globally, limited national data exist concerning PGx readiness among community pharmacists in Jordan. This study aimed to (i) quantify Clinical Pharmacogenetics Implementation Consortium (CPIC)-aligned PGx knowledge and characterize attitudes; (ii) assess implementation readiness across organizational, leadership, and structural dimensions; (iii) map perceived barriers; and (iv) identify independent predictors of knowledge, attitudes, and readiness. A national, cross-sectional survey was conducted using a proportionate stratified random sampling method. A content-validated and reliability-tested electronic questionnaire was distributed to community pharmacists across Jordan’s three administrative regions. The instrument assessed demographics, CPIC-aligned knowledge, attitudes and perceived barriers on five-point Likert scales, and theory-informed implementation readiness. Data were analyzed using descriptive statistics, bivariate tests, and multiple linear regression. A total of 347 community pharmacists completed the survey. A vast majority (83.0%) reported no prior formal PGx training. Knowledge of practical PGx was low, with a mean score of 5.54 ± 2.12 out of 10. Attitudes were neutral (mean = 3.49 ± 0.26), while perceived barriers were rated as significant (mean severity = 3.45 ± 0.30), with privacy concerns being the highest-rated challenge (mean = 3.65 ± 0.78). Total implementation readiness was moderate (mean = 3.34 ± 0.25), with organizational readiness (mean = 3.39) rated higher than structural readiness (mean = 3.21) or leadership support (mean = 3.27). Bivariate analyses revealed few significant associations, and crucially, multiple linear regression models showed that no demographic or practice characteristics within the variables tested were significant independent predictors of knowledge or readiness. Jordanian community pharmacists demonstrated a significant gap between their positive attitudes towards PGx and the practical knowledge and systemic support required for clinical implementation. The findings revealed that the identified deficits in knowledge and readiness were widespread across all surveyed subgroups, not concentrated in specific demographic or professional subgroups. Translating the existing positive sentiment into routine clinical practice urgently requires a nationwide, standardized educational strategy coupled with the development of systemic enablers, including reimbursement pathways, integrated clinical workflows, and explicit leadership support.

Cognitive effects of STN-DBS on mental rotation performance in Parkinson’s disease

Abstract In Parkinson’s disease (PD), cognitive symptoms progressively worsen with disease progression and present a major clinical challenge that remains difficult to treat. Deep brain stimulation of the subthalamic nucleus (STN-DBS) is a widely used and clinically validated therapy for motor symptoms in PD; however, its cognitive effects remain underexplored. In this study, we examined how STN-DBS influences executive functioning, focusing on a well-established mental rotation task. In the task, patients were shown two images (reference, comparison) and were asked to decide whether the comparison image was rotated or mirrored. Twelve PD patients (6 women; mean age: 60 ± 10 years; mean disease duration: 12 ± 6 years) completed the task under two conditions: with therapeutic STN-DBS turned on and turned off. Behavioural cognitive performance was correlated with the volume of tissue activated, as determined by MR based electrode reconstruction. Results indicated that STN-DBS significantly improved mental rotation accuracy, suggesting a beneficial effect on visuospatial executive processing. Notably, stimulation involving limbic-associated regions of the right STN was associated with impaired performance, highlighting the relevance of stimulation site and its functional connectivity. Together, these findings contribute to the growing body of evidence that STN-DBS produces region-specific effects on distinct cognitive domains.

Emergency department wait time in Newfoundland and Labrador, Canada: Trends and projections of physician initial assessment 2015–2026

Background This study aims to analyze and project the trend of physician initial assessment (PIA) time in rural and urban emergency departments (ED’s) across Newfoundland and Labrador, Canada, considering different levels of the Canadian Triage and Acuity Scale (CTAS). Methods The data for this study were obtained from the Newfoundland and Labrador Health Services Digital Health Department (NLHS-DH), sourced from electronic health records of emergency departments in Newfoundland and Labrador, from April 2015 to the end of 2021. A mixed-effects model was used to analyze trends in PIA time. This process also projects the mean PIA time from 2015 to 2026 across different rural/urban areas and CTAS levels (3–5). Furthermore, the Monte Carlo simulation methods are employed to estimate the uncertainty interval associated with PIA time. Results Our projection showed that the overall mean PIA time in Newfoundland and Labrador emergency departments is expected to increase from a model-estimated 1 hour and 32 minutes in 2015 to a projected 2 hours and 59 minutes in 2026, corresponding to a 94.3% increase over the study period. This increasing trend is observed across various rural and urban areas, including varying CTAS levels. Urban regions are projected to have the biggest change, with a PC of 126.73% as compared to rural areas. The greatest overall change in PIA time is from 1 hour 25 minutes in 2015 to 3 hours 44 minutes in 2026 for CTAS 5 (PC = 163.34). However, when considering rural and urban areas separately, the most notable shift occurs for CTAS level 3 for both areas. Conclusion PIA time trends and patterns have drastically changed across CTAS levels 3–5 in both rural and urban areas. An intervention is needed to control the increasing delay in PIA time, with a particular emphasis on urgent patients residing in rural areas.

AgroQuali-FSL: a few-shot deep learning framework with QualiProtoNet for automated quality grading of fruits and vegetables

Social norms vs socioeconomic vulnerability: Gender identity and female labor force participation in Ecuador

Despite recent advances in reducing the gender gap globally, female labor force participation is still lower compared to men’s. Discriminatory social norms, such as the one that assigns to men the role of breadwinners, are important drivers of this difference. Building on the social prescription that “a man should earn more than his wife”, we explore the effect that relative income potential has on female engagement in the labor market in Ecuador. Results show that women with potentially higher relative income tend to increase their labor force participation (LFP), which is counter-intuitive with respect to the male breadwinner hypothesis. However, we find a differentiated effect according to women’s education and income level. More educated women do not increase their LFP, but tend to shift towards more precarious positions (informal or part-time); women with secondary education increase both their LFP and precariousness; women with only primary education, associated to lower income, increase LFP but do not increase precariousness, which is already quite high. These findings suggest that socio-economic characteristics of households condition the adherence to social norms.

Waste derived starch and activated carbon biocomposite hydrogel as a green and reusable adsorbent for tetracycline removal

The w-eCura system is a novel indicator of the need for salvage surgery after non-curable endoscopic submucosal dissection in early gastric cancer: A retrospective case-controlled study

Objective This study sought to evaluate the effectiveness of the w-eCura system in determining the necessity of salvage surgery after non-radical endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) and to compare its efficacy with the eCura system. Methods This retrospective case-control study was conducted at Fujian Provincial Hospital and included 290 patients with EGC who underwent ESD between January 2011 and July 2024. All patients were confirmed with non-radical resection upon pathological evaluation. Various clinicopathological characteristics such as gender, age, lesion location, size, Paris classification, histological type, depth of invasion, ulceration, lymphatic and venous invasion, and margin status were documented. Subsequent salvage procedures, lymph node involvement, and recurrence were monitored. Risk stratification was performed using the w-eCura and eCura systems, and the Cox proportional hazards model was employed to identify factors influencing positive cancer residue status (CRS). Survival analysis was conducted using Kaplan-Meier curves, and the predictive performance of the two models was compared using receiver operating characteristic (ROC) curves. Results The study included patients with a mean age of 64.42 ± 9.35 years and a median maximum tumor diameter of 4.50 cm, who were monitored for a median duration of 32 (range 15–54) months. Factors such as w-eCura grade, horizontal resection margin, depth of invasion, lymphatic invasion, and venous invasion exhibited significant associations with CRS-positive classification (P < .05). A higher w-eCura grade was linked to an elevated risk of CRS-positive classification. Utilizing Cox proportional hazard models, we identified that lesion location (The middle 1/3 stomach), w-eCura grade (high and intermediate), and infiltration depth (SM2 and SM3) independently influenced CRS-positive classification. Kaplan-Meier survival analysis demonstrated a significant correlation between both eCura and w-eCura grades and survival time (Logrank P < .001). Notably, the w-eCura classification displayed enhanced sensitivity in detecting high-risk patients promptly. ROC curve analysis revealed that the w-eCura model exhibited an area under the curve (AUC) of 0.82, surpassing the eCura model’s AUC of 0.79 and underscoring the superior predictive accuracy of the w-eCura model for CRS-positive classification. Within the intermediate-risk w-eCura subgroup, positive vertical resection margin and SM3 infiltration depth emerged as independent factors influencing CRS-positive classification. Conclusion The w-eCura system demonstrated superiority as a tool for assessing the necessity of salvage surgery following non-curative ESD in EGC compared to the eCura system. For patients presenting intermediate-risk, the w-eCura system in conjunction with positive vertical resection margin or SM3 depth of invasion, additional salvage surgery is advised for consideration.

Methodological validation and inter-site analysis in Late Bronze and Early Iron Age cremations using tooth cementum annulation counts

Abstract Estimating age at death in archaeological populations is often limited by poor skeletal preservation, particularly in cremated remains. Tooth cementum annulation counts (TCAc), based on incremental lines of Salter (ILS), offer a promising alternative. In this study, TCAc is evaluated in terms of feasibility, microstructural preservation and internal consistency in cremated archaeological teeth, focusing on methodological applicability rather than chronological accuracy. We analysed 62 roots from eight Lusatian Urnfield culture cemeteries in southwestern Poland, dating to the Late Bronze and Early Iron Age. Undecalcified transverse sections were prepared, and ILS were examined alongside two complementary indicators: ILS width (ILSw) and the ratio of acellular extrinsic fibre cementum thickness to ILSw (AEFCt/ILSw). Results showed good intra- and inter-observer repeatability of ILSc, and both AEFCt and ILSc displayed significant age-related increases ( p  < 0.01). Combined estimates based on TCAc and AEFCt/ILSw yielded narrower age ranges than morphology alone. ILSw did not differ by sex, age group or tooth type, but varied significantly between cemeteries ( p  < 0.001), potentially reflecting environmental or life-history factors. These findings indicate that TCAc shows practical potential for use on cremated archaeological material, while also highlighting the need for future comparisons with known-age collections to refine interpretative standards.

Thiol-functionalized ZrP reinforced poly(MMA-co-MI) nanocomposites: High optical transparency and superior thermal stability for optical coatings

This study presents novel transparent and thermally stable nanocomposites based on poly(methyl methacrylate-co-N-2-methyl-4-nitrophenylmaleimide) (P(MMA-co-MI)) reinforced with thiol-functionalized zirconium phosphate (ZrP-SH) nanofillers. The key innovation is the thiol modification of ZrP, which enhances interfacial interactions and ensures uniform dispersion at low loadings (≤1 wt%). The nanocomposites were prepared through solution blending and characterized using FTIR, XRD, SEM, TEM, TGA, DSC, and UV-Vis spectroscopy. Compared to the neat copolymer, the nanocomposites demonstrated an approximately 30 °C increase in glass transition temperature (from 164.3 °C to 168.4 °C) and an increase in onset degradation temperature from 265 °C to about 297 °C while maintaining high optical transparency in the visible range at low filler contents. These silicon-free materials effectively address the trade-off between thermal stability and optical clarity, offering significant potential for advanced optical coatings, sensors, protective layers, and optoelectronic packaging applications.

Management strategies of multinational corporations’ green supply chains by deep reinforcement learning

A streaming, certificate-based reduction for convex hull preservation in planar point sets

Convex hull computation on large planar point sets is commonly preceded by geometric filtering to reduce input size. Motivated by invariants used in incremental convex hull maintenance, we derive a streaming, certificate-based reduction that discards only points certified interior to the hull. We show that the reduction preserves the exact convex hull and operates in a single streaming pass with only local geometric operations. Experiments on synthetic and real-world datasets demonstrate substantial reduction, retaining between 5% and 11% of input points on average for synthetic distributions and below 1% on large real-world data under typical arrival order.

Modulated high-frequency stimulation enables precisely timed, selective nerve block

The impact of sports participation on the psychological state of the Chinese population from the perspective of sports resources

Objective Against the backdrop of the Chinese people’s growing demand for health, it is of great significance to explore the impact of sports participation on different psychological states among the population, as well as the specific mechanisms and theoretical adaptations under varying conditions of sports resources—such as the sports environment, facilities, and safety. Such an investigation not only contributes to the widespread promotion of public participation in sports but also provides targeted theoretical guidance for improving psychological well-being. Method Using data from the China General Social Survey (CGSS) published in 2023, a linear regression model was constructed. Results Sports participation exerts a comprehensive positive effect on the psychological well-being of the Chinese population. Robustness tests using instrumental variable methods confirm that the impact of sports participation on psychological well-being is free from endogeneity issues and exhibits strong robustness. The influence of sports participation on psychological well-being varies significantly depending on sports resource conditions: ① Under favorable sports environment conditions, it exerts a comprehensive positive effect; under poor sports environment conditions, it has no effect on depression and despondency. ② In well-equipped facilities, it more effectively promotes calmness and vitality, while in under-equipped facilities, it has no effect on depression/despondency or calmness. ③ Under low-safety conditions, it has a comprehensive positive effect, while under high-safety conditions, it has no effect on depression/despondency. Conclusion Sports participation exerts a robust, positive influence on overall mental well-being and vitality at the macro level. However, its effects manifest in complex interrelationships under specific sports resource conditions. Recommendations: Comprehensively enhance the role of sports participation in improving public mental health; Implement intelligent strategies for sports resource development to amplify the positive impact of sports participation on psychological well-being.

Tensor language model enables generative scheduling for efficient tensor compilation

Abstract The high rate of increase in the deep learning tasks as well as heterogeneous computing systems necessitates compilers that achieve low compile time and high performance. The current state of the art in the use of tensor compilers is based on exhaustive search, a slow and prohibitive process, or heuristics at the expense of generality and quality of optimisation. The paper presents the Tensor Language Model (TLM), a generative framework of a compiler that redefines the optimisation of tensor programmes as a language modelling problem. TLM is also based on a GPT-2 architecture that is pre-trained on millions of tensor programs coded as compact tensor code capturing operator graphs, hardware metadata, and reconfiguration choices as a sequence of tokens. The model creates optimised schedules of tensors, thus avoiding any search or reinforcement learning at run time. Experimental results using ResNet-50, BERT, GPT-2 and LLAMA-7B indicate that TLM compiles up to 61 times faster than search-based compilers (e.g., Ansor, MetaSchedule) and is up to 2.25 times faster than heuristic models (e.g. Roller), and has similar runtime efficiency. TLM then selects a trade-off seemingly traditional between compilation time and execution performance, a scalable, hardware-agnostic and reproducible generative paradigm of next-generation deep learning compilers.

Impact of the 2024 Korean medical workforce crisis on transfers in a pediatric emergency center: including comparative analyses with adults

Background In February 2024, the South Korean government announced a substantial increase in medical school admissions, leading to the sudden departure of most junior doctors. This unprecedented workforce shortage significantly impacted emergency departments. Pediatric care, known to require specialized readiness, may have been disproportionately affected. Methods We conducted a retrospective study at an emergency institution with a specialized pediatric emergency center. The study period was divided into pre-policy (March 2023–January 2024) and post-policy (March 2024–January 2025) periods. All emergency visits were analyzed, and interhospital transfers were compared between periods. Interrupted time series (ITS) analysis, multivariable logistic regression and inverse probability of treatment weighting were performed to evaluate associations between the policy-driven workforce shortage and transfer occurrence. Subgroup analyses of transferred pediatric patients examined total length of stay, transfer reasons, and accompaniment by medical staff. Results Among 97,916 ED visits (46,165 pediatric; 51,751 adult), there were 48 and 89 pediatric transfers in the pre- and post-policy periods, respectively, and 130 and 83 adult transfers in the same periods. Notably, pediatric transfers nearly doubled (an 85% increase) despite an approximately 42% decline in pediatric ED visit volume (29,211–16,954 visits). ITS analysis showed a continuing upward trend in pediatric transfers, although this trend did not reach statistical significance. In multivariable regression, only pediatric transfers were significantly associated with the post-policy period (OR 2.49, 95% CI 1.74–3.61). Transfer reasons shifted toward the unavailability of specialized care and physician accompaniment during transfers increased significantly. Conclusions This study evaluated and identified the potential association between pediatric transfers and the government policy announcement, as well as the subsequent workforce departure, using statistical analyses and adjustment methods. Compared to adults, departure of the workforce following the policy announcement was more potentially associated with rises in pediatric transfers. Also, periodic changes in characteristics of pediatric interhospital transfers were observed. These findings reflect the vulnerability and complexity of pediatric emergency care and emphasize the necessity of ensuring medical readiness and specialized workforce capacity during times of healthcare disruption.

From blur to blueprint: a fuzzy delphi methodology for evaluating early-stage emerging technologies—the case of end-of-life automotive traction battery disassembly

Abstract Recycling end-of-life automotive traction batteries is paramount in reducing greenhouse gas emissions and mitigating supply chain dependencies associated with critical raw materials utilized in producing electric vehicle batteries. Deploying disassembly technologies represents a crucial step in the pretreatment process, enhancing the recycling process’s sustainability and profitability. This study evaluates disassembly technologies based on a multi-stage expert-driven research approach. We present a systematic stakeholder identification and analysis for the disassembly process step, resulting in the 14 relevant stakeholders. 65 expert interviews were then conducted with the relevant stakeholders and yielded a corpus of 16 evaluation criteria. Each criterion underwent a delphi evaluation process with 13 experts to ascertain its relative importance. Ultimately, another delphi panel was utilized to evaluate each disassembly technology conjunction with all identified criteria. To address potential uncertainties, the fuzzy delphi method was employed, resulting in two rounds until a consensus was achieved. Laser cutting and shredding emerged as particularly promising technological approaches, recommended for consideration by industrial stakeholders in the expansion of their facilities and by policymakers in the formulation of their regulatory environment. The developed methodological approach aims to systematically evaluate early-stage emerging technologies and has been validated by the given use case.

Multiplex profiling of 16 immune checkpoints identifies novel serum biomarker panels for breast cancer detection and TNBC stratification: A case-control study

Background Immune checkpoints (ICs) are key regulators of anti-tumor immunity, yet their diagnostic potential as blood-based biomarkers in breast cancer (BC) remains insufficiently characterized. Comprehensive serum profiling using multiplex immunoassays may enable minimally invasive detection and molecular stratification, particularly for triple-negative breast cancer (TNBC). Methods Serum samples from 88 treatment-naïve BC patients and 49 age-matched controls were analyzed using a 16-analyte MILLIPLEX® immuno-oncology panel. Six co-inhibitory and ten co-stimulatory IC proteins were quantified. Diagnostic accuracy was assessed using ROC curves and logistic regression. Associations with TNBC subtype, chemotherapy response, and 6-month progression-free survival (PFS) were evaluated. Results Seven immune checkpoint proteins (LAG-3, BTLA, CD80, GITRL, CTLA-4, GITR, TLR-2) showed significant differential expression between BC patients and controls. A seven-protein panel demonstrated high diagnostic accuracy (AUC = 0.89; sensitivity 83%; specificity 86%), surpassing CA15−3 and CEA. TNBC patients exhibited a distinct eight-protein signature, with TIM-3, CTLA-4, and CD28 independently associated with TNBC classification. Elevated baseline TIM-3 and PD-L1 were associated with chemotherapy resistance and shorter PFS. Conclusions Comprehensive serum IC profiling identified biomarkers with strong diagnostic and subtype-discriminatory potential. These minimally invasive panels show potential for BC detection and TNBC stratification, pending validation in prospective and longitudinal studies. Validation in larger, multi-center cohorts is warranted.

Effect of biological and agricultural foaming agents on concrete waste for the preparation of porous ceramic materials

Abstract This study offers a novel method for recycling leftover concrete to create porous ceramic materials. Various pouring agents, such as starch mixed with flour, yeast, baking powder, wheat straw, or sawdust, have created porous waste concrete ceramic materials. The starch is a binder for ceramic particles and a growth substrate for forming gas bubbles. Utilizing starch consolidation procedures, the green bodies are produced by firing them at temperatures of 1200 °C, 1250 °C, and 1300 °C. Various techniques characterize the fired sample, including Fourier Transform Infrared Spectroscopy, Thermogravimetric analysis, Differential Scanning Calorimetry, Apparent porosity, Bulk density, Compressive strength, Phase composition, and Microstructure. The acquired results showed that apparent porosity decreased except for samples containing baking powders, while the bulk density and compressive strength increased as the firing temperature increased. With apparent porosity of 56% and 39%, bulk density of 1.27 g/cm 3 and 1.64 g/cm 3 , and mechanical characteristics of 0.55 MPa and 1.47 MPa at 1250 °C and 1300 °C, respectively, samples containing flour have a highly porous structure. At 1250 °C, the thermal transmittance of this sample reaches 0.327 W/m 2 K. The sawdust-containing sample exhibited the highest strength, reaching 1.54 MPa at 1250 °C and 5.23 MPa at 1300 °C. At those respective temperatures, its apparent porosity measured approximately 55% and 38%. Additionally, sawdust samples had a thermal transmittance of up to 0.336 W/m 2 K. Therefore, the current study created porous structure ceramics by substituting all or some of the more expensive polymer additives with recycled concrete debris. The resulting ceramics are potentially used in gas burners, membranes, filters, and refractory thermal conductivity.