Higher Benefits Research Articles

Determination of River Ecological Flow Thresholds and Development of Early Warning Programs Based on Coupled Multiple Hydrological Methods

In order to safeguard the health of river ecosystems and maintain ecological balance, it is essential to rationally allocate water resources. This study utilized continuous runoff data from 1967 to 2020 at the Zhouqu Hydrological Station on the Bailong River. Five hydrological methods, tailored to the hydrological characteristics of the Zhouqu hydrological cross-section, were employed. These methods included the improved dynamic calculation method, the NGPRP method, the improved monthly frequency computation method, the improved RVA method, and the Tennant method. Ecological flow calculations were conducted to determine the ecological flow, with analysis carried out through the degree of satisfaction, economic benefits, and the nonlinear fitting of the GCAS model. We established an ecological flow threshold and early warning program for this specific hydrological cross-section. Ecological flow values calculated using different methods for each month of the year were compared. The improved RVA method and Tennant method resulted in small values ranging from 4.05 to 36.40 m3/s and 7.65 to 22.94 m3/s, respectively, with high satisfaction levels and economic benefits, but not conducive to ecologically sound development. In contrast, the dynamic calculation method, NGPRP method, and improved monthly frequency calculation method yielded larger ecological flow values in the ranges of 21.79–97.02 m3/s, 23.90–137.00 m3/s, and 28.50–126.00 m3/s, respectively, with poor fulfillment and economic benefits. Ecological flow thresholds were determined using the GCAS model, with values ranging from 16.72 to 114.58 m3/s during the abundant water period and from 5.03 to 63.63 m3/s during the dry water period. A three-level ecological warning system was proposed based on these thresholds, with the orange warning level indicating optimal sustainable development capacity for the Zhouqu Hydrological Station. This study provides valuable insights into the scientific management of water resources in the Bailong River Basin to ensure ecological security and promote sustainable development.

A nomogram-based predictive model for tooth survival in Chinese patients with periodontitis: An 11-year retrospective cohort study.

To develop a nomogram-based predictive model of tooth survival by comprehensively analysing clinical and radiographic risk factors of tooth loss (TL). In this study, 3447 teeth of 131 subjects who underwent non-surgical periodontal treatment were examined retrospectively within a mean follow-up period of 11.6 years. The association of risk factors including clinical and radiographic parameters with TL was assessed using univariate and multivariate Cox regression analyses. A nomogram-based predictive model was developed, and its validation and discriminatory ability were analysed. In all, 313 teeth were lost in 94 patients in this study (overall tooth loss [OTL] 9.08%; 0.21 teeth/patient/year). Male, heavy smoking, molar teeth, probing depth (PD), attachment loss (AL), tooth mobility and radiographic bone loss were significantly associated with TL (p < .05). A gradient effect of tooth mobility on TL increased from degree I to III versus none (p < .0001). The area under the curve (AUC) of the model was 0.865. Calibration curve and decision curve analysis demonstrated good performance and high net benefit, respectively. Adopting a specific nomogram could facilitate the prediction of tooth survival and the development of tailored treatment plans in Chinese patients with advanced periodontitis.

Construction of the prognostic nomogram and treatment recommendation in patients with mixed endometrial carcinoma treated with hysterectomy.

The study aimed to identify the independent prognostic factors of mixed endometrial carcinoma (MEC) patients treated with hysterectomy and to explore the optimal treatment modalities for overall survival (OS) and cancer-specific survival (CSS). Using the Surveillance, Epidemiology, and End Results (SEER) database, a total of 12,848 MEC patients treated with hysterectomy were screened out. Independent prognostic factors were identified by Cox regression analysis and used to construct the nomogram. The concordance index (C-index) of OS and CSS were 0.807 and 0.834 in the training set. Validation of the nomogram revealed that the receiver operating curve (ROC) maintained good discrimination, the decision curve analysis (DCA) had a high net benefit rate, and the calibration curves showed high consistency. Patients were grouped by the nomogram formula and the number of positive regional lymph nodes (NPR-Lymph node) to evaluate the therapeutic outcomes of chemotherapy, radiotherapy, neoadjuvant treatment and lymph node operation. Survival analysis revealed that chemotherapy could improve the prognosis for OS and CSS in the high-risk group and in the group with NPR-Lymph node counts above 1 (P < 0.05). Radiotherapy was associated with better OS and CSS in the intermediate-risk and high-risk groups, and in the group with NPR-Lymph node counts above 0 (P < 0.05). Lymphadenectomy was found to prolong OS and CSS in the high-risk group (P < 0.05), while neoadjuvant treatment did not prolong OS and CSS in any group. Thus, in this study, the nomogram for MEC patients treated with hysterectomy was successfully built and validated which could effectively predict the prognosis and identify at-risk population to guide clinical decision-making. The NPR-Lymph node was identified as a potentially strong prognostic indicator with good clinical value.

Modeling natural resources exploitation in low-information environments

The sustainable exploitation of natural resources constitutes a real-world problem of interest for many fields. In this work, we study those situations in which the exploiting agents have information about the state of the resource and their own benefits and costs but not about the behavior or performance of the rest of the agents. Cognitive Hierarchy Theory provides a framework for those low-information scenarios by focusing on the assumptions that agents make about other individuals’ behavior. Motivated by this theory, we introduce a theoretical agent-based model in which agents exhibit varying degrees of rationalization when exploiting the resource, and this resource’s evolution is driven by a differential equation that mirrors the dynamics of real-world resource growth. Our results show that, although most regimes imply depletion, higher benefits and sustainability are obtained when agents assume overexploitation by the rest and try to compensate for it. Furthermore, many exploiting agents and a long-term perspective also involve a better resource state, reaching the optimal exploitation level when all these factors come together.

Greening Infection Prevention and Control: Multifaceted Approaches to a Sustainable Future

Abstract Infection prevention and control, or IP&amp;C, is a critical stakeholder in advancing environmental sustainability in healthcare. IP&amp;C activities seek to ensure safety of processes in health care from an infection perspective, but how these are performed can drive substantial waste and pollution. There are certain IP&amp;C measures that can, without compromising safety or efficiency, be adapted to more environmentally friendly practices and have a high impact benefit to sustainability without affecting patient outcomes. Moreover, IP&amp;C practice stands to be significantly altered by climate change and pollution. Here, we describe the complex interdependence between sustainability, climate change, and IP&amp;C, and opportunities for IP&amp;C to be at the leading edge of optimizing healthcare’s environmental footprint.

Unveiling Pyrolysis Mechanisms of Waste Printed Circuit Boards Through Multiphysics Simulation

The pyrolysis process of waste printed circuit board (WPCB) with high economic benefit has been a black box problem, limiting the upgrading of pyrolysis processes. The resourcefulness and hazardous nature of WPCB will make it necessary for it to be treated properly. Multiphysics model was built to simulate the whole processes of WPCB pyrolysis and contaminants’ release. The circuit board samples containing six components were selected for pyrolysis in a tube furnace at a rate of 10[Formula: see text]C/min from room temperature to 600[Formula: see text]C, and the residual rate of Br- was determined by the oxygen bomb method. The results showed that the difference in temperature distribution could be attributed to thermal conductivity and surface area. Heat distribution would be more even from the inner material in areas where holes existed. The assembly method would affect the stress distribution around the components. Thermal stress at the pins might cause the separation of components from the substrate. The concentration of brominated contaminants was influenced by the material and assembly method. The instantaneous concentration around the pin was 3–4 times compared to the bare substrate, which was beneficial for the release and control of brominated organics. This study provided the research method for the in-depth understanding of the pyrolysis process of complex materials; and provided a basis for the upgrading of related processes.

Prediction-Augmented Shared Decision-Making and Lung Cancer Screening Uptake

ImportanceAddressing poor uptake of low-dose computed tomography lung cancer screening (LCS) is critical, especially for those having the most to gain—high-benefit persons with high lung cancer risk and life expectancy more than 10 years.ObjectiveTo assess the association between LCS uptake and implementing a prediction-augmented shared decision-making (SDM) tool, which enables clinicians to identify persons predicted to be at high benefit and encourage LCS more strongly for these persons.Design, Setting, and ParticipantsQuality improvement interrupted time series study at 6 Veterans Affairs sites that used a standard set of clinical reminders to prompt primary care clinicians and screening coordinators to engage in SDM for LCS-eligible persons. Participants were persons without a history of LCS who met LCS eligibility criteria at the time (aged 55-80 years, smoked ≥30 pack-years, and current smoking or quit &amp;amp;lt;15 years ago) and were not documented to be an inappropriate candidate for LCS by a clinician during October 2017 through September 2019. Data were analyzed from September to November 2023.ExposureDecision support tool augmented by a prediction model that helps clinicians personalize SDM for LCS, tailoring the strength of screening encouragement according to predicted benefit.Main outcome and measureLCS uptake.ResultsIn a cohort of 9904 individuals, the median (IQR) age was 64 (57-69) years; 9277 (94%) were male, 1537 (16%) were Black, 8159 (82%) were White, 5153 (52%) were predicted to be at intermediate (preference-sensitive) benefit and 4751 (48%) at high benefit, and 1084 (11%) received screening during the study period. Following implementation of the tool, higher rates of LCS uptake were observed overall along with an increase in benefit-based LCS uptake (higher screening uptake among persons anticipated to be at high benefit compared with those at intermediate benefit; primary analysis). Mean (SD) predicted probability of getting screened for a high-benefit person was 24.8% (15.5%) vs 15.8% (11.8%) for a person at intermediate benefit (mean absolute difference 9.0 percentage points; 95% CI, 1.6%-16.5%).Conclusions and RelevanceImplementing a robust approach to personalized LCS, which integrates SDM, and a decision support tool augmented by a prediction model, are associated with improved uptake of LCS and may be particularly important for those most likely to benefit. These findings are timely given the ongoing poor rates of LCS uptake.

What are the right configurations of just-in-time and just-in-case when supply chain shocks increase?

Shocks caused by COVID-19 pandemic have compelled manufacturers to decrease their reliance upon just-in-time (JIT) and embrace a more just-in-case (JIC) approach. This study clarifies the right configurations of JIT and JIC under low/high upstream and downstream shocks. Drawing upon contingency theory and configuration theory, a framework is developed to differentiate configurations of JIT/JIC under low/high magnitude SC shocks. Survey data from China's manufacturing industry, which experienced SC shocks due to COVID-19, are analysed by regression and sub-group analyses. The results show that only upstream shocks have a negative impact on operational performance. The effect of JIC (but not JIT) on operational performance is strengthened by upstream and downstream shocks. When shocks are high, increasing JIC is effective only when JIT is low. These empirical findings demonstrate that manufacturers can improve operational performance by emphasising JIC models under high SC shocks. Those with high JIT benefit from low JIC under low shock settings.

Elephant Grass (Pennisetum purpureum): A Bioenergy Resource Overview

Elephant grass (EG), or Pennisetum purpureum, is gaining attention as a robust renewable biomass source for energy production amidst growing global energy demands and the push for alternatives to fossil fuels. This review paper explores the status of EG as a sustainable bioenergy resource, integrating various studies to present a comprehensive analysis of its potential in renewable energy markets. Methods employed include assessing the efficiency and yield of biomass conversion methods such as pretreatment for bioethanol production, biomethane yields, direct combustion, and pyrolysis. The analysis also encompasses a technoeconomic evaluation of the economic viability and scalability of using EG for energy production, along with an examination of its environmental impacts, focusing on its water and carbon footprint. Results demonstrate that EG has considerable potential for sustainable energy practices due to its high biomass production and ecological benefits such as carbon sequestration. Despite challenges in cost competitiveness with traditional energy sources, specific applications like small-scale combined heat and power (CHP) systems and charcoal production show economic promise. Conclusively, EG presents a viable option for biomass energy, potentially playing a pivotal role in the biomass sector as the energy landscape shifts towards more sustainable solutions; although, technological and economic barriers need further addressing.

Improving HPV Vaccination Uptake Among Adolescents in Low Resource Settings: Sociocultural and Socioeconomic Barriers and Facilitators.

Lower- and middle-income countries (LMICs) are disproportionately impacted by human papillomavirus (HPV) and would benefit from implementing the HPV vaccine. In the context of competing health priorities, utilizing scarce domestic infrastructure and human resources for HPV vaccination remains challenging for many LMICs. Given the high benefits of the HPV vaccine, the World Health Organization (WHO) is now encouraging for all countries, particularly LMICs, to introduce HPV vaccines into their routine immunization programs. Understanding the barriers and facilitators to HPV adolescent vaccine programs in LMICs may help strengthen how LMICs implement HPV vaccine programs, in turn, increasing HPV vaccine acceptance, uptake, and coverage. To identify and assess barriers and facilitators to implementing adolescent HPV vaccination programs in LMICs. This study comprised a review of literature assessing adolescent HPV vaccination in LMICs published after 2020 from a sociocultural perspective. Overall, the findings showed that LMICs should prioritize increasing HPV vaccine availability and HPV vaccine knowledge, particularly focusing on cancer prevention, as knowledge reduces misinformation and increases vaccine acceptance. Evidence suggests that factors promoting HPV vaccine uptake include fostering low vaccine hesitancy, integrating HPV vaccination as a primary school routine vaccination, and vaccinating both genders. A one-dose HPV vaccine may enable many LMICs to increase vaccine acceptance, uptake, and coverage while controlling financial, infrastructure, and human resource costs. As HPV is one of the leading causes of death in many LMICs, implementing the HPV vaccine may be highly beneficial. Cohesive national HPV vaccine buy-in and understanding the success and challenges of prior LMIC HPV vaccine implementation is crucial to developing effective, efficient, and sustainable HPV vaccination programs.

Unveiling awareness and knowledge of orphan plants: catalysts for sustainable transformation in Al-Zarqa Basin, Jordan

The awareness of orphan plants and underutilized species that have agricultural, nutritional, and medicinal importance is critical to the sustainable civilization of people. The lack of knowledge of the orphan plant’s importance stems from insufficient outreach and educational efforts and this may increase the underappreciation of these plants’ ecological relevance which will affect the sustainable environment in the determined region. In this study, Al Zarqa basin region located in the northern part of Jordan was selected as a study case. This is due to it having rich plant biodiversity with many endangered plant species. This study aimed to assess the awareness levels of the civil people in the Al Zarqa basin regarding orphan plants and identify key factors influencing the community’s understanding of these underutilized species. In this study, local youth volunteers distributed an e-questionnaire, and 1000 participants from seven villages were engaged. Different parameters that measure people’s awareness regarding orphan plants were evaluated. Data were collected and statistically analyzed to show the range of the people’s awareness. Data showed the predominant of the samples used were male representation (66%), aged 18–45, engaged in agricultural and handicraft activities, with diverse educational backgrounds, and monthly incomes of 300–500 JD. Limited awareness (23.3%) of ‘orphan plants’ was linked to lower academic levels in the studied areas. Perceived benefits varied, with 36.1% acknowledging moderate advantages and 25.6% perceiving high benefits. Despite recognizing utility, participants lacked specificity in benefits or classification. The study concludes that the region exhibits a dearth of knowledge about orphan plants, necessitating educational initiatives to raise awareness and advocate for the agricultural and medicinal potential of underutilized plant species, contributing to the socioeconomic advancement of residents in the agriculturally endowed Zarqa Basin. This investigation is essential for highlighting the current state of awareness and informing potential outreach and education strategies. Addressing the root cause of underappreciation through targeted initiatives can play a pivotal role in fostering a better understanding of the ecological significance of rare and endangered plants, ultimately contributing to their conservation and sustainable use.

Evaluation of static and dynamic PV-Integrated shading systems for office spaces in Australia

The paper summarizes a comprehensive analysis to determine the energy and cost benefits of static and dynamic photovoltaic (PV)-integrated shading devices when applied to windows of office spaces located in different climate zones across Australia. The evaluated dynamic shading systems consist of rotating overhangs placed above the windows and operated to minimize the annual energy demands of office spaces. For the first time, the study determines through optimization-based controls the best angle settings for the rotating overhangs on hourly, daily, or monthly basis to minimize the energy consumption of office spaces in Australia. The analysis results indicate that both optimally designed static and optimally operated dynamic PV-integrated overhangs have substantial potential to reduce the annual energy needs of office spaces for all Australian climates with annual energy savings ranging from 45% to over 100% depending on the building orientation, window size, glazing type, and overhang depth. This high energy benefits are attributed to the multi-function capability of the PV-integrated shading systems to minimize cooling and space thermal loads while maximizing on-site electricity generation. Unlike the case of static shading devices, it is found that dynamic PV-integrated overhangs allow office spaces to reach net-zero energy operation for certain climate zones in Australia.

Distribution path optimization of carbon emission-reducing agricultural products in the cold chain from a green economy perspective

As people's environmental awareness improves, the development of green economy has become an important goal for countries to achieve sustainable development. The extensive generation of greenhouse gases during the cold chain logistics and distribution process poses a significant challenge to the advancement of the green economy. By utilizing an enhanced genetic algorithm (GA), this research examines the expenses associated with distributing fresh agricultural products via the cold chain and constructs a model for optimizing the path of distribution. Simulation experiments show that the total cost of this model constructed in the study is 2323.94 RMB, which is less than 2623.35 RMB of the traditional path planning model, and the carbon emission is 85 kg less. It proves that the path optimization model constructed by the research has high economic and environmental benefits, and the designed and planned path is more in line with the needs of green economy than the traditional path, which has the potential to minimize carbon emissions during the fresh agricultural product cold chain distribution process while simultaneously promoting sustainable development.

Amyloid-related imaging abnormalities (ARIA): diagnosis, management, and care in the setting of amyloid-modifying therapy.

Amyloid-related imaging abnormalities, were originally described by dementia care experts. The wider use of aducanumab and now lecanemab warrant broader understanding by the health care provider continuum. The optimal care approach for patients with Alzheimer's dementia, treated with amyloid-targeted therapy, includes proper clinical diagnosis, complication surveillance, specific imaging protocols, expert specialty consultation, integrated treatment strategies, and proper facility system planning. Improved awareness and understanding of amyloid-modifying therapy, both benefits and potential complications, among the health care provider continuum is paramount to the success of complex care programs. Specifically, recognition of treatment high risk, high benefit groups, and the interface of concurrent antiplatelet and anticoagulation. This integrated acute, specialty, and primary care approach should improve patient care quality and outcome.

Potential Probiotic Weizmannia coagulans WC10 Improved Antibiotic-Associated Diarrhea in Mice by Regulating the Gut Microbiota and Metabolic Homeostasis.

Antibiotic-associated diarrhea (AAD) is a common side effect of long-term and heavy antibiotic therapy. Weizmannia coagulans (W. coagulans) is an ideal probiotic because of its high viability, stability, and numerous health benefits to the host. In this study, the strains were first screened for W. coagulans WC10 (WC10) with a high combined ability based on their biological properties of gastrointestinal tolerance, adhesion, and short-chain fatty acid production ability. The effect of WC10 on mice with AAD was further evaluated. The results showed that WC10 was effective in improving the symptoms of AAD, effectively restoring antibiotic-induced weight loss, and reducing diarrhea status score and fecal water content. In addition, WC10 decreased the expression of pro-inflammatory cytokines and increased the expression of anti-inflammatory cytokines, alleviated intestinal tissue damage and inflammation, and improved intestinal epithelial barrier function by decreasing serum levels of enterotoxin, DAO, and D-lactic acid, and by increasing the expression of the intestinal mucosal immune factors sIgA and occludin. Importantly, the composition and function of the gut microbiota gradually recovered after WC10 treatment, increasing the number of SCFAs-producing Bifidobacterium and Roseburia. Subsequently, the short-chain fatty acid (SCFA) content was examined and WC10 significantly increased acetate, propionate, and butyrate production. Additionally, metabolomic analysis also showed that WC10 reversed the antibiotic interference with major metabolic pathways. These findings provide a solid scientific basis for the future application of W. coagulans WC10 in the treatment of AAD.

A Hybrid Preference Interaction Mechanism for Multi-Satellite Imaging Dynamic Mission Planning

The existing multi-satellite dynamic mission planning system hardly satisfies the requirements of fast response time and high mission benefit in highly dynamic situations. In the meantime, a reasonable decision-maker preference mechanism is an additional challenge for multi-satellite imaging dynamic mission planning based on user preferences (MSDMPUP). Therefore, this study proposes the hybrid preference interaction mechanism and knowledge transfer strategy for the multi-objective evolutionary algorithm (HPIM–KTSMOEA). Firstly, an MSDMPUP model based on a task rolling window is constructed to achieve timely updating of the target task importance degree through the simultaneous application of periodic triggering and event triggering methods. Secondly, the hybrid preference interaction mechanism is constructed to plan according to the satellite controller’s preference-based commands in different phases of the optimal search of the mission planning scheme to effectively respond to the dynamic changes in the environment. Finally, a knowledge transfer strategy for the multi-objective evolutionary algorithm is proposed to accelerate population convergence in new environments based on knowledge transfer according to environmental variability. Simulation experiments verify the effectiveness and stability of the method in processing MSDMPUP. This study found that the HPIM–KTSMOEA algorithm has high task benefit, short response time, and high task completion when processing MSDMPUP.

Mechanical properties and electromagnetic wave absorption characteristics of solid waste low-carbon cementitious materials

A low-carbon multi-functional cement substitute material has been developed to reduce electromagnetic pollution in building spaces and protect human health. The solid waste electromagnetic absorption cementitious material (SWEACM) is produced by combining steel slag (SS), blast furnace slag (BFS), and phosphogypsum (PG). In this study, the properties of SWEACM were analyzed, including flow, electromagnetic wave absorption, strength, and environmental properties. Additionally, the hydration and electromagnetic wave absorption mechanisms were examined. The results indicate that SS, BFS, and PG content significantly affect the strength and electromagnetic wave absorption properties of SWEACM. S-6 exhibits the best overall performance (SS: BFS: PG = 3:6:1), with the highest strength (28 days compressive strength = 33.5 MPa) and fluidity (19.1 cm). Furthermore, it has excellent electromagnetic absorption performance (RLmin = −45.4 dB), with an adequate absorption bandwidth of up to 10 GHz in the 2–18 GHz range. The excellent electromagnetic wave absorption capability of SWEACM is mainly due to the resonance, polarization relaxation loss, and conduction loss of the magnetic and conductive components in the material. The results show that SWEACM can be used as a multi-functional construction engineering material for electromagnetic protection, combining high levels of high electromagnetic wave absorption, strength performance, and environmental benefits.

Spinal muscular atrophy genetic epidemiology and the case for premarital genomic screening in Arab populations

BackgroundSpinal muscular atrophy (SMA) is a fatal autosomal recessive disorder for which several treatment options, including a gene therapy, have become available. SMA incidence has not been well-characterized in most Arab countries where rates of consanguinity are high. Understanding SMA disease epidemiology has important implications for screening, prevention, and treatment in those populations.MethodsWe perform SMA diagnostic testing in a clinical multi-national patient cohort (N = 171) referred for hypotonia and/or muscle weakness. In addition, we carry out genetic newborn screening for SMA on 1502 healthy Emirati newborns to estimate the carrier frequency and incidence of the disease in the United Arab Emirates.ResultsPatients referred for SMA genetic testing are mostly Arabs (82%) representing 18 countries. The overall diagnostic yield is 33.9%, which is higher (>50%) for certain nationalities. Most patients (71%) has two SMN2 copies and earlier disease onset. For the first time, we estimate SMA carrier frequency (1.3%) and incidence of the disease (1 in 7122 live births) in the United Arab Emirates. Using birth and marriage rates in two Arab populations (United Arab Emirates and Saudi Arabia), as well as disease incidence in both countries, we show that, besides preventing new cases, premarital genetic screening could potentially result in around $8 to $324 million annual cost savings, respectively, relative to postnatal treatment.ConclusionsThe SMA carrier frequency and incidence we document suggests high potential benefit for universal implementation of premarital genomic screening for a wide range of recessive disorders in Arab populations.

Development and validation of a lung metastases-predicting nomogram for intermediate- to high-risk differentiated thyroid carcinomapatients.

Aim: This research aimed to construct a clinical model for forecasting the likelihood of lung metastases in differentiated thyroid carcinoma (DTC) with intermediate- to high-risk.Methods: In this study, 375 DTC patients at intermediate to high risk were included. They were randomly divided into a training set (70%) and a validation set (30%). A nomogram was created using the training group and then validated in the validation set using calibration, decision curve analysis (DCA) and receiver operating characteristic (ROC) curve.Results: The calibration curves demonstrated excellent consistency between the predicted and the actual probability. ROC analysis showed that the area under the curve in the training cohort was 0.865 and 0.845 in the validation cohort. Also, the DCA curve indicated that this nomogram had good clinical utility.Conclusion: A user-friendly nomogram was constructed to predict the lung metastases probability with a high net benefit.

External validation and comparison of magnetic resonance imaging-based risk prediction models for prostate biopsy stratification.

Magnetic resonance imaging (MRI) is a promising tool for risk assessment, potentially reducing the burden of unnecessary prostate biopsies. Risk prediction models that incorporate MRI data have gained attention, but their external validation and comparison are essential for guiding clinical practice. The aim is to externally validate and compare risk prediction models for the diagnosis of clinically significant prostate cancer (csPCa). A cohort of 4606 patients across fifteen European tertiary referral centers were identified from a prospective maintained database between January 2016 and April 2023. Transrectal or transperineal image-fusion MRI-targeted and systematic biopsies for PI-RADS score of ≥ 3 or ≥ 2 depending on patient characteristics and physician preferences. Probabilities for csPCa, defined as International Society of Urological Pathology (ISUP) grade ≥ 2, were calculated for each patients using eight models. Performance was characterized by area under the receiver operating characteristic curve (AUC), calibration, and net benefit. Subgroup analyses were performed across various clinically relevant subgroups. Overall, csPCa was detected in 2154 (47%) patients. The models exhibited satisfactory performance, demonstrating good discrimination (AUC ranging from 0.75 to 0.78, p < 0.001), adequate calibration, and high net benefit. The model described by Alberts showed the highest clinical utility for threshold probabilities between 10 and 20%. Subgroup analyses highlighted variations in models' performance, particularly when stratified according to PSA level, biopsy technique and PI-RADS version. We report a comprehensive external validation of risk prediction models for csPCa diagnosis in patients who underwent MRI-targeted and systematic biopsies. The model by Alberts demonstrated superior clinical utility and should be favored when determining the need for a prostate biopsy.