This paper presents an experimental and analytical study on the structural performance and resource efficiency of hybrid glulam beams manufactured from pine ( Pinus nigra ) and poplar ( Populus × euramericana, clone MC ). In hybrid glulam beams, the modulus of elasticity is inherently non-uniform, varying both longitudinally and transversely because individual boards exhibit spatial stiffness variability along their length and across the cross-section. The main objective is to quantify the mechanical benefits of pine-poplar hybridization and to develop a predictive formulation for the beam modulus of elasticity accounting for these longitudinal and transverse stiffness distributions. Single-species and hybrid glulam beams were manufactured from pine and poplar boards and characterized by non-destructive testing and four-point bending tests according to UNE-EN 408. A new analytical formulation was developed to predict the beam modulus of elasticity from the spatial distribution of board elastic moduli, explicitly considering the strategic placement of the highest-stiffness boards in the outer lamellas, where bending stresses are maximum. The results show that this selection and placement increases the modulus of elasticity of hybrid glulam beams by 21 %, reaching values comparable to single-species pine beams, while also increasing flexural strength by 18 % and reducing beam density by 22 %. These findings are relevant for both researchers and the structural timber industry, enabling efficient, lightweight, and competitive hybrid glulam solutions for structural applications.

Core competency characteristics of integrated care managers in the context of service resource integration: A qualitative study.

Photosynthesis underpins crop yield formation, and understanding its response to integrated water-nitrogen management is essential for sustainable agricultural development. While drip fertigation has proven effective in conserving water, enhancing yield and reducing nutrient losses, its regulatory effects on photosynthetic performance of densely-planted maize under plastic-mulched drip irrigation in arid regions remain poorly understood. To address this knowledge gap, a two-year field experiment was conducted from 2024 and 2025 to investigate the combined effects of irrigation and nitrogen fertilization on maize photosynthesis and yield formation, with irrigation amounts ranging from 42.75 to 52.5 mm and nitrogen application rates from 0 to 360 kg ha−1. The results showed that moderate nitrogen application significantly increased relative chlorophyll content, net photosynthetic rate, maximum quantum efficiency, effective quantum yield of PSII, and photochemical quenching, while markedly reducing non-photochemical quenching. These combined effects promoted carbon assimilation and assimilate accumulation, benefiting grain yield formation. However, excessive nitrogen application diminished these beneficial effects. Among all treatments, irrigation with 47.25 mm of water combined with 240 kg ha−1 of nitrogen fertilization was identified as optimal for improving photosynthesis and grain yield, achieving a two-year average yield of 20,873.78 kg ha−1.Compared with conventional fertigation practices used by local farmers, this optimal treatment reduced irrigation water and nitrogen fertilizer inputs by 10.0 % and 33.3 %, respectively, while increasing grain yield, irrigation water use efficiency, and nitrogen partial factor productivity by 18.77 %, 30.56 %, and 78.17 %, respectively. Structural equation modelling revealed that the optimal fertigation enhanced grain yield primarily through increasing photosynthetic capacity and PSII function. A comprehensive evaluation using the TOPSIS method further indicated that the optimal fertigation provided the greatest synergistic benefits in photosynthetic performance, and resource-use efficiency. Overall, this study results demonstrate that optimizing fertigation can synergistically improve photosystem function, resource-use efficiency and crop productivity, they provide practical guidance for sustainable and efficient maize production under drip irrigation in arid regions.

Coral bleaching events are intensifying with rising sea surface temperatures, yet the role of nutrient availability in influencing coral responses to thermal stress remains complex. Excessive nutrient enrichment often increases bleaching susceptibility, but moderate, balanced enrichment may provide physiological benefits. We tested this through a six-month in situ enrichment experiment on an oligotrophic reef in the Maldives during a mild bleaching event. Diffusers supplied either nitrogen-rich (High N; elevated N relative to P) or balanced nitrogen-phosphorus (High P; relative to typical Redfield N:P ratios) fertiliser to Pocillopora spp. colonies, and responses were assessed using bleaching surveys and stable isotope analyses (δ15N, δ13C, and C:N ratios) of host tissue and algal symbionts to monitor changes nitrogen assimilation strategies. Enriched colonies bleached significantly less than controls during peak heat stress. Isotopic signatures shifted toward fertiliser values, with δ15N reduced by up to 2 ‰ in symbionts and∼1 ‰ in tissue, indicating assimilation of external nitrogen. Symbiont C:N ratios also declined under enrichment, consistent with reduced N limitation and altered metabolic balance within the symbiosis. Together, these results provide the first field evidence from the Indian Ocean that short-term nutrient enrichment in oligotrophic reef environments can reduce bleaching severity under mild heat stress by enhancing metabolic flexibility, i.e., the capacity of corals and their symbionts to adjust nutrient assimilation and internal resource use under stress. However, the long-term consequences of sustained or unbalanced nutrient exposure remain uncertain, highlighting the need for caution in management applications.

EEG practices and discontinuation of anti-seizure medications in people with epilepsy: A cross-sectional survey in the Eastern Mediterranean region.

Routine preprocedural pathology testing is no longer recommended for minor and intermediate-risk elective procedures. British Thoracic Society guidelines advise hemoglobin, platelet count, and coagulation studies only in patients with risk factors for bleeding. Despite this, such tests are commonly ordered without a clear clinical indication before bronchoscopic procedures, incurring unnecessary financial and environmental costs. We conducted a retrospective review of outpatient bronchoscopic procedures over a 12-month period at an Australian tertiary hospital. Preprocedural pathology testing was defined as any test ordered at bronchoscopy referral or repeated within 6 weeks before the procedure. We evaluated the impact on clinical management and complication rate. Financial cost was estimated using Australian Medical Benefits Schedule (MBS) prices, and environmental impact via carbon dioxide equivalent (CO2e) emissions. A total of 436 bronchoscopic procedures were performed, with all with preprocedural pathology testing. Abnormal results occurred in 8.3% of cases, but only 4.0% led to clinical intervention-all in patients with established risk factors. No interventions were required for patients without risk factors, and no procedures were delayed or cancelled. There was no correlation between abnormal blood test results and adverse outcomes. Routine testing cost AUD 30,441.20 (19,548.12 USD) and produced an estimated carbon footprint of 103.2kg CO2e. Routine pathology testing before bronchoscopic procedures offers limited value, with most results not influencing management. Clinically significant abnormalities occurred only in patients with established risk factors, supporting a targeted approach. Given the significant financial and environmental costs, transitioning to selective, evidence-based testing is essential to optimize resource use and improve sustainability.

In Europe, ecological restoration efforts remain restricted and fragmented, with limited success and coordination across policies. The newly adopted Nature Restoration Regulation aims to address these challenges by setting ambitious, legally binding restoration targets. For freshwater ecosystems, its success depends on better integration of existing legislative frameworks, particularly the Habitats Directive (HD) and the Water Framework Directive (WFD). We present a novel European-scale modeling framework that for the first time, combines HD and WFD-related indicators, and applies specific Bayesian Network features, to achieve: i) a Europe-wide status prediction to identify areas with potential for restoration, conservation or mitigation measures, including spatially explicit information on uncertainty and data gaps, and ii) spatially explicit restoration targets, such as lateral and longitudinal connectivity improvements, derived through backward inference. Model validation demonstrated acceptable performance for six of twelve HD groups, including Bogs, Mires, Fens, as well as Amphibia, Fish and Plants, while sensitivity analysis indicated that taxon-specific responses were primarily driven by pressures from hydrology, morphology, and organic pollution. We provide a large-scale data-driven tool to maximize the ecological impact of restoration efforts across Europe, support efficient resource use, and help policymakers to direct efforts where they are most likely to succeed.

Combining the cumulative impact and marine use conflict-synergy assessment for identifying priority potential conservation areas for estuarine spatial planning.

Twelve-month cost analysis of a geriatrician-led falls prevention clinic in Canada.

Introduction: Anatomy is considered a difficult subject with a broad curriculum, and many students encounter difficulty in understanding it effectively. Modern-day learning involves the integration and use of new technologies and resources. Aim: To examine the perceptions of medical students regarding various teaching, learning, and assessment methods. Materials and Methods: This cross-sectional survey was conducted among undergraduate medical students (n=266) of the American International Institute of Medical Sciences, Udaipur, Rajasthan, India, after obtaining ethical clearance. A structured questionnaire consisting of 28 questions encompassing the current teaching, learning, and assessment methods in anatomy was used for the study. The data obtained were analysed and represented as percentages. Results: More than half of the participants, 164 (61.65%), believed that a one-year duration is adequate for proper understanding of the subject. About 82 (30.83%) of the participants felt that classical large-group lectures were the best teaching method. Students appreciated problem-based teaching, small-group demonstrations, and the use of advanced teaching-learning methodologies. A total of 248 (93.23%) of the participants enjoyed teaching at the dissection table. The majority of participants found difficulty in learning embryology 190 (71.43%) and histology 140 (52.63%). They expressed difficulty in comprehending the sequence of events, inability to visualise structures, and inadequate time allocation in embryology, as well as difficulty in identifying structures under the microscope and insufficient lecture and practical time in histology. Participants were satisfied with continuous assessment methods such as weekly assessments and part-ending tests. Conclusion: The survey received a mixed response from the participants. They were satisfied with the existing oneyear anatomy curriculum. Participants appreciated classical chalkboard teaching and cadaveric dissection even in the age of multimedia and artificial intelligence. Problem-Based Learning (PBL) and clinical case discussions as part of CompetencyBased Medical Education (CBME) encouraged critical thinking and application of knowledge among the participants. Students expressed anxiety regarding embryology and histology but appreciated continuous assessment strategies, as these aided ongoing learning and improved performance.

The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory marker predicting cardiovascular mortality (CVM) and all-cause mortality (ACM). To investigate the association between the NLR and CVM and ACM in patients with peritoneal dialysis (PD). We reviewed articles from PubMed, Google Scholar, and Scopus until May 2024 for the association of ACM and CVM in patients with NLR following PD. We used a fixed effects model and I 2 statistics to pool hazard ratio (HR) and measure heterogeneity. Leave-one-out sensitivity analysis assessed the robustness of our study. Multivariate meta-regression (MMR) was utilized to identify influencing confounding factors. Joanna Briggs Institute (JBI) tool was used for quality assessment. Out of 160 articles screened, seven studies from 2011 to 2024 with 4350 patients, a mean age of 49.9 years ± 15 years, and a median follow-up of 4 years were included. We found that higher NLR (> 3) was significantly associated with ACM [adjusted HR (aHR): 1.18, 95%CI: 1.03-1.36, P = 0.016]. However, there was no significant association of NLR (> 3) with CVM (aHR: 1.16, 95%CI: 0.68-1.98, P = 0.59) in patients following PD. Sensitivity analysis showed no variations. JBI tool revealed low bias among the studies. MMR revealed a significant relationship between age and ACM (coefficient: 0.14, P = 0.04). Our meta-analysis identifies a significant association between NLR (> 3) and ACM outcome, which can help prevent deaths in the elderly and optimize resource use. Caution is needed when predicting mortality in this group as age significantly confounds ACM in patients undergoing PD.

ABSTRACT Addressing the tension inherent in educational research between locally based realities and broader trends, this exploratory study draws on semi-structured interviews to identify English-medium education lecturers’ use of languages, resources and tools in the classroom, and their professional development (PD) needs. The dataset comprises ten lecturers from two universities, one each in Austria and Spain. The qualitative content analysis revealed some differences regarding the roles of English and other languages. Reflecting institutional policies, findings underline the site-specific framing of English mainly as a lingua franca in the Austrian setting vs. as a foreign language in the Spanish one. While all lecturers identify translanguaging as key to overcoming communication barriers and ensuring content accessibility, it is specific to the Austrian context that it is also seen as a resource for enhanced knowledge development. Additionally, all lecturers showed awareness of using multimodal resources to facilitate disciplinary content delivery. For the future, lecturers expressed interest in learning about the implementation of artificial intelligence, and in strategies to promote communication skills and the use of English in the classroom. This study calls for further research to identify lecturers’ discipline and context-specific needs, supporting PD initiatives that are relevant and tailored to effectively strengthen teaching practices.

The Dai people of Lujiangba area, Baoshan, Yunnan Province, have rich knowledge of collecting and consuming wild edible plants (WEPs). These plants contribute significantly to local food security, nutrition, and cultural identity. Rapid economic development and environmental changes threaten the transmission of traditional ecological knowledge (TEK) of WEPs. However, few research or inventory of such TEK had been completed. This study adopted ethnobotanical research methods, including semi-structured interviews and participatory observation, involving 147 local participants. Data were analyzed using the relative citation frequency (RCF) index to determine commonly used species, traditional harvesting techniques, and conservation strategies. In the Lujiangba area, a total of 177 wild edible plants (WEPs) were documented among the Dai people, representing 64 families. Herbaceous species predominated, comprising 63.84% of the recorded flora, with leaves (58.19%) and stems (55.93%) as the principal edible parts. Vegetables (67.23%) and herbal medicine (29.38%) constituted the primary categories of utilization. Among these species, 171 were wild, while 66 were cultivated either in situ or in translocated sites, primarily distributed across homegardens, mountainous areas, and ricefields. Approximately 50.85% of wild edible plants required management interventions such as weeding, irrigating, or fertilizing, whereas 10.73% did not require any additional management. Harvesting exhibited distinct seasonality, predominantly occurring in spring (69.49%), followed by summer and autumn, with minimal activity in winter; only 2.82% of species were harvested year-round. Through RFC value, the more significant plants are: Diplazium esculentum, Elsholtzia kachinensis, Lasia spinosa, and Buddleja officinalis. These findings indicate that this pattern demonstrates the high degree of cultural adaptation embedded within their traditional ecological knowledge regarding species selection, management practices, and seasonal utilization. Furthermore, traditional ecological knowledge (TEK) of wild edible plants (WEPs) is in danger of being lost due to the influence of modern life and generations. The Dai people of the Lujiangba area exhibit profound TEK in their use of WEPs. The traditional ecological knowledge not only supports the sustainable use of plant resources but also embodies the Dai people's cultural identity and regional heritage, highlighting the importance of preserving and transmitting this knowledge to maintain local biodiversity and promote food security and cultural continuity. Furthermore, both in situ and ex situ conservation strategies can mitigate the loss of TEK. However, additional measures are required, including the development of comprehensive databases, the integration of TEK with scientific knowledge, and the promotion of multidisciplinary and cross-cultural exchange.

Athlete monitoring is widely used to support training and recovery decisions in elite sport, yet practitioners often face challenges related to data quality, feasibility, and the interpretation of short-term readiness signals within longer-term training adaptation. This narrative review synthesizes conceptual and applied developments in athlete monitoring through the lens of 'training effects', encompassing positive adaptation, maintenance, or maladaptation arising from training, competition, and contextual stressors. We distinguish assessment as isolated or periodic measurement from monitoring as repeated, systematic data collection used to track change over time. Building on contemporary conceptual models, readiness is positioned as an operational proxy for training effects that can inform day-to-day decision making when interpreted longitudinally and within context. We integrate the Minimal, Adequate, and Accurate framework to support tool selection that is economical in resource use, sufficient to meet clearly defined objectives, and grounded in valid and reliable measurement. Tools and metrics are organized according to the primary construct they inform: training load, athlete state and training response. We summarize practical considerations across neuromuscular, subjective, physiological, biochemical, and sleep-related indicators, emphasizing interpretive scope, measurement variability, and implementation constraints. To operationalize individualized monitoring, we outline pragmatic approaches using athlete-specific baselines and distribution-based thresholds (e.g., standard deviation intervals, minimum detectable change), alongside decision-making considerations related to Type I and Type II errors. Overall, this framework aims to reconcile scientific rigor with real-world feasibility, supporting practitioner decision making while acknowledging that monitoring should function as a decision-support process rather than a stand-alone determinant of performance outcomes.

Cost-effectiveness of Add-On Ivabradine Versus Standard Pharmacotherapy in the Treatment of Heart Failure in Vietnam: An Analysis From a Health System Perspective.

Algal resource availability shapes trophic convergence of deposit feeders in a low-turbidity dredged estuary.

Cost-Effectiveness of Triple Versus Dual-Drug Therapy for Elimination of Lymphatic Filariasis in India.

ABSTRACT Educational technology (EdTech) resources are essential in modern pedagogy; however, their implementation often prioritises physical tools over pedagogical theories. This study aims to explore TVET college lecturers’ reflections on their use of educational technology resources to facilitate teaching and learning. A qualitative case study was conducted with 20 lecturers at two South African TVET colleges in KwaZulu-Natal, using focus group discussions and reflective activities. Data were analysed through Cultural-Historical Activity Theory (CHAT). Results indicate that while lecturers utilize hardware (computers, projectors) and software (MS Teams, Moodle, Zoom), there is a significant absence of ideological-ware resources, such as specific teaching approaches and theories, to facilitate module content. This lack of ideological grounding is critical because these resources are necessary to balance the technical aspects of EdTech with pedagogical purposes. The study recommends enhanced training focused on ideological resources to ensure a balanced integration of EdTech in South African TVET colleges.

ABSTRACT The Australian protected area estate aims to address the biodiversity crisis by managing landscapes within clearly defined geographical boundaries. However, by focusing on the spatial aspects of landscapes, the temporal dimension of protected area management is often overlooked. In this study, we examine terrestrial protected areas in Australian environmental legislation and consider how time is accounted for in biodiversity management. When protected area legislation is informed by recent, short timeframes, the management of ecological communities can be confined by an imperfect reference, leading to ineffective and unsustainable conservation outcomes. We find that many protected area laws are stuck in a procedural present, where the present is prioritised through a focus on administrative procedures with no reference to time-bound outcomes. When legislation referenced future goals, it was in the context of an anthropocentric focus on the future human use of resources. Conversely, the past-oriented references we identified often referenced goals based on colonial notions of wilderness as an unpeopled, pristine state. Our analysis indicates that past and future considerations are not integrated holistically into Australia’s contemporary protected area regime. We suggest this has adverse impacts on environmental management, effectively freezing landscapes in a static state and potentially hindering overarching conservation objectives.

This paper aims to systematically synthesize the current evidence on bypass surgery for peripheral artery disease, focusing on key outcomes, prognostic factors, and comparisons with alternative treatment modalities, as extracted from a structured summary of scientific literature. The review utilises 144 original studies with 663925 total participants (topic deduplicated ΣN). This scoping review indicates that outcomes after PAD bypass surgery are strongly patterned by baseline patient risk, with chronic kidney disease and especially hemodialysis status emerging as a prominent signal for worse survival and major adverse events across the evidence map. Across procedural domains, the literature consistently supports a role for careful treatment selection between bypass and endovascular approaches, with bypass often associated with durable patency in complex disease while endovascular strategies may reduce short-term resource use but can require more reinterventions in some settings. Conduit choice and post-operative management recur as practical determinants of success, with autologous vein preference, optimized antithrombotic/medical therapy, and structured surveillance and rehabilitation repeatedly linked to better limb and graft-related trajectories. Interpretation is limited by the scoping, LLM-assisted, and non–risk-of-bias–appraised nature of the workflow, which prioritizes evidence mapping over causal estimation. Clinically, the findings highlight the need for intensified preoperative risk stratification and longitudinal follow-up in high-risk groups, while research should focus on phenotype-specific comparative effectiveness studies that align technique, conduit, and medical therapy to patient risk profiles.