Surgical care significantly contributes to greenhouse gas emissions, with operating rooms consuming three to six times more energy than other departments relying heavily on single-use materials and anaesthetic gases. We conducted a systematic review of literature from 2023 to 2025 following PRISMA guidelines. The PubMed, Scopus and Healthcare LCA databases were searched, and eligibility criteria were applied. A total of 26 studies met inclusion criteria. Data were extracted on each study’s scope and system boundaries, reported emission values, identified carbon hotspots, and any mitigation strategies evaluated. A structured quality assessment was conducted to evaluate the reliability of the included studies and to identify potential sources of bias. The included studies demonstrated wide variability in reported carbon footprints of surgery, ranging from under 5 kgCO₂e for minor procedures to over over 400 kgCO₂e for complex single-stage operations and approximately 1,000 kgCO₂e for whole multistage patient pathways. This systematic review underscores that surgical operations could have a significant carbon footprint, with emissions hotspots concentrated in consumable materials and energy consumption. It also reveals substantial variability and methodological heterogeneity in how surgical carbon footprints are calculated, pointing to the urgent need for standardized life-cycle based frameworks in surgical settings. Establishing common standards will enable more reliable benchmarking of surgical emissions and better comparisons across studies.

In this study, we investigated the impact of tempi variations (60, 100, 120, and 150 beats per minute) and major and minor modes on the perceived emotional content of music. To explore this, we created eight versions of five original compositions, resulting in 40 musical stimuli. Control stimuli included variants of white, brown, and pink noise, as well as six human voice recordings. A total of 1280 participants took part in an online survey. Participants were diverse, comprising 262 musicians (defined as individuals with over six years of instrument-playing experience who identified as amateur, semi-professional, or professional). Participants were asked to rate the perceived emotional content of the stimuli, using the second-order factors of the GEMS-9 framework: ‘sublimity’, ‘unease’, and ‘vitality’. We employed a mixed between-within-subjects analysis of variance to analyse the data. Specifically examining the influence of the four tempi, the two modes, while controlling for musicianship, gender, age, and education level. Results showed that as tempi increased, compositions were consistently rated as less sublimity and more vitality, in both major and minor modes. A higher tempi in the major mode resulted in lower ratings of uneasiness. There were also several significant findings for musicianship, gender, and education level, although these mostly had small effect sizes. For age groups, there were two substantial differences between the groups with larger effect sizes. Overall, our findings suggest that tempi and mode significantly influence how compositions are rated for sublimity, unease, and vitality, as they interact.

ObjectiveIntegrative Neuromuscular Training (INT) is recognized not only for its potential in preventing sports injuries but also for enhancing athletic performance. Understanding the relationship between INT and the physical qualities of elite Sanda athletes is important for addressing performance limitations in elite Sanda athletes. While INT has been applied in various sports, there is a lack of research in the context of Sanda. This empirical study aims to investigate the effects of INT on the physical qualities of elite Sanda athletes.MethodsA randomized controlled trial design was employed, with 26 elite male Sanda athletes randomly assigned to either the Integrative Neuromuscular Training group (INT, n = 13) or the control group (CON, n = 13). The INT group engaged in three sessions of INT training per week, lasting 45 minutes each for 12 weeks, while the CON group completed a conventional conditioning program. Pre- and post-intervention assessments included one-repetition maximum tests (1RM), 30-meter sprint tests (30MST), counter movement jump tests (CMJ), reaction agility tests (RAT), and Y balance tests (YBT).ResultsPost-intervention, the INT group showed significant improvements in these physical fitness measures: [1RM bench press (p < 0.001, d = 2.599), 1RM squat (p < 0.001, d = 2.610), T-5m (p = 0.011, d = −1.000), T-10m (p = 0.011, d = −0.833), T-30m (p < 0.001, d = −6.120), CMJ (p < 0.001, d = 4.236), RAT (p < 0.001, d = −3.312), YBT-L (p < 0.001, d = 3.075), YBT-R (p < 0.001, d = 2.722)]. In the CON group, there were no significant changes in physical quality test scores post-intervention. Relative changes from pre- to post-intervention indicated no significant differences in △-T-5m between INT and CON groups, while significant differences were found in other physical quality assessments [△-1RM bench press (3.376 vs 0.220 kg, p < 0.001), △-1RM squat (3.665 vs −0.533 kg, p < 0.001), △-T-10m (−0.005 vs 0.005 s, p = 0.004), △-T-30m (−0.153 vs −0.017 s, p < 0.001), △-CMJ (4.846 vs 0.615 cm, p < 0.001), △-RAT (−0.048 vs −0.002 s, p < 0.001), △-YBT-L (5.154 vs −0.615, p < 0.001), △-YBT-R (5.615 vs −0.308, p < 0.001)].ConclusionA 12-week INT intervention significantly enhances the physical qualities of Sanda athletes. The overall improvements in the INT group across 1RM, 30MST, CMJ, RAT, and YBT tests demonstrate that the INT program may serve as an effective conditioning strategy for improving selected physical fitness outcomes in elite Sanda athletes.

In the southwestern Brazilian Amazon, palm-dwelling triatomines maintain sylvatic transmission cycles of Trypanosoma cruzi, the causative agent of Chagas disease, and Trypanosoma rangeli, a related non-pathogenic parasite. Deforestation can reduce biodiversity and increase pathogen prevalence in triatomine populations; however, the effects of landscape structure on triatomine infection patterns remain poorly understood. Here, we address this knowledge gap by examining how forest cover and proximity to human dwellings influence triatomine infection patterns across gradients of deforestation. Field surveys were conducted in 2022 and 2024 in 20 landscape units in Cruzeiro do Sul, Acre state, Brazil, where triatomines were collected from palm trees located at varying distances from inhabited households. Distances and land-use composition were quantified from high-resolution drone and satellite imagery, while parasite infections were identified using molecular assays. Bayesian binomial mixed-effects models revealed contrasting responses between parasites. T. cruzi infection probability was higher in more deforested landscapes and was further modulated by palm-household distance, with the strongest effects observed for palms closer to dwellings. In contrast, T. rangeli infection showed no supported association with forest cover or distance to households. Blood meal analysis revealed frequent feeding on sylvatic hosts, particularly marsupials, and detected human blood in a nymph collected only 33 m from a household; T. cruzi infections detected in the study were exclusively assigned to TcI discrete typing unit, a lineage commonly associated with sylvatic transmission. These findings demonstrate that deforestation reshapes host-vector-parasite interactions in palm-based systems, increasing spillover risk at the sylvatic-human interface without requiring domiciliated triatomines.

BackgroundSulfated polysaccharides (SPs) from red algae have attracted considerable interest due to their antioxidant and anticancer properties. Gracilaria corticata is a rich source of sulfated polysaccharides with notable antioxidant and anticancer potential.ObjectivesThis study aimed to optimize the extraction process of SPs from G. corticata, determine their chemical and structural features, and evaluate their antioxidant and anticancer activities.Materials and methodsThe SPs were extracted from G. corticata using ultrasound-assisted extraction. The chemical composition, molecular weight (230 kDa), and structure of the extracted SPs were characterized using standard biochemical assays and nuclear magnetic resonance (NMR) spectroscopy. Antioxidant capacity was evaluated using 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2’-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) radical scavenging assays. Cytotoxicity was assessed against HT-29 colon cancer cells and normal CCD-841 cells via 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Apoptosis induction was further examined through Annexin V-FITC/PI staining and gene expression analysis of apoptosis-related markers.ResultsUltrasound-assisted extraction was optimized at 12 min, 800 W power, and a solvent-to-biomass ratio of 30 mL/g, yielding 34.8% SPs. The SPs contained 84.4% carbohydrates, 8.7% sulfate, and 2.55% protein, with galactose identified as the predominant sugar. Molecular weight was determined to be 230 kDa. Antioxidant assays demonstrated dose-dependent activity, reaching 81.92% (DPPH) and 86.34% (ABTS) radical scavenging. SPs inhibited HT-29 cell viability with an IC₅₀ of 171 μg/mL and a selectivity index (SI) of 3.48. Apoptosis was induced via increased intracellular reactive oxygen species (ROS) and altered expression of key genes, including upregulation of Bax, P53, and Caspase 3, and downregulation of BCL2.ConclusionsSPs extracted from G. corticata, show strong antioxidant and selective anticancer activity through ROS-mediated apoptosis. These findings support their potential use as natural therapeutic agents in pharmaceutical development.

Biofloc aquaponics presents a sustainable approach to soilless crop production, but its long-term reliability is often compromised by root-zone disorders such as root rot and wilt. This study evaluated four media-based biofloc aquaponic designs over two years (encompassing two full fish production cycles and four tomato growing seasons) to investigate system failures, including plant wilting, necrosis, and the underlying physical and microbial stressors. In the first year, plant wilt was primarily linked to poor drainage and sludge accumulation in coupled systems, resulting in root-zone hypoxia and a 21% reduction in yield compared to decoupled systems. In response, system modifications were implemented in the second year, including the implementation of radial flow settlers upstream of filters and timer-controlled pumps, which improved oxygenation and solids management. These interventions reversed previous trends: coupled systems had > 45% higher yields than decoupled systems. However, wilting still occurred in a subset of plants during the second year. Root-zone analysis showed that wilted plants exhibited 65% lower dissolved oxygen levels than non-wilted, and a tendency for higher relative abundance of potential pathogens and parasitic organisms (Pythium graminicola and Xiphinema rives). In contrast, healthy root zones were associated with greater abundance of plant growth-promoting bacteria (PGPB), particularly taxa with known biocontrol potential. These findings highlight the importance of maintaining oxygen-rich root environments and effective solids management to support long-term aquaponic productivity.

Confronting the growing disparity between standardized evaluation systems and personalized competency development in practical education, this study proposes a novel data-driven framework integrating Multi-Criteria Group Decision Making (MCGDM) to enhance curriculum assessment within Problem-Based Learning (PBL) environments. Specifically, the framework incorporates Z-number theory to effectively capture the uncertainty and reliability inherent in expert evaluations, addressing the challenges posed by subjective and imprecise human judgments. The well-established Multi-Attributive Border Approximation Area Comparison (MABAC) method is extended through the integration of Z-number modeling to enhance robustness in ranking and decision-making processes. A multi-stage assessment process is designed, encompassing a Pass check phase, a Score determination phase, and a Grading phase, aligned with the pedagogical principles of PBL. Furthermore, a hybrid Entropy-Criteria Importance Through Intercriteria Correlation (CRITIC) weighting scheme under Z-number representation is introduced to objectively determine the importance of evaluation criteria, considering both information dispersion and inter-criteria correlation. The proposed method is applied to a real-life case study involving 24 students, evaluated by multiple stakeholder groups, including peer teams, instructors, and industry experts. Sensitivity and comparative analyses suggest that the proposed framework provides a robust and reliability-aware assessment procedure within the studied course context. The findings indicate its potential to support a more transparent and structured evaluation process, although broader generalizability requires further validation across cohorts, courses, and institutions.

Trypanosomatids (Protozoa; Kinetoplastea) are obligate parasitic protozoans that infect a wide range of vertebrate hosts, including bats – the only volant mammals, widely distributed across the globe. In Rio de Janeiro, Brazil, Atlantic Forest remnants persist within urban landscapes, including the Fiocruz Atlantic Forest Biological Station (EFMA), a unit embedded in a highly urbanized environment. Between 2013 and 2019 (excluding 2015), field surveys were conducted in four landscape physiognomies with different degrees of environmental degradation. Blood and other tissue samples (spleen, liver and skin) were collected from bats to investigate the infection and diversity of trypanosomatid infections. A total of 270 bats were examined through parasitological techniques (fresh blood examination and hemoculture) and molecular diagnosis through phylogenetic analysis. Overall, 24.1% (n = 65) of bats tested positive for trypanosomatids. Molecular identification revealed a diverse assemblage of species, including Crithidia mellificae, Trypanosoma cruzi (DTUs TcI and TcII), Trypanosoma dionisii, Trypanosoma sp. Neobat 1 and 4, Trypanosoma lainsoni, and Trypanosoma rangeli A. Our findings underscore the critical role of direct molecular detection in tissue samples for uncovering infections missed by traditional parasitological methods, particularly those caused by uncultivable species/genotypes such as Trypanosoma sp. Neobat 1 and 4. The recurrent detection of T. dionisii, T. cruzi DTU TcI and T. rangeli A, reinforces their sustained circulation in bats from this urban-forest interface. Moreover, the presence of C. mellificae, traditionally regarded as a monoxenous species, adds new bat hosts to the already extant list of mammal species recognized as able to harbor this parasite. Notably, this study provided the first record of T. lainsoni and T. cruzi DTU TcI in mammals from the EFMA, highlighting a surprising richness of trypanosomatids in this small, and human-impacted forest remnant. The high diversity of trypanosomatid communities infecting bats, recognized as habitat-resilient hosts, reinforces the complexity of the sylvatic transmission of those parasites that may not be disrupted even under strong anthropogenic pressures.

The Eastern Tropical Pacific (ETP) Spotted Eagle Ray, Aetobatus laticeps Gill, 1865, is an understudied species with limited information on its ecology and conservation status. Only in the last 10 years has this lineage been re-described as a distinct species from the formerly widespread Aetobatus narinari species complex (Euphrasen, 1790) (ANSC). The sampling in the studies that divided the ANSC was not geographically balanced, with most individuals (50) collected from the Atlantic and only (5) from the ETP. Given the vast extent and environmental heterogeneity of this region, it is possible that a significant portion of the genus’s genetic variation, and possibly even the presence of undescribed species, is being overlooked. Because eagle rays have relatively low fecundity and are subject to targeted and incidental fisheries, they are highly susceptible to population declines. Consequently, elucidating the genetic diversity, distribution range, genetic variability and interconnectivity of this species is crucial to assess its conservation status correctly. Through a mixed genetic marker approach, we assessed ETP eagle rays’ phylogeny, genetic diversity and phylogeography. First, we confirmed that eagle rays in this region correspond to A. laticeps. Second, we found low levels of genetic variability across all markers, coupled with a high degree of geographic-genetic structure. Finally, our data suggested three potential mechanisms that could explain the population structure we encountered: a) Isolation by distance b) Isolation by philopatry, and c) Isolation by depth. To date, this is the first comprehensive study of the genetic diversity of eagle rays in the Eastern Tropical Pacific, shedding light on a species that has long been overlooked. Our findings suggest that this species is more susceptible to direct and bycatch fishing pressures, as well as other indirect human impacts. Therefore, we recommend a re-evaluation of the conservation status of this species.

ObjectiveTo examine trends in mental health service use across four provider types (family doctors, psychiatrists, psychologists, and social workers) and identify sociodemographic predictors of provider-specific access in Canada.MethodsThis study analyzes seven cycles (2007–2020) of the Canadian Community Health Survey, a nationally representative cross-sectional survey. Trends over time were examined using weighted proportions and counts of service users. Weighted multivariable logistic regression models were applied to the 2019–2020 cycle to assess associations between sociodemographic factors and provider-specific service use.ResultsFamily doctors were consistently the most accessed providers for mental health concerns, followed by psychologists and social workers, with psychiatrists being least accessed. Psychologist and social worker use increased between 2017 and 2019. In the adjusted regression models (2019–2020), women had higher odds of using family doctors (AOR = 1.21, 95% CI: 1.05–1.39) and social workers (1.19, 1.02–1.40) and lower odds of psychiatrists (AOR = 0.66, 95% CI:0.55–0.79) than men. Adults 65 + had greater odds of family-doctor use (AOR = 4.82, 95% CI: 3.59–6.47) and lower odds of psychologist (AOR = 0.33, 95% CI: 0.24–0.45) and social-worker use (AOR = 0.21, 95% CI:0.16–0.29) than ages 12–17. Post-secondary education (vs less than secondary school) was associated with higher psychologist use (AOR = 1.83, 95% CI 1.12–2.98). Higher income (≥$80,000 vs < $20,000) was associated with lower psychiatrist use (AOR = 0.66, 95% CI 0.50–0.86). Non-Indigenous respondents more often used psychologists (AOR = 1.58, 95% CI: 1.13–2.23), and respondents who are not a visible minority more often used family doctors (AOR = 1.37, 95% CI:1.06–1.77).ConclusionThis study reveals a stratified mental health care system in Canada, where sociodemographic factors shape who accesses which providers. While primary care dominates, growth in psychologist and social worker use suggests shifting patterns of engagement. Findings underscore the need for policies that address financial and structural barriers, promote equitable access, and expand coverage for community-based mental health providers.