Abstract: Since 2020, the Swiss Personalized Health Network has adopted Semantic Web technologies to standardize health-related data for research in Switzerland. The SPHN Semantic Interoperability Framework promotes semantic interoperability, following the FAIR principles. Within this framework, the SPHN RDF Schema has evolved over five years to define more than 200 concepts across domains such as patient demographics, diagnoses, and laboratory results, enabling the representation of structured and machine-interpretable datasets. This study evaluates the evolution of schema versions from 2021 to 2025 and their adoption, examining structural and semantic changes, and analyzing quantitative metadata from projects in the SPHN Metadata Catalog. Results show consistent reuse of core concepts, especially demographics, diagnoses, and laboratory-related concepts, with 67% of SPHN concepts used in projects. The SPHN framework has proven to be a viable national standard for FAIR health data representation. Nonetheless, semantic modeling alone does not guarantee full interoperability. Future efforts must enhance data structuring and quality at the source, promote RDF adoption in research workflows, and develop user-friendly tools for querying and visualizing data.

Abstract: Background: The Toscana Virus is a little-known virus, present in Italy, transmitted by sandflies and associated with cases of meningitis and meningoencephalitis in humans. this study compared three statistical models (SARIMA, Poisson, and Negative Binomial) to forecast monthly Toscana virus (TOSV) cases in Italy for the period 2023–2024. Materials and Methods: data were extracted from the epidemiological bulletins of the Italian National Institute of Health for the period January 2016–December 2024. The 2016–2022 training set was used to estimate the models, while the 2023–2024 test set validated the predictions. Results: in the model comparison, SARIMA showed the best predictive ability, with the lowest MAE (3.46) and RMSE (5.05), demonstrating that seasonality and temporal de-pendence were well captured. The Poisson and Negative Binomial models, although use-ful, showed lower performance in terms of accuracy (higher RMSE). Conclusions: the results indicate that the SARIMA model is the best suited for forecasting monthly TOSV cases, but it is not perfect, highlighting the need for more complex ap-proaches that also integrate exogenous variables to improve forecast quality.

Abstract: The digitalisation of Indigenous medicinal knowledge constitutes a qualitatively new form of bioprospecting — one that operates through artificial intelligence, open-access repositories, genomic databases, and state-led data infrastructure rather than field collection alone. This article examines this transformation through the Rakhain community of Bangladesh, whose plant-based and non-plant healing heritage occupies a structurally vulnerable position at the intersection of biodiversity law, data governance, and digital capitalism. Drawing on long-term ethnographic engagement with the Rakhain community (2004–2024), Indigenous Gnoseology (Chowdhury, 2026a), reciprocal methodology (Chowdhury, 2026b), and the CARE Principles for Indigenous Data Governance (Carroll et al., 2020), the article argues that existing legal regimes are insufficient without community-centred digital sovereignty. A Rakhain Digital Healing Sovereignty Framework is proposed, grounded in collective consent, tiered knowledge classification, sacred secrecy, reciprocal benefit sharing, and post-research accountability.

Abstract: Tear film instability and dry eye disease (DED) are among the most common postoper-ative complaints after anterior segment surgery. Cataract surgery, corneal refractive procedures, keratoplasty, glaucoma filtration surgery, and pterygium excision can all alter ocular surface homeostasis through mechanisms including corneal denervation, inflammation, loss of goblet cells, and meibomian gland dysfunction. However, the severity and duration of postoperative dry eye vary significantly depending on the procedure performed. This comprehensive review of the literature summarises current evidence on pathophysiology, clinical manifestations, objective tear film changes, and recovery patterns following major anterior segment interventions. Particular emphasis is placed on standardised, non-invasive assessment methods, including tear breakup time, tear meniscus height, meibography, and validated symptom questionnaires. Proce-dure-specific recovery trajectories are compared, distinguishing transient postoperative tear film instability from persistent chronic dry eye disease. Evidence-based management strategies including preoperative risk stratification, intraoperative optimisation, and multimodal postoperative therapy are also reviewed. Understanding these distinct re-covery patterns allows for better surgical planning, improved patient counselling, and earlier intervention to reduce chronic postoperative dry eye and improve visual outcomes and patient satisfaction.

Abstract: The building renovation sector is under growing pressure to balance environmental responsibility, economic efficiency, and occupant well-being simultaneously. Existing evaluation approaches remain predominantly finance-driven, marginalising ecological and social dimensions. This study develops and validates a parametric multi-criteria assessment framework for building renovation elements, structured around the three pillars of sustainability: environmental, economic, and social. A dataset of 33 renovation elements — encompassing green façade systems, extensive and intensive green roofs, interior wall, floor, and ceiling solutions, and exterior envelope and site components — was compiled and digitised as BIM objects in ArchiCAD 26, enriched with non-graphic parameters including cost, lifespan, recyclability, eco-index, maintenance effort, and qualitative social descriptors. Parameters were aggregated using type-specific logic: additive for economic indicators, minimum-value for lifespan, arithmetic mean for environmental indicators, and descriptive aggregation for social attributes. Five renovation scenarios (A–E), each composed of nine elements, were evaluated to demonstrate how the sustainability profile changes with selection priorities. Scenarios A, B, and C confirmed single-dimension dominance (environmental, economic, and social, respectively), Scenario D achieved a balanced three-pillar profile, and Scenario E revealed a latent economic bias in an apparently random element selection. The framework is scalable, extensible, and designed for future integration with BIM environments, mixed reality platforms, and AI-driven decision-support tools.

Abstract: In oral surgery, the classification of the proximity of the mandibular third molar to the mandibular canal, typically performed on panoramic radiographs, is essential for surgical planning. While artificial intelligence (AI) tools have been explored for this task, their performance is limited due to data scarcity and class imbalance. In this work, we study the potential of synthetic data generation for this task using Denoising Diffusion Probabilistic Models (DDPMs) and Generative Adversarial Networks (GANs), both unconditional and conditioned to the tooth-canal relationship. We used public datasets to create and label a training dataset of 5416 images. The results show the lowest Fréchet inception distance (FID) / second-highest Inception Score (IS) for the unconditional GAN (32.48 / 2.14). The unconditional DDPM showed an FID of 34.28 and IS of 1.95. Conditional models showed similar IS but a worse overall FID of 68.19 and 219.11 for DDPM and GAN, respectively. In a paired observer study between the two unconditional models, clinical observers found the DDPM image to be more realistic in 69.6% of cases. Future work should investigate downstream effects of GANs and DDPMs used in data augmentation for the training of an AI classifier.

Abstract: Background/Objectives: This study aimed to examine the associations between diet-related quality of life (DRQOL) and psychological distress, autonomic dysfunction, and migraine in patients with dizziness and balance disorders. Methods: In this retrospective cross-sectional study, 122 patients (56 men, 66 women; mean age 40.4 ± 12.8 years, minimum 14, maximum 65) from the vertigo outpatient clinic at JR Tokyo General Hospital completed self-reported questionnaires. These included the DRQOL scale, Dizziness Handicap Inventory (DHI), Hospital Anxiety and Depression Scale (HADS), Self-rating Depression Scale (SDS), Orthostatic Dysregulation (OD) checklist, and migraine assessments (POUNDing [Pulsating, duration of 4–72 h, Unilateral, Nausea, Disabling], MIDAS, migraine screener). Correlational analyses, group comparisons, and receiver operating characteristic (ROC) analyses were conducted. Results: DRQOL scores showed positive correlations with psychological distress (SDS: ρ = 0.58; HADS-A: ρ = 0.50; HADS-D: ρ = 0.52; all p <  0.001) and OD severity (ρ = 0.48, p <  0.001), but not with age, DHI, or individual migraine indices. Migraine screener-positive patients had significantly higher DRQOL scores (p <  0.01). DRQOL alone modestly discriminated positive migraine screener (AUC = 0.65), improving to AUC = 0.77 in a multivariable model including age and sex. Conclusions: DRQOL can capture psychological and autonomic symptom burden rather than vestibular or headache severity, suggesting that it may serve as a complementary, patient-centered metric in the holistic assessment of dizziness patients.

Abstract: Primary hepatic masses in dogs represent a heterogeneous group of lesions with variable biological behavior and challenging preoperative characterization. The objective of this retrospective study was to describe the clinical presentation, diagnostic findings, surgical management, and outcome of dogs with primary hepatic masses treated surgically. Ten dogs with resectable hepatic lesions and no evidence of extrahepatic metastasis were included. Clinical records, imaging findings, histopathological diagnoses, treatment, and follow-up data were reviewed. Histopathological diagnoses included hepatocellular carcinoma (n=3), nodular hyperplasia (n=2), lobular hyperplasia (n=1), hepatocellular adenoma (n=1), undifferentiated sarcoma (n=1), osteosarcoma (n=1), and one case without definitive histological diagnosis. Tumor size ranged from 3.3 to 18 cm and was not associated with biological behavior. Preoperative cytology showed poor concordance with final histopathological diagnosis in all sampled cases. Abdominal ultrasound identified solitary lesions in all evaluated dogs, although surgery revealed previously undetected multifocal disease in two cases. Most lesions were located in the right hepatic lobes, differing from the predominance of left-sided lesions commonly reported in the literature. All dogs underwent surgical resection. Two perioperative deaths occurred secondary to postoperative renal failure. In the remaining dogs, surgery resulted in complete remission of clinical signs and prolonged survival, including dogs with malignant tumors. Four dogs remained alive and disease-free at the end of the follow-up period (>730 days). These findings highlight the limitations of preoperative diagnostic techniques for predicting the biological behavior and extent of canine hepatic masses. Surgical resection provided substantial clinical benefit and prolonged survival in most cases, supporting its consideration whenever complete excision is technically feasible.

Abstract: The objective of this study was to evaluate the effects of partially replacing wheat bran with poplar wood composite fiber (PWCF) on growth performance, immune status, apparent total tract digestibility (ATTD), and gut microbial composition in growing pigs. A total of 140 healthy crossbred (Duroc × Landrace × Yorkshire) growing pigs with an initial body weight of 47.25 ± 0.49 kg were randomly assigned to two dietary treatments, with five replicates per treatment and fourteen pigs per replicate. The control (CT) group was fed a corn–soybean meal–based diet, whereas the experimental group re-ceived the same diet in which 2% wheat bran was replaced by PWCF. The experiment lasted for 60 days. Compared with the CT group, replacing wheat bran with PWCF did not affect body weight, average daily feed intake, feed conversion ratio, or average daily gain on days 30 or 60 (P > 0.05). In addition, no negative effects were observed on ATTD of nutrients and serum immunoglobulin A (IgA), IgG, and IgM levels at either time point, indicating that PWCF can serve as a suitable partial substitute for wheat bran in growing pig diets. However, it could regulate nitrogen metabolism by reducing blood urea nitrogen (BUN) concentration and the BUN/creatinine ratio, as well as decreasing total free amino acids in serum (P < 0.05). In addition, the antioxidant capacity can be improved by increasing catalase activity. Gut microbiota analysis showed that the re-placement significantly increased the relative abundances of Treponema, Lachnospi-raceae_XPB1014_group, Prevotellaceae_UCG-001, Prevotellaceae_UCG-003, Prevotel-laceae_UCG-004, and norank_f_Oscillospiraceae (P < 0.05). These changes suggest that PWCF modulates gut microbiota and enriches fiber-degrading bacterial populations. Overall, substituting wheat bran with PWCF did not impair growth performance, im-munity, or digestibility, while altering microbial community composition. These find-ings support the potential application of PWCF as an alternative fiber source, contrib-uting to greater diversity in feed formulation.

Abstract: Transcatheter edge-to-edge repair (TEER) is a recent minimally invasive method of managing mitral regurgitation (MR) in dogs with myxomatous mitral valve disease (MMVD). The goal of interventions is to minimize MR severity. The objective of this study was to determine the association between reduced MR and changes in myocardial work indices after TEER in dogs. Client-owned dogs with moderate-to-severe MR were enrolled in the study. TEER performance was completed with multimodal imaging guidance in all 10 dogs. Before and after the procedure, myocardial work was analyzed. MR severity, transmitral pressure gradients, left atrial and ventricular measurements, and index of myocardial work (GWI, GCW, GWW, and GWE) were calculated. TEER significantly reduced MR severity in the majority of dogs. MR decrease was associated with a greater efficiency of myocardial work, more constructive work, and less wasted energy. No significant negative associations of moderate post-procedure gradients with short-term clinical outcomes emerged. TEER-mediated reduction of MR improves myocardial function in dogs. However, long-term studies are also needed to examine the effects of residual MR and transmitral gradients on cardiac function and clinical outcome.

Abstract: This paper examines the datafication of migrant labor governance in Malaysia, arguing that the growing digital infrastructure surrounding migration — biometric registration, employer-tied databases, algorithmic productivity monitoring, and cross-border recruitment platforms — constitutes a regime of digital dispossession that is legally unaddressed and politically uncontested. Drawing on critical data studies, decolonial political economy, and the emerging field of digital migration studies, the paper interrogates how migrant workers in Malaysia are rendered exhaustively visible to state and capital through data, while remaining structurally invisible to the law that is supposed to protect them. Anchored in Chowdhury's (2022, 2023, 2026a, 2026b) frameworks of reciprocal methodology and Indigenous Gnoseology, and engaging with Couldry and Mejias's (2019) concept of data colonialism, Spanger and Andersen's (2023) analysis of convoluted mobility, Leurs and Smets's (2018) digital migration studies framework, and Beduschi's (2021) international human rights analysis of AI-driven migration management, the paper develops a concept of relational data sovereignty as an alternative governance foundation. It proposes five institutional reforms for Malaysia and ASEAN and argues that the reform of digital governance in migration contexts requires both epistemological and institutional transformation — centering the knowledge, agency, and rights of those most governed by data and least protected by law.

Abstract: Accurate donor-recipient allograft size matching remains a critical determinant of outcomes in lung transplantation, yet current approaches rely predominantly on predicted total lung capacity (pTLC) and height-based metrics derived from population-based equations. These simplified surrogates fail to capture individual anatomical variability, disease-specific alterations in thoracic geometry, and the spatial relationship between donor lungs and recipient chest cavities. In this review, we examine the limitations of conventional size matching and synthesize emerging evidence supporting imaging-based approaches, including computed tomography (CT) volumetry, radiomics, and machine learning. CT-derived volumetric analysis enables individualized anatomical assessment and has been associated with clinically relevant prediction of primary graft dysfunction and mortality. Advanced computational methods may further support extraction of imaging-derived features and integration with clinical data, although these approaches remain investigational. Collectively, these developments signal a paradigm shift from crude population-based metrics toward imaging-driven and computational approaches in the modern era. With rigorous validation and careful clinical integration, imaging-based approaches may complement conventional size metrics and support more individualized donor-recipient assessment.

Abstract: Background:Chronic musculoskeletal pain is a common condition, for which pain self-management is recommended. Digital tools offer potential to support individuals with chronic pain, but it is unknown to what extent existing tools are responsive to the social context of Pakistanis living with chronic pain and are engaging for them. Objective: This study aimed to explore strategies to enhance engagement with digitally enabled pain self-management tools among people with chronic musculoskeletal pain.Methods: A mixed-methods sequential explanatory design was used. We first reviewed Android app store and published literature to identify content and engagement strategies incorporated in digital tools. Following this, we conducted a narrative study involving adults with chronic musculoskeletal pain to capture their lived experiences and requirements for pain self-management. Review findings were synthesised descriptively, qualitative data were analysed thematically, and overall findings were combined to generate design and content recommendations.Results: Literature and app reviews revealed that digital tools commonly included components related to patient education and physical or mental therapy. They often included engagement features such as personalization and reminders. Dietary advice and peer or social support were less commonly included in digital tools but were commonly discussed during group discussions by individuals living with chronic pain. Nineteen individuals with chronic pain participated in group discussions and described how their pain self-management practices were shaped by cultural beliefs and perceptions and digital health information. These factors also influenced their decision making related to treatment choices and adoption of non-pharmacological strategies. Although participants trusted healthcare professionals but expressed concerns about limited guidance on how to apply clinical advice in their daily lives. Moreover, they identified several requirements for pain self-management tools, including evidence based audio-visual content and incorporating aspects related to symptom monitoring, symptom relief and physical rehabilitation, psychological wellbeing, lifestyle management, social support, patient education. Conclusion:Existing pain self-management tools rarely address the social context of South Asians. While pain self-management is shaped by digital information and cultural beliefs and perceptions, participants valued evidence-based digital resources. Therefore, future research should focus on co-developing these resources to ensure they are clinically meaningful, culturally responsive, and supportive of patient-centred and equitable pain self-management.

Abstract: Objective: To characterize the structural fragility of installed health-service capacity in Barranquilla, Atlántico, Colombia, using absolute capacity, supply concentration, reserve or transitory capacity, and service-line clinical sensitivity as structural-risk dimensions. Methods: An ecological health-services study was conducted using a local installed-capacity dataset traceable to the Colombian Special Registry of Health Service Providers and SISPRO, together with two contextual World Bank series for Colombia: physicians per 1,000 population and premature mortality from noncommunicable diseases. Traceable data cleaning, functional normalization, separation of baseline versus transitory capacity when allowed by the source fields, and exploratory estimation of a relative structural fragility proxy index using a normalized Poisson-type transformation were performed. This index was interpreted exclusively as a comparative structural-fragility ranking and not as an observed probability of saturation. Results: The analytical capacity of the Barranquilla node included 5,397 installed capacity slots. Adult ICU accounted for 707 slots and neonatal ICU for 160. Reserve capacity was low in neonatal ICU (2.5%) and higher in adult ICU (32.2%). The largest service lines were adult general hospitalization, adult ICU, and pediatric general hospitalization, whereas the highest relative structural fragility was observed in low-scale and highly concentrated services, including burn care, acute mental health, and selected highly specialized lines. Conclusion: Barranquilla has a broad but markedly heterogeneous structural health-service capacity network. The critical pattern is not determined only by the absolute number of slots, but by the interaction between limited capacity, high concentration, low stable reserve, and clinical sensitivity. The evidence generated is structural and should not be interpreted as observed occupancy, real-time saturation, or operational collapse.

Abstract: The topological properties of planetary fluids are typically analyzed by mapping classical fluid equations onto complex quantum mechanical models. Here we present a purely real, six-dimensional Stueckelberg quantum mechanical formulation of the rotating shallow water equations to demonstrate that these topological features are intrinsic to the classical kinematics itself. Operating entirely within R⁶ we decouple the complex quantum geometric tensor into an independent real Fubini-Study metric and a real antisymmetric Berry curvature. Our real-variable approach explicitly derives a topological magnetic monopole of charge C = −2 and captures the inherent scale invariance of the fluid's geometry without explicit complex coordinate representation. We suggest that continuous variations in the Coriolis parameter model the adiabatic geometric evolution of the Archean Earth, and we propose a laboratory rotating-tank experiment to physically measure this parameter sweep. Finally, we show that our real 6D formulation naturally maps to unbroken supersymmetric quantum mechanics. By identifying a purely real supercharge and calculating a fluid Witten index of W = −2, we demonstrate a strict mathematical symmetry between the topological charge of the propagating bands and the invariant of the unbroken zero-energy geostrophic vacuum. We advance the mathematically supported viewpoint that steady-state geostrophic weather patterns represent the exact supersymmetric ground states of the rotating fluid system. Consequently, the topological isolation of this vacuum naturally restricts the spectral flow across the equator, providinga theoretical explanation for the unidirectional eastward motion of equatorial boundary waves.

Abstract: Coordinated responses of intestinal epithelial and immune cells are essential for maintaining barrier integrity and immune homeostasis in dogs, yet mechanistic understanding of probiotic‑derived metabolites remains limited due to reliance on non‑canine experimental models. Here, we investigated metabolites derived from Limosilactobacillus reuteri strain ATCC PTA6127 (Lr6127), delivered as cell-free supernatants (CFS), using canine epithelial MCA-B1 cells and macrophage-like DH82 cells subjected to lipopolysaccharide (LPS)–induced inflammatory stress. Lr6127 CFS significantly reduced epithelial permeability, decreasing FITC‑dextran leakage to 94.9 ± 1.9% relative to LPS-treated controls normalized to 100% (P < 0.001), despite no detectable transcriptional changes in tight junction, adherent junction, or mucin genes. Barrier effects were instead associated with changes in markers of cellular stress re-sponses, with heme oxygenase expression reduced from 0.9 ± 0.1 to 0.7 ± 0.1 (P < 0.05). In DH82 immune cells, Lr6127-derived metabolites suppressed LPS-induced stress and inflammatory signaling, enhanced anti-apoptotic responses as reflected by increased BCL2 expression (1.4 ± 0.1 vs. 1.0 ± 0.0; P < 0.01) and elevated BCL2/BAX ratios (P < 0.01), and reduced pro-inflammatory mediators including IL-6 and CCL2 (P < 0.05–0.001). Proteomic analysis corroborated reduced abundance of inflammatory and STAT-associated signaling proteins under LPS challenge while promoting immune readiness under resting conditions. Collectively, these results suggest that Lr6127‑derived metabolites may support epithelial barrier integrity and immune re-balancing potentially through modulation of cellular stress and inflammatory path-ways.

Abstract: Background/Objectives: Acute ischemic stroke (AIS) care depends on rapid, coordinated workflows. This study compared two real-world in-hospital stroke models—a neurohospitalist-led model and a stroke practitioner–led multidisciplinary model—in terms of time metrics, radiological outcomes, and 3-month clinical outcomes in patients undergoing reperfusion therapy. Methods: This retrospective, single-center cohort study evaluated patients across two sequential workflow periods. In the practitioner-led model, trained non-neurologist clinicians coordinated care with a stroke nurse under neurologist supervision. Time metrics included door-to-needle time (DNT) and door-to-puncture time (DPT). Clinical outcomes included intensive care unit (ICU) transfer and 3-month functional outcomes assessed by the modified Rankin Scale (mRS). Results: A total of 573 patients were included (284 neurohospitalist-led, 289 practitioner-led). Baseline NIHSS scores were similar between groups. The proportion achieving DNT <60 minutes was significantly higher in the practitioner-led period (74.0% vs. 52.5%, p<0.001), while mean DNT and DPT were comparable. Early radiological outcomes at 24 hours were similar between groups. ICU transfer rates were significantly lower in the practitioner-led period (17.6% vs. 28.2%, p=0.002). Three-month mRS outcomes did not differ significantly. Conclusions: A structured, practitioner-led multidisciplinary workflow was as safe and efficient as a neurohospitalist-led model. Improved adherence to DNT targets and reduced ICU transfers highlight the importance of system-level organization in optimizing AIS care.

Abstract: Remote and hybrid work have altered where many high-skill workers live, commute, and participate in professional networks, raising new questions for technology-based economic development (TBED) in the United States. This conceptual review asks whether remote work is dispersing innovation activity, creating durable opportunities for smaller metropolitan areas, or reorganizing established geographies of advantage. The article uses a focused conceptual review that synthesizes foundational scholarship on agglomeration, clusters, and innovation geography with post-2020 research on remote work, urban restructuring, regional migration, local innovation systems, and policy responses. Sources were selected for their relevance to spatial concentration, metropolitan hierarchy, remote-worker embeddedness, and TBED strategy. The review shows that remote work has not dissolved agglomeration. Large metropolitan regions continue to concentrate remote-capable, innovation-intensive, and digitally intensive employment, while some smaller and mid-sized metros have gained visibility and mobile talent. However, the evidence points more strongly to selective gains at the margin than to broad spatial equalization. The findings also show that residential inflows alone do not create durable innovation capacity. The article argues that remote work is reorganizing rather than replacing TBED. Its central contribution is a framework of partial geographic decoupling, in which remote work loosens the routine overlap among residence, workplace, and firm location while increasing the importance of local institutions. The main policy challenge is building connective capacity that converts mobile labor into entrepreneurship, collaboration, civic participation, and long-term regional innovation. This framing clarifies how regions can compete without assuming that attracting remote workers automatically produces transformation. Recent federal and multi-survey evidence strengthens the article’s claim that remote work has stabilized above pre-pandemic levels while remaining uneven by education, occupation, and metropolitan context.

Abstract: This paper investigates bifurcation dynamics in a fractional-order extension of the classical Susceptible–Latent–Breaking–Out model for computer virus propagation. The proposed framework incorporates two distinct transmission-related time delays and employs Caputo fractional derivatives of incommensurate orders, with the delays associated with infection rate and latent period selected as the primary bifurcation parameters. Due to the combined influence of multiple delays and incommensurate fractional exponents, the resulting system exhibits a complexity that goes beyond most existing models in the literature. By linearizing the model around its endemic equilibrium and analyzing the associated characteristic roots, we characterize how the system’s qualitative behavior depends on the magnitudes of the time delays, and establish explicit sufficient conditions for bifurcation to occur. In particular, the endemic equilibrium remains asymptotically stable as long as each delay stays below a certain critical value; once any delay exceeds its threshold, the system undergoes a Hopf bifurcation, leading to sustained periodic oscillations in virus prevalence. Numerical simulations are provided to support the analytical results, and they show strong agreement between predicted and observed system responses. These findings enhance theoretical insight into bifurcation mechanisms in fractional-order delay models of epidemic dynamics on networks, and may offer useful guidance for designing containment strategies in large-scale interconnected systems.

Abstract: Endoscopic submucosal dissection (ESD) has revolutionized the management of superficial colorectal neoplasms, offering superior en bloc resection rates compared with conventional endoscopic mucosal resection (EMR). While ESD has been the standard of care in East Asian countries for over two decades, its adoption in Western countries has been considerably slower, hampered by the steep learning curve, prolonged procedural times, limited training infrastructure, and differences in disease epidemiology. However, recent years have witnessed a paradigm shift, with growing evidence from Western multicenter studies demonstrating outcomes that increasingly approach those reported from high-volume Eastern centers. The landmark RESECT-COLON randomized trial provided level-1 evidence supporting the superiority of ESD over piecemeal EMR for large colorectal polyps. Concurrently, novel training paradigms, technological innovations including traction-assisted devices and artificial intelligence (AI)-guided systems, and evolving societal guidelines from the American Gastroenterological Association (AGA), American Society for Gastrointestinal Endoscopy (ASGE), and European Society of Gastrointestinal Endoscopy (ESGE) are accelerating Western adoption. This state-of-the-art review comprehensively examines the current landscape of colorectal ESD in Western practice, highlighting the evolution of outcomes, training pathways, guideline recommendations, technological advances, and future directions. We provide a critical appraisal of the East–West outcome gap and discuss strategies to bridge this divide, positioning colorectal ESD as an increasingly viable first-line therapy for appropriate lesions in Western endoscopy centers.