Search Results (2,377)

Background/Objectives: Incarcerated people experience high rates of trauma, psychological distress, and social marginalization. Yoga has been introduced in prisons as a trauma-sensitive mind–body practice, yet its rehabilitative contribution remains uncertain. This systematic review aimed to synthesize evidence on the feasibility and effectiveness of yoga interventions delivered in correctional settings. Methods: Following PRISMA guidelines and a preregistered PROSPERO protocol, we searched PubMed, PsycINFO, Cochrane CENTRAL, and Scopus for peer-reviewed publications from May 2012 to November 2025. Eligible studies involved structured yoga interventions for incarcerated populations and reported psychological, behavioral, or institutional outcomes. Two reviewers independently performed screening, data extraction, and quality appraisal using the Mixed-Methods Appraisal Tool (MMAT). Results: Ten studies reported in twelve publications and involving 1815 incarcerated individuals met the inclusion criteria. Interventions included Hatha-based protocols, Krimyoga, trauma-informed approaches, and multicomponent programs. Across randomized, quasi-experimental, and pre–post designs, yoga was feasible and acceptable. Reported benefits included reduced psychological distress, negative affect, anger, and trauma-related symptoms, as well as improved mood, self-regulation, and mindfulness. Evidence specific to women and girls was limited, but the available trauma-informed and gender-responsive studies suggested potential reductions in post-traumatic stress, depression, and anxiety, alongside increases in self-compassion. One large quasi-experimental cohort found lower reincarceration rates among yoga participants, although institutional outcomes were otherwise limited. Evidence was constrained by small samples, heterogeneous intervention formats, short follow-up, and variable outcome measures. Conclusions: Yoga appears to be a promising adjunct to rehabilitation in correctional settings. However, methodological limitations prevent firm conclusions. Larger, well-controlled studies with standardized outcomes and longer follow-up are needed to clarify effectiveness and support integration into correctional health and rehabilitation policy. Full article

Background/Objectives: The increasing rate of complex patients with multiple chronic somatic and/or mental disorders in modern medicine is challenging, necessitating special management programs. The aim of the present study was to identify clinical variables and the use of health services associated with the primary-physician-driven inclusion of complex patients in the “Team Management for Complex Patients” (TMCP) special program. Methods: Using validated electronic medical records of a nationwide health maintenance organization, a case–control study was performed. The study compared parameters before enrollment of complex patients included in the TMCP program with those of complex patients during the same time period who were not included, and were matched using a propensity score for age, sex, socioeconomic status, place of residence, ethnicity, smoking status, physical activity, and the balance before the day of enrollment for the major body measurements and laboratory results. Results: The control group was well-balanced, except for the South region and no physical activity. Several respiratory, cardiac, gastrointestinal, neurological, inflammatory and autoimmune diseases were significantly more common among patients included in the TMCP program than among those not included. Complex patients included in the program presented significantly higher previous rates of attending outpatient urgent care centers, visiting hospital emergency departments, hospitalization, and medication use. Conclusions: Although limited by subjective inclusion criteria and potential confounding, the present comparative study identified clinical variables associated with the identification of complex patients for enrollment into a special managed program. These associations may inform future work to develop and validate criteria to support physician decision-making in selecting complex patients for managed programs and designing healthcare resources for patients who need them most. We currently meticulously follow the outcomes of the patients included in the special managed program. Full article

Background/Objectives: Cyclin-dependent kinase 4/6 inhibitors combined with endocrine therapy have become the standard of care for HR+/HER2− metastatic breast cancer. Given the metabolic functions of CDK4/6 and the endocrine activity of adipose tissue, body mass index has been proposed as a potential prognostic or predictive factor in this setting. This systematic review aimed to summarize current evidence on the association between BMI and treatment outcomes in HR+/HER2− MBC patients receiving CDK4/6i. Methods: A systematic literature search was conducted in PubMed and Scopus databases, covering publications from 2015 to 2025. We included real-world studies and clinical cohorts reporting survival outcomes of HR+/HER2− MBC patients treated with CDK4/6i in relation to BMI and other body composition parameters. Results: From 69 records identified, 14 studies met the inclusion criteria. Findings were heterogenous; four studies reported improved survival outcomes in higher BMI patients, whereas most identified no significant association. Studies incorporating computed tomography-based metrics demonstrated that body composition parameters such as visceral adiposity and skeletal muscle area were more reliable predictors of prognosis than BMI alone. Conclusions: Our findings indicate that BMI as a standalone metric is an insufficient predictor of clinical outcomes or treatment response for those receiving CDK4/6i, highlighting the need for precise body composition evaluation. More detailed anthropometric and metabolic profiling could clarify the clinical significance of adiposity in HR+/HER2− MBC. Full article

Orthognathic surgery restores functional balance and facial esthetics in patients with dentofacial deformities. The use of adjunctive facial implants—made from materials such as porous polyethylene, titanium, or polyetheretherketone (PEEK)—has increased to enhance contour and projection, although standardized guidelines for their selection and integration remain scarce. Following PRISMA-ScR guidelines, a systematic search of PubMed, Scopus, Embase, and LILACS identified studies reporting facial implants placed concomitantly with orthognathic surgery. Eligible studies included case reports, case series, observational studies, clinical trials, and reviews involving human patients, without language or date restrictions. Seventeen studies published between 1998 and 2025 met the inclusion criteria, comprising retrospective and prospective designs, case series, and one technical note. Implants were used in the malar, infraorbital, paranasal, chin, mandibular body, and angle regions. Materials included PEEK, porous polyethylene, silicone, hydroxyapatite, polymethylmethacrylate, and titanium. PEEK was mainly used for patient-specific implants, while porous polyethylene was commonly used as stock implants. Follow-up time, outcome reporting, and study design varied widely, reflecting substantial methodological heterogeneity and predominantly observational evidence. As a result, outcomes were primarily reported qualitatively, limiting comparative assessment and long-term inference. Overall, the available literature suggests that alloplastic facial implants may serve as useful adjuncts to orthognathic surgery for contour enhancement, with outcomes influenced by implant design, surgical expertise, fixation, and soft tissue conditions. However, the current evidence base remains limited, underscoring the need for standardized outcome measures, comparative studies, and longer follow-up to better inform clinical decision-making and future research. Full article

Gender remains a significant yet often subtle dimension of literacy in early childhood education and care (ECEC). Picturebooks and digital texts may introduce young children to patterned cues about how gender is seen, valued, and enacted, sometimes reinforcing binary expectations even when such messages are not explicit. This paper considers how children may encounter and interpret gender through schemas, scripts, and multimodal features embedded in the texts they read and the literacy practices they participate in. Drawing on insights from picturebook scholarship, cognitive studies, queer theory, and childhood studies, the discussion explores how gender may be shaped through repeated visual, verbal, and affective cues that children learn to recognise and respond to. At the same time, a growing body of inclusive and counter-normative texts may offer opportunities for children to expand or adjust their existing understandings of gender, although such shifts are often partial and dependent on context, mediation, and broader cultural messages. By approaching literacy as an embodied, relational, and multimodal experience, this paper aims to open a reflective space for considering how early literacy practices may support more diverse and expansive possibilities for gender in ECEC settings. Full article

The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) is the first international treaty to provide a basis for standards for the rights of persons with disabilities. It also represents the first human rights convention formally ratified by the European Union. In 2008, the UNCRPD was ratified by the majority of EU and EEA member states. Article 30 of the Convention specifically addresses the right to participate in cultural life, recreation, leisure, and sport is referenced and addressed in the UNCRPD States Parties reports submitted by all EU and EEA countries, as well as the United Kingdom. Research Question: How is sport represented in the State Party reports submitted under the UNCRPD? Methods: Data were collected from the UN Treaty Body Database. When multiple States Parties reports were available for a country, both reports were included for analysis. Results: Thematic analysis of 31 UNCRPD States Parties reports from EU, EEA, and UK countries revealed six key themes: General Factors, Sport in Article 30, Types of Support, Entities, Assistive Technologies, and Assistive Technologies in Sport. Sport was mentioned in all reports, with 90.3% referencing recreational sport and 83.9% elite-level sport. Funding and programmes were the most frequently cited supports for inclusive sport. Nearly half of the countries reported dedicated entities overseeing disability sport. Assistive technology was widely referenced across multiple UNCRPD articles, but only 16.1% of countries discussed its use specifically in sport. Countries differ significantly in their implementation of the UNCRPD in the context of sports. While some nations are advancing toward full inclusion, where disability does not affect an individual’s ability to participate in sports, others remain in the early stages of addressing participation in sport. These countries often rely on targeted programs specifically designed to facilitate the participation of persons with disabilities. Discussion: The analysis reveals significant disparities in how countries report and implement sport-related provisions under the UNCRPD. Ambiguities in categorizing elite versus recreational sport, underreporting of existing programs and entities, and limited references to strategic frameworks like the Kazan Action Plan highlight inconsistencies in reporting. Assistive technology (AT), while widely acknowledged across UNCRPD articles, is rarely linked to sport, despite its critical role in facilitating access and participation. These gaps suggest a need for clearer guidelines and more comprehensive reporting to ensure inclusive and equitable sport opportunities for persons with disabilities. Conclusions: There are notable disparities among countries’ reports in terms of mentioning participation for people with disability in sport, with some mentioning greater emphasis in integration and accessibility than others. To advance the UNCRPD rights through sport, clearer guidelines, standardized terminology, and more comprehensive reporting practices are essential. Full article

Since its emergence two decades ago, podcasting has spurred a rapidly evolving body of scholarship examining its social, technological, political, and cultural impact. However, much of podcast theory relies on analytical frameworks derived from other media. Moving beyond the binary debate that positions podcasting either as a wholly unique medium or merely an extension of radio, this article proposes a podcast-specific theoretical framework that advances a third approach within podcast studies. Rather than treating these perspectives as mutually exclusive, this approach synthesizes their strengths, recognizing podcasting’s broad esthetic range and time-shifted consumption patterns alongside its narrative lineage in radio drama and longform storytelling. In doing so, it situates podcasting within the genealogy of longform documentary journalism, aligning it with the evolving structures of digital publishing. At the intersection of podcast and journalism studies, this historically informed paradigm foregrounds three defining characteristics of podcast journalism: intimacy (manifested in personal narratives and parasocial relationships), reflexivity (evident in metajournalistic transparency and postmodern approaches to evidence), and democracy (leveraging progressive inclusivity or its oppositional countercurrents). While these features may be adapted or subverted across different productions, they remain core conventions that distinguish podcast journalism as a unique form of narrative digital media. Full article

Background: Childhood obesity continues to pose a major global health challenge, and schools offer a structured and scalable setting for implementing physical activity programs. However, the effectiveness of these interventions remains inconsistent. This systematic review synthesizes evidence from school-based physical activity interventions and evaluates their impact on obesity-related parameters, physical activity levels, physical fitness, and cardiorespiratory fitness among children. Methods: A comprehensive search of PubMed, Scopus, and the Cochrane Library identified randomized controlled trials published between January 2015 and March 2025. Eligible studies included children aged 5–18 years and assessed school-based physical activity interventions. Outcomes included BMI, body fat percentage, physical activity levels (including MVPA), physical fitness, and cardiorespiratory fitness. Due to methodological heterogeneity, a narrative synthesis was conducted. Results: A total of 28 studies met inclusion criteria. Among the 16 studies reporting obesity-related outcomes, 7 demonstrated statistically significant improvements in BMI or BMI z-scores, while 6 of 16 (37.5%) showed no measurable effect. Reductions in body fat percentage were more consistently observed (5 of 6 studies). Both short-term (<6 months) and long-term (>12 months) interventions showed comparable proportions of studies with statistically significant BMI improvements (~50%). For physical activity outcomes, 5 of 11 studies reported increased MVPA, whereas others showed no significant change. Sedentary behavior outcomes were mixed, with only 2 of 6 studies demonstrating significant reductions. Improvements in physical fitness were reported in two-thirds of studies, while cardiorespiratory fitness improvements were inconsistent, with significant gains observed primarily in higher-intensity or well-structured programs. Across outcomes, several findings were statistically significant but modest in clinical magnitude. Conclusions: School-based physical activity interventions have the potential to improve select obesity-related parameters, particularly body fat percentage and BMI in a subset of studies. However, effects on MVPA, sedentary time, overall activity levels, and cardiorespiratory fitness remain variable. The effectiveness of these programs appears influenced by intervention structure, intensity, and adherence rather than duration alone. Future interventions should incorporate tailored, multi-component approaches to enhance both clinical relevance and long-term sustainability. While several effects were statistically significant, most were modest in magnitude. However, even modest improvements in BMI z-score, body fat percentage, and fitness can be meaningful at a population level, particularly when delivered through universal, scalable school platforms that reach large numbers of children. Full article

Background: An anterior cruciate ligament (ACL) rupture is one of the most psychologically demanding injuries in professional sport. This study aimed to describe a structured psychological intervention conducted during the rehabilitation process following an ACL rupture in a professional female futsal player. Methods: A single-case longitudinal design was implemented with three phases (pre-test, intervention, post-test) across a 12-month rehabilitation period. Psychological assessment was conducted at four key points: initial evaluation, rehabilitation follow-up, medical discharge, and three- and six-month follow-ups. The battery included perfectionism (FMPS), anxiety (STAI), depression (BDI-II), mental health indicators (DASS-21, GHQ-12), sleep quality (PSQI), pain perception and catastrophizing (VAS, PCS), mood states (POMS), psychological readiness for return to play (PRIA-RS), and perceived intervention effectiveness. The program consisted of 15 individual sessions plus a follow-up, combining cognitive–behavioral therapy principles, mindfulness-based techniques (relaxation, body scan, visualization), cognitive restructuring, sleep hygiene, goal setting, problem-solving, and emotional expression strategies. Results: Progressive and sustained improvements were observed in mood states and pain catastrophizing, along with enhanced sleep quality, psychological readiness, and reintegration into competition. Improved overall mental health indicators were also observed, supporting adherence to rehabilitation and return-to-play confidence. Conclusions: This case highlights the relevance of structured psychological intervention as an integral component of injury rehabilitation in professional athletes with ACL rupture, supporting its inclusion in multidisciplinary care and future research to optimize recovery and prevent maladaptive outcomes. Full article

The European Water Framework Directive (2000/60/EC) (WFD) aims to protect inland surface waters, transitional waters, coastal waters and groundwater. The overarching goal of the WFD is to reach a good aquatic ecosystem throughout all of Europe. With the aim of reaching this goal, article 4 of the WFD sets certain environmental objectives. According to article 4 of the WFD, all the surface water bodies falling under its scope should be of good chemical and ecological quality by the end of 2027, as most extension deadlines will expire. For artificial and heavily modified surface water bodies—which make up the vast majority in the Netherlands—the goal is not to achieve a good ecological status but instead a good ecological potential and a good chemical status. Point source discharges may have a major impact on water quality and in order to progress, a well-functioning permitting, supervision and enforcement (PSE) process is of considerable interest. So far little academic attention has been paid to the functioning and quality of the governance processes underlying the PSE process. This paper aims to reduce this knowledge gap by conducting a case study on Sitech, the wastewater company for the Chemelot industrial complex in Geleen in the province of Limburg, the Netherlands. We first elaborate on an assessment framework consisting of 18 good governance criteria. The framework is used to assess the permitting, supervision and enforcement process concerning the discharges of Chemelot industrial plant. Our assessment reveals that, despite significant improvements over the last decade, good governance in this case is only partially achieved. While in terms of accountability and resilience the process shows robust strengths, gaps are found in its inclusiveness, effectiveness and transparency. We conclude our paper with some reflections on the generalizability of our findings and some suggestions for further research and policymaking. Full article

Objective: Pediatric overweight and obesity represent a growing public health concern with significant long-term implications. In children diagnosed with attention-deficit/hyperactivity disorder (ADHD), stimulant medications may alter appetite, potentially impacting body weight and growth patterns. However, real-world data on the effect of these treatments on body mass index (BMI) classification remains scarce. We aimed to evaluate the effect of ADHD stimulant therapy on transitions in the BMI categories among children. Study Design: We conducted a large-scale observational cohort study assessing longitudinal changes in BMI classification following the initiation of stimulant treatment, utilizing data from Clalit Health Services, Israel’s largest healthcare provider. BMI was categorized into four groups: normal weight, overweight, obesity, and severe obesity. Subgroup analysis was performed by sex and age groups: <7 years; >7 <13 years and >13 <18 years. Results: At baseline, 26,930 children met the study inclusion criteria. 12,448 (46%) were classified as overweight or obese. Most children with normal weight at baseline maintained their BMI classification (90%). 48% of children with overweight, 42% with obesity, and 29% with severe obesity transitioned to a lower BMI category. 39% of children with underweight transitioned to normal weight. Similar patterns in BMI category transitions were observed between sexes. Transition to a lower BMI category was more prevalent in the younger age group. Conclusions: Stimulant therapy for ADHD is associated with significant shifts in BMI classification among pediatric patients. While many children, especially younger with higher baseline BMI, experienced improvements in weight status, a notable minority exhibited weight gain. These findings underscore the importance of routine BMI monitoring and weight management strategies during ADHD treatment. Full article

Objective: Intraoperative hypothermia is a common perioperative complication. This large-scale, multicenter, prospective clinical study aimed to delineate the occurrence patterns of intraoperative hypothermia in adults and to identify its major independent risk factors, thereby providing evidence-based support for early clinical risk assessment and intervention. Methods: This study adopted a multicenter, prospective, observational design. Eligible participants were screened based on predefined inclusion and exclusion criteria, and a total of 4516 surgical patients (≥18 years) from 12 tertiary general hospitals across China were ultimately enrolled. Core body temperature was continuously monitored intraoperatively using standardized methods. Data on demographic characteristics, surgical and anesthesia-related parameters, and perioperative temperature management interventions were collected. Patients were stratified into groups according to the presence or absence of hypothermia (core temperature <36.0 °C). Univariate analyses were first conducted to identify associated factors, followed by multivariable logistic regression to determine factors independently associated with intraoperative hypothermia. Results: The overall incidence of intraoperative hypothermia among surgical patients was 23.82%. Hypothermia occurred most frequently in patients with a preoperative baseline core temperature ≤ 35.9 °C (85.93%). Among surgical specialties, hand surgery had the highest incidence of hypothermia (51.35%), and among surgical sites, procedures involving the upper extremities showed the highest rate (35.00%). Multivariable logistic regression analysis identified the following as independent risk factors for intraoperative hypothermia: Type of anesthesia (OR = 1.743, 95% CI: 0.834–3.644), ASA classification (OR = 1.408, 95% CI: 1.197–1.657), Surgical approach (OR = 0.735, 95% CI: 0.577–0.936), Skin disinfection site (OR = 2.024, 95% CI: 1.534–2.670), Volume of cold intravenous fluids infused (mL) (OR = 1.365, 95% CI: 1.140–1.633), Volume of transfused blood (U) (OR = 1.116, 95% CI: 0.807–1.542), Intraoperative blood loss (mL) (OR = 1.252, 95% CI: 0.892–1.756), and Duration of surgery (hours) (OR = 2.014, 95% CI: 1.683–2.411). Conclusions: The incidence of intraoperative hypothermia in adults was relatively high at 23.82% and was observed to be associated with multiple modifiable perioperative factors. These findings support the need to strengthen risk assessment and implement individualized temperature management strategies in clinical practice, with the goal of reducing the risk of intraoperative hypothermia and improving perioperative safety and outcomes. Full article

This study explores the interrelationships between community participation, environmental awareness and education, heritage conservation, and sustainable tourism development in shaping quality of life and conservation support in the Mt. Rtanj protected area, Serbia. Using a quantitative approach, data were collected from local residents of Boljevac and Sokobanja municipalities and analyzed through structural equation modeling (SEM). The results confirmed all hypothesized relationships, indicating that active participation and environmental education significantly enhance sustainable tourism development, conservation support, and quality of life. The findings highlight the need for inclusive governance, environmental education programs, and equitable benefit-sharing mechanisms to strengthen local engagement in sustainable tourism. This study contributes to the limited body of literature on sustainable tourism in Southeast European Mountain regions and offers a replicable framework for community-based conservation and development, aligned with the United Nations Sustainable Development Goals (SDGs 8, 12, and 15). Full article

Schools situated in indigenous territories have historically replicated Western Eurocentric spatial models, often excluding local cultural knowledge and practices. This exclusion has impacted students’ emotional well-being, learning quality, and the contextual relevance of pedagogical approaches. This study aims to explores the socio-ecological context of school spaces in Mapuche territories in La Araucanía, Chile, and examines how teachers perceive these spaces and their influence on emotional regulation and learning. Using a qualitative multi-case study design, data were collected from three schools in Cholchol, Nueva Imperial, and Toltén through land cover/use mapping within a 3 km radius and semi-structured interviews with 15 teachers. Analysis was conducted using constructivist grounded theory. The findings reveal that schools are embedded in landscapes comprising agricultural zones, water bodies, monoculture plantations, and nearby Mapuche communities. Teachers conceptualize school spaces beyond physical infrastructure, recognizing socio-ecological and cultural dimensions. However, school design remains predominantly Western and monocultural, with limited integration of Mapuche spiritual and territorial elements. The main contribution of this research is to provide empirical evidence that strengthening the connection between school spaces and their biocultural context can enhance students’ sense of belonging, emotional regulation, and learning. This study advances the topic by highlighting the critical role of teachers’ perceptions and the socio-ecological context in the design of intercultural and sustainable schools, offering a concrete framework for overcoming regulatory and architectural limitations that continue to impede the implementation of inclusive public policies in indigenous educational settings. Full article

In precision agriculture, accurate, non-destructive estimation of fruit volume is crucial for quality grading, yield prediction, and post-harvest management. While vision-based methods provided some usefulness, fruits with complex geometry—such as mangosteen (Garcinia mangostana L.)—are difficult due to their large calyx, which may lead to difficulties in solving using traditional form-modeling methods. Traditional geometric solutions such as ellipsoid approximations, diameter–height estimation, and shape-from-silhouette reconstruction often fail because the irregular calyx generates asymmetric protrusions that violate their basic form assumptions. We offer a novel study framework employing both multi-view instance segmentation and hybrid geometrical feature modeling to quantitatively model mangosteen volume with traditional 2D imaging. A You Only Look Once (YOLO)-based segmentation model was employed to explicitly separate the fruit body from the calyx. Calyx inclusion resulted in dense geometric noise and reduced model performance ($R^2<0.40$). We trained eight regression models on a curated and augmented 900 image dataset ($N=720$, test $N=180$). The models used single-view and multi-view geometric regressors ($V\propto A^{1.5}$), polynomial hybrid configurations, ellipsoid-based approximations, as well as hybrid feature formulations. Multi-view models consistently outperformed single-view models, and the average predictive accuracy improved from $R^2=0.6493$ to $R^2=0.7290$. The best model is indeed a hybrid linear regression model with side- and bottom-area features—($A_s^{1.5}$, $A_b^{1.5}$)—combined with ellipsoid-derived volume estimation—($V_{\mathrm{ellipsoid}}$)—which resulted in $R^2=0.7290$, a Mean Absolute Percentage Error (MAPE) of 16.04%, and a Root Mean Square Error (RMSE) of 31.9 ${\mathrm{cm}}^3$ on the test set. These results confirm the proposed model as a low-cost, interpretable, and flexible model for real-time fruit volume estimation, ready for incorporation into automated sorting and grading systems integrated in post-harvest processing pipelines. Full article