Search Results (118)

Background/Objectives: Gestational diabetes (GD), which affects approximately 15% of pregnancies worldwide, poses significant risks to both maternal and fetal health, underscoring the need for effective prevention and management strategies. This umbrella review aims to evaluate the role of probiotics in the prevention of GD. Methods: The review was conducted in accordance with the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis. A comprehensive literature search was performed in November 2024 across four databases: PubMed/Medline, Cochrane Library, Embase, and CINAHL. A total of 307 articles were identified, of which 6 met the inclusion criteria and were included in the final synthesis. Results: Probiotic supplementation was associated with a significant reduction in the incidence of GD in selected populations, particularly in women with a body mass index (BMI) < 26, age < 30 years [Relative Risk (RR): 0.58], and p < 0.05 in the other studies included, alongside improvements in several metabolic parameters. However, consistent benefits on maternal or neonatal complications were not observed but a 33% reduction in GD was confirmed (RR 0.67). The combination of probiotics with healthy lifestyle behaviors appeared to exert a stronger protective effect against GD and its potential complications. Conclusions: This umbrella review suggests that probiotics—particularly multi-strain formulations—may have a potential role in reducing the risk of GD in certain populations. However, the findings across the included studies are inconsistent and sometimes conflicting. While probiotics are generally considered safe and have recognized benefits for metabolic health, their efficacy as an adjunct intervention for GD prevention remains not fully clear. Further well-designed research is needed to clarify which specific probiotic interventions may be effective and to better guide clinical practice. Full article

High-albedo ground and wall materials are promoted to mitigate heat stress in tropical climates, yet conflicting evidence driven by climatic and metric variability make their impact on Outdoor Thermal Comfort (OTC) unclear. This study employed parametric simulations to assess how ground and wall albedo affect OTC, measured via the Universal Thermal Climate Index (UTCI) in typical urban canyons. Using ENVI-met, we tested ground albedo (0.2–0.8) and wall albedo (0.05–0.90) with emissivity fixed at 0.9. Findings reveal that ground albedo had a minimal impact on the UTCI (mean amplitude 0.44 °C), while wall albedo reduced the UTCI by up to 2.80 °C, prioritizing wall material selection for heat mitigation. It was also found that the increase in ground albedo offsets the cooling potential of high-albedo walls. Furthermore, differences in the impact under shaded and unshaded areas were observed. These results question assumptions of universal high-albedo benefits, recommending case-specific simulations in urban design. Full article

As human activities increasingly encroach on ecologically sensitive lake zones, China’s lake-ring urban agglomerations struggle to balance the intensifying human footprint (HF) and declining habitat quality (EQ). Addressing the spatiotemporal interactions between HF and EQ is essential for achieving human–environment coordination. This study examined five major freshwater lake-ring urban agglomerations in China during the period from 2000 to 2020 and developed an HF–EQ assessment framework. First, the coupling coordination degree (CCD) model quantified the spatiotemporal coupling between HF and EQ. Second, GeoDetector identified how HF and EQ interact to influence CCD. Finally, the four-quadrant static model and CCD change rate index formed a dual-dimensional management framework. The results indicate that the spatiotemporal evolution patterns of HF and EQ are highly complementary, exhibiting a significant coupling interaction. High-CCD zones expanded from lakeside urban areas and transport corridors, while low-CCD zones remained in remote, forested areas. HF factors such as GDP, land use intensity, and nighttime lights dominated CCD dynamics, while EQ-related factors showed increasing interaction effects. Five human–environment coordination zones were identified based on the static and dynamic characteristics of HF and EQ. Synergy efficiency zones had the highest coordination with diverse land use. Ecological conservation potential zones were found in low-disturbance hilly regions. Synergy restoration zones were concentrated in croplands and urban–rural fringe areas. Imbalance regulation zones were in forest areas under development pressure. Conflict alert zones were concentrated in urban cores, transport corridors, and lakeshore belts. These findings offer insights for global human–environment coordination in lake regions. Full article

Background: Statins are commonly used cholesterol-lowering drugs with evidence of additional chemoprotective and immunomodulatory effects resulting from the inhibition of DNA replication, cell proliferation, and TH1-cell inhibition. There are conflicting reports regarding the potential benefit of concurrent statin treatment on non-muscle invasive bladder cancer (NMIBC) and specifically on intravesical Bacillus Calmette–Guerin (BCG) outcomes. We therefore aimed to analyze the effects of concurrent BCG and statin use in patients with NMIBC. Methods: National Veterans Affairs databases were used to retrospectively identify men with NMIBC between 2000 and 2010 who were treated with BCG. Pharmacy data was interrogated, and patients were divided according to statin therapy status. Statins had to be given at the beginning of BCG treatments and continued for at least 6 months. Cox proportional hazard ratios after inverse propensity score-weighted and competing risks adjustments were calculated for recurrence, secondary events (e.g., progression), cancer-specific survival, and overall survival. Results: Among 8814 patients, with a median follow-up of 11.3 years, statins were used by 38% of the patients. Patients taking statins were older (71 vs. 68, p < 0.0001), had more comorbidities (Charlson Comorbidity Index (CCI > 2; 38.6% vs. 31.4%, p < 0.0001), and had a higher-grade disease (40.2% vs. 34.3%, p < 0.0001) compared to those not on statins. After adjusting for stage, grade, age, race, CCI, agent orange exposure, and year of diagnosis, Cox proportional hazard analysis revealed no association with recurrence (HR 1.05, 95% CI 0.97–1.15, p = 0.23), secondary events (HR 0.91, 95% CI 0.80–1.05, p = 0.189), or bladder cancer specific survival (HR 0.88, 95% CI 0.76–1.02, p = 0.09) of statin use. However, statins were associated with improved overall survival (HR 0.89, 95% CI 0.83–0.96, p = 0.002). Conclusions: Concurrent statin and BCG use in patients with NMIBC was associated with improved overall survival, but not recurrence, secondary events, or bladder cancer-specific survival. These results confirm the real-world well-established cardiovascular benefit of statin treatment and primary preventive care. However, this large population study did not find any association between statins and the outcomes of patients with NMIBC treated with BCG immunotherapy. Full article

Urban thermal environment challenges in China have made outdoor thermal comfort a key factor in evaluating spatial quality and livability. Building layout not only affects internal performance but also shapes the microclimate of surrounding outdoor spaces. The climatic characteristics of temperate monsoon climate regions significantly impact residents’ outdoor activities. Most existing studies focus solely on either the external thermal environment or the buildings themselves in isolation. This study focuses on Beijing, a representative city in the temperate monsoon climate zone, and explores block-scale spatial optimization using computational typology. The objective is to balance architectural performance with outdoor thermal comfort in both winter and summer. Optimization targets include the Universal Thermal Climate Index (UTCI), winter sunshine duration, and summer solar radiation. Results show winter UTCI can be optimized to −6.13 °C to −1.18 °C and summer UTCI to 28.19 °C to 29.17 °C, with greater optimization potential in winter (23.5% higher). Synergistic relationships are observed between winter comfort and sunshine duration (coefficient: 0.777) and between summer comfort and solar radiation (coefficient: 0.947). However, trade-offs exist between seasonal comfort indicators, with strong conflicts between winter and summer objectives. Two distinct form types—“low-south-high-north enclosed” for winter and “high-rise point-type low-density” for summer—are identified as effective for seasonal adaptation. The study proposes an integrated method combining data-driven generation, multi-objective optimization, and clustering-based decision-making. This approach moves beyond traditional empirical design, offering a quantitative and adaptable strategy for climate-responsive urban block planning and supporting low-carbon urban transformation. Full article

Background and Objectives: Padua (1997) and Bland (2000) have already proposed neurophysiological classification scales for patients with carpal tunnel syndrome (CTS), where the absence of orthodromic sensory response is used as a criterion of a severe stage. We hypothesized that antidromic values cannot be used equally for correct staging. Materials and Methods: We performed a consecutive investigation with nerve conduction studies in 60 arms of patients with CTS and prolonged distal motor latency. Results: In 11 out of 60 arms (18.3% of cases), orthodromic sensory nerve action potential (SNAP) was undetectable, while the antidromic SNAP was present. ROC curve analysis with Yoden index calculation were utilized in the study. The cut-off value of antidromic SNAP amplitude as a diagnostic marker of unrecordable orthodromic SNAP was 3.9 µV with high sensitivity and specificity. Conclusions: Our findings conflict with Padua et al.’s assertion that CTS staging can be determined irrespective of the stimulation technique. Antidromic SNAP amplitude is the most reliable parameter for predicting the absent orthodromic SNAP. Our study addresses the bias associated with the application of antidromic stimulation of median nerve sensory fibers for accurately staging moderate to severe CTS. Full article

Background/Objectives: Patient safety is directly linked with health and wellbeing of healthcare workers. In the UK, COVID-19 severely disrupted healthcare, with surgeons tackling prolonged waiting lists and working longer hours under high stress. This study explored the biomechanical and psychosocial demands on hospital surgeons, as well as their experience of pain and work-life balance post-pandemic. Methods: A questionnaire was developed combining validated tools assessing physical demands; modified job demand, control, and support; the WHO-5 wellbeing index; work–life balance from the Copenhagen Psychosocial Questionnaire; musculoskeletal pain; job satisfaction and retirement intentions. An online survey was developed using the Qualtrics© (Provo, UT, USA) platform and circulated through surgical networks using snowball sampling. Poisson regression modelling with robust confidence intervals was used to explore relationships between work-related factors and musculoskeletal pain, and associations with retirement intentions. Results: In total, 242 replies were received. Surgeons frequently reported strenuous occupational activities and work–life imbalance, and one in six reported job dissatisfaction. Only 17% reported no pain; the one-month prevalence of pain ranged from 46% at the lower back to 12% at the ankle, and pain was frequently disruptive. Better work–life balance had a protective effect for pain (PRR = 0.92, 95% CI = 0.85–0.99), while risk of pain increased with increasingly physically demanding activities at work (PRR = 1.04, 95% CI = 1.01–1.07) in the age- and sex-adjusted models. Job dissatisfaction was associated with intention to retire early (PRR = 1.83, 95% CI = 1.02–3.27). Conclusions: This study demonstrated high physical and mental demands among surgeons and poor work–life balance. Physical and emotional links to pain were identified. Fit surgeons ensure safe patient care. Our findings suggest that surgeons were facing health issues and work–life conflict post-pandemic, potentially limiting their job satisfaction and career span. A follow-up study is recommended. Full article

Despite the growing popularity of organic foods, research on their effects on human health, particularly regarding cancer and diabetes, remains limited. While some studies suggest potential health benefits, others yield conflicting results or lack sufficient evidence to draw conclusions. Understanding the causal relationship between organic food consumption and health outcomes is challenging, especially with limited datasets. Our study examines the correlation between organic food consumption and the prevalence of cancer and diabetes in European nations over time. We compared these findings with data from 100 Italian citizens regarding their perceptions of organic food’s health benefits collected through a novel questionnaire. To identify patterns, we applied Affinity Propagation clustering to group countries based on organic food consumption and disease prevalence. We also created an animated map to visualize cluster progression over time and used the Global Multiplexity Index to evaluate consistency. Our analysis revealed two subgroups of European countries exhibiting significant similarities in organic food consumption and health outcomes. The clustering analysis performed year-by-year on three variables across European nations using the Affinity Propagation algorithm revealed that two clusters consistently maximized the Global Multiplexity Index over time. The first cluster included Belgium, Finland, Ireland, Italy, and Spain, while the second comprised Bulgaria, Turkey, Romania, Ukraine, Czech Republic, Hungary, Poland, Greece, and Russia. These clusters displayed distinct trends concerning sustainable development goals (SDGs) related to organic farming and non-communicable diseases. Additionally, mapping SDG indicators along with geographic and socio-economic factors supported our findings. Moreover, we introduced a novel dataset and offered insights into both the European context and the Italian scenario, contributing to further research on organic food’s impact on public health. Full article

Background: Vitamin D deficiency is recognized as a significant public health concern, and it has been identified as one of the potentially modifiable risk factors for mild cognitive impairment (MCI). However, evidence regarding the relationship between vitamin D status and cognitive function remains conflicting. Objective: Therefore, this study aimed to examine the prevalence of vitamin D deficiency in the Thai elderly population and an association between vitamin D status and cognitive function, adiposity, and insulin sensitivity. Methods: This study enrolled participants aged 55–80 years with normal cognitive function (normal group) or MCI from the prospective cohort in the “Holistic approach of Alzheimer’s disease in Thai people (HADThai study)”. We used the baseline clinical data to determine the prevalence of vitamin D deficiency and its association between vitamin D status and cognitive function, adiposity, and insulin sensitivity. Results: A total of 718 subjects (71.9% women) with a mean age of 65.7 ± 5.8 years and a mean BMI of 23.9 ± 3.7 kg/m² were enrolled. There were 470 (65.5%) participants with normal cognitive function and 248 (34.5%) with MCI. Vitamin D status did not differ significantly between individuals with normal cognitive function and those with MCI. The prevalence of vitamin D deficiency (<20 ng/mL) and vitamin D inadequacy (<30 ng/mL) in both normal cognitive function and MCI was around 6.5% and 40.0%, respectively. While serum 25(OH)D concentrations were inversely associated with body mass index (BMI), body fat, %body fat, and the homeostasis model assessment of insulin resistance (HOMA-IR), no relationship was found between vitamin D status and cognitive function. Conclusions: Our study emphasized the high prevalence of vitamin D inadequacy among elderly individuals and an inverse association of vitamin D status and adiposity and insulin resistance. These findings emphasize the importance of addressing vitamin D deficiency in the elderly population to improve overall health outcomes. Nevertheless, our results do not support a direct role of vitamin D status in cognitive decline in this population. Further research, particularly studies with longer follow-up periods and the inclusion of patients with dementia with details of vitamin D supplementation, is needed to clarify the potential role of vitamin D in cognitive decline and neurodegenerative diseases. Full article

This study investigates the multifractal characteristics of the tanker freight market from 1998 to 2024. Using multifractal detrended fluctuation analysis (MF-DFA) and multifractal detrending moving average (MF-DMA), we analyze temporal correlations and volatility, revealing subtle differences in multifractal features before and after 2010. We further examine the influence of key external factors—including economic disturbances (the 2008 financial crisis), technological innovations (the 2014 Shale Oil Revolution), supply chain disruptions (the COVID-19 pandemic), and geopolitical uncertainties (the Russia–Ukraine conflict)—on market complexity. Building on this, a predictive framework is introduced, leveraging the Baltic Dirty Tanker Index (BDTI) to forecast Brent oil prices. By integrating multifractal analysis with machine learning models (e.g., XGBoost, LightGBM, and CatBoost), our framework fully exploits the predictability from the freight index to oil prices across the above four major global events. The results demonstrate the potential of combining multifractal analysis with advanced machine learning models to improve forecasting accuracy and provide actionable insights during periods of heightened market volatility. On average, the coefficient of determination (R²) increases by approximately 62.65% to 182.54% for training and 55.20% to 167.62% for testing, while the mean squared error (MSE) reduces by 60.83% to 92.71%. This highlights the effectiveness of multifractal analysis in enhancing model performance, especially in more complex market conditions post-2010. Full article

The Darfur conflict, which emerged in the early 21st century, represents a multifaceted crisis driven by socio-political and environmental factors, with resource scarcity, exacerbated by climate change, playing a pivotal role in intensifying tensions between agricultural and pastoral communities. While climate change is typically associated with adverse environmental outcomes, an analysis of data spanning four decades (1980–2023) reveals a contrasting trend of increased precipitation, enhanced vegetation, and decreased drought frequency in recent years. This research explores the potential of these positive environmental changes to mitigate resource-based conflicts and foster political stability in Darfur as improved environmental conditions are posited to create a foundation for conflict resolution and sustainable peacebuilding. The present study integrates trends in the Enhanced Vegetation Index (EVI) and the Standardized Precipitation Evapotranspiration Index (SPEI) to examine these shifts. EVI data, derived from the Moderate Resolution Imaging Spectroradiometer (MODIS) at a 250 m resolution, was used to assess large-scale vegetation patterns in arid and semi-arid landscapes. The Autoregressive Integrated Moving Average (ARIMA) model was employed to forecast future precipitation scenarios up to the year 2034, enhancing the understanding of long-term climatic trends. Data processing and analysis utilized advanced tools, including Google Earth Engine (GEE), ArcGIS Pro (version 3.4), and R software (version 4.3.2). The findings reveal a significant (33.19%) improvement in natural vegetation cover between 2000 and 2023, with degraded and unchanged areas accounting for 1.95% and 64.86%, respectively. This finding aligns with a marked increase in annual precipitation and a reduction in drought intensity over the study period. Historical SPEI analysis showed persistent drought events between 1980 and 2012, followed by a notable decline in drought frequency and severity from 2013 to 2024. Precipitation projections suggest a stable trend, potentially supporting further vegetation recovery in the region. These environmental improvements are preliminarily linked to climate-change-induced increases in precipitation and reductions in drought severity. This study’s findings contribute to a nuanced understanding of the interplay between environmental dynamics and socio-political stability in Darfur, offering actionable insights for policy interventions aimed at fostering sustainable peace and resilience in the region. Full article

This research investigates the potential of computational argumentation, specifically the application of the Abstract Argumentation Framework (AAF), to enhance the evaluation of deliberative quality in public discourse. It focuses on integrating AAF and its related semantics with the Discourse Quality Index (DQI), which is a reputable indicator of deliberative quality. The motivation is to overcome the DQI’s constraints using the AAF’s formal and logical features by addressing dependency on hand coding and attention to specific speech acts. This is done by exploring how the AAF can identify conflicts among arguments and assess the acceptability of different viewpoints, potentially leading to a more automated and objective evaluation of deliberative quality. A pilot study is conducted on the topic of abortion to illustrate the proposed methodology. The findings of this research demonstrate that AAF methods can improve discourse analysis by automatically identifying strong arguments through conflict resolution strategies. They also emphasise the potential of the proposed procedure to mitigate the dependence on manual coding and improve deliberation processes. Full article

Frailty is a key concept in geriatric care; yet its definition and assessment remain debated. Since the early 2000s, two main models have emerged: the Fried frailty phenotype, focusing on physical deficits, and the Mitnitski frailty index, which incorporates broader health factors. These divergent approaches have led to over 50 frailty instruments, reflecting the absence of a unified framework. This review explores the content, weighting, and scoring methods of frailty instruments, identifying potential concerns derived from this. This review exposes the overlap of frailty with other constructs including function, disability, morbidity, and sarcopenia. Many instruments lack content validity, and detect highly heterogeneous samples within and between scales, all labeled under the “frail” tag. This poses challenges to interpreting instrument responsiveness. In addition, frailty should not be considered a clinical entity with a unique etiology. This review discusses how the broad nature of frailty conflicts with modern paradigms of individualization and precision. They may be useful in primary care, but lack the specificity for secondary care evaluations. This article also discusses how the predictive validity of frailty should be interpreted with caution. Finally, we summarize our findings and propose a new definition of frailty, highlighting the strengths and weaknesses of the construct. The identified inconsistencies should serve as a guide for refining the concept of frailty, both in research and in its application to geriatric care. Full article

With the rapid advancement of urbanisation and transit networks, exploring the spatial relationship between metro systems and cultural heritage is crucial for both heritage preservation and sustainable urban development. This study uses the nearest neighbour index, kernel density analysis, and spatial value evaluation to examine the distribution patterns of cultural heritage in Beijing and its spatial interaction with the metro network. The results show that different types of cultural heritage have distinct distribution characteristics: stone inscriptions are widely dispersed due to their need for preservation in natural settings; traditional villages and ancient tombs are shaped by historical and geographical factors; and industrial heritage is concentrated in areas of historical industrial activity, reflecting strong functional zoning traits. The metro network enhances the accessibility of cultural heritage, especially national- and provincial-level sites, which are predominantly clustered near metro stations. However, geographically isolated world heritage sites, such as the Great Wall and the Ming Tombs, remain less connected to the metro network, helping preserve their authenticity and avoid overdevelopment. Furthermore, thematic designs and cultural displays within Beijing’s metro stations successfully bridge the gap between history and modernity, positioning metro stations as key platforms for cultural dissemination. Nevertheless, metro construction presents challenges to heritage conservation, including potential impacts on site stability due to tunnelling and conflicts between modern station design and the aesthetic integrity of historic districts. These findings offer practical insights for cultural heritage preservation and transit planning in Beijing and serve as a reference for the sustainable development of other historic cities worldwide. Full article

Water stress has induced many environmental and developmental conflicts in the arid basins in the Middle East region under the context of climate change and increasing anthropogenic influence. Quantifying the anthropogenic influence on water stress at the basin scale is very challenging because of insufficient anthropogenic-related spatial data. Given that climate change is a global impact that is hard to mitigate at the basin scale, quantifying anthropogenic influence is practical to inform strategies for alleviating regional water stress. Thus, this study attempts to quantify the contribution of potential anthropogenic factors driving the water stress in the Tigris–Euphrates river basin (TERB) using pure spatial data. The water stress level in the studied basin was evaluated via the water stress index (WSI), which can be obtained as the ratio of water demand to water availability, from the Aqueduct 4.0 dataset. The driving contributions of social development (population, POP; fine particulate matter, PM2.5), economic development (gross domestic product, GDP; electricity consumption, EC), and landscape modification (urban expansion index, UEI; cultivated land expansion index, CEI) factors were quantitatively evaluated based on a spatial statistical geographical detector model (GDM). Assessment showed that nearly 66.13% of the TERB area was under severe water stress, particularly in Syria, Iraq, Saudi Arabia, and Iran. The q statistic of the GDM, adopted to quantify the contribution of driving factors, revealed that CEI (0.174), EC (0.145), and GDP (0.123) were the dominant factors driving water stress. These individual influences were further enhanced particularly in the interaction between economic development and landscape modification factors such as UEI and CEI (0.566), PM2.5 and UEI (0.350), EC and CEI (0.346), GDP and CEI (0.323), and PM2.5 and GDP (0.312). The findings of this research can provide some beneficial references to alleviate the TERB’s water stress for its future sustainable development. Full article