Search Results (4,410)

Background: This up-to-date narrative review examines the associations of low environmental exposure to toxic trace elements—arsenic (As), cadmium (Cd), lead (Pb), and mercury (Hg)—on pregnancy. While high levels are known to be harmful, the impact of low levels has not been fully analyzed. The aim was to summarize global data on As, Cd, Pb, and Hg levels in maternal and cord blood of healthy pregnant women, compare their distribution, and assess associations with demographic factors, lifestyle, and pregnancy outcomes. Methods: A systematic literature search was conducted in PubMed, Cochrane Library, and Scopus for studies published between 1 January 1990 and 14 May 2025. The review was conducted in accordance with PRISMA 2020 guidelines. A total of 824 records were assessed for eligibility, and 656 were excluded based on predefined criteria. Exclusion criteria encompassed in vivo or in vitro studies, non-English written publications, treatment-based studies, and studies involving occupationally exposed pregnant women. Inclusion criteria included original full-length research papers with cross-sectional, prospective cohort, or case–control designs; studies measuring As, Cd, Pb, and/or Hg in maternal and/or cord blood; and studies examining associations with demographic, lifestyle, and pregnancy outcomes. The review was not registered, and no external funding was received. Given the narrative synthesis approach of the review, a formal risk-of-bias assessment was not undertaken. Results: A total of 168 studies were included: 32 reported findings on As, 55 on Cd, 78 on Pb, and 64 on Hg, with 26 addressing all four elements. No meta-analysis was performed; results were summarized narratively. Results show that As and Cd levels are higher in maternal blood, whereas Pb and Hg, including methylmercury, are higher in cord blood. Key factors include smoking, rural residence, and fish or seafood consumption, linked to higher Cd, Pb, and Hg levels, respectively. Interpretation: Low Pb levels show the strongest associations with adverse pregnancy outcomes, while As shows the weakest. Pb’s effects may relate to passive placental diffusion, unlike other elements. Further studies are needed. Full article

Background/Objectives: Shoulder pain or instability have different causes and therefore different treatment approaches. The most common are surgical approaches, ranging from more conservative to more radical, such as arthroplasty. In the presence of irreparable rupture or tears of the supraspinatus and subscapularis muscles, particularly in younger patients without arthritis or osteoarthrosis, it becomes a surgical challenge to avoid early arthroplasty. Despite the development and proposal of various surgical techniques to restore stability and function, and eliminate pain of the glenohumeral joint, there remains a lack of consensus on the most effective approach in the absence of arthritis. This work aims to systematically review the available evidence on surgical procedures for treating shoulder joint instability and pain due to irreparable subscapularis and supraspinatus tendon tears, excluding cases with coexisting arthritis or arthrosis. Methods: This systematic review was conducted following PRISMA 2020 guidelines. Search was performed across the major databases PubMed, Scopus, and Web of Science, up to 2025. Inclusion criteria comprised clinical studies (randomised controlled trials, cohort studies, case series), reviews and systematic reviews reporting on surgical interventions for shoulder instability and pain caused by irreparable tears of the subscapularis and supraspinatus in patients without degenerative joint disease. As shoulder surgery techniques have been continually evolving since the early procedures, no lower limit was set for the time interval. The related literature that was not identified in the mentioned databases was added manually through parallel searches of associated themes and suggestions from the websites of those databases. To be eligible, papers had to describe shoulder instability surgery, surgical techniques, indications, and patients’ recovery outcomes. The key tasks, such as title and abstract screening, were performed by V. M., L. R., and M. A. N. to ensure thoroughness and reduce bias. Results: From an initial search result of 98 works, a total of 66 titles and abstracts were analysed, resulting in a final selection of 24 studies that fulfilled the mentioned criteria and were therefore included in this review. The oldest paper mentioning a shoulder surgery in this context was published in 2003. The most frequently described procedures included total joint replacement, tendon transfers, Superior Capsule Reconstruction, partial rotator cuff repair and others. Across studies, improvements were noted in shoulder stability, range of motion, and functional scores. However, heterogeneity in surgical techniques and outcome measures limited direct comparison. Conclusions: The conducted systematic review reveals an important gap and highlights the need to evolve beyond traditional shoulder surgery techniques and, if possible, to provide a single solution for the different origins of shoulder instability. Several surgical options demonstrate promising outcomes in managing shoulder instability and pain due to irreparable subscapularis and supraspinatus tears in patients without glenohumeral arthritis. However, those procedures are associated with anatomical changes in the shoulder joint, compromising the joint’s full function and prolonging recovery time. Nevertheless, this conclusion is based on a small sample size of the current literature and a lack of high-level evidence. Further comparative and long-term studies are needed to establish optimal treatment strategies. Full article

Background/Objectives: Minimally verbal autistic children face profound communication challenges that significantly affect daily functioning, including social interaction, behavioral regulation, and overall well-being. Identifying effective interventions is a key clinical-educational priority. This systematic review examines communication-focused interventions for these children, including both spoken language approaches and augmentative and alternative communication (AAC) strategies. Methods: The review was registered in PROSPERO and conducted following PRISMA-S guidelines. Four electronic databases were searched, and 18 studies met the inclusion criteria. Due to heterogeneity in study designs and outcome measures, a narrative synthesis was conducted, with subgroup analyses exploring sample characteristics, intervention types, targeted outcomes, and reported effects. Methodological quality of randomized controlled trials was assessed using the Cochrane Risk of Bias tool. Results: Interventions were implemented across clinical, educational, and home settings, using strategies such as Joint Attention, Symbolic Play, and Emotion Regulation, often combined with AAC technologies. Most included studies reported improvements in at least one communication outcome, although findings were heterogeneous and several studies reported mixed, subgroup-specific, or non-significant effects. The most consistent improvements were observed in spontaneous communication, particularly in interventions integrating developmental approaches with technological support. Conclusions: These findings highlight the value of individualized interventions. Future research should establish standardized definitions of “minimally verbal”, assess long-term outcomes, and adopt broader measures capturing both language and social-emotional development to enhance quality of life and inclusion. Full article

Background: Transverse maxillary discrepancies during mixed dentition can negatively affect occlusal development and facial harmony. Clear aligners have been increasingly proposed as an interceptive alternative to traditional expansion approaches, but the extent and nature of the transverse dentoalveolar changes associated with their use in growing patients remain incompletely defined. While previous reviews have qualitatively explored this topic, no prior meta-analysis has been conducted to provide a quantitative synthesis of these changes in mixed dentition. Methods: A comprehensive electronic search was conducted for English-language studies published from January 2019 to April 2026 using the PubMed, Ovid MEDLINE, Web of Science, Embase, and Cochrane Library databases. The final database search was performed on 30 April 2026. Randomized controlled trials, prospective studies, and retrospective studies evaluating transverse maxillary changes in growing patients treated with clear aligners were included. Case reports, reviews, and studies involving syndromic patients or surgical interventions were excluded. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. Furthermore, a meta-analysis of quantitative outcomes with sufficient comparability across studies was performed. Effect sizes were reported as standardized mean differences (SMDs). Results: From 40 screened records, a total of 7 studies were included in this review. The meta-analysis revealed a reasonably consistent trend toward increased transverse dimensions. The pooled SMDs were 0.685 (distal intermolar), 1.141 (mesial intermolar), 0.828 (transpalatal), 2.052 (intercanine transpalatal), and 1.541 (intercanine width). However, the magnitude of the effect remains uncertain because of the small number of included studies, methodological variability, heterogeneous outcome definitions, limited long-term follow-up, and substantial statistical heterogeneity observed for selected outcomes. Conclusions: The current evidence base reveals a reasonably consistent direction toward favorable transverse dentoalveolar changes with clear aligner therapy. However, the exact magnitude of the benefit remains uncertain due to methodological heterogeneity and the lack of robust long-term data. Due to the qualitative limitations of the included studies, the meta-analysis was intended to provide exploratory insights rather than definitive conclusions. Further high-quality studies with 3D imaging, standardized 3D outcomes, and long-term follow-up are needed to corroborate these results and guide clinical protocols. Full article

Background/Objectives: Mood disorders, such as major depressive disorder (MDD) and bipolar disorder (BD), along with obstructive sleep apnea (OSA), are prevalent conditions that have serious effects on affected individuals and public health. These issues have received more attention recently, as research shows there are similar risk factors and they can influence each other by worsening symptoms and treatment response. However, there is still no clear understanding of the extent of this co-occurrence and the factors that influence it. Methods: A systematic review of comorbid OSA and mood disorders was conducted from EMBASE, Ovid MEDLINE, Global Health, and APA PsycINFO (1 January 2013–25 July 2025), with meta-analyses applying random-effects models in R (metafor). Heterogeneity, publication bias, subgroup effects, and meta-regression analyses were performed by assessing demographic, clinical, and study quality variables. Results: Out of 6221 screened studies, 23 articles met eligibility criteria, yielding 2,380,986 OSA patients, with 446,495 comorbid mood disorders (MDD = 446,290; BD = 205), and 5724 mood disorder patients (MDD = 1987; BD = 3737) with 450 comorbid OSA. All meta-analyses demonstrated a significant prevalence of comorbidity, accompanied by substantial heterogeneity. Meta-regression analyses identified mean age (β = 0.18, 95% CI 0.03–0.33, p = 0.02) and mean body mass index (β = −0.18, 95% CI −0.32 to −0.04, p = 0.01) as significant moderators of OSA prevalence. Conclusions: This meta-analysis indicates a high prevalence of comorbidity between OSA and mood disorders, including MDD and BD, with significant heterogeneity. Age and body mass index emerged as significant moderators of OSA prevalence, emphasizing the need for systematic screening and tailored approaches in both clinical practice and research. Full article

Monocular depth estimation for ${360}^{\circ }$ omnidirectional images is essential for immersive scene understanding and 3D reconstruction but remains challenging due to the non-uniform geometric distortions introduced by equirectangular projection (ERP). In particular, ERP suffers from latitude-dependent sampling bias, where the effective receptive field of standard convolution varies with the spherical latitude, leading to inconsistent feature representation and degraded depth prediction in high-distortion regions. To address this problem, this paper proposes a distortion-aware bi-projection fusion framework that integrates the global contextual continuity of ERP with the locally distortion-reduced geometric representation of cube map projection (CMP). The core component of the proposed framework is a Multi-scale Coordinate-Transformer Fusion (MCTF) module, which combines convolutional feature mixing, Transformer-based global context modeling, and Coordinate Attention-based spatial recalibration. By explicitly encoding vertical coordinate information into the fusion process, MCTF adaptively recalibrates feature responses according to latitude-dependent distortion patterns. Extensive experiments on the 3D60, Matterport3D, and Stanford2D3D benchmarks demonstrate that the proposed method consistently outperforms state-of-the-art omnidirectional depth estimation approaches. On the 3D60 dataset, our method reduces RMSE by 21.2% compared with the ERP baseline and achieves a 30% RMSE reduction in polar regions, where ERP distortion is most severe. These results validate the effectiveness of coordinate-aware feature calibration for robust ${360}^{\circ }$ monocular depth estimation. Full article

This study evaluates a DR-GEE approach based on Doubly Robust Generalized Estimating Equations for marginal inference under a hybrid informative cluster size structure. Hybrid informative cluster size refers to situations where cluster size can be related to both the marginal response variable and the distribution of covariates associated with the response. The proposed approach aims to achieve a cluster-balanced marginal estimator designed to mitigate the excessive influence of cluster sizes. To this end, the method combines a flexible cluster-size weighting component, defined by the α adjustment parameter, with an augmentation term derived from the study’s outcome model. Thus, both the direct cluster size–outcome relationship and the imbalance in the distribution of covariates are taken into account. A comprehensive Monte Carlo simulation evaluated performance under varying informativeness levels (γ = 0.1, 0.5, 1.0) and average cluster sizes (λ = 3, 5, 8). DR-GEE was compared with standard GEE, CWGEE, WCR, and DWGEE across different tuning parameters (α = 0.25, 0.50, 1.0). The results show that DR-GEE with α = 1 generally achieved the most favorable performance under hybrid ICS conditions. For example, when γ = 1 and λ = 5, GEE exhibited substantial bias (0.538) and high RMSE (0.566), whereas DR-GEE (α = 1) markedly reduced bias (0.076) and RMSE (0.224). Unlike CWGEE and DWGEE, which address only one dimension of informativeness, DR-GEE balances both cluster size–outcome dependence and covariate information. Full article

Background: Micro- and nanoplastics (MNPs) are emerging contaminants increasingly detected in human tissues and biological fluids. Their presence in blood, vascular tissues, thrombi, and atherosclerotic plaques raises concern about their possible association with cardiovascular disease. This systematic review synthesized evidence on associations between MNPs and cardiovascular pathology. Methods: A systematic search was conducted in October 2025 in PubMed, Scopus, Web of Science, and Embase according to PRISMA guidelines and a PICOS-based strategy. Original human studies from the last 10 years were eligible. Fourteen studies were included. Due to methodological heterogeneity, a narrative synthesis was performed. Risk of bias was assessed using ROBINS-E, and certainty of evidence was evaluated using a GRADE-informed approach. Results: MNPs were detected in multiple cardiovascular-related matrices. Included studies suggested possible associations with major adverse cardiovascular events, acute coronary syndrome, myocardial infarction, arterial stenosis, vascular calcification, thromboembolic disease, hypertension, inflammatory markers, coagulation-related parameters, and lipid profiles. However, the certainty of evidence was very low, and most studies had a high or very high risk of bias. Conclusions: Current evidence suggests a possible association between MNPs and cardiovascular pathology, but causality remains unproven. Larger prospective studies using standardized detection protocols, rigorous contamination control, and adjustment for confounders are needed. Full article

A long-term, consistent dataset of blowing snow (BLSN), a common phenomenon over Antarctica, is essential for ice sheet mass balance analysis. While space-borne lidar missions such as Cloud–Aerosol Lidar and Infrared Pathfinder Satellite Observation (CALIPSO) and Ice, Cloud, and Land Elevation Satellite (ICESat-2) have provided valuable continental-scale BLSN observations, their temporal resolutions and spatial reaches present notable limitations. Using CALIPSOs for training, a machine learning approach has been developed to generate hourly Antarctic BLSN data on the Modern-Era Retrospective Analysis for Research and Applications, Version 2 (MERRA-2) grid, extending back to the 1980s. ICESat-2 observations are used to assess the post-CALIPSO period; the results demonstrate greater bias with BLSN layer heights and better agreement with BLSN fraction and optical depth. When compared with ground-based observations, MERRA-2 exhibits a comparable and lower BLSN fraction and lower layer heights than those recorded by ceilometers. This data record represents the longest continuous BLSN data record to date. This study provides an overview of key BLSN properties, including occurrence, height, and optical depth. The results highlight strong seasonal patterns: BLSN occurrence peaks during Antarctic winter, while both height and optical depth are higher in summer with no statistically significant trend. Spatially, East Antarctica exhibits higher BLSN occurrence than West Antarctica. Full article

Large online marketplaces increasingly rely on multi-stage ranking pipelines where a learned relevance model is complemented by business-aware constraints such as contractual pacing, exposure caps and commercial alignment objectives. This paper develops a second-stage, contract-aware re-ranking layer for real-estate recommendation that explicitly balances user–item relevance with plan fulfillment, lead value and operational guardrails. The proposed multi-objective re-ranker (PMOR) combines a calibrated base relevance score with multiplicative business adjustments and subtractive penalties for approaching contractual caps and for within-slate similarity. The method supports heterogeneous settlement models, including pay-per-action and fixed-fee contracts, via contract-specific weights. Because the scoring function is deterministic and structured, it admits exact component-wise contribution analysis and counterfactual ablations without relying on surrogate explainability methods. Offline evaluation on production logs from an anonymized marketplace covers 4219 recommendation requests and 184,147 candidate items, joined with daily business snapshots using an as-of strategy to prevent look-ahead bias. Under a profit proxy based on effective lead value, position discounting and billability, PMOR achieves an indexed expected-revenue proxy of 487.4 (baseline = 100), corresponding to a lift of 387.4% over a model-only baseline and 48.4% over a legacy production re-ranker (LPR). The gain is primarily associated with improved billable exposure, increasing the share of billable positions in TOP-3 to 78.22% compared with 37.85% for LPR. We discuss parameter sensitivity, operational considerations and limitations of offline proxy objectives for deployment. Full article

Large language models (LLMs) have become central to how people access and interact with information, yet their potential to reproduce ableist bias remains underexamined, especially in non-English-language settings. This study examines disability representation in LLM-generated outputs across English and Bahasa Indonesia using a hybrid analytical framework. A total of 360 responses were generated by ChatGPT, Gemini, and Microsoft Copilot through a factorial prompt design varying disability type, socioeconomic class, and language. The proposed analysis combined lexicon-based sentiment analysis, topic modeling, qualitative thematic analysis (three analysts), and consensus-based human ableism scoring. The results show that positive sentiment dominated across both languages but did not reliably indicate non-ableist representation. Ableist classifications were most concentrated in lower socioeconomic class condition, with schizophrenia-related prompts and Gemini-generated outputs showing the highest proportions of ableist classifications across disability types and LLMs, respectively. Theme-level analysis showed that ableism was most prevalent in responses framing disability through sensory overload, mobility barriers, and uneven professional access in negative sentiment outputs, and through life trajectories, aspirations, and participation shaped by socioeconomic access in positive sentiment outputs. Overall, ableist bias appeared intersectionally across socioeconomic class and disability type, with the proposed hybrid framework providing a more sensitive approach for identifying ableist representation in AI-generated text. Full article

Accurate estimation of tree height from diameter at breast height (DBH) is essential for forest inventory, biomass estimation, and management applications, yet conventional height–diameter (H–D) models often show substantial bias when applied across structurally heterogeneous stands. This study evaluates whether incorporating forest structural information can improve H–D model performance and reduce unexplained variation beyond size-based approaches. Using large-scale forest inventory data from South Korea (197,685 trees across 14,357 plots and 216 species), together with independent datasets from the United States, we applied a stepwise modelling framework combining generalized additive models and machine-learning-based residual analysis. DBH provided a strong baseline predictor of tree height but did not fully capture observed variation. Including forest structural variables, primarily clear bole height, substantially improved model performance (RMSE reduced from ~2.94 m to ~1.98 m; R² increased from ~0.486 to ~0.770) and reduced systematic deviations across stand conditions. Variance partitioning showed that structural variables explained a larger independent fraction of variation than DBH, while environmental variables (including altitude, slope, distance to road, temperature, and precipitation) contributed smaller but spatially structured effects. Machine-learning models improved predictions for size-only models; however, these gains declined markedly when structural predictors were included, indicating that much of the improvement arises from representing underlying stand conditions rather than model complexity. These results demonstrate that incorporating forest structural information provides a practical and effective approach for improving H–D models, reducing prediction bias, and enhancing model transferability across diverse forest conditions. The proposed framework can be readily applied in forest inventory and modelling systems to improve the accuracy and reliability of tree height estimation. Full article

Postpancreatectomy acute pancreatitis grade C (PPAP-C) is the most severe grade of this complication, associated with the highest mortality rate after pancreatoduodenectomy (PD). Most PPAP-C cases require surgical intervention. However, no treatment guidelines for PPAP-C have been established. Literature reports are largely based on the coexistence of postoperative pancreatic fistula grade C (POPF-C) and PPAP-C, with similar surgical treatment methods. However, in PPAP-C, the evolution of inflammation can vary in course and severity: from necrosis limited to the anastomotic line to extensive necrosis involving the entire pancreatic parenchyma. In this narrative review, we summarize the surgical techniques proposed for PPAP-C treatment and attempt to create a decision-making algorithm for optimizing the choice of surgical treatment for PPAP-C depending on the extent of pancreatic necrosis and the patient’s general condition after PD. Our retrospective review is largely based on retrospective evidence and contains an inevitable selection bias. According to the cited literature, in cases of limited necrosis, parenchyma-sparing methods show an advantage over completion pancreatectomy. However, the complete pancreatic removal is usually performed in the initially more advanced cases or as a second choice when the pancreas-preserving methods fail. Therefore, the superiority of any approach cannot be clearly determined. More studies and uniform guidelines for optimal PPAP-C treatment are needed. Full article

Pedestrian Spatial Experience PSE in urban spaces is a multi-faceted topic that requires the thematization of assessment methods due to their fragmentation across studies. Accordingly, this systematic review followed an inductive approach to define a framework of PSE assessment themes reflecting their evaluation in public and university campus spaces. This systematic review included open-access, accessible, peer-reviewed sources based on assessment-focused English research that followed defined frameworks on the effects of urban environments on adult PSE. Studies were excluded if they focused on non-pedestrians or vulnerable user groups, examined non-pedestrian-scale contexts, explored pedestrian experience in virtual environments, assessed interior spaces, lacked a structured attribute-based assessment framework, were review articles, did not specify how urban environments shape pedestrian experience, investigated non-urban or rural areas, or examined urban settings without clearly defined street or square infrastructure. The review relied on querying PSE-related bibliography from the Scopus and Web of Science databases on 12 October 2025; results were processed through a screening procedure according to the inclusion and exclusion criteria. The final sets of sources reviewed included 83 and 24 sources related to PSE assessment in public and university campus spaces, respectively. Risk of Bias (RoB) tools included the Joanna Briggs Institute (JBI) tool for cross-sectional studies, tailored for urban spatial studies, and the Prediction model Risk Of Bias Assessment Tool (PROBAST+AI), tailored for ABM studies. Using a data extraction sheet and codebook to identify the prominent codes in the included sources, in addition to reviewing frequent words and the methods of the included sources, clarified the main conceptual framework of PSE assessment themes. The thematic categorization of PSE studies was followed by analyses of the frequencies of the themes, the prevalence of themes across countries and cities, and the theoretical explorations within the themes over the years in both reviewed contexts. Subsequently, synthesizing both sets clarified the interrelations between themes, methods, and tools as an attempt to address gaps in PSE assessment methods. The main results of this review are the 11 themes of PSE assessment that were identified from the reviewed sources. Data analyses and syntheses indicated a high prevalence of quantitative methods relying on visual aspects, signifying the dominance of the Cognitive and Navigational Experience theme due to its frequent assessment by numerous and diverse sets of methods in both reviewed sets. Nevertheless, the Temporal Experience theme emerged as the least considered. The key limitations of this systematic review include its reliance on accessible articles from bibliographic databases, as well as its focus on adult populations as the common users of public and university campus spaces. This review decodes PSE in terms of its assessment themes through the methods followed and the applied tools within real environments. As an application of the introduced conceptual framework, this systematic review clarifies the comparison of the themes examined between public and university campus spaces. The findings of this systematic review provide a foundation for a comprehensive understanding of PSE, thereby informing the design of more user-centered environments. Full article

Background/Objectives: Within pediatric healthcare systems, integrated strategies combining dietary and oral hygiene interventions have been proposed to improve oral health outcomes. In order to evaluate the effects of combined dietary and oral hygiene approaches on behavioral, knowledge-based, and clinical outcomes in pediatric populations, this systematic review synthesized evidence from intervention studies. Methods: A comprehensive literature search was conducted on 5 September 2025 using PubMed, Scopus, Web of Science, Google Scholar, and arXiv. Children and adolescents (0–18 years old) exposed to dietary and oral hygiene interventions with documented behavioral, clinical, or knowledge-related outcomes were included in eligible studies. Studies were stratified by age groups (0–5, 6–12, and 13–18 years) in order to address developmental heterogeneity. The Cochrane RoB 2 tool for randomized trials and the ROBINS-I tool for non-randomized studies with a comparator were used to evaluate the risk of bias. For single-arm pre–post studies, a narrative risk-of-bias assessment was conducted, as ROBINS-I is not designed for uncontrolled studies. Due to methodological and clinical heterogeneity, a narrative synthesis approach was applied. Results: Out of 1231 records, eight outcome-reporting intervention studies satisfied the inclusion criteria. Improvements in self-reported oral hygiene behaviors, dietary habits, and oral health knowledge were consistently linked to integrated interventions across developmental subgroups. There was little and inconsistent evidence for clinical outcomes, such as caries and periodontal indicators. Conclusions: In pediatric populations, integrated dietary and oral hygiene interventions seem to enhance behavioral and educational oral health outcomes. These findings highlight the need for developmentally tailored preventive strategies integrated within pediatric healthcare frameworks. Full article