Search Results (2,699)

This study examines the dynamic transmission of geopolitical risk across Brent crude oil, gold, the U.S. Dollar Index, and the Thai stock market using a Bayesian time-varying coefficient vector autoregressive (TVC-VAR) framework. Using monthly data from January 1990 to December 2025, the analysis combines time-varying impulse responses, generalized forecast error variance decomposition, dynamic connectedness measures, and network analysis. The results show substantial time variation in spillover intensity and direction. On average, Brent crude oil is the strongest net transmitter, gold has a smaller positive net position, and the U.S. Dollar Index and the Thai stock market are net receivers. Episode-specific point estimates indicate changes in transmitter-receiver roles and bilateral channels, but bootstrap sensitivity analysis shows that several apparent role changes are not statistically distinguishable once uncertainty is considered. The evidence therefore supports a dynamic, reconfigurable connectedness structure while cautioning against causal, safe-haven, or portfolio-performance interpretations that are not directly tested in this study. The findings are relevant to financial-risk monitoring and macro-financial surveillance under changing geopolitical conditions. Full article

Chronic low back pain (CLBP) is a leading cause of disability and is characterized by marked clinical heterogeneity. Structural imaging remains fundamental for diagnosis and treatment planning, yet anatomical abnormalities alone do not fully explain differences in pain, disability, physical performance, or treatment response. Increasing evidence implicates paraspinal muscle morphology, composition, neuromuscular behavior, endurance, and physical conditioning as complementary determinants of spinal function. This narrative review synthesizes current evidence within the concept of spinal muscle health, defined here as a multidimensional, region-specific construct reflecting the structural, compositional, neuromuscular, and functional capacity of the muscles contributing to spinal control and load management. The construct is not proposed as a new diagnosis or as a substitute for established concepts such as sarcopenia, myosteatosis, or deconditioning; rather, it provides an integrative framework for considering complementary muscle-related domains that cannot be represented adequately by a single imaging or performance measure. We review muscle-specific and level-specific findings, measurement approaches, sources of heterogeneity, longitudinal and interventional evidence, and the interaction of muscle-related features with systemic and psychosocial factors. Current evidence supports associations between selected paraspinal muscle abnormalities and CLBP, particularly for multifidus composition, but findings vary substantially across muscles, spinal levels, populations, and measurement methods. Most evidence remains cross-sectional, and causal direction is uncertain. Clinical improvement after exercise may occur without consistent normalization of imaging-derived muscle composition. Accordingly, spinal muscle health is best regarded at present as a research and clinical reasoning framework rather than a validated diagnostic phenotype. Standardized measurement, longitudinal studies, and intervention trials linking changes in muscle-related parameters to patient-centered outcomes are required before routine clinical implementation. Full article

European mistletoe (Viscum album L.) is an expanding hemiparasitic plant in European forests, but its association with below-canopy hydrothermal conditions remains poorly understood. We compared near-ground air, surface, and upper-soil temperatures, volumetric soil moisture, and selected soil properties beneath healthy and naturally infected silver fir (Abies alba Mill.) and Scots pine (Pinus sylvestris L.) trees in south-eastern Poland. Continuous measurements were collected at 15-min intervals from April to August 2025 using TMS-4 loggers, while soil samples collected at 35 cm depth were analysed for texture, bulk density, organic matter, carbon, nitrogen, electrical conductivity, and selected nutrient-related properties. The observations showed contrasting patterns between the two host stands. In Abies alba, infected-tree microsites were descriptively warmer, with approximately 1 °C higher near-ground air and surface temperatures and up to approximately 2 °C higher upper-soil temperature than healthy-tree microsites. Temperature–soil-moisture relationships were also weaker beneath infected fir trees (maximum reported R² approximately 0.09) than beneath healthy trees (up to approximately 0.39). Differences were smaller in Pinus sylvestris. However, because infection was naturally occurring, the host stands may differ in canopy structure, soil conditions, tree characteristics, and other environmental factors. In addition, the available manuscript does not report the number of independent TMS loggers/trees per treatment or the raw-data reanalysis required to account for repeated temporal observations. Therefore, the present results should be interpreted as host- and stand-associated patterns rather than causal effects of mistletoe infection. The study provides a basis for testing whether mistletoe-associated changes in canopy water partitioning and tree condition are linked to localized hydrothermal variation. Full article

Corporate sustainability governance is often measured as a set of coexisting mechanisms, leaving unclear whether the order in which reporting and internal accountability first become visible is associated with later formal cross-domain assembly and climate implementation. Using Bloomberg FY2020–FY2024 data, this study defines provider-observed pathways in a focal cohort of 478 firms with no observed architecture component at the FY2020 baseline; the principal adjusted staged-adopter model uses 262 firms, while direct-climate models use 53–171 firms depending on the outcome. Reporting-first entry is associated with an 18.7 percentage-point higher probability of FY2024 formal cross-domain architecture under HC1 inference (p < 0.001). The point estimate is unchanged when uncertainty is clustered by country-of-domicile jurisdiction (p = 0.048), but finite-cluster inference is materially weaker (CR2/Satterthwaite p = 0.137; restricted Rademacher wild-cluster p = 0.303). Thus, coefficient magnitude is stable while jurisdiction-level statistical precision is not. Annual transition and two-year persistence estimates are positive, but a stricter three-year persistence check among firms with sufficient exposure shows no detectable adjusted difference. Component decomposition further shows that the precisely estimated domain contrast is driven mainly by GRI-first relative to committee-first entry; SASB-first and pay-first estimates are statistically imprecise. Reporting-first firms show no broader climate strategy advantage or lower-emissions advantage. TCFD adoption is lower after controls and remains significant after Holm adjustment, whereas the nominal positive Scope 2 result does not. The evidence therefore identifies a bounded, associational pattern in provider-observed formal governance assembly, not a causal adoption mechanism or evidence of superior climate performance. Information infrastructure remains a theoretically plausible interpretation for direct testing in future research. Full article

Generative flow quality need not improve monotonically as numerical integration is refined when the learned velocity field is itself approximate. We investigate this behavior in Product Manifold Flow Matching (PMFM), which represents image patches on Products of hyperbolic factors and samples with exponential-map Euler updates. Across 32 M and 129 M CIFAR-100 models, Product at NFE = 4 achieves lower FID than the original Euclidean baseline at NFE = 32 in all six architecture–training-seed configurations, with an approximately eightfold reduction in measured sampling time. A targeted 32 M ablation shows, however, that this crossover is not specific to Product geometry: a factor-wise Euclidean analog of the Product target-speed reweighting improves the Euclidean baseline across the evaluated NFE range and reproduces the cross-budget advantage in all three training seeds. Removing the same reweighting from the Product target degrades FID from NFE ≥ 4. Product FID reaches an early optimum at NFE = 8 on CIFAR-100 and at NFE = 4 on a balanced synthetic pile-driver corpus, while same-initial-condition step-doubling discrepancies continue to decrease. These results separate numerical refinement from generative fidelity and identify target-speed reweighting as a major contributor to low-NFE quality, without supporting a curvature-only causal interpretation. Full article

Vitamin D is involved in endothelial regulation, inflammatory control, oxidative stress responses, angiogenesis, and neurovascular homeostasis, providing a biological basis for its potential involvement in the retinal and choroidal circulation. This narrative review synthesizes evidence from studies investigating associations between serum 25-hydroxyvitamin D [25(OH)D] concentrations and ocular vascular parameters assessed using optical coherence tomography (OCT), OCT angiography (OCTA), and retinal vascular imaging. Evidence from adult and pediatric populations generally associated vitamin D deficiency (VDD) with lower vessel density in the superficial and deep capillary plexuses, altered retinal vascular caliber and foveal avascular zone morphology, and reduced choroidal thickness or vascularity. However, the direction and magnitude of retinal OCTA findings were inconsistent, and conventional retinal structural measurements frequently remained unchanged. Supplementation studies reported relatively consistent increases in choroidal thickness and vascularity, whereas retinal perfusion responses were limited. Preliminary studies suggested that correction of VDD might support a more sustained response to bevacizumab in diabetic macular edema and central retinal vein occlusion, although this effect was not demonstrated consistently across retinal vascular diseases. Lower 25(OH)D concentrations were also more frequent among patients with retinal vascular occlusions, but residual systemic vascular confounding limits causal interpretation. Overall, current evidence supports a biologically plausible association between vitamin D status and ocular microvascular health but does not establish causality, functional visual benefit, or a specific therapeutic indication for supplementation. Longitudinal multicenter studies and randomized trials using standardized imaging protocols, functional outcomes, biochemical confirmation of vitamin D correction, and validated automated image analysis are required to determine the clinical relevance and reversibility of these findings. Full article

The European Union’s common climate and energy framework—the Renewable Energy Directives and the European Green Deal—seeks to align national energy systems, yet whether electricity-generation structures converge remains underexplored. Using Eurostat data (SIEC classification), we examine the generation mix of the 27 EU member states over 1990–2024, measured as unweighted country-level source shares, with generation-weighted EU aggregates reported as a complement. We assess diversification (normalized Shannon entropy, the Herfindahl–Hirschman index and the effective number of sources) and convergence (σ- and β-convergence and source-by-source Phillips–Sul log-t club tests computed on source shares, with log-ratio balances used as a robustness check). Mix diversification rises (mean normalized entropy from 0.41 to 0.62) and, as measured by entropy, its levels converge to a single club. Convergence across sources is selective: the shares of the contracting carriers—coal, oil, nuclear and hydro—display σ-convergence, whereas wind, solar and bioenergy form single all-country convergence clubs in relative terms, even as their cross-country dispersion widens. The fossil–nuclear base remains structurally divided: coal fragments into multiple clubs with a divergent group that includes Poland, and nuclear separates member states into nuclear and non-nuclear groups. These patterns emerged during the development of the common EU policy framework; identifying the causal contribution of specific instruments is left for future work. The findings carry implications for security of supply, as exposed during the 2022 energy crisis. Full article

Background/Objectives: Patient safety incidents can adversely affect healthcare professionals, but relationships between leadership and organizational responses, clinician recovery, professional consequences, and safety-related outcomes remain incompletely synthesized. This review examined contemporary quantitative evidence on these relationships and the extent to which directly measured safety behaviors and patient-safety outcomes have been evaluated. Methods: This PROSPERO-registered systematic review (CRD420261453278) followed PRISMA 2020 and PRISMA-S. PubMed and Scopus were searched as the primary bibliographic databases, supplemented by Europe PMC and OpenAlex and by forward citation searching in Scopus and the Web of Science Core Collection, for English-language studies published from January 2021 through July 2026. Two reviewers independently screened records and extracted data; design-specific JBI appraisal judgments were agreed by two reviewers. Heterogeneity precluded meta-analysis, and findings were synthesized narratively using SWiM-informed structured reporting. Results: Of 6838 records, 44 studies were included. Distress/recovery was assessed in 40 studies (90.9%), professional consequences in 21 (47.7%), other safety-related outcomes or indicators in five (11.4%), and disclosure-related behavior in one (2.3%). No study prospectively evaluated incident or near-miss reporting or speaking up as a principal exposure-linked outcome. Supportive organizational responses, just and non-punitive cultures, learning-oriented safety climates, and structured support were generally associated with less distress, more favorable recovery, and fewer negative professional outcomes. Structured-support evaluations suggested feasibility, acceptability, and favorable short-term signals but did not establish intervention effectiveness. Conclusions: Contemporary evidence is substantially stronger for clinician recovery and professional functioning than for safety behavior or patient outcomes. Predominantly cross-sectional, self-reported, and uncontrolled evidence precludes causal conclusions. Direct evaluation of reporting, disclosure, speaking up, verified workforce outcomes, and patient-safety effects remains a major research priority. Full article

Background/Objectives: Epidural electrical stimulation (EES) is an investigational, off-label neuromodulation strategy used adjunctively with rehabilitation in chronic spinal cord injury (SCI), but safety and longitudinal functional data specific to traumatic cervical SCI remain limited. This is a descriptive safety-and-feasibility study, not an efficacy study; no efficacy or causal claim is made. Methods: In this single-centre observational cohort, 32 consecutive patients with traumatic cervical SCI underwent EES implantation and were included in baseline and safety analyses, while longitudinal analyses comprised the 26 participants with complete Spinal Cord Independence Measure (SCIM) III data at baseline and 3, 6, 9 and 12 months. Rehabilitation dose was quantified (approximately 1087 prescribed therapy hours over 12 months) and adverse events were classified using ISO 14155:2020 definitions with WHO–UMC causality grading. Prespecified outcomes were device- and procedure-related adverse events and total and domain-specific SCIM III scores; analyses were descriptive. Results: Patients were aged 33.8 ± 10.3 years, 28 (87.5%) were male, and baseline AIS grade was A in 31 and B in 1. Mean total SCIM III increased from 14.81 ± 8.92 at baseline to 21.77 ± 14.60, 25.12 ± 15.90, 28.23 ± 17.68 and 32.42 ± 19.45 at 3, 6, 9 and 12 months (all p < 0.001), with gains across self-care, respiration and sphincter management, and mobility; 10 of 32 patients (31.3%) improved by at least one AIS grade. Adverse events were infrequent: sterile hardware-site inflammation (2, 6.3%), explantation (1, 3.1%) and a first-ever seizure (1, 3.1%), without stimulation-related neurological deterioration. Conclusions: The cohort was highly selected (31/32 baseline AIS A; 87.5% male; injury-to-implant interval 10–339 months), no comparator group was available, stimulation programming was individualised rather than protocolised, and 6 of 32 patients lacked complete 12-month follow-up; these features limit reproducibility and generalisability and preclude any inference about effectiveness. EES with rehabilitation was well tolerated and accompanied by progressive functional gains, although the uncontrolled design precludes causal inference. The contribution of this report is therefore transparent safety, dose and programming data, together with a prespecified protocol framework intended to make a controlled, propensity-matched evaluation of EES in traumatic cervical SCI feasible and reproducible. Full article

As ESG disclosure and climate governance requirements become increasingly institutionalized, understanding how firms respond to external sustainability pressures through specific governance mechanisms and how these responses relate to carbon performance has become an important research issue. Moving beyond aggregate ESG ratings, this study examines the informational value of specific ESG-related factors for corporate carbon management, including energy management systems, innovation capability, human capital, market valuation, and board governance. Using data on Taiwanese listed and over-the-counter companies from the ESG database of the Financial Supervisory Commission, the Taiwan Economic Journal, and the Leadership ISO Survey, this study employs a time-lagged design linking 2023 firm characteristics to 2024 carbon emission intensity. Multiple regression analysis is the primary method, with firm size, leverage, capital intensity, profitability, and firm age included as firm-level controls in extended models; exploratory data analysis (EDA) serves as a supplementary diagnostic for data distribution, nonlinearity, and variable operationalization. Cross-year, alternative dependent-variable, and supplementary analyses are used to assess the stability of the estimates. The results show that ISO 50001 certification is positively associated with subsequent carbon emission intensity, whereas the structural characteristics of R&D investment and independent director governance show more stable negative associations. Average salary, female director representation, and Tobin’s Q yield inconsistent results. Proportion-based board measures outperform director-count and threshold-based measures, but no clear critical-mass threshold is supported. Results also vary under alternative carbon-performance measures, suggesting that carbon intensity and absolute emissions capture different dimensions of environmental performance. These findings indicate conditional statistical associations rather than causal effects. Full article

Background: Major depressive disorder (MDD) arises from genetic and environmental factors. We evaluated functional variation in methylenetetrahydrofolate reductase (MTHFR), circulating MTHFR protein, and homocysteine (HCY) in Mexican-Mestizo participants. Methods: We analyzed 1507 individuals across four cohorts: a primary case–control sample (358 DSM-IV-TR MDD cases, 170 psychiatrically screened controls), a community cohort (n = 204), and a general population cohort (n = 775) for allele-frequency context. We genotyped rs1801133 (C677T) and rs13306560 using TaqMan assays. Serum MTHFR and HCY were measured by ELISA in available subsamples (n reported where applicable). Primary analyses tested association of genotypes with MDD under codominant, allelic, and recessive models; false discovery rate (FDR) correction accounted for multiple genetic models. Exploratory multivariable logistic regression adjusted for sex, age, and adverse childhood experiences. Results: The rs13306560 A allele was rare (~2.6%) and showed no association with MDD. Under a recessive model, the rs1801133 TT genotype was more frequent among cases (33.3%) than controls (23.5%) (χ² p = 0.036); this association did not survive FDR correction (q = 0.117) and is reported as hypothesis-generating. In an exploratory adjusted logistic regression (N = 446) using the post hoc recessive coding, TT homozygotes had higher odds of MDD versus CC/CT (OR = 1.98, 95% CI 1.23–3.17, p = 0.005). Serum MTHFR concentrations were higher in cases than controls (median 1834.8 vs. 1241.9 pg/mL; Mann–Whitney U = 343, p = 0.017). Serum MTHFR displayed a borderline positive correlation with HAM-D scores (Spearman r = 0.24, p = 0.050). Conclusions: In this Mexican-Mestizo sample, MTHFR C677T (rs1801133) homozygosity and elevated circulating MTHFR emerged as preliminary, hypothesis-generating candidates for MDD risk. The genetic association did not meet multiple-testing correction (q = 0.117) and requires independent replication; the serum MTHFR case–control difference survived correction (q = 0.034) but warrants confirmation given the small biomarker subsample. A mechanistic study is needed to clarify causality and clinical relevance. Full article

Constructed wetlands rely on microscale redox heterogeneity to couple ammonium oxidation with downstream nitrogen loss, yet the causal role of radial oxygen loss (ROL) is often inferred from planting effects, bulk redox potential, functional genes, or outlet performance rather than measured directly. This narrative mechanistic review aims to determine when ROL-generated root oxygen microzones become functionally relevant, how they alter competition and coupling among nitrification, denitrification, anammox, DNRA, and NO/N₂O branch points, and whether present evidence supports scaling from individual roots to bed-scale total-nitrogen (TN) performance. We conduct a structured narrative evidence synthesis that separates direct root-zone O₂/ROL measurements from redox-resolved contextual evidence and mechanistic analogy, and appraises studies by measurement directness, resolution, nitrogen-endpoint resolution, operating-context reporting, control of competing explanations, and scale relevance. The broader mechanistic corpus is extensive, but only a small subset contains spatially resolved root-zone oxygen measurements coupled with nitrogen-related endpoints. Direct measurements show strong heterogeneity: reported lateral-root DO is 0.64–2.04 mg L⁻¹ with 0.76–1.16 mm oxygen layers, root-surface oxygen declines from about 2.0 to 0.5 mg L⁻¹ with depth in one Acorus system, and potential radial oxygen diffusion in Typha middle-root sections spans 0.003–0.316 µmol O₂ L⁻¹ µm⁻¹. We therefore treat ROL as a context-dependent oxygen budget rather than a fixed species property. Root-associated oxygen gradients are demonstrated and strongly heterogeneous; their effects on pathway feasibility and spatial coupling are conditionally supported; however, a transferable ROL coefficient that predicts bed-scale TN removal is not yet demonstrated. Progress requires direct root-zone mapping, pathway-rate measurements, complete nitrogen mass balances, internally constrained reactive-transport models, and seasonal field validation. Full article

Background/Objectives: Subtle facial and interactional cues may prompt clinicians to explore possible anxiety, confusion or hesitation, but they do not establish a patient’s internal state. The Micro-Expression Decoder (MED) links cue recognition with tentative interpretation, direct checking and communication adaptation. Methods: This preliminary, uncontrolled, single-group pre–post convergent mixed-methods evaluation involved 60 final-year medical students from three London medical schools. Ten groups of six completed a 270 min simulation-based programme comprising conceptual teaching, video observation, standardised-patient encounters, feedback and reflection. Study-specific self-ratings and a parallel-form recognition task were completed before teaching and immediately after the instructional and simulation components, before the final debrief. Standardised-patient ratings were obtained during the first and final simulated encounters. There was no control group or follow-up. Results: Recognition confidence increased from 2.7 to 4.3 (mean change 1.6, 95% CI 1.39–1.81; dz = 1.98), interpretation confidence from 3.0 to 4.5 (dz = 2.01), standardised-patient-rated attentiveness from 3.2 to 4.6 (dz = 2.02), and satisfaction from 3.5 to 4.8 (dz = 1.94). Anxiety recognition increased from 25/60 (41.7%) to 55/60 (91.7%), and confusion recognition from 29/60 (48.3%) to 52/60 (86.7%). Qualitative accounts described earlier noticing, clarification and checking, alongside difficulty distinguishing cues, distraction, cultural variation and over-interpretation. Nineteen students increased confidence without categorical improvement in anxiety or confusion recognition. Conclusions: MED was associated with immediate improvement across study-specific outcomes in simulation. The uncontrolled design, immediate assessment, investigator-developed measures, expectancy effects and ceiling in post-training satisfaction preclude conclusions about causality, retention, real-patient benefit, empathy or clinical competence. Full article

This study aimed to develop, implement, and evaluate an integrated leadership and entrepreneurship training program for family farmers participating in rural associations and cooperatives. Grounded in competency-based management and experiential learning theory, the study adopted a quantitative quasi-experimental pretest–posttest design with a non-equivalent control group. Eighty family farmers participated, comprising an experimental group (n = 40) and a control group (n = 40). The intervention consisted of a 24-h competency-based training program delivered over three months through face-to-face workshops, problem-based learning activities, and AI-supported tutoring. Entrepreneurial competencies related to achievement, planning, and power were assessed before and after the intervention using a structured questionnaire based on McClelland’s Entrepreneurial Behavioral Characteristics framework. Data were analyzed using mixed-design ANOVA following assessments of instrument reliability, normality, and homogeneity of variances. Compared with the control group, participants in the experimental group exhibited larger increases in self-reported entrepreneurial competency scores over time across the overall score and the three competency dimensions. These observed differences were consistent with participation in the educational intervention; however, because the study employed a non-randomized quasi-experimental design and relied exclusively on self-reported measures, the findings should be interpreted as evidence of associations rather than definitive causal effects. Overall, the study provides preliminary evidence that competency-based educational interventions integrating entrepreneurship and leadership-related competencies may help strengthen managerial competencies among family farmers in the context under study. Nevertheless, the absence of participant-level data for additional robustness analyses, together with the limited psychometric evidence and the lack of long-term follow-up, suggests that the findings should be interpreted with caution and confirmed in future studies employing longitudinal designs, stronger measurement procedures, and independent replication. Full article

Introduction: The high prevalence of anxiety and depression in adults affects their overall functioning. Within Relational Frame Theory, psychological inflexibility is theoretically associated with avoidance of private events and has been linked to greater anxiety and depressive symptoms and lower resilience. However, the integration of these constructs into explanatory models remains limited, restricting the understanding of their interrelationships and potentially relevant protective resources. Objective: To examine the indirect association between psychological inflexibility and psychological distress through resilience within a theoretically specified cross-sectional model. Methods: A cross-sectional design with latent variables was employed using a quantitative approach. The sample consisted of 950 Peruvian adults (64% women), recruited in Metropolitan Lima, who completed a sociodemographic questionnaire and psychological measures. Statistical analyses were conducted using structural equation modeling. Results: The proposed model demonstrated adequate fit (robust CFI = 0.94, robust RMSEA = 0.05, 90% CI [0.050, 0.057], SRMR = 0.04). Psychological inflexibility showed a strong positive direct association with psychological distress (β = 0.803, p < 0.001) and a significant indirect association through resilience (β = 0.073, p < 0.001]). This pattern was consistent with complementary mediation within the specified cross-sectional model. Conclusions: Higher psychological inflexibility was associated with lower resilience and greater psychological distress. Resilience statistically accounted for a small but significant portion of the association between psychological inflexibility and distress, whereas the direct association remained predominant. Given the cross-sectional design, these findings should not be interpreted as evidence of temporal or causal relationships. Longitudinal research is required to examine the directionality of these associations. Full article