Search Results (2,527)

Armed conflict poses a significant threat to the mental health of youth worldwide. This study focused on the role of teachers as protective agents fostering resilience among their students. The study examined the moderating effects of teachers’ personal well-being and their efficacy in the school on relations between their students’ armed conflict exposure and student psychiatric symptoms. Participants included 1260 students and their homeroom teachers from 62 8–11th grade classes. Using self-report standardized measures, teachers reported their life satisfaction and sense of efficacy while students reported their armed conflict exposure and psychiatric symptoms. Data were analyzed using a multilevel modeling (MLM) approach. Findings revealed positive correlations between student armed conflict exposure and psychiatric symptoms. In the between-class level of analysis, teacher personal life satisfaction and efficacy in participation in the school system emerged as protective factors for the students, significantly moderating relations between student exposure and their psychiatric symptoms. However, teacher efficacy in class management showed no significant moderating effect on student mental-health difficulties. Results highlight the importance of supporting teachers in conflict-affected environments and emphasize the need for preventive and therapeutic initiatives that prioritize teacher well-being and organizational resources to enhance teachers’ capacity to foster student resilience. Full article

Objectives: Diabetes Mellitus involves demanding challenges that interfere with family functioning and routines. In turn, family and social context impacts individual glycemic control. This study aims to identify this recursive interplay, the mutual influences of family systems and diabetes management. Design: Data was collected through a cross-sectional design comparing patients, aged 22–55, with and without metabolic control. Methods: Participants filled out a set of self-report measures of sociodemographic, clinical and family systems assessment. Patients (91) were also invited to describe their perception about disease management interference regarding family functioning. We first examined the extent to which family variables grouped dataset to determine if there were similarities and dissimilarities that fit with our initial diabetic groups’ classification. Results: Cluster analysis results identify a two-cluster solution validating initial classification of two groups of patients: 49 with metabolic control (MC) and 42 without metabolic control (NoMC). Independent sample tests suggested statistically significant differences between groups in family subscales- family difficulties and family communication (p < 0.05). Binary logistic regression shed light on predictors of explained variance to no metabolic control, in four models: Sociodemographic, Clinical data, SCORE-15/Congruence Scale and Eating Behavior. Furthermore, groups differ on family support, level and sources of family conflict caused by diabetes management issues. Considering only patients who co-habit with a partner for more than one year (N = 44), NoMC patients score lower on marital functioning in all categories (p < 0.05). Discussion: Family-Chronic illness interaction plays a significant role in a patient’s adherence to treatment. This study highlights the Standards of Medical Care for Diabetes, considering caregivers and family members on diabetes care. Full article

Constrained multi-objective optimization problems (CMOPs) require optimizing multiple conflicting objectives while satisfying complex constraints. These constraints generate infeasible regions that challenge traditional algorithms in balancing feasibility and Pareto frontier diversity. chemical reaction optimization (CRO) effectively balances global exploration and local exploitation through molecular collision reactions and energy management, thereby enhancing search efficiency. However, standard CRO variants often struggle with CMOPs due to the absence of specialized constraint-handling mechanisms. To address these challenges, this paper integrates the CRO collision reaction mechanism with an existing evolutionary computational framework to design a dual-stage and dual-population chemical reaction optimization (DDCRO) algorithm. This approach employs a staged optimization strategy, which divides population evolution into two phases. The first phase focuses on objective optimization to enhance population diversity, and the second prioritizes constraint satisfaction to accelerate convergence toward the constrained Pareto front. Furthermore, to leverage the infeasible solutions’ guiding potential during the search, DDCRO adopts a two-population strategy. At each stage, the main population tackles the original constrained problem, while the auxiliary population addresses the corresponding unconstrained version. A weak complementary mechanism facilitates information sharing between populations, which enhances search efficiency and algorithmic robustness. Comparative tests on multiple test suites reveal that DDCRO achieves optimal IGD/HV values in 53% of test problems. The proposed algorithm outperforms other state-of-the-art algorithms in both convergence and population diversity. Full article

In this study, we investigate the return propagation mechanism, hedging effectiveness, and portfolio performance across several common agricultural commodities, crude oil, and S&P 500 index, ranging from July 2000 to June 2024 by using a time-varying parameter vector autoregression (TVP-VAR) connectedness approach and three common multiple assets portfolio optimization strategies. The empirical results show that, the total connectedness peaked during the 2008 global financial crisis, followed by the European debt crisis and the COVID-19 pandemic, while it remained relatively lower at the onset of the Russia-Ukraine conflict. In the transmission mechanism, commodities and S&P 500 index exhibit distinct and dynamic characteristics as transmitters or receivers. Portfolio analysis reveals that, with exception of the COVID-19 pandemic, all three dynamic portfolios outperform the S&P 500 benchmark across major global crises. Additionally, the minimum correlation and minimum connectedness strategies are superior than transitional minimum variance method in most scenarios. Our findings have implications for policymakers in preventing systemic risk, for investors in managing portfolio risk, and for farmers and agribusiness enterprises in enhancing economic benefits. Full article

Asthma is a persistent ailment that impacts the respiratory system and stands as a formidable public health challenge globally. Inhaled corticosteroids and bronchodilators, while effective in asthma management, are accompanied by side effects and high costs. Recently, nutraceuticals have gained significant attention as adjuvant therapy due to their promising outcomes. Given the antioxidant properties, nutrient richness, and an array of health benefits, beetroot and its bioactive compounds have been tested as an adjuvant therapy for asthma management. Although its main bioactive compound, betalains (betanin), has demonstrated promising results in mouse studies, beetroot juice has been found to worsen asthma. This review investigated the full spectrum of active compounds associated with beetroots to understand the underlying factors contributing to the conflicting findings. The finding suggests that individual bioactive compounds, such as phenolic compounds, flavonoids, nitrates, betalains, saponins, vitamins, fiber, and carotenoids, possess asthma-managing properties. However, the consumption of juice may exacerbate the condition. This discrepancy may be attributed to the presence of sugars and oxalates in the juice, which could counteract the beneficial effects of the bioactive compounds. Full article

Background: While several test-automation maturity models (e.g., CMMI, TMMi, TAIM) exist, none explicitly integrate ISO 9001-based quality management systems (QMS), leaving a gap for organizations that must align E2E test automation with formal quality assurance. Objective: This study proposes a test-automation maturity model (TAMM) that bridges E2E automation capability with ISO 9001/ISO 9004 self-assessment principles, and evaluates its reliability and practical impact in industry. Methods: TAMM comprises eight maturity dimensions, 39 requirements, and 429 checklist items. Three independent assessors applied the checklist to three software teams; inter-rater reliability was ensured via consensus review (Cohen’s κ = 0.75). Short-term remediation actions based on the checklist were implemented over six months and re-assessed. Synergy with the organization’s ISO 9001 QMS was analyzed using ISO 9004 self-check scores. Results: Within 6 months of remediation, mean TAMM score rose from 2.75 → 2.85. Inter-rater reliability is filled with Cohen’s κ = 0.75. Conclusions: The proposed TAMM delivers measurable, short-term maturity gains and complements ISO 9001-based QMS without introducing conflicting processes. Practitioners can use the checklist to identify actionable gaps, prioritize remediation, and quantify progress, while researchers may extend TAMM to other domains or automate scoring via repository mining. Full article

The soil-borne fungi, Setophoma terrestris and Fusarium spp., are often associated with pink root, although the etiology of the disease remains doubtful. While recognized as the primary inoculum, studies show conflicting views on the formation of chlamydospores and microsclerotia in Setophoma. Therefore, this study aims to clarify the etiology of the pink root of garlic and onion and the formation of chlamydospores and microsclerotia in Setophoma. The isolates were obtained from symptomatic tissues of garlic, leeks, brachiaria, onions, chives, and maize collected from seven different states in Brazil. Representative isolates were selected for pathogenicity tests. Sequence comparison of the tubulin gene showed Setophoma (n = 50) and Fusarium clades (n = 25). Garlic and onion plants inoculated with Setophoma showed pink root symptoms, while plants inoculated with different Fusarium isolates remained asymptomatic. Multigene analysis of pathogenic isolates confirms that only Setophoma terrestris causes pink root in garlic and onion. In addition, brachiaria, chives, and leeks are newly identified hosts of this pathogen in Brazil. To our knowledge, the main sources of primary inoculum of the disease are chlamydospores, pycnidia, colonized roots of garlic, onion, and plant debris of susceptible crops. The new information obtained in this study will be fundamental for researchers in the development of genotypes that are resistant to pink root and will help the efficient management of the disease. Full article

Background/Objectives: Gallbladder cancer (GBC) is a lethal malignancy curable only by surgical resection in early stages (Tis, T1, T2). Significant controversy exists regarding the optimal extent of surgery. This review summarizes recent trends and evidence on surgical strategies for Tis, T1, and T2 GBC to guide practice and research. Methods: This narrative review synthesizes recent literature on surgical management of Tis, T1a, T1b, and T2 GBC based on American Joint Committee on Cancer (AJCC) 8th edition staging. It examines simple vs. extended cholecystectomy (simple cholecystectomy (SC) vs. extended/radical cholecystectomy (EC/RC)), the role of lymphadenectomy (LND) and hepatectomy, and minimally invasive surgery (MIS). Results: Simple cholecystectomy is curative for Tis/T1a GBC. For T1b, regional LND is essential for staging/potential benefit, especially examining ≥5–6 nodes. Tumor size is critical; SC alone may suffice for T1b < 1 cm (low lymph node metastasis (LNM) risk), while EC/RC with LND is indicated for ≥1 cm (higher LNM risk). Routine hepatectomy for T1b lacks survival support. For T2 GBC, mandatory regional LND (≥6 nodes) is required for both T2a and T2b substages due to high LNM rates; T2b has higher LNM than T2a. Routine hepatectomy for T2 is debated; evidence suggests no routine benefit for T2a beyond LND, with conflicting findings for T2b. R0 resection is paramount. MIS is feasible for early stages in experienced hands. Conclusions: Management of early GBC is moving towards risk stratification. SC is standard for Tis/T1a. Adequate regional LND is crucial for T1b (especially ≥1 cm) and mandatory for T2 GBC. Routine hepatectomy, particularly for T2b, remains controversial. Tailored surgery prioritizes R0 resection and comprehensive LND, necessitating further standardized research. Full article

Background: Midportion Achilles tendinopathy (Mid-AT) is a complex condition that may be exacerbated by anatomical variations of the plantaris tendon. Recent anatomical studies, particularly the classification proposed by Olewnik et al., have enhanced the understanding of plantaris–Achilles interactions and their clinical implications. Objective: This review aims to assess the anatomical types of the plantaris tendon, their imaging correlates, and the impact of the Olewnik classification on diagnosis, treatment planning, and surgical outcomes in patients with Mid-AT. Methods: We present an evidence-based analysis of the six anatomical types of the plantaris tendon and their relevance to Achilles tendinopathy, with emphasis on MRI and ultrasound (USG) evaluation. A diagnostic and therapeutic algorithm is proposed, and clinical outcomes of both conservative and operative management are compared across tendon types. Results: Types I and V were most strongly associated with symptomatic conflict and showed the highest benefit from surgical resection. Endoscopic approaches were effective in Types II and III, while Type IV typically responded to conservative treatment. Type VI, often misdiagnosed as tarsal tunnel syndrome, required combined neurolysis. The classification significantly improves surgical decision-making, reduces overtreatment, and enhances diagnostic precision. Conclusions: The Olewnik classification provides a reproducible, clinically relevant framework for individualized management of Mid-AT. Its integration into imaging protocols and treatment algorithms may improve therapeutic outcomes and guide future research in orthopaedic tendon pathology. Full article

Multi-objective evolutionary algorithms (MOEAs) have emerged as powerful optimization tools for addressing the complex, often conflicting goals present in modern waste disposal systems. This review explores recent advances and practical applications of MOEAs in key areas, including waste collection routing, waste-to-energy (WTE) systems, and facility location and allocation. Real-world case studies from cities like Braga, Lisbon, Uppsala, and Cyprus demonstrate how MOEAs can enhance operational efficiency, boost energy recovery, and reduce environmental impacts. While these algorithms offer significant advantages, challenges remain in computational complexity, adapting to dynamic environments, and integrating with emerging technologies. Future research directions highlight the potential of combining MOEAs with machine learning and real-time data to create more flexible and responsive waste management strategies. By leveraging these advancements, MOEAs can play a pivotal role in developing sustainable, efficient, and adaptive waste disposal systems capable of meeting the growing demands of urbanization and stricter environmental regulations. Full article

Container liner shipping companies operate within a complex environment where they must balance profitability and service reliability. Meanwhile, evolving regulatory policies, such as surcharges imposed on ships of a particular origin or type on specific trade lanes, introduce new operational challenges. This study addresses the heterogeneous ship routing and demand acceptance problem, aiming to maximize two conflicting objectives: weekly profit and total transport volume. We formulate the problem as a bi-objective mixed-integer programming model and prove that the ship chartering constraint matrix is totally unimodular, enabling the reformulation of the model into a partially relaxed MIP that preserves optimality while improving computational efficiency. We further analyze key mathematical properties showing that the Pareto frontier consists of a finite union of continuous, piecewise linear segments but is generally non-convex with discontinuities. A case study based on a realistic liner shipping network confirms the model’s effectiveness in capturing the trade-off between profit and transport volume. Sensitivity analyses show that increasing freight rates enables higher profits without large losses in volume. Notably, this paper provides a practical risk management framework for shipping companies to enhance their adaptability under shifting regulatory landscapes. Full article

Background and Objectives: Diabetes is a global public health challenge, with increasing prevalence worldwide. The implementation of artificial intelligence (AI) in the management of this condition offers potential benefits in improving healthcare outcomes. This study primarily investigates the barriers and facilitators perceived by healthcare professionals in the adoption of AI. Secondarily, by analyzing both quantitative and qualitative data collected, it aims to support the potential development of AI-based programs for diabetes management, with particular focus on a possible bottom-up approach. Materials and Methods: A scoping review was conducted following PRISMA-ScR guidelines for reporting and registered in the Open Science Framework (OSF) database. The study selection process was conducted in two phases—title/abstract screening and full-text review—independently by three researchers, with a fourth resolving conflicts. Data were extracted and assessed using Joanna Briggs Institute (JBI) tools. The included studies were synthesized narratively, combining both quantitative and qualitative analyses to ensure methodological rigor and contextual depth. Results: The adoption of AI tools in diabetes management is influenced by several barriers, including perceived unsatisfactory clinical performance, high costs, issues related to data security and decision-making transparency, as well as limited training among healthcare workers. Key facilitators include improved clinical efficiency, ease of use, time-saving, and organizational support, which contribute to broader acceptance of the technology. Conclusions: The active and continuous involvement of healthcare workers represents a valuable opportunity to develop more effective, reliable, and well-integrated AI solutions in clinical practice. Our findings emphasize the importance of a bottom-up approach and highlight how adequate training and organizational support can help overcome existing barriers, promoting sustainable and equitable innovation aligned with public health priorities. Full article

It is crucial to clarify the grassland carrying capacity (CC) and the balance between grass and livestock under different scenarios for ecological protection and sustainable development in the Three River Headwaters Region (TRHR). This study focused on the TRHR and used livestock data, MODIS Net Primary Productivity (NPP) data, and artificial supplementary feeding data to analyze grassland CC and explore changes in the grass–livestock balance across various scenarios. The results showed that the theoretical CC of edible forage under complete grazing conditions was much lower than that of crude protein under nutritional carrying conditions. Furthermore, without increasing the grazing intensity of natural grasslands, artificial supplementary feeding reduced overstocking areas by 21%. These results suggest that supplementary feeding effectively addresses the imbalance between forage supply and demand, serving as a key measure for achieving sustainable grassland livestock husbandry. Despite the effective mitigation of grassland degradation in the TRHR due to strict grass–livestock balance policies and ecological restoration projects, the actual livestock CC exceeded the theoretical capacity, leading to overgrazing in some areas. To achieve desired objectives, more effective grassland management strategies must be implemented in the future to minimize spatiotemporal conflicts between grasses and livestock and ensure the health and stability of grassland ecosystems. Full article

Recent theoretical and empirical studies highlight that information asymmetry and owner–manager conflict of interest can distort corporate investment decisions. Building on this premise, we hypothesize that superior environmental, social, and governance (ESG) performance mitigates these frictions by (H1) alleviating financing constraints and (H2) intensifying external analyst scrutiny. To test these hypotheses, we examine all Shanghai and Shenzhen A-share non-financial firms from 2009 to 2023. Using panel fixed-effects and two-stage least squares with an industry–province–year instrument, we find that higher ESG performance significantly reduces investment inefficiency; the effect operates through both lower financing constraints and greater analyst coverage. Heterogeneity analyses reveal that the improvement is pronounced in small non-state-owned, non-high-carbon firms but absent in large state-owned high-carbon emitters. These findings enrich the literature on ESG and corporate performance and offer actionable insights for regulators and investors seeking high-quality development. Full article

Background: Chemotherapy-induced peripheral neuropathy is a common and debilitating side effect of cancer treatment. While exercise has shown promise in alleviating this burden, it remains underutilised in clinical practice due to the lack of accessible, clinician-friendly guidance. Aim: This review aimed to synthesise current evidence on exercise interventions for managing chemotherapy-induced peripheral neuropathy and provide practical insights to support clinicians in integrating these approaches into patient care. Methods: A search was conducted across MEDLINE, CINAHL, and SPORTDiscus using keywords related to exercise and CIPN. Studies were included if they involved adults receiving neurotoxic chemotherapy and exercise-based interventions. Two authors independently screened studies and resolved conflicts with a third author. Study quality was assessed using the JBI Critical Appraisal Tools, and only studies meeting a minimum quality standard were included. A balanced sampling approach was employed. Data on study design, participant characteristics, interventions, and outcomes were extracted. Results: Eleven studies were included, covering various exercise modalities: multimodal (n = 5), yoga (n = 2), aerobic (n = 1), resistance (n = 1), balance (n = 1), and sensorimotor (n = 1). Exercise interventions, particularly multimodal exercise, significantly improved symptom severity, functionality, and quality of life (p < 0.05). The studies had high methodological quality, with randomised controlled trials scoring between 9/13 and 11/13, and quasi-experimental studies scoring 8/9 on JBI tools. Conclusions: This review highlights the significant benefits of exercise, especially multimodal exercise, for managing CIPN and provides guidance for integrating these strategies into clinical practice. Future research is needed to refine exercise prescriptions and develop standardised guidelines. Full article