Search Results (1,266)

As cities worldwide pursue sustainable and inclusive mobility, understanding the travel behavior of vulnerable populations in peri-urban resettlement areas is essential for designing equitable built environments. In Shanghai, as in many rapidly urbanizing megacities, government-led redevelopment in central Shanghai displaces residents to the urban periphery, creating accessibility deficits and raising transport inclusivity concerns. Using travel diary data from five peri-urban affordable housing communities collected in 2012 (N = 8390)—a critical baseline before major infrastructure improvements—this study documents limited mobility (residents make significantly fewer trips than the city average) and examines its correlates via logistic regression. A core finding is a type-based threshold effect: awareness of a nearby large shopping mall is associated with higher shopping trip frequency (coefficient −0.332, p = 0.024), whereas awareness of small-to-medium supermarkets shows no significant association. This pattern is consistent with elastic demand theory and challenges the assumption that any retail facility improves accessibility equally. Our models explain very little variance (Nagelkerke R² = 0.078 for overall trip frequency; 0.048 for shopping frequency). This low explanatory power is itself a diagnostic signal—and a core motivation for our hypothesis-generating approach—indicating that unmeasured psychological (attitudes, perceived behavioral control), social (networks, norms), and technological (e-commerce) factors likely dominate travel decisions—directing future research priorities. Methodologically, the 2012 data provide an uncommon early-stage baseline for policy-induced resettlement, enabling future longitudinal comparisons and mechanism identification (e.g., before/after metro or mall openings). For contemporary policy, the findings suggest a testable hypothesis that anchor-type facilities (e.g., mid-sized community hubs with mixed use, rather than merely small supermarkets) may activate suppressed demand, requiring re-evaluation with recent data and causal designs. Readers should not extrapolate numeric trip rates to today’s Shanghai. The primary contributions are theoretical (type-based threshold effects, the anchor-vs.-routine facility distinction, the role of basic spatial awareness) and methodological (historical baseline). The 2012 data predate widespread e-commerce; digital substitution may substantially attenuate these relationships in contemporary contexts. Full article

Robotic-assisted minimally invasive esophagectomy (RAMIE) has emerged as an increasingly utilized approach for the surgical management of esophageal malignancies, offering potential advantages over conventional minimally invasive esophagectomy (MIE) and open esophagectomy (OE). Advances in robotic technology, enhanced visualization, instrument articulation, and surgeon ergonomics have facilitated wider adoption of RAMIE in thoracic surgical oncology. This review summarizes contemporary evidence regarding intraoperative, postoperative, oncologic, and patient-centered outcomes associated with RAMIE while highlighting emerging technologies and future directions in the field. Current literature, including randomized controlled trials, meta-analyses, propensity-matched studies, and international registry data, suggests that RAMIE is associated with reduced blood loss, improved lymph node harvest, and lower pulmonary morbidity compared with OE, while demonstrating outcomes comparable or favorable to conventional MIE. Oncologic outcomes, including R0 resection rates and overall survival, appear equivalent across approaches in most contemporary studies. In addition, robotic platforms may facilitate recurrent laryngeal nerve lymphadenectomy and complex mediastinal dissection. Despite these advantages, RAMIE is frequently associated with longer operative times and remains dependent on institutional expertise, surgeon experience, and resource availability. Current evidence is promising but remains limited by heterogeneity of surgical techniques, institutional expertise, and a relative scarcity of long-term randomized data. Emerging innovations including fluorescence-guided imaging, perfusion assessment technologies, artificial intelligence integration, augmented reality, and advanced robotic platforms may further enhance precision, safety, and personalization of esophageal cancer surgery. As robotic technology and perioperative systems continue to evolve, ongoing prospective investigation and long-term oncologic evaluation will remain essential to define the optimal role of RAMIE within multidisciplinary esophageal cancer care. Full article

Background: The Authorized Economic Operator (AEO) status has become the “gold standard” for supply chain security and trade facilitation under the WCO SAFE Framework. Nevertheless, contemporary certification remain largely limited to binary compliance with minimum requirements, restricting deeper strategic evaluation of security management; Methods: This article develops a Maturity Model for Authorized Supply Chains (MMASC), categorizing operators into five evolutionary levels across eight critical dimensions—Leadership, Risk Management, Collaboration and External Partnership, Access Control and Physical Security, Supply Chain Visibility and Protection, Cybersecurity, Personnel Security, and Security Culture. The model was validated through a two-round modified Delphi process and a post-Delphi consensus workshop with ten regional experts (Cronbach’s $\alpha =0.935),$operationalized through a diagnostic engine grounded in Mamdani-type fuzzy logic to reduce subjectivity in qualitative assessments; Results: The framework converts qualitative self-assessment into a crisp 0–100 maturity index, enabling customs administrations and private enterprises to move beyond regulatory compliance while aligning with the 2025 SAFE Framework updates—environmental sustainability, MSME inclusion, and ethical conduct codes; Conclusions: The MMASC provides a basis for a proportional allocation of trade facilitation benefits, such as expedited release, according to an operator’s maturity level, promoting a more resilient, transparent, and sustainable global trade ecosystem. Full article

Nutritional deterioration in adults with acute myeloid leukemia (AML) may be present at diagnosis and may evolve rapidly during intensive chemotherapy, lower-intensity treatment, and allogeneic hematopoietic cell transplantation (allo-HCT). This structured narrative review critically examines nutritional screening and diagnostic instruments, anthropometry and body composition, laboratory-derived composite indices, and objective physical-function measures. PubMed was searched for publications from 1 January 2015 through 13 July 2026; Google Scholar and reference lists were used foradditional citation searching. Of 292 records screened, 52 full-text reports were assessed and 34 empirical studies were included. Methodological limitations were appraised with the 2018 Mixed Methods Appraisal Tool. Evidence was heterogeneous and predominantly observational. PG-SGA and NRS-2002 identified nutritional risk and nutrition-impact symptoms, but their classifications were not interchangeable with GLIM diagnosis, body-composition phenotyping, or prognostic indices. BMI alone did not capture muscle depletion. CT, quantitative CT, BIA-derived phase angle, skeletal muscle indices, and repeated anthropometry detected clinically relevant changes, although thresholds varied and fluid shifts may bias BIA. Albumin-based indices, including CONUT, sCONUT, NRI, GNRI, PNI, and the C-reactive protein/albumin ratio, were associated with outcomes in several retrospective cohorts, but largely reflect inflammation, disease burden, and treatment effects as well as nutrition; no head-to-head evidence establishes superiority. SPPB, gait speed, walking tests, chair stands, and grip strength provided prognostic information in selected older and transplant cohorts, including patients treated with hypomethylating agents plus venetoclax. The evidence supports repeated, multimodal assessment, while remaining insufficient to prove that any single tool or tool-guided intervention improves survival. Future studies require standardized definitions, sex-stratified validation, contemporary treatment cohorts, and trials integrating nutrition, symptom control, and exercise. Full article

Avian influenza A virus (AIV) and Newcastle disease virus (NDV) are among the most damaging pathogens of poultry, and AIV also carries zoonotic potential that places it within the One Health agenda. The two infections frequently produce overlapping clinical signs, so a method that detects both in a single reaction has clear practical value for surveillance. We developed a duplex one-step real-time reverse-transcription PCR (RT-qPCR) that detects AIV in the FAM channel and NDV in the ROX channel. Primers and hydrolysis probes were designed against conserved regions of the AIV nucleoprotein and matrix genes and the NDV matrix, phosphoprotein and nucleoprotein genes, after alignment of 500 sequences per virus retrieved from GenBank from different geographic regions. Annealing temperature, primer and probe concentrations were optimised, and recombinant plasmids carrying the target fragments served both as positive controls and as quantitative standards. The assay was specific for AIV and NDV, with no cross-reactivity with infectious bronchitis virus and no signal crossover between channels; its analytical sensitivity reached approximately 10–20 RNA copies per reaction. Qualitative results on reference isolates were fully concordant with two commercial veterinary kits (Cohen’s κ = 1.00), and the assay passed inter-laboratory commission testing. This study establishes the design and core analytical performance of a laboratory-developed duplex assay; expanded in silico inclusivity on contemporary sequences, a broader specificity panel, inhibitor-containing matrices, an internal amplification control, and prospective clinical validation are required before routine surveillance deployment. Full article

Background/Objectives: Oral mucosal melanoma (OMM) is a malignancy in which durable local control must be balanced against preservation of speech, swallowing, mastication, and oral structure. Although cryotherapy is a repeatable and function-preserving local modality, its role within contemporary multidisciplinary care has not been clearly defined. This study describes a stage-adapted cryotherapy-based management framework for primary OMM and evaluates survival, local recurrence, and prognostic factors in a contemporary single-center cohort. Methods: We retrospectively reviewed 43 patients with primary OMM treated between 2016 and 2026. Treatment allocation was non-randomized and made through multidisciplinary assessment: stage II–III patients received cryotherapy alone, whereas stage IV patients received cryotherapy combined with wide local excision; postoperative adjuvant therapy was considered individually. Overall survival (OS) was estimated using Kaplan–Meier methods, and prognostic factors were explored using univariable Cox regression. Results: Median follow-up was 35 months. Estimated 2-year and 5-year OS for the whole cohort were 93.0% and 69.8%, respectively. Local recurrence occurred in 2/11 stage II–III patients and 18/32 stage IV patients. Among stage IV patients, postoperative adjuvant therapy was associated with OS in an unadjusted exploratory comparison (p = 0.03); this association may be affected by confounding by indication and selection bias and should not be interpreted as a treatment effect. Nodal metastasis was associated with worse OS in univariable analysis (HR, 3.342; p = 0.036). Conclusions: This small, single-center, non-randomized cohort describes an institutional stage-adapted cryotherapy-based management framework for OMM. The findings do not establish comparative efficacy or objectively demonstrate functional preservation. Prospective multicenter studies with standardized treatment selection, complete treatment reporting, validated functional outcomes, and quality-of-life measures are required. Full article

Despite the success of modern antiretroviral therapy in achieving virological suppression, people living with HIV face an elevated risk of cardiovascular diseases, particularly heart failure with preserved ejection fraction. This study evaluates the cardiometabolic phenotype and functional capacity in a Romanian HIV cohort to delineate the metabolic footprint of chronic infection. In this cross-sectional study based on prospectively collected, protocol-driven phenotyping, we evaluated 50 consecutive outpatients from a university-affiliated infectious diseases clinic in Timisoara. Eligibility strictly required clinical stability and sustained virological suppression (plasma HIV-RNA < 50 copies/mL for ≥12 months). The analysis revealed widespread metabolic dysregulation, with 52% exhibiting excess weight and 64% showing atherogenic dyslipidemia. Integrase strand transfer inhibitor-based regimens were significantly correlated with an increased body mass index (p = 0.034) and elevated LDL cholesterol (aOR = 2.4, 95% CI [1.18–4.95], p = 0.022). Furthermore, we observed a pronounced metabolic age gap (+4.5 ± 2.8 years), defined as the deviation of bioimpedance-estimated metabolic age from the patients’ chronological age. This gap (p = 0.028), alongside historical immunodeficiency indicated by a low nadir CD4+ count (aOR = 0.998, 95% CI [0.991–0.999], p = 0.021), strongly predicted exercise intolerance, independent of current immune reconstruction. Sarcopenic obesity (present in 18% of the cohort) and an elevated triglycerides-to-HDL ratio (aOR = 2.14, 95% CI [1.15–3.98], p = 0.016) emerged as robust independent negative predictors of functional capacity. Additionally, subclinical myocardial remodeling, evidenced by impaired Global Longitudinal Strain, significantly predicted reduced aerobic capacity (aOR = 0.72, 95% CI [0.58–0.89], p = 0.003). Consequently, contemporary HIV management must transition beyond virological control to integrated cardiometabolic screening. Utilizing cardiopulmonary exercise testing, echocardiography, and metabolic biomarkers is critical for the early identification of subclinical “functional HIV-associated frailty” and mitigating the trajectory toward overt cardiovascular diseases. Full article

Background and Objectives: Periodontal health represents a condition characterized by homeostasis between the teeth and the surrounding supporting tissues and implies the absence of inflammation, confirmed by the lack of bleeding, epithelial attachment loss, mobility, or periodontal pocket formation. Fixed prosthetic restorations may compromise periodontal health already during the fabrication phase, given that decisions made during their planning and placement affect long-term clinical outcomes. The aim of this manuscript was to provide insight into the interaction between periodontal tissues and fixed prosthetic restorations. Materials and Methods: A narrative literature review was conducted using a structured search of the PubMed/MEDLINE, Scopus, and Google Scholar databases to identify studies addressing periodontal health in relation to fixed dental prostheses. The impacts of tooth preparation, gingival retraction methods, supracrestal tissue attachment, periodontal phenotype, crown emergence profile, and marginal fit of various biomaterials were analyzed. Results: According to the literature data, subgingival margin placement and violation of the supracrestal tissue attachment (biological width) induce chronic inflammation, loss of epithelial attachment, and alveolar bone resorption. Gingival retraction agents, used in chemomechanical retraction procedures, particularly ferric sulfate-based agents, may lead to a transient but significant spike in inflammatory markers and dysbiosis of the subgingival microbiome. Contemporary approaches, such as the biologically oriented preparation technique and the use of CAD/CAM (Computer-Aided Design and Computer-Aided Manufacturing) technology, may improve the precision of marginal fit. Zirconia restorations exhibit significantly better biocompatibility and reduced microbial adhesion compared to metal–ceramic restorations. Conclusions: Biological response of the periodontium to fixed prosthetic restorations depends on the complex interaction between the material, position of the marginal line, and oral hygiene control. Regardless of the material used or the fabrication technique employed, adequate plaque control and regular maintenance remain key factors in preserving periodontal health. Full article

The modern multi-domain battlespace increasingly demands cost-effective, persistent platforms for Forward Air Control (Airborne) (FAC(A)) and Close Air Support (CAS) missions. While utilizing Commercial Derivative Aircraft (CDA) presents a viable alternative to high-maintenance military assets, the specific aerodynamic, ergonomic, and cognitive workload limitations encountered during the transition across the civil–military “airworthiness seam” remain a significantly underexplored gap in contemporary aerospace literature. To address this gap, a comprehensive empirical flight test campaign was executed on the LX7-135 turboprop to evaluate its tactical mission suitability. Employing the Cooper–Harper Handling Qualities Rating and Bedford Workload scales, and guided by military specifications (MIL-HDBK-516C, MIL-F-8785C), the study systematically assessed the aircraft’s pure performance, unaugmented flight dynamics, and human–machine interface during simulated combat scenarios, including dynamic 9-Line briefings and kinetic “Box Pattern” delivery profiles. Flight test data indicated 12 “SATISFACTORY” parameters, highlighting climb rates, extended endurance, and heavily damped short-period and Dutch roll modes optimal for target tracking. Conversely, the evaluation identified 4 “UNSATISFACTORY” and 10 “TOLERABLE” deficiencies—chiefly a single-door egress bottleneck, restricted stick clearance, degraded longitudinal static stability, and the absence of secure tactical communications. Although these constraints elevated pilot cognitive workload during multi-axis tasks, the LX7-135 demonstrates potential suitability for further development for the FAC(A) role, subject to the successful implementation and subsequent flight-test verification of the identified critical engineering modifications and specialized training syllabi. Full article

Tuberculosis (TB) continues to be a significant public health challenge in Europe, despite a sustained decline in disease incidence over recent decades. This narrative review briefly traces the historical development of TB diagnosis and focuses on the evolution of TB control protocols from the early twentieth century to the present across Europe, through a longitudinal comparative analysis of its geographical regions. A literature search was conducted using publications, guidelines, and surveillance reports from the World Health Organization (WHO), the European Centre for Disease Prevention and Control (ECDC), and national public health authorities. The analysis follows a geographical framework encompassing Eastern, Western, Northern, and Southern Europe, reflecting historical, socioeconomic, and healthcare system differences. This study presents the transition from traditional diagnostic approaches based on clinical assessment, chest radiography, and smear microscopy to modern molecular and immunological techniques, including Xpert MTB/RIF assays and interferon-gamma release assays (IGRAs). Similarly, treatment strategies have evolved from sanatorium-based supportive care to standardized, evidence-based short-course regimens employing first- and second-line anti-TB drugs. However, marked regional differences remain in the implementation of contemporary protocols. Western and Northern European countries have largely adopted advanced diagnostic technologies and comprehensive surveillance systems and are approaching TB elimination targets. In contrast, Eastern Europe continues to bear a disproportionate disease burden, driven by multidrug-resistant TB, HIV co-infection, and socioeconomic disparities. TB control protocols in Southern Europe are progressively converging with those of Western Europe through the adoption of modern diagnostic approaches, standardized treatment regimens, and WHO-endorsed guidelines. The findings of this study underscore the need for greater harmonization of TB control protocols across Europe through an initiative coordinated by the ECDC/WHO. Accelerating progress toward TB elimination in the European Region will depend on expanding access to modern diagnostic technologies, implementing targeted interventions in high-burden settings, and strengthening cross-border collaboration through coordinated public health policies. Full article

The discovery of activating epidermal growth factor receptor (EGFR) mutations transformed the management of non-small cell lung cancer and has driven two decades of therapeutic advances in precision oncology across metastatic, resectable, and unresectable locally advanced disease, including central nervous system (CNS) control. Consequently, treatment outcomes for patients with tumors harboring classical EGFR mutations have markedly improved. Despite these advances, many questions remain unanswered, and the expanding number of treatment options has created new challenges in treatment selection and sequencing. This narrative review summarizes contemporary data on the management of classical EGFR-mutant NSCLC, encompassing novel therapeutic approaches across disease stages, biomarker-informed resistance strategies, multimodality treatment integrating radiotherapy, CNS-directed management, and challenging scenarios such as small-cell transformation. We also discuss emerging fourth-generation inhibitors, nucleic-acid delivery platforms, and data-enabled personalized treatment. We highlight evolving standards of care, unresolved knowledge gaps, and research priorities for the next decade. Full article

This editorial introduces the Special Issue “Mathematical Methods and Operation Research in Planning, Scheduling and Supply Chain Operations Management” of the journal Mathematics. The Special Issue gathers nine peer-reviewed papers that, together, illustrate the breadth of contemporary operations research applied to the planning and control of modern industrial systems. The accepted contributions span the full methodological spectrum—from exact combinatorial optimisation (constraint programming, branch and bound, and mixed-integer programming) through heuristics, metaheuristics and reinforcement learning to worst-case performance analysis and stochastic models—and they address problems across the whole operations hierarchy, ranging from single- and parallel-machine scheduling, flow shops and flexible job shops to inventory systems and supply-chain logistics, with a recurrent emphasis on sustainability, robustness and real-world applicability. This editorial summarises the scope of the Special Issue and the individual contributions, and outlines some cross-cutting trends and directions for future research. Full article

Background: Tuberculosis remains a major public health challenge in Latin America, where social inequalities, fragmented health systems, and barriers to care continue to undermine disease control. Although effective treatment is available, treatment abandonment and loss to follow-up remain persistent obstacles to successful outcomes. Methods: A structured critical analysis of the contemporary literature on tuberculosis treatment abandonment and retention in care was conducted using a narrative evidence synthesis approach. Forty scientific documents published between 2018 and 2026 were included. Of these, 23 Latin American studies informed the results synthesis, while 13 international studies supported the comparative critical reflection. Results: Findings were organised into five domains: social vulnerability, clinical complexity, health system barriers, priority populations, and protective factors and innovation. The evidence indicates that treatment abandonment is not an isolated individual behaviour, but a phenomenon associated with the convergence of social, clinical, and institutional determinants across the care trajectory. Poverty, migration, drug resistance, incarceration, weak follow-up systems, and fragmented care were repeatedly associated with discontinuity, whereas social support, active follow-up, digital tools, and economic measures were linked to improved adherence and retention in care. Conclusions: From a biopsychosocial perspective, treatment abandonment should be understood as a systemic and preventable failure across the tuberculosis care continuum. The proposed Latin American Integrated Model for Retention in Tuberculosis Care (MILERTB) offers an anticipatory, equity-oriented, and person-centred framework to strengthen retention in care and guide future implementation research. Full article

Background/Objectives: Contemporary secondary students increasingly learn in technology-rich classrooms characterized by digital stimulation, multitasking demands, compressed pacing, platform switching, and persistent attentional competition. Established scholarship on cognitive load, multimedia learning, self-regulated learning, disciplinary literacy, attentional control, and environmental restoration identifies mechanisms relevant to these conditions, but these mechanisms are often examined at different levels of analysis. This conceptual review develops the Cognitive Ecology of Learning Framework (CELF) as an applied, classroom-level framework for examining how disciplinary cognitive demand, attentional fragmentation conditions, and restoration opportunities may interact during sustained secondary science learning. Methods: An integrative conceptual-review and theory-synthesis design was used. Iterative searches conducted from January through May 2026 identified theoretical, empirical, and review literature across education, psychology, attentional science, digital learning, environmental psychology, and secondary science education. Sources were selected purposively according to their relevance to the research questions and synthesized through cross-domain comparison. Results: The synthesis proposes CELF as a hypothesis-generating framework organized around three classroom-level dimensions: Disciplinary Cognitive Demand, Attentional Fragmentation Conditions, and Restoration Opportunities. The framework also proposes cognitive malnourishment and cognitive endurance as context-sensitive constructs requiring empirical validation. Cognitive malnourishment describes a possible ecological mismatch in which substantial informational or disciplinary demand coincides with persistent fragmentation and insufficient opportunities for elaboration, reflection, consolidation, and coherent reengagement. Cognitive endurance refers to the context-sensitive capacity to sustain attention, conceptual processing, and disciplinary reasoning during extended, cognitively demanding work. Preliminary indicators, measurement approaches, and testable propositions are presented for future classroom-based research. Conclusions: CELF organizes selected task-level, learner-level, disciplinary, attentional, and environmental constructs within a bounded framework for technology-rich secondary science classrooms. It does not revise or replace the foundational theories from which these constructs are drawn, nor does it claim causal validation. Instead, CELF provides a structure for investigating how classroom conditions may support or constrain attentional continuity, conceptual persistence, restoration, and sustained disciplinary engagement. Full article

Background and Objectives: Diabetes mellitus is a major systemic modifier of oral infection, periodontal inflammation, and tissue healing. Persistent hyperglycemia may intensify oxidative stress, immune dysfunction, dysbiotic biofilm activity, and advanced glycation end-product/receptor signaling, thereby reducing the predictability of periapical and periodontal healing. In patients with endo-periodontal lesions, these mechanisms may interact with pulpal infection and periodontal breakdown, complicating diagnosis, prognosis, and therapeutic sequencing. This review summarizes current evidence on diabetes, glycated hemoglobin (HbA1c), and endo-periodontal outcomes and proposes an HbA1c-guided clinical framework for risk stratification and treatment planning. Materials and Methods: A structured narrative review with an expert-informed clinical framework was conducted using the literature published between January 2016 and December 2025. Eligible sources included consensus reports, clinical practice guidelines, systematic reviews, meta-analyses, umbrella reviews, randomized and non-randomized clinical studies, observational studies, and selected mechanistic studies or contemporary narrative reviews with direct relevance to the framework. Case reports, animal studies, and in vitro investigations without direct relevance to the clinical framework were excluded from the main synthesis. Results: Diabetes is associated with increased periodontal severity, impaired periodontal treatment response, a higher prevalence of radiolucent periapical lesions in root-filled teeth, delayed periapical healing, and increased non-retention of endodontically treated teeth. Periodontal therapy is safe in diabetic patients and may be associated with modest reductions in HbA1c, especially when baseline metabolic control is poor. Conclusions: HbA1c should complement, not replace, pulpal testing, periodontal charting, and radiographic assessment. The proposed framework prioritizes endodontic infection control when pulpal necrosis or active intracanal infection is present, adapts periodontal intervention to metabolic risk, and postpones elective surgical or regenerative procedures in poorly controlled diabetes until medical stabilization is achieved. Full article