Search Results (7,951)

Aggressiveness in dogs is a complex behavioral trait with implications for animal welfare and public safety. Despite domestication, dogs retain aggressive tendencies shaped by both genetic and environmental factors. This systematic review synthesizes the literature from 2000 to 2024 on the genetic and environmental bases of canine aggression. Using PRISMA 2020 guidelines, 144 articles were retrieved from Scopus and PubMed and screened in two phases, resulting in 33 studies selected for analysis. These were evaluated using a 20-question grid across seven categories, including phenotyping, genetic analysis, population structure, and future directions. The studies support a polygenic model of aggressiveness, with associations reported for genes involved in neurotransmission, hormone signaling, and brain function. However, inconsistencies in phenotyping, small sample sizes, and a limited consideration of environmental factors hinder robust conclusions. Most studies focused on popular companion breeds, while those commonly labeled as aggressive were underrepresented. The findings highlight the relevance of gene–environment interactions but underscore that aggression is often poorly defined and measured across studies. Future research should prioritize standardized phenotyping tools, broader breed inclusion, and the functional validation of genetic findings. These efforts will improve the understanding of dog aggression and inform breeding, behavioral assessment, and public policy. Full article

Background and Objectives: Depression is a leading cause of disability globally, with treatment challenges including limited access, stigma, and poor adherence. Gamification, which applies game elements such as points, levels, and storytelling into non-game contexts, offers a promising strategy to enhance engagement and augment traditional treatments. Our research is the first study designed to explore the implementation of gamification within the Malaysian context. The objective was to explore the feasibility of implementation of gamification as an adjunctive treatment for adults with depression. Materials and Methods: Focus group discussions were held with five mental health professionals and ten patients diagnosed with moderate depression. The qualitative component assessed perceptions of gamified interventions, while quantitative measures evaluated participants’ depressive and anxiety symptomatology. Results: Three key themes were identified: (1) understanding of gamification as a treatment option, (2) factors influencing its acceptance, and (3) characteristics of a practical and feasible intervention. Clinicians saw potential in gamification to boost motivation, support psychoeducation, and encourage self-paced learning, but they expressed concerns about possible addiction, stigma, and the complexity of gameplay for some patients. Patients spoke of gaming as a source of comfort, escapism, and social connection. Acceptance was shaped by engaging storylines, intuitive design, balanced difficulty, therapist guidance, and clear safety measures. Both groups agreed that gamification should be used in conjunction with standard treatments, be culturally sensitive, and be presented as a meaningful therapeutic approach rather than merely as entertainment. Conclusions: Gamification emerges as an acceptable and feasible supplementary approach for managing depression in Malaysia. Its success depends on culturally sensitive design, robust clinical oversight, and seamless integration with existing care pathways. Future studies should investigate long-term outcomes and establish guidelines for the safe and effective implementation of this approach. We recommend targeted investment into culturally adapted gamified tools, including training, policy development, and collaboration with key stakeholders to realistically implement gamification as a mental health intervention in Malaysia. Full article

Childhood obesity increases chronic disease risk, but no comprehensive synthesis has evaluated the impact of school-based combined nutrition education and physical activity interventions on cardiometabolic biomarkers in children aged 3 to 12 years. This systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251085194). Five databases were systematically searched through June 2025. Twelve randomized controlled trials involving 18,231 children were included and assessed using the PEDro scale. Ten trials demonstrated significant improvements in at least one cardiometabolic biomarker. Blood pressure (8 studies) outcomes showed systolic reductions of 1.41–6.0 mmHg in six studies. Glucose metabolism (5 studies) improved in two studies with reductions of 0.20–0.22 mmol/L. Lipid profiles (7 studies) improved in three studies, including total cholesterol (−0.32 mmol/L). Insulin levels (5 studies) decreased significantly in two investigations. Anthropometric improvements included BMI and body fat. Physical activity increased by >45 min/week and dietary habits improved significantly. Programs with daily implementation (90-min sessions 4x/week), longer duration (≥12 months), family involvement (parent education), and curriculum integration (classroom lessons) showed superior effectiveness. Interventions targeting children with overweight/obesity demonstrated higher changes compared to the general population. However, methodological limitations included a lack of assessor blinding, absence of subject/therapist blinding, and inadequate retention rates. School-based interventions combining nutrition and physical activity can produce significant improvements in cardiometabolic biomarkers, supporting comprehensive, sustained multicomponent programs for early chronic disease prevention. Full article

Background and Clinical Significance: Angioleiomyoma (ALM) is a benign tumor that generally presents as a single lesion and, according to the updated WHO classification, includes the following three histological subtypes: solid (or capillary), cavernous, and venous. Typically, ALMs are described as well-defined nodules in the lower extremities but are unusually located in the acral locations and toes. We summarize two cases of ALM and perform a systematic review to provide foot surgeons with the most up-to-date and useful information on the epidemiological aspects, anatomical distribution, and specific histological subtypes of ALM in the foot. Materials and Methods: A systematic review was carried out according to the criteria of a PICO framework, and a systematic search and data processing were carried out according to the PRISMA guidelines. We analyzed patient demographics, clinical characteristics, diagnostic workup, treatment, and clinical outcomes. Each one of the included articles was independently assessed for methodological quality and risk of bias by an independent evaluator. The risk of bias of the included studies was assessed based on their characteristics. Results: This systematic review included 14 case series with 172 reported cases of ALM. One hundred and seventy-two (18.57%) were cases of ALM located on foot, excluding the ankle region. The female-to-male ratio was 1.48. The most common location was the hindfoot (41.5%), followed by the forefoot (20.2%) and the midfoot (8.9%). In 29.4% of cases, the location of the lesions could not be determined. The most frequent location of the lesions was subcutaneous (69%), followed by subaponeurotic (16.5%) and skin (14.5%) locations. The most frequent histological presentation was the solid histologic subtype (65%), followed by the venous subtype (21%) and the cavernous subtype (14%), respectively. Of the total reported cases of ALM located in foot, 63.1% presented as solid painful lesions. Calcified presentations occurred in 7% of cases, with more than half of the cases located in the hindfoot. Surgical excision was the treatment of choice in the two herein reported cases of solid ALM located in the hindfoot, one of them with a calcified presentation. No recurrence was observed in either case after two and five years of follow-up, respectively. All cases reviewed after surgical excision showed a low recurrence rate with a favorable prognosis regardless of the histological subtype and a very rare tendency toward malignancy. Conclusions: ALMs of the foot present as well-defined, painful nodules in the subcutaneous tissue of middle-aged women. Solid histological subtypes are the most prevalent. Histopathological analysis is usually essential for confirmation. Treatment consists primarily of direct excision, with remarkably low recurrence rates. Full article

Context: Many patients at the end of life receive antibiotics to alleviate symptoms and improve quality of life; however, clear guidelines supporting decision making about the use of antibiotics are still lacking. Objectives: This study aimed to evaluate the benefits and harms of antibiotic use among patients under a palliative care community support team in Portugal. Methods: An observational, cross-sectional, retrospective study was conducted on 249 patients who died over a two-year period, having been followed for at least 30 days prior to their death. Data included patient demographics, clinical diagnoses, antibiotic prescriptions, and symptomatic outcomes. The effects of commonly prescribed antibiotics—amoxicillin + clavulanic acid, cefixime, ciprofloxacin, and levofloxacin—were compared using statistical analyses to assess survival, symptom intensity, and functional scales. Results: Adverse events, primarily infections and secretions, occurred in 57.8% of cases, with 33.7% receiving antibiotics. No significant difference in survival was observed across the antibiotic groups (p = 0.990). Symptom intensity significantly reduced after 72 h of treatment (p < 0.05), with ciprofloxacin demonstrating the greatest symptom control. The Palliative Outcome Scale decreased uniformly, with higher scores associated with amoxicillin + clavulanic acid (p = 0.004). The Palliative Performance Scale declined post-treatment, with significant changes noted for cefixime and ciprofloxacin (p < 0.05). Conclusions: Antibiotics may improve symptom control and quality of life in the end-of-life stage. While second-line antibiotics may offer additional benefits, the heterogeneity of the sample and limited adverse effect data underscore the need for further research to guide appropriate prescription practices in palliative care. Full article

Background: Environmental enrichment is a promising strategy to improve the welfare of dairy goats and sheep. However, studies in this field remain scattered, and its effects on productivity are unclear. Objectives: To evaluate the effects of environmental enrichment on behavioral, physiological, and productive parameters in dairy goats and sheep. Data sources: Scopus and Web of Science were searched for studies published from 2010 to 2025. Study eligibility criteria: Experimental or observational peer-reviewed studies comparing enriched vs. non-enriched housing in dairy goats or sheep, reporting on welfare or productivity outcomes. Methods: This review followed PRISMA 2020 guidelines and the PICO framework. Two independent reviewers screened and extracted data. Risk of bias was assessed with the SYRCLE tool. Results: Thirteen studies were included, mostly with goats. Physical, sensory, and social enrichments showed benefits for behavior (e.g., activity, fewer stereotypies) and stress physiology. However, results varied by social rank, enrichment type, and physiological stage. Only three studies assessed productive parameters (weight gain in kids/lambs); none evaluated milk yield or quality. Limitations: Most studies had small samples and short durations. No meta-analysis was conducted due to heterogeneity. Conclusions: Environmental enrichment can benefit the welfare of dairy goats and sheep. However, evidence on productivity is scarce. Long-term studies are needed to evaluate its cost-effectiveness and potential impacts on milk yield and reproductive performance. Full article

The 2025 avian influenza A(H5N1) outbreak has highlighted the urgent need for rapidly generated health communication materials during public health emergencies. Artificial intelligence (AI) systems offer transformative potential to accelerate content development pipelines while maintaining scientific accuracy and impact. We evaluated an AI-generated health communication material on bird flu precautions among 100 U.S. adults. The material was developed using ChatGPT for text generation based on CDC guidelines and Leonardo.AI for illustrations. Participants rated perceived message effectiveness, quality, realism, relevance, attractiveness, and visual informativeness. The AI-generated health communication material received favorable ratings across all dimensions: perceived message effectiveness (3.83/5, 77%), perceived message quality (3.84/5, 77%), realism (3.72/5, 74%), relevance (3.68/5, 74%), attractiveness (3.62/5, 74%), and visual informativeness (3.35/5 67%). Linear regression analysis revealed that all features significantly predicted perceived message effectiveness in unadjusted and adjusted models (p < 0.0001), e.g., multivariate analysis of outcome on perceived visual informativeness showed β = 0.51, 95% CI: 0.37–0.66, p < 0.0001. Also, mediation analysis revealed that visual informativeness accounted for 23.8% of the relationship between material attractiveness and perceived effectiveness. AI tools can enable real-time adaptation of prevention guidance during epidemiological emergencies while maintaining effective risk communication. Full article

Background: Depression that is resistant to two or more adequate treatment trials—treatment-resistant depression (TRD)—is a prevalent clinical challenge. Although psychotherapies have been recommended by clinical guidelines as an alternative or adjunctive treatment strategy, the effectiveness of psychotherapy in individuals with TRD has not yet been evaluated through meta-analytic methods, primarily due to a limited number of trials. This highlights the necessity of personalized research targeting this specific population. This systematic review and meta-analysis aimed to summarize the evidence on psychotherapy in treating TRD. Methods: A systematic search was conducted following the Guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles were included if they quantitatively examined the efficacy of psychotherapy on depression symptoms in individuals diagnosed with depression who had not responded to at least two prior treatments (i.e., pharmacotherapy and/or psychotherapy). Results: A total of 12 studies were included. The quality of evidence was evaluated as being globally moderate. When pooling all psychotherapies, a small-to-moderate, but significant, effect on depressive symptoms was observed compared to the control group (SMD = −0.49, CI = −0.63; −0.34). The observed effect remained unchanged after removing the outlier (SMD = −0.47, CI = −0.62; −0.32). When examining depressive symptoms by type of psychotherapy, Mindfulness-Based Cognitive Therapy (SMD = −0.51, CI = −0.76; −0.25), Cognitive Behavioral Therapy (SMD = −0.53, CI = −0.92; −0.14), and Cognitive Therapy (SMD = −0.51, CI = −1.01; −0.01) showed a moderately significant effect on depressive symptoms compared to the control group. Conclusions: Although this potentially represents the first meta-analysis in this area, the number of studies specifically addressing this complex population remains limited, and the existing literature is still in its early stages. Research focusing on TRD is notably sparse compared to the broader body of work on depression without treatment resistance. Consequently, it was not possible to conduct meta-analyses by type of psychotherapy across all treatment modalities and by type of control group. Due to several study limitations, there is currently limited evidence available about the effectiveness of psychotherapy for TRD, and further trials are needed. Beyond the treatments usually offered for depression, it is possible that TRD requires a personalized medicine approach. Full article

Previous reviews have examined specific facets of Geographic Information Systems (GIS) in transportation planning, such as transit-focused applications and open source geospatial tools. However, this study offers the first systematic, PRISMA-guided longitudinal evaluation of GIS integration in transportation planning, spanning thematic domains, data models, methodologies, and outcomes from 2004 to 2024. This study addresses this gap through a longitudinal analysis of GIS-based transportation research from 2004 to 2024, adhering to PRISMA guidelines. By conducting a mixed-methods analysis of 241 peer-reviewed articles, this study delineates major trends, such as increased emphasis on sustainability, equity, stakeholder involvement, and the incorporation of advanced technologies. Prominent domains include land use–transportation coordination, accessibility, artificial intelligence, real-time monitoring, and policy evaluation. Expanded data sources, such as real-time sensor feeds and 3D models, alongside sophisticated modeling techniques, enable evidence-based, multifaceted decision-making. However, challenges like data limitations, ethical concerns, and the need for specialized expertise persist, particularly in developing regions. Future geospatial innovations should prioritize the responsible adoption of emerging technologies, inclusive capacity building, and environmental justice to foster equitable and efficient transportation systems. This review highlights GIS’s evolution from a supplementary tool to a cornerstone of data-driven, sustainable urban mobility planning, offering insights for researchers, practitioners, and policymakers to advance transportation strategies that align with equity and sustainability goals. Full article

Background: Hypoxic–ischemic encephalopathy (HIE) is a leading cause of severe neurological impairments in childhood. Therapeutic hypothermia (TH) is both safe and effective in neonates born at ≥36 weeks gestation with moderate to severe HIE. We aimed to evaluate short-term outcomes—including brain injury detected on magnetic resonance imaging (MRI)—in infants born at 34–35 weeks of gestation drawing on our clinical experience with neonates under 36 weeks of gestational age (GA). Methods: In this retrospective cohort study, 20 preterm infants with a GA of 34 to 35 weeks and a matched cohort of 80 infants with a GA of ≥36 weeks who were diagnosed with moderate to severe HIE and underwent TH were included. Infants were matched in a 1:4 ratio based on the worst base deficit in blood gas and sex. Maternal and neonatal characteristics, brain MRI findings and short term outcomes were compared. Results: Infants with a GA of 34–35 weeks had a lower birth weight and a higher rate of caesarean delivery (both p < 0.001). Apgar scores, sex, intubation rate in delivery room, blood gas pH, base deficit and lactate were comparable between the groups. Compared to infants born at ≥36 weeks of GA, preterm neonates were more likely to receive inotropes, had a longer time to achieve full enteral feeding, and experienced a longer hospital stay. The mortality rate was 10% in the 34–35 weeks GA group. Neuroimaging revealed injury in 66.7% of infants born at 34–35 weeks of gestation and in 58.8% of those born at ≥36 weeks (p = 0.56). Injury was observed across multiple brain regions, with white matter being the most frequently affected in the 34–35 weeks GA group. Thalamic and cerebellar abnormal signal intensity or diffusion restriction, punctate white matter lesions, and diffusion restriction in the corpus callosum and optic radiations were more frequently detected in infants born at 34–35 weeks of gestation. Conclusions: Our study contributes to the growing body of literature suggesting that TH may be feasible and tolerated in late preterm infants. Larger randomized controlled trials focused on this vulnerable population are necessary to establish clear guidelines regarding the safety and efficacy of TH in late preterm infants. Full article

Background/Objectives: The aim of our study was to evaluate clinical outcomes in patients with small pleomorphic adenoma (PA) after extracapsular dissection (ED) versus superficial parotidectomy (SP). Methods: Following the PRISMA guidelines, a systematic review covering the years from 1950 to 2025 was conducted using the Pubmed/MEDLINE, Cochrane Library, Scopus, Ovid MEDLINE and Embase databases. A single-arm meta-analysis was performed to evaluate intraoperative capsular rupture, recurrence, transient and permanent facial nerve palsy, Frey’s syndrome, salivary fistula, seroma and hematoma of patients who underwent ED vs. those who underwent SP, and funnel plots were constructed to evaluate the robustness of the findings. Results: Of the 1793 identified papers, 21 articles met the inclusion criteria. The meta-analysis (2507 patients) reported the following: (1) the risk of recurrence is similar in patients treated with ED and SP; (2) the transient facial nerve palsy rate is lower after ED (p < 0.05), while the permanent facial nerve palsy rate is similar with ED and SP; (3) post-operative complications, especially Frey’s syndrome (p < 0.05), are more common after SP. Conclusions: Given the similar recurrence rate and the lower morbidity compared to SP, ED could be considered the treatment of choice for pleomorphic adenomas of the parotid gland that are up to 3 cm in size, mobile and located in the superficial lobe of the parotid gland. Full article

The Ministry of Land, Infrastructure, and Transport conducted a demonstration project targeting pilot areas to commercialize drone delivery services in urban areas and to present a standard model. In this study, flight data on drone delivery routes in Ulju and drone hovering in Yeosu were collected and analyzed for flight safety. Since there are no domestic or international regulations on the stability of drone flight, we were given the task of analyzing whether drone path flight should be maintained within a 10 m error range from the planned path line by the Korea Transportation Safety Authority and whether hovering works while satisfying the left and right radius errors and altitude errors within 3 m. Accordingly, the drone flight path data analyzed in Ulju met the criteria of up to 1.07%, and the hovering data analyzed in Yeosu met the criteria of less than 3% for the entire section data. Therefore, the drone flight stability evaluation analyzed in this paper is considered to have been passed. Based on the results of this study, is the data are expected to serve as a cornerstone for establishing guidelines for drone delivery flight data analysis regulations. Full article

Background: Intravenous vancomycin remains a key agent in the treatment of complex orthopedic infections, particularly those involving methicillin-resistant Staphylococcus aureus (MRSA). However, its use is associated with significant risks, most notably nephrotoxicity. Despite guideline recommendations, standardized dosing and monitoring protocols are often absent in orthopedic settings, leading to inconsistent therapeutic drug exposure and preventable adverse events. This study evaluated the clinical impact of implementing a structured standard operating procedure (SOP) for intravenous vancomycin therapy in orthopedic inpatients. Methods: We conducted a single-center, pre-post cohort study at a university orthopedic department. The intervention consisted of a standard operating procedure (SOP) for intravenous vancomycin therapy, which mandated weight-based loading doses, renal function-adjusted maintenance dosing, trough level monitoring, and defined dose adjustments. Patients treated before SOP implementation (n = 58) formed the control group; those treated under the SOP (n = 56) were prospectively included. The primary outcome was the incidence of vancomycin-associated acute kidney injury (VA-AKI) defined by KDIGO Stage 1 criteria. Secondary outcomes included therapeutic trough level attainment and infusion-related or ototoxic adverse events. Results: All patients in the post-SOP group received a loading dose (100% vs. 31% pre-SOP, p < 0.001). The range of measured vancomycin trough levels narrowed substantially after SOP implementation (7.1–36.2 mg/L vs. 4.0–80.0 mg/L). The proportion of patients reaching therapeutic trough levels increased, although this was not statistically significant. Most notably, VA-AKI occurred in 17.2% of patients in the control group, but in none of the patients after SOP implementation (0%, p = 0.0013). No cases of ototoxicity were observed in either group. Infusion-related reactions decreased after the implementation of the SOP, though not significantly. Conclusions: The introduction of a structured vancomycin protocol significantly reduced adverse drug events and improved dosing control in orthopedic inpatients. Incorporating such protocols into routine practice represents a feasible and effective strategy to strengthen antibiotic stewardship and clinical quality in surgical disciplines. Full article

Background and objectives: Trismus is a frequent and debilitating complication in people with head and neck cancer (HNC) which leads to significant functional limitations and reduced quality of life. Rehabilitation interventions are commonly recommended to manage or prevent trismus. However, in many randomized controlled trials (RCTs), the theoretical justification for these interventions is poorly articulated, and the underlying biological or physiological mechanisms are not described in detail, limiting our understanding of why certain treatments may (or may not) work. This review aimed to identify and analyze how RCTs report the rationale for rehabilitation interventions and the explanations used to manage this population. Materials and Methods: A scoping review was conducted in accordance with the PRISMA-ScR guidelines. Five databases (PubMed, PEDro, Web of Science, Scopus, and EMBASE) were searched up to May 2025 for RCTs evaluating rehabilitation interventions for the management or prevention of treatment-induced trismus in patients with HNC. Data were extracted and synthesized narratively, focusing on the type of intervention, the rationale for its use, and the proposed mechanisms of action. Results: Of 2215 records identified, 24 RCTs met the inclusion criteria. Thirteen studies focused on preventive interventions—primarily exercise therapy—while the remainder addressed established trismus using exercise, manual therapy, electrotherapy, or combined treatment modalities. The rationales provided for intervention selection were heterogeneous and often lacked depth, with most studies justifying interventions based on their potential to improve mouth opening or reduce fibrosis but rarely grounding these claims in detailed pathophysiological models. Only half of the studies provided any mechanistic explanation for the intervention’s effects, and these were typically generic or speculative. Conclusions: RCTs investigating rehabilitation interventions for treatment-induced trismus in patients with HNC frequently lack comprehensive rationales and mechanistic explanations for their interventions. This gap limits the ability to refine and optimize treatment approaches, as the underlying processes driving clinical improvements remain poorly understood. Future research should be guided by theoretical models and include objective outcomes to better elucidate the mechanisms of action of interventions to inform clinical practice. Full article

Three-dimensional printing is commonly used to fabricate provisional dental restorations. Studies have reported that changes in printing orientation affect the physical and mechanical properties of 3D-printed polymeric provisional restorations; however the findings have been inconsistent. Therefore, this systematic review and meta-analysis aims to analyze the articles evaluating the influence of printing orientation on the physical and mechanical properties of 3D-printed polymeric provisional dental restorations. Recommendations provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to structure and compose the review. The PICO (Participant, Intervention, Comparison, Outcome) question ordered was: ‘Do 3D-printed provisional dental restorations (P) printed at various orientations (except 0°) (I) exhibit similar physical and mechanical properties (O) when compared to those printed at a 0° orientation (C)?’. An electronic search was conducted on 28 and 29 April 2025, by two independent researchers across four databases (MEDLINE/PubMed, Scopus, Cochrane Library, and Web of Science) to systematically collect relevant articles published up to March 2025. After removing duplicate articles and applying predefined inclusion and exclusion criteria, twenty-one articles were incorporated into this review. Self-designed Performa’s were used to tabulate all relevant information. For the quality analysis, the modified CONSORT scale was utilized. The quantitative analysis was performed on only fifteen out of twenty-one articles. It can be concluded that the printing orientation affects some of the tested properties, which include fracture strength (significantly higher for specimens printed at 0° when compared to 90°), wear resistance (significantly higher for specimens printed at 90° when compared to 0°), microhardness (significantly higher for specimens printed at 90°and 45° when compared to 0°), color stability (high at 0°), and surface roughness (significantly higher for specimens printed at 45° and 90° when compared to 0°). There were varied outcomes in terms of flexural strength and elastic modulus. Full article