Search Results (447)

Background: Para-aortic lymph node involvement is present in approximately 17–24% of women with locally advanced cervical cancer (LACC) and is one of the strongest adverse prognostic factors in this population. Current international guidelines recommend two alternative staging techniques: the International Federation of Gynecology and Obstetrics (FIGO) and European Society of Gynecologic Oncology (ESGO) endorse imaging-based staging as the primary method to define radiation fields, whereas the National Comprehensive Cancer Network (NCCN) lists pre-treatment minimally invasive para-aortic lymphadenectomy as a Category 2B recommendation. Objective: We aimed to review and critically appraise the available evidence on the oncologic impact (progression-free and overall survival) of pre-treatment surgical para-aortic staging compared with clinical imaging-based staging in women with LACC. Methods: We searched MEDLINE (Ovid), Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Scopus from inception to January 2026, complemented by manually searching the reference lists for relevant articles and prior reviews. The review focused on comparative studies of women with LACC of squamous, adenocarcinoma, or adenosquamous histology—operationally defined as FIGO 2009 stages IB2–IVA with pelvic nodal involvement or FIGO 2018 stages IB3–IVA who received definitive-intent radiotherapy with or without concurrent chemotherapy and brachytherapy, and for whom comparative survival outcomes between a surgical-staging arm and an imaging-staging arm were reported. For this manuscript, a narrative review style was planned and reported in line with SANRA (Scale for the Assessment of Narrative Review Articles) quality criteria. Results: Twelve studies were included: two randomized controlled trials and ten observational studies (nine retrospective cohorts and one population-based analysis). Surgical staging consistently increased detection of occult para-aortic disease and led to more frequent use of extended-field radiotherapy (18–44%), but it did not yield a reproducible advantage in terms of progression-free or overall survival over imaging-guided chemoradiation. Conclusions: In LACC, pre-treatment surgical para-aortic staging improves anatomic and prognostic information but has not shown a consistent survival advantage over imaging-based staging combined with contemporary chemoradiation. Current comparative evidence does not support routine surgical staging, and its use still warrants further prospective evaluation in large clinical trials. Until results from ongoing phase III trials are available, surgical staging should be considered an individualized option in highly selected cases within multidisciplinary decision-making at experienced clinical centers. Full article

Education is crucial for addressing the global biodiversity crisis and encouraging behaviours that support sustainable resource use and biodiversity protection. Species identification skills are an important part of biodiversity education, but research shows that educational practitioners have limited species knowledge and preferences for certain biodiversity. This study compares UK practitioners’ knowledge, awareness, and perceptions regarding four biodiversity categories (invertebrates, mammals, birds, flowering plants). UK schoolteachers in primary education, secondary science, and geography (n = 192) completed an online survey, comprising an identification test, free listing exercise, Likert scale, and closed and open-text questions. Knowledge was poor overall but highest for birds and mammals, followed by plants and lastly invertebrates. Few respondents correctly identified all six plant species, and none correctly identified all six invertebrates. Identification knowledge was positively associated with age, nature connectedness, and type of university degree. Relative awareness was high for mammals, similar for trees, flowers and birds, and low for invertebrates and other vertebrate groups. Respondents perceived colourful flying species as attractive but species with stinging structures as unattractive. Approximately half the respondents thought it was important for teachers to possess identification skills and two thirds thought that children had poor identification skills. The potential impacts of low invertebrate knowledge and awareness on environmental education are discussed and solutions proposed for teacher training, support, and classroom interventions. Full article

This study employs sample data of Chinese A-share listed companies from 2008 to 2023, takes investment efficiency as a core indicator to measure corporate sustainable development, and adopts the difference-in-differences (DID) model to examine the impact of free trade zone policies on enterprise sustainable development. The research results show that the establishment of FTZs has significantly improved the level of enterprise sustainable development, and this conclusion has passed a series of robustness tests. In the mechanism analysis, the main paths of action include alleviating financing constraints, optimizing internal control, and reducing transaction costs. The heterogeneity analysis finds that there are different regional effects in FTZs, and the policy effects are more obvious in the eastern, western, provincial capital, sub-provincial, and non-coastal areas. This study deepens the understanding of the sustainable impact of FTZs on enterprises, presents how the interaction between institutions and the market promotes the efficiency improvement of different regions, and also provides key suggestions for enterprises to make wise investment decisions by using the policies of FTZs and find a sustainable development path. Full article

Carbonated beverages are widely consumed worldwide, and carbonation-related texture plays an important role in consumer sensory perception and preference during consumption. This study aims to determine the perception of carbonation and texture characteristics among young Korean adult consumers using a combination of focus group interviews and free-sorting tasks. Participants were asked to describe their experiences with various carbonated beverages, focusing on textural attributes and perceptions. The free-sorting tasks revealed distinct groupings based on perceived carbonation intensity and flavor attributes. At the end of the interview, consumers were presented with a list of texture attribute terms for carbonated beverages and were asked to check all that applied to the essential sensory characteristics of carbonated beverages. The most frequently selected texture attributes were cooling (93.3%, p < 0.001), carbonation (86.7%, p < 0.001), bite (83.3%, p < 0.001), and overall fizziness (76.7%, p < 0.01), indicating that these attributes are considered essential by consumers when evaluating carbonated beverages. Interestingly, participants described their carbonation experiences by detailing both their perceived sensations and the precise oral locations at which carbonation, bubble bursting, and tingling attributes were perceived. Overall, this study provides valuable insights into diverse texture perceptions and characteristics of carbonation among young Korean adult consumers. Full article

Background/Objectives: Phenylketonuria (PKU) is a rare autosomal recessive disorder caused by phenylalanine hydroxylase (PAH) deficiency, impairing the conversion of phenylalanine (Phe) to tyrosine. Although early diagnosis and intervention yield excellent outcomes, dietary adherence often declines in adulthood, potentially leading to poor metabolic control and adverse nutritional consequences. This study aimed to evaluate physical activity levels, nutritional status, metabolic control, and anthropometric outcomes in adults with classic PKU, which have not been sufficiently researched in the current literature. Methods: This cross-sectional study included 100 adults with classical PKU (cPKU; baseline phenylalanine levels ≥ 1200 µmol/L) under regular follow-up at the Division of Metabolism, Hacettepe İhsan Doğramacı Childrens’ Hospital. Sociodemographic traits and dietary behaviors were evaluated through structured interviews carried out by a dietitian. Dietary intake was assessed by using a 24 h dietary recall method, and nutrient analyses were performed with the Bebis 7.2 software program. Using the short version of the International Physical Activity Questionnaire (IPAQ), physical activity levels were specified, and participants were categorized according to established scoring criteria. Results: A hundred adults with classical PKU took part in the study, including 47 males and 53 females, with a mean age of 23.84 ± 5.41 years; 5% of participants were underweight, 40% had normal weight, 39% were overweight, and 16% were listed as obese. The intake of mean daily energy is 2443.8 ± 384.6 kcal for men and 1822.5 ± 312.7 kcal for women. Carbohydrates contributed approximately 61% of total daily energy intake in both genders, whereas protein accounted for 12–13% and fat for approximately 26–27% of total energy intake; 17% of participants were physically inactive, 40% were minimally active, and 43% met criteria for sufficient physical activity according to IPAQ-based classification. Energy intake, the use of Phe-free protein substitutes, and BMI were significantly higher in the sufficiently active group compared to the low-active group in men, while no significant differences were observed between physical activity groups among women. Conclusions: Adults with classical PKU showed a high prevalence of overweight and obesity, together with differences in dietary intake and physical activity patterns. Physical activity levels were associated with several nutritional and metabolic characteristics; however, further long-term research is required to fully understand these connections. Full article

The lack of publicly available demographic and prevalence data on service dog (SDog) teams in Canada challenges our understanding of how and to what degree limited industry regulations, unharmonized standards, differing pathways to acquiring an SDog, and other variables can affect individuals with disabilities’ (i.e., handlers/consumers) ability to acquire, train with, or live with an SDog in Canada. The present study aims to develop empirical knowledge on SDog handler/consumer experiences with navigating the Canadian SDog industry. Current, former, and prospective Canadian SDog handlers/consumers (N = 263) were surveyed on personal demographics, SDog acquisition experiences, and experiences training/working with an SDog. Descriptive statistics were calculated for all quantitative data and open-ended responses were content analyzed. Participants reported diverse experiences and processes in acquiring an SDog. The typical respondent was a novice SDog handler, inexperienced in formally training with dogs, grew up with dogs and cats, had no negative experiences with dogs, needed an SDog to support a mental health disability/ies, trained their SDog on their own or with some professional support, did not join a wait list, completed basic obedience, public access, and/or task-specific training with their SDog 0 to 5 h daily using positive reinforcement or fear-free training approaches, spent on average $2567 to purchase their dog and $6695 for ongoing training costs, and had minimal but satisfactory experiences with Canadian SDog organizations. There are numerous gaps in our understanding of SDog team experiences in Canada, and future research is warranted. Full article

Two new mesophotic species of Chrysymenia are reported for the Gulf of Mexico. Chrysymenia oliverhardyii sp. nov. is a broadly foliose species growing attached to rhodoliths (free-living carbonate nodules predominantly accreted by crustose coralline algae) at 58–66 m depth offshore Louisiana (northwestern Gulf) and at ~64–68 m depth in the vicinity of the Dry Tortugas, Florida (southeastern Gulf). A multi-marker phylogenetic analysis based on chloroplast-encoded rbcL and UPA, as well as nuclear LSU rDNA sequences, indicates that this taxon is most closely related to C. stanlaurelii sp. nov., a slender, branched species from the vicinity of the Florida Middle Grounds, Florida (northeastern Gulf), growing at 60 m depth. These two species from the eastern Gulf of Mexico share a basal most recent common ancestor with respect to the other known species of Chrysymenia. Illustrations and discussion are provided for the new species, as well as for the other Gulf of Mexico members C. planifrons, C. littleriana, C. halymenioides and C. nodulosa. A nomenclatural list, morphological figures, a dichotomous key, and a phylogenetic tree of pertinent Chrysymenia are provided. Full article

Background/Objectives: GLP-1-based obesity pharmacotherapy has shifted clinical attention from the magnitude of weight loss to the quality of weight loss. This review evaluates whether body composition changes during treatment with GLP-1-based agents represent clinically meaningful muscle loss and identifies nutrition, supplementation, exercise, and monitoring strategies that may help preserve lean mass, function, bone health, and nutritional adequacy. Methods: A comprehensive narrative review was performed using focused searches of PubMed, publisher-hosted journal platforms, and reference lists of key primary studies and recent evidence syntheses through March and May 2026. Evidence was organized around body composition, muscle quality and function, dietary protein and micronutrient adequacy, exercise, supplementation, bioelectrical impedance analysis, imaging, and emerging biomarkers. Results: Semaglutide and tirzepatide preferentially reduce fat mass, including visceral and ectopic adiposity, while producing smaller but consistent reductions in lean mass or lean soft tissue. However, DXA-derived lean mass and BIA-derived fat-free mass are not equivalent to skeletal muscle, and lean tissue loss does not necessarily indicate impaired strength or physical performance. The most defensible supportive care model combines food-first nutritional counseling, adequate protein intake, structured resistance exercise, management of gastrointestinal adverse effects, and risk-based monitoring of micronutrient inadequacy. Protein supplementation and nutritionally complete meal replacements may be useful when intake is insufficient, whereas creatine, essential amino acids or leucine, beta-hydroxy-beta-methylbutyrate, fiber, probiotics, omega-3 fatty acids, and multi-ingredient products remain adjunctive options supported mainly by indirect or phenotype-specific evidence. Conclusions: Future GLP-1 trials and clinical care should move beyond body weight and total lean mass toward integrated assessment of muscle quantity, muscle quality, function, bone, and nutritional adequacy, and standardized BIA-based clinical monitoring where advanced imaging is not feasible. Full article

Sarcopenia is an age-related syndrome characterized by the progressive loss of skeletal muscle mass, strength, and function, significantly impairing older adults’ independence and quality of life. Given their anti-inflammatory, antioxidant, and metabolic regulatory properties, n-3 polyunsaturated fatty acids (n-3 PUFAs) have emerged as a promising nutritional strategy to mitigate this muscle degeneration. This review systematically synthesizes existing evidence regarding the association between n-3 PUFAs and sarcopenia. To capture the relevant literature, we searched PubMed, Web of Science, CNKI, and Wanfang Data using a combination of subject headings and free-text terms. We supplemented primary search terms—such as “n-3 polyunsaturated fatty acids,” “omega-3 fatty acids,” “sarcopenia,” and “muscle mass”—with mechanism-related keywords like “inflammation,” “muscle satellite cells,” and “oxidative stress.” We also manually screened the reference lists of the included literature. Our inclusion criteria encompassed interventional studies, observational studies, and high-quality reviews, while excluding conference abstracts, duplicate publications, and studies with incomplete data. This review first outlines the established biological mechanisms linking n-3 PUFAs to the pathological progression of sarcopenia, specifically detailing how these fatty acids improve muscle satellite cell function, suppress inflammation and oxidative stress, and ameliorate metabolic disorders. Next, we critically evaluate recent clinical studies and reviews, analyzing sources of study heterogeneity such as variations in sample size, intervention dose and duration, outcome measures, and baseline participant characteristics. We also highlight current research hotspots—including specialized pro-resolving mediators (SPMs), the gut–organ axis, combined interventions, and precision nutrition strategies—while emphasizing the functional differences between EPA and DHA to guide future intervention designs. Current evidence indicates that while n-3 PUFA supplementation can improve muscle strength and physical performance in older adults, its effects on muscle mass remain inconsistent. Addressing key research gaps, particularly the lack of standardized core outcome measures and unclear dose–response relationships, is critical. Ultimately, future research must prioritize developing high-bioavailability formulations, conducting personalized trials based on baseline n-3 PUFA status, and deepening investigations into inter-organ networks to translate these nutritional insights into effective sarcopenia prevention and management strategies. Full article

Invasive species, whose geographic distribution is expanding, seeing introduction and establishment in previously pest-free areas, have major environmental and economic impacts. The problem of invasive pests is multidimensional and complex and can only be tackled through strong integration and the use of various approaches [1]. Climate change, intense human mobility, and increased international and transcontinental trading have brought biological invasions to the forefront of the list of threats to agricultural production worldwide. Full article

There is clear evidence that non-safety-related concerns abound in child protection hotline calls. In the United States, over half of Child Protective Services (CPS) calls are screened out because they do not meet criteria for a child welfare investigation. While reporter bias is one factor theorized to contribute to this level of screened out calls, the field has neither used methods that account for culturally specific socialization processes involved in bias nor analyzed hotline calls to determine if these biases were present. This paper describes cultural domain analysis (CDA) as an innovative method to inform the measurement and assessment of bias in reporters’ narratives about children and families during calls to a CPS hotline. We describe CDA, which involves a rapid interviewing technique (freelisting), a participatory method for coding (pile sorting) and how the resultant findings can be used to inform the development of a measurement framework (codebook and scale), which may be tested using recorded hotline calls. Together, these methods provide a useable framework that can help surface common and shared ways bias is conceptualized and defined in the context of CPS hotline calls. This proposed approach provides a socially valid and reliable way for measurement to make generalizable inferences across a jurisdiction. When applied in practice, data collected and analyzed from the proposed measurement framework can inform jurisdictional CPS hotline policy, practice, and training. Full article

Human eyes do not have perfectly aligned optical components; the fovea is displaced from the posterior pole, and the crystalline lens is tilted away from the eye’s optical axis. Important in the study of vision quality, it is included here in binocular and oculomotor research. In the binocular system, with the eye’s optical asymmetry, all axes differ. The eye’s posture change is decomposed into the torsion-free part that gives the change in visual axis direction and the torsional part that best approximates the rotation about the lens’s optical axis. This geometric formulation, supported by computer simulations and modern ophthalmology studies, leads to binocular Listing’s law and the related half-angle rule, important for oculomotor control by constraining the eye’s redundant torsional degree of freedom. The eye’s primary position and the Listing plane, indispensable ingredients of Listing’s law, are replaced with the binocular eyes’ posture corresponding to the eye muscles’ natural tonus resting position, which serves as a zero-reference level for convergence effort. Further, the binocular constraints couple 3D changes in the torsional positions of the eyes within the ab initio formulation of Listing’s law here, which was previously proposed ad hoc. Finally, the noncommutativity rule underlying Listing’s law and the half-angle rule are discussed by specifying the configuration space of sequences of fixations of binocularly constrained eyes, which are visualized in 3D simulations. The results obtained in this study should be a part of the answers to the questions posted in the literature on the relevance of Listing’s law to clinical practices. Full article

Background: Preoperative contrast-enhanced breast imaging, particularly magnetic resonance imaging (MRI) and contrast-enhanced mammography (CEM), has become increasingly integrated into the surgical management of breast cancer. Although these techniques improve detection of multifocal, multicentric, and contralateral disease, their clinical value cannot be defined by sensitivity alone. Methods: This article was conceived as a critical narrative review supported by a targeted literature search primarily conducted in PubMed/MEDLINE, with additional cross-checking in Scopus and reference lists. English-language studies addressing preoperative MRI or CEM in relation to surgical planning, re-excision, mastectomy, additional disease detection, and oncologic outcomes were prioritized. Overall, 38 clinically relevant studies were included in the qualitative narrative synthesis. Results: A decision-oriented reading of the literature suggests that preoperative contrast-enhanced imaging does not produce a uniform clinical effect, but rather reshapes management through recurring patterns. Three main patterns can be identified: (1) refinement of surgical extent through improved disease mapping, most clearly in invasive lobular carcinoma, where MRI may reduce repeat surgery without consistently increasing mastectomy rates; (2) pre-emptive escalation aimed at avoiding reoperation, particularly in ductal carcinoma in situ, where lower re-excision rates are often accompanied by higher initial mastectomy rates; and (3) decision amplification driven by the detection of additional or indeterminate disease, frequently resulting in additional biopsies and treatment escalation without consistent evidence of long-term oncologic benefit. Across large observational cohorts, routine preoperative MRI has not been consistently associated with improvements in overall survival, disease-free survival, or locoregional control in unselected populations. These patterns should be understood as interpretive categories derived from recurring trends in a heterogeneous literature, rather than as formally validated decision classifications. Conclusions: The value of preoperative contrast-enhanced breast imaging depends less on sensitivity itself than on how imaging findings are translated into surgical action. Selective, question-driven use appears most valuable in settings such as invasive lobular carcinoma and assessment of nipple–areola complex involvement, whereas routine use in unselected populations often appears to increase surgical intensity more clearly than it improves long-term oncologic outcomes. Contrast-enhanced imaging should therefore be regarded as a decision-shaping tool whose clinical usefulness depends on explicit interpretive and multidisciplinary thresholds. Full article

Seismic Shake-e is a free app that provides valuable data and tools related to earthquakes, covering the stages before, during, and after seismic events. In this text, we describe the main features of the Seismic Shake-e 2.1 (SSe) app, the considerations that guided its development, examples of its use, and the challenges for future versions. Version 1.0 of this app was awarded as one of the winners of EOVALUE: Call for Innovative Apps in environmental and social fields, a project by the Joint Research Centre (JRC), the European Commission’s science and knowledge service. SSe recognizes two user levels: basic and intermediate/advanced. There are six modules for each level. The main topics of these modules for both user types are: (1) Accelerometer Networks (AN), (2) Seismograms Analyzer-e (SAe), (3) Seismic Design of Buildings (SDB), (4) Earthquake Preparedness (EP), (5) Earthquake Early Warning Systems (EEWS) & Tsunami Warning Systems (TWS), and (6) Earthquake Emergency Response & Recovery. The two key modules are AN and SAe: the first explains how to obtain seismic records, and the second provides tools for their analysis. We include some applications of SSe, along with their results and discussion. We also list the advantages of the main modules and discuss potential future developments and improvements. The uniqueness of this work is that we highlight the software’s essential features and demonstrate its applications. Full article

The objective of this paper is to offer a mathematical formulation of economic value added (EVA) that incorporates distance-to-default (DD) and thus a default-free capital structure. The latter is extended via the weighted average cost of capital (WACC) to introduce a default-free EVA. The data include the nonfinancial firms listed in the DJIA30 and NASDAQ100 covering the period 1992Q2–2023Q3. The results of standard specification tests and the GMM estimator show that (a) DD causes an increase in WACC and thus, EVA decreases; (b) the interest coverage ratio can be used effectively to compensate for default risk, thus adjusting the default-free EVA positively; (c) both EVA and default-free EVA can effectively be managed via common determinants, namely, net working capital ratio, total liabilities to EBITDA, sales growth rate, debt–equity ratio, and earnings per share; (d) the positive impact of the inflation rate on both EVA and default-free EVA justifies the use of default-free EVA as a metric for equity risk premium; and (e) the robustness of the results via stochastic geometric Brownian motion shows that the determinants of default-free EVA are stable. This paper contributes to related studies by incorporating credit risk via the DD into default-free EVA. Full article