Search Results (32,873)

Cushing’s syndrome is one of the most common endocrine disorders in dogs and is typically managed with long-term medical treatment. Several pharmacological agents are available: trilostane, mitotane, ketoconazole, cabergoline, selegiline, and aminoglutethimide, but their comparative effects on survival remain unclear. This systematic review and meta-analysis compared the impact of these agents on survival outcomes in dogs with naturally occurring diseases. A comprehensive search of MEDLINE, Embase, Web of Science, Academic Search Complete, and the Cochrane Library was conducted between 1 September 2024 to 3 January 2025. Eligible studies included dogs diagnosed with Cushing’s syndrome that reported survival outcomes for at least one of the specified treatments. Five studies (n = 295 dogs) met the inclusion criteria, with trilostane and mitotane providing sufficient data for meta-analysis. Pooled mean difference in survival time across four studies was 85.1 days (95% CI: −255.9 to 85.7, p = 0.21) with substantial heterogeneity (I² = 89%), indicating no statistically significant difference between the drugs. In contrast, pooled survival rates at fixed intervals favored trilostane, with an 11% higher survival at 36 months (p = 0.005) and no heterogeneity observed (I² = 0%). These findings suggest trilostane may offer long-term survival benefits over mitotane. Full article

The 2020 Europe Strategy was designed as a comprehensive framework to promote smart, sustainable and inclusive growth in the European Union (EU), particularly emphasising the ‘20/20/20’ targets related to climate protection and energy policy. This study provides an ex post evaluation of the extent to which the strategy’s objectives were achieved in the member states of the EU in the period 2010–2020. The analysis is based on Eurostat data and uses Hellwig’s multidimensional comparative analysis to construct a synthetic indicator of progress. The results show that EU countries have made significant advances in reducing greenhouse gas emissions and increasing the share of renewable energy in gross final energy consumption, with Sweden and Finland identified as leaders, while Malta and Hungary lagged behind. Primary energy consumption overall decreased, although only a minority of the member states reached the planned thresholds. Progress was less evident in research and development (R&D) expenditure, where the average value of the EU remained below the 3% GDP target, and strong disparities persisted between innovation leaders and weaker performers. Improvements in higher education attainment were observed, contributing to the long-term goal of a knowledge-based economy, although labour market difficulties, especially among young people, remained unresolved. The findings suggest that, although the Strategy contributed to tangible progress in several areas, uneven achievements among member states limited its overall effectiveness. The study is limited by the reliance on aggregate statistical data and a single methodological approach. Future research should extend the analysis to longer time horizons, include qualitative assessments of national policies, and address implications for the implementation of the European Green Deal and subsequent EU development strategies. Full article

Rural communities face persistent transport disadvantages due to low population density, limited-service availability, and high operational costs, restricting access to essential services and exacerbating social inequality. Autonomous public transport systems offer a transformative solution by enabling flexible, cost-effective, and inclusive mobility options. This study investigates the operational determinants for autonomous road-based transit systems in rural and peri-urban South-East Queensland (SEQ), employing a structured survey of 273 residents and analytical approaches, including General Additive Model (GAM) and Extreme Gradient Boosting (XGBoost). The findings indicate that small shuttles suit flexible, non-routine trips, with leisure travelers showing the highest importance (Gain = 0.473) and university precincts demonstrating substantial influence (Gain = 0.253), both confirmed as significant predictors by GAM (EDF = 0.964 and EDF = 0.909, respectively). Minibus shuttles enhance first-mile and last-mile connectivity, driven primarily by leisure travelers (Gain = 0.275) and tourists (Gain = 0.199), with shopping trips identified as a significant non-linear predictor by GAM (EDF = 1.819). Standard-sized buses are optimal for high-capacity transport, particularly for school children (Gain = 0.427) and school trips (Gain = 0.148), with GAM confirming their significance (EDF = 1.963 and EDF = 0.834, respectively), demonstrating strong predictive accuracy. Hybrid models integrating autonomous and conventional buses are preferred over complete replacement, with autonomous taxis raising equity concerns for low-income individuals (Gain = 0.047, indicating limited positive influence). Integration with Mobility-as-a-Service platforms demonstrates strong, particularly for special events (Gain = 0.290) and leisure travelers (Gain = 0.252). These insights guide policymakers in designing autonomous road-based transit systems to improve rural connectivity and quality of life. Full article

Introduction: Renal cell carcinoma (RCC) develops metastatic disease in 30–50% of patients during their disease course, with approximately one quarter presenting with metastases at diagnosis. While the lungs, liver, bones, brain, and adrenal glands are the most frequent metastatic sites, duodenal involvement is exceptionally rare. This uncommon presentation poses diagnostic and therapeutic challenges, particularly regarding the role of surgical resection in the metastatic setting. Objective: We aim to evaluate the clinical presentation, management strategies, and outcomes of patients with duodenal metastasis from RCC, with particular emphasis on the potential role of surgery, through a systematic review of the literature. Methods: A comprehensive electronic search of Medline, Embase, and Scopus was conducted according to PRISMA guidelines. The following MeSH terms were applied: Kidney Neoplasms [MeSH] AND Duodenal Neoplasms/metastasis [MeSH]. Eligible studies included original reports or case series describing RCC with duodenal metastasis. Demographic, clinical, surgical, and survival data were extracted and synthesized. Results: Of 89 records identified, 83 underwent full-text review and 51 met inclusion criteria, representing 55 patients. The median age at diagnosis was 64 years, and 80% of primary tumors arose from the right kidney. Nearly all patients (98%) were symptomatic, most commonly with upper gastrointestinal bleeding, anemia, or obstructive features. Pancreaticoduodenectomy was the predominant surgical approach, performed with curative intent in selected cases. Patients undergoing surgery achieved a 5-year overall survival of 70%, compared with 0% among non-operated patients. Conclusions: Duodenal metastasis from RCC remains an uncommon entity, limiting the strength of available evidence. Nevertheless, our findings suggest that surgical management—when feasible and decided within a multidisciplinary framework—can provide meaningful survival benefit and should be considered as a complement to contemporary systemic therapies for metastatic RCC Full article

Background: Attention-deficit/hyperactivity disorder (ADHD) affects not only children but also their families. Mothers, as primary caregivers, frequently experience high stress and reduced well-being. This scoping review mapped recent literature (2015–2025) on the quality of life (QoL) of mothers of children with ADHD and identified key factors influencing maternal QoL. Methods: Following the Arksey and O’Malley framework and Joanna Briggs Institute guidance for scoping reviews, we searched PubMed, Scopus, and ERIC in June 2025 for peer-reviewed quantitative studies in English. Eligible studies focused on mothers of children (6–18 years) with ADHD and used validated parent QoL measures. Eight studies met inclusion criteria. Results: Eight studies published between 2015 and 2025 satisfied the inclusion criteria. Mothers regularly indicated a worse quality of life relative to control groups, demonstrating shortcomings in physical, psychological, social, and environmental domains. Severe ADHD symptoms in children, accompanying disruptive disorders, parental distress or anxiety, and inadequate social support were important variables. Adaptive coping strategies correlated with enhanced outcomes, and a longitudinal study showed that effective ADHD intervention reduced familial stress over several months. Several studies have identified maternal depression, child comorbidities, and inadequate social support as key factors that adversely affect parental quality of life. Conclusions: Mothers of children with ADHD are at heightened risk for compromised QoL. Family-centered strategies that support maternal mental health, strengthen social support, and enhance coping—alongside the child’s ADHD care—are warranted. Heterogeneity in QoL measures and limited longitudinal evidence highlight priorities for future research. Full article

This study examines the complex relations between corruption, income inequality, and sustainable economic development within the European Union (EU) for the 2003–2023 period. Employing panel data for all 27 EU member states, as well as for the subgroups of Old (OMS) and New Member States (NMS), the analysis applies pooled OLS, random- and fixed-effects models, and panel-corrected standard errors (PCSE) estimations. The results indicate that higher perceived corruption is robustly associated with greater income inequality, while higher tertiary education attainment, greater social protection expenditures, and increased urbanization apparently reduce inequality. Subsample evidence reveals that institutional context conditions the strength of these relationships, with NMS exhibiting a more significant corruption–inequality nexus. These findings highlight that achieving sustainable and inclusive economic growth in the EU depends on institutional integrity and good governance. Strengthening anti-corruption frameworks, investing in human capital, and enhancing social protection are essential policy instruments for supporting the EU’s sustainable development objectives. Full article

Objectives: This study examines the relationship between maxillary morphology and the severity of obstructive sleep apnea (OSA) in adults, with a focus on intermolar distance (IMD) and palatal height (PH) as predictive factors. Methods: A retrospective observational study was conducted at private orthodontic practices in Sydney, Australia. A total of 100 adults (50 OSA patients and 50 controls) were included. OSA diagnosis and severity were confirmed via hospital-based polysomnography. Digital maxillary models were analyzed using the Medit Link software (version 3.2.0; Medit Corp., Seoul, Republic of Korea), and IMD and PH were measured. Statistical analyses included one-way ANOVA and linear regression modeling, with adjustments for age and sex. Results: The OSA group exhibited significantly narrower IMD (28.96–35.01 mm) and higher PH (21.68–29.56 mm) compared to the control group (IMD: 36.35–41.50 mm; PH: 18.57–23.51 mm). A negative correlation was observed between IMD and PH across all groups. Linear regression analysis demonstrated a strong association between these craniofacial parameters and OSA severity (R² = 0.76, p < 0.001). IMD was negatively correlated with the Apnea-Hypopnea Index (AHI) (p = 0.003), while PH was positively correlated (p < 0.001). The inclusion of demographic variables did not significantly enhance the predictive model. Conclusions: Maxillary morphology associates with OSA severity, with narrower IMD and greater PH linked to higher AHI. Full article

Achieving environmentally sustainable growth is a core challenge for developing economies, yet the welfare consequences of green development policies for vulnerable populations remain understudied. This article investigates the distributional impacts of one of the world’s largest development interventions: China’s energy transition. By integrating provincial-level energy metrics with a decade-long household panel survey (CFPS), we employ a fixed-effects model to provide a holistic assessment of the policy’s effects on household well-being. The analysis reveals a stark trade-off: a 10% increase in clean energy adoption generates significant non-monetary well-being gains, equivalent to a 190,000 CNY annual income rise, primarily through improved environmental quality and cleaner cooking fuel access. However, these benefits are partially offset by rising energy costs. Our heterogeneity analysis reveals a clear regressive burden: the transition significantly increases energy expenditures for rural and low-income households, while having a negligible or even cost-reducing effect on their urban and high-income counterparts. Our findings demonstrate that while the energy transition promotes aggregate welfare, its benefits are unevenly distributed, potentially exacerbating energy poverty and inequality. This underscores a critical development challenge: green growth is not automatically inclusive. We argue that for the energy transition to be truly pro-poor, it must be accompanied by robust social protection mechanisms, such as targeted subsidies, to shield the most vulnerable from the adverse economic shocks of the policy. Full article

AI-based assistive technologies (AIATs) are increasingly recognised as essential tools to enhance accessibility, independence, and inclusion for visually impaired students in higher education. However, limited evidence exists regarding the determinants of their acceptance and use, particularly in terms of psychosocial factors. This study aimed to extend the Unified Theory of Acceptance and Use of Technology (UTAUT) by incorporating physical self-esteem (PSE) as a moderator and behavioural intention (BI) as a mediator within a single model. Data were collected through a validated questionnaire administered to 395 visually impaired undergraduates across five Saudi universities. Constructs included effort expectancy (EE), performance expectancy (PE), facilitating conditions (FCs), social influence (SI), BI, and PSE. Partial Least Squares Structural Equation Modelling (PLS-SEM) was used for analysis. Results showed that PE and SI significantly predicted both BI and adoption, while EE strongly predicted BI but not AIAT adoption; FC had no significant influence on either outcome. BI positively affected AIAT adoption and mediated the effects of PE, EE, and SI, but not FC. Moderation analysis indicated that PSE strengthened the influence of PE, EE, and SI on BI and adoption. These findings underscore the significance of psychological factors, particularly self-esteem, in promoting the adoption of AIAT and offer guidance for developing inclusive educational strategies. Full article

In this work, we numerically investigate the fractional clannish random walker’s parabolic equations (FCRWPEs) and the nonlinear fractional Cahn–Allen (NFCA) equation using the Hybrid Decomposition Method (HDM). The analysis uses the Atangana–Baleanu fractional derivative (ABFD) in the Caputo sense, which has a nonsingular and nonlocal Mittag–Leffler kernel (MLk) and provides a more accurate depiction of memory and heredity effects, to examine the dynamic behavior of the models. Using nonlinear analysis, the uniqueness of the suggested models is investigated, and distinct wave profiles are created for various fractional orders. The accuracy and effectiveness of the suggested approach are validated by a number of example cases, which also support the approximate solutions of the nonlinear FCRWPEs. This work provides significant insights into the modeling of anomalous diffusion and complex dynamic processes in fields such as phase transitions, biological transport, and population dynamics. The inclusion of the ABFD enhances the model’s ability to capture nonlocal effects and long-range temporal correlations, making it a powerful tool for simulating real-world systems where classical derivatives may be inadequate. Full article

Background: Anthracycline-based chemotherapy is associated with a risk of cancer therapy-related cardiac dysfunction (CTRCD), particularly in patients with moderate to high cardiovascular risk. Left ventricular global longitudinal strain (GLS) is a sensitive marker for early myocardial dysfunction, but the prognostic value of baseline GLS in this population remains unclear. Objective: We aimed to evaluate whether baseline GLS can predict CTRCD in moderate- to high-risk cancer patients undergoing anthracycline chemotherapy. Methods: In this prospective, single-center observational study, 80 anthracycline-naive cancer patients classified as moderate or high risk were enrolled. Baseline GLS was assessed via speckle-tracking echocardiography, with a threshold of ≥−18% considered decreased. Patients were followed for 12 months, and the primary endpoint was the development of CTRCD per ESC 2022 Cardio-oncology guidelines. Results: Of the 77 patients completing follow-up, 27.3% had decreased baseline GLS. CTRCD occurred in 62.4% of patients, with higher incidence among those with decreased GLS (76.7%) compared to those with normal GLS. In multivariable analysis, GLS ≥−18% was the only significant independent predictor of CTRCD (RR 12.0, 95% CI 2.0–71.9; p = 0.0065). All-cause mortality was also significantly higher in patients with decreased baseline GLS (19.1% vs. 1.8%, p = 0.018). Conclusions: Decreased baseline global longitudinal strain is an independent predictor of cancer therapy-related cardiac dysfunction and all-cause mortality in moderate- to high-risk patients receiving anthracycline therapy. These findings support the inclusion of baseline GLS in pre-treatment cardiovascular risk assessment, particularly in patients with an LVEF above 54%, to more effectively identify those who may benefit from early cardioprotective interventions. Full article

Background and Objectives: Endoscopic sleeve gastroplasty (ESG) is a minimally invasive endoscopic procedure that has demonstrated both safety and effectiveness in the treatment of obesity. By reducing the stomach’s volume without the need for surgical incisions, ESG promotes weight loss and can improve obesity-related comorbidities. However, patient responses to ESG can vary significantly. Materials and Methods: A comprehensive search was performed on PubMed, Embase, and Cochrane for studies with endoscopic sleeve gastroplasty; the main outcomes of interest are BMI, weight loss, and postinterventional complications. The search strategy employed a combination of keywords and Medical Subject Heading (MeSH) terms, including “endoscopic sleeve gastroplasty,” “endoscopy,” and “overweight”. To ensure the thoroughness of the review, additional manual searches of key journals and the reference lists of identified studies were performed. Grey literature, such as dissertations and conference abstracts, meta-analysis, and systematic reviews, was excluded to maintain a focus on peer-reviewed evidence. Duplicate records were identified and removed using Rayyan software to streamline the screening process. The I2 test was employed for heterogeneity assessment, while the risk of bias was evaluated utilizing ROBINS-I. Results: Our literature search resulted in the inclusion of 38 studies. Endoscopic sleeve gastroplasty for weight loss is important since it is more effective than pharmacological treatments and lifestyle changes and presents lower adverse event rates compared to bariatric surgery. Long-term weight loss outcomes varied, with total body weight loss ranging from 16% to 20.9% over a period from 2 to 5 years, while excess weight loss ranged from 13% to 79%. Revisional procedures showed higher failure rates, with up to 34.3% of patients experiencing insufficient weight loss. Most interventions led to clinically significant and sustained weight loss, though variability in outcomes highlights the need for further research to optimize long-term weight management strategies. Conclusions: Endoscopic sleeve gastroplasty (ESG) emerges as a promising minimally invasive option for weight loss, offering significant improvements in both weight reduction and obesity-related comorbidities, such as diabetes, hypertension, and dyslipidemia. Full article

Virus-like particles (VLPs) formed as a result of self-assembly of viral capsid proteins are widely used as a platform for antigen presentation in vaccine development. However, since the inclusion of a foreign peptide into the capsid protein can alter its spatial structure and interfere with VLP assembly, such insertions are usually limited to short peptides. In this study, we have demonstrated the potential of capsid protein (CP) of single-stranded RNA phage PQ465 to present long peptides using green fluorescent protein (GFP) as a model. GFP was genetically linked to either the N- or C-terminus of PQ465 CP. Hybrid proteins were expressed in Escherichia coli and Nicotiana benthamiana plants. Spherical virus-like particles (~35 nm according to transmission electron microscopy) were successfully formed by both N- and C-terminal fusions expressed in E. coli, and by plant-produced CP with GFP fused to the C-terminus. ELISA revealed that GFP in VLPs was accessible for specific antibodies suggesting that it is exposed on the surface of PQ465-GFP particles. VLPs carrying GFP were recognized by anti-CP antibodies with less efficiency than VLPs formed by empty CP, which indicates shielding of the CP core in PQ465-GFP particles. Therefore, PQ465 CP can be used as a chimeric VLP platform for the display of relatively large protein antigens, which can operate in bacterial and plant expression systems. Full article

Greater Casablanca, one of Africa’s largest metropolitan regions, is undergoing significant spatial and demographic transformation. Yet, the underlying patterns of these dynamics remain poorly understood. This study investigates population dynamics and spatial inequalities in Greater Casablanca between 2014 and 2024. The analysis combines geospatial data, regression modeling, and clustering techniques to explore the interplay between demographic change, housing affordability, public-transport accessibility, and economic activity, providing a data-driven perspective on how these factors shape spatial inequalities and the region’s urban development trajectory. The results reveal a clear core–periphery divide. The central prefecture has lost population despite continued land consumption, while peripheral communes have experienced rapid demographic and economic expansion. This growth is strongly associated with affordable housing and high rates of new-firm formation, but it occurs where transport access remains weakest. Cluster analysis identifies four socio-spatial types, ranging from a shrinking but well-served core to fast-growing, poorly connected peripheries. The study underscores the need for integrated policy interventions to improve transport connectivity, implement inclusive housing strategies, and manage economic decentralization in ways that foster balanced and sustainable metropolitan development. By situating Greater Casablanca’s trajectory within global urbanization debates, this research extends core–periphery and shrinking-city frameworks to a North African context and provides evidence-based insights to support progress towards Sustainable Development Goal 11. Full article

This article examines the global efforts to govern and regulate Artificial Intelligence (AI) in response to its rapid development and growing influence across many parts of society. It explores how governance takes place at multiple levels, including international bodies, national governments, industries, companies, and communities. The study draws on a wide range of official documents, policy reports, and international agreements to build a timeline of key regulatory and standardization milestones. It also analyzes the challenges of coordinating across different legal systems, economic priorities, and cultural views. The findings show that while some progress has been made through soft-law frameworks and regional partnerships, deep divisions remain. These include unclear responsibilities, uneven enforcement, and risks of regulatory gaps. The article argues that effective AI governance requires stronger international cooperation, fair and inclusive participation, and awareness of power imbalances that shape policy decisions. Competing global and commercial interests can create obstacles to building systems that prioritize the public good. The conclusion highlights that future governance models must be flexible enough to adapt to fast-changing technologies, yet consistent enough to protect rights and promote trust. Addressing these tensions is critical for building a more just and accountable future of AI. Full article