Search Results (2,778)

Computational imaging shifts part of the aberration correction from optical hardware to algorithms, offering a viable path toward compact, simplified systems. However, overexposed regions—often caused by phenomena such as water-body reflections—can readily induce severe ringing artifacts in reconstructed images. To address this problem, we propose a Ringing-perceptive Cooperative Reconstruction Network (RPCR-Net). This network integrates a learned Wiener filter and a field-of-view shared kernel prediction network (FOV-KPN) for feature extraction and innovatively incorporates a combined regularization mechanism that leverages a Local Maximum Gradient Prior and a multi-scale ringing measurement model within its loss function to suppress artifacts while preserving details. Validated on a constructed overexposed image dataset, RPCR-Net improves the Peak Signal-to-Noise Ratio (PSNR) from 29.08 dB to 37.06 dB and the Structural Similarity Index Measure (SSIM) from 0.8795 to 0.9549. Experiments on real-world scenes further confirm its capability to suppress ringing artifacts while maintaining visual quality. The proposed method can generate high-quality images such as image reconstruction and robustness improvement in optical systems. Full article

Tool wear degrades machining quality and, if unchecked, can progress to breakage, causing workpiece defects, downtime, and spindle damage; automatic tool condition monitoring is therefore essential. In real production, new and reground tools are used interchangeably and differ slightly in geometry and material, so the “normal” baseline shifts from one tool and mounting to the next. This makes both global-baseline diagnostics and deep-learning methods that require large labeled fault datasets difficult to apply. This study proposes a lightweight, self-referencing framework—whose per-tool baseline is built from acceptable-state data alone—for diagnosing milling tool wear under tool-to-tool variability. Its novelty lies not in the individual techniques—self-referencing, order tracking, and the Mahalanobis distance, which are established—but in their integration into a single framework, designed for fault-label-free operation, that rebuilds a dedicated baseline for every newly mounted tool. Whenever a tool is mounted, its own acceptable data, a short initial segment of machining taken as healthy immediately after mounting, form the baseline; kinematics-based order-tracked features from a single spindle-bearing accelerometer are used to compute the Mahalanobis distance from the acceptable state, which serves as a continuous health index. A warning limit set statistically from the acceptable data alone, together with a defect limit set as a pragmatic engineering multiple of it, separates the acceptable, warning, and defect grades. On four end mills of identical specification, the primary full-baseline analysis yielded a warning-detection AUC of 0.986 and a defect-detection AUC of 0.936; with a persistence rule, defect-grade wear was detected in all four tools with no false alarms in the acceptable state. Because the baseline is built from only a short acceptable segment and the computation is inexpensive, the framework is, in principle, suited to shop floors with frequent tool changes and to on-machine or edge deployment (not yet benchmarked on an edge device); the present validation, however, is limited to four tools and a single workpiece material under fixed cutting conditions with accelerated wear, so broader verification remains necessary. Full article

Background/Objectives: Clinical alarm management in continuous patient monitoring systems remains a major challenge in intensive care units (ICUs). The high frequency of nonactionable alarms contributes to alarm fatigue among healthcare professionals, potentially compromising patient safety, clinical surveillance, and the quality of nursing care. As nurses play a central role in monitoring critically ill patients, evidence-based alarm management strategies are essential to improve the quality of care and patient outcomes. This review aimed to synthesize the scientific evidence on nursing interventions for managing clinical alarms in continuous monitoring systems and their contribution to patient safety and quality of care among critically ill patients. Methods: An integrative literature review was conducted following the methodological framework proposed by Whittemore and Knafl. A comprehensive literature search was performed in CINAHL Plus with Full Text, MEDLINE with Full Text, Supplemental Index, Complementary Index, Academic Search Index, the Directory of Open Access Journals (via EBSCOhost^®), PubMed, Scopus, and ScienceDirect. Studies published between 2020 and 2025 in English, Portuguese, or Spanish were eligible for inclusion. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. Nine studies met the eligibility criteria and were included in the final synthesis. Results: The identified interventions were grouped into five main domains: alarm parameter customization, nurse education and training, implementation of structured protocols and alarm management bundles, optimization of monitoring devices and sensors, and interventions addressing human and organizational factors. The evidence indicated that multifaceted and integrated interventions were associated with reductions in nonactionable alarms and improvements in clinical responses to alarms. However, their effectiveness in reducing alarm fatigue appeared to depend on organizational culture, staff engagement, and contextual factors. Conclusions: Effective alarm management requires the consistent implementation of evidence-based nursing interventions. Nurses play a pivotal role in promoting patient safety through clinical expertise, technological competence, and adherence to structured alarm management practices. Strengthening alarm management strategies may contribute to improved quality of care, safer care delivery, and better outcomes for critically ill patients. Full article

Urban streets are critical public spaces that support residents’ daily psychological recovery, and their landscape quality is directly related to pedestrians’ physical and mental well-being. In the rapid urbanization process, numerous urban streets have exhibited problems such as excessive building density, cluttered visual interfaces, a lack of natural elements, and an absence of regional characteristics, leading to a continuous decline in the psychological restorative capacity of street spaces and failure to meet residents’ demands for a healthy urban environment. Existing research mostly employs qualitative assessment methods to evaluate walking experiences and psychological restoration levels of street environments, lacking high-precision, pixel-level quantification of street landscape elements and rarely incorporating regional cultural elements into the analytical framework of restorative environments. This study takes Foshan, a famous historical and cultural city in China, as the research object, and selects five typical streets in the main urban area, including comprehensive streets, living streets, landscape streets, commercial streets, and historical–cultural streets, to construct a technical route of “data collection–element quantification–model construction–effect analysis.” Leveraging the pre-trained Mask2Former semantic segmentation model and pedestrian-perspective street-view images (SVIs), combined with field research, the study quantifies 22 street landscape elements across five dimensions: environment, transportation, social interaction, facilities, and culture. Through PCA principal component analysis and K-means clustering, 20 typical photos were objectively sampled, and public psychological evaluations were conducted using the Perceived Restorativeness Scale (PRS). A stepwise multiple linear regression model was then employed to construct an exploratory explanatory model for street psychological restoration, identifying key influencing factors and their effect intensities. The results indicate the following: (1) Environmental and cultural elements are the core characteristics associated with pedestrians’ psychological restoration, whereas transportation, social, and facility elements are correlated only with certain restoration dimensions and show no significant association with the overall psychological restoration level. (2) Among the 22 element indicators, the Green View Index showed the strongest positive association with psychological restoration (β = 0.681, p < 0.001); historical memory markers and the Blue View Index also exhibited significant positive associations. (3) By integrating the elements associated with pedestrians’ psychological restoration and their association strengths, an exploratory explanatory model of the psychological restoration benefits of urban street landscapes was constructed, with an adjusted coefficient of determination of 69.8%, accounting for 69.8% of the variation in street psychological restoration levels. The findings establish an exploratory analytical framework and furnish empirical evidence for healthy city planning and street renewal in similar historical and cultural cities. Full article

This study investigates the impact of critical raw material mining and processing on surface water quality within a representative catchment area, using the Luda Yana River Basin in Southern Bulgaria as a case study. Water quality was evaluated using the Canadian Council of Ministers of the Environment Water Quality Index (CCME WQI), based on data collected from five monitoring stations. The analysis focused on key heavy metals, including Cu, Zn, Pb, Cd, Fe, Mn, Ni, and As, reflecting the influence of both active and historical mining activities in the region. Index values were calculated for the period 2008–2024 and revealed considerable temporal variability and pronounced spatial differences in water quality along the river course. This study provides one of the first long-term integrated assessments of heavy-metal-related water quality in a mining-impacted river basin in Bulgaria using the CCME WQI framework and offers new evidence on the cumulative effects of historical and ongoing mining activities on surface waters. The calculated CCME WQI values ranged from very low levels indicating poor conditions to moderate values corresponding to marginal and, occasionally, fair conditions. Overall, the predominant water quality categories were “poor” and “marginal.” The results demonstrate that the waters of the studied river basin remain below the thresholds for “fair” physicochemical status as defined by the European Water Framework Directive (2000/60/EC) and the corresponding Bulgarian legislation, including Regulation No. H-4/2012 on surface water characterization and the 2010 Ordinance on environmental quality standards for priority substances and certain pollutants. The findings highlight the persistent anthropogenic pressure exerted on the river system and emphasize the need for improved water management strategies. The study further underlines the importance of integrating environmental protection measures into the exploitation of critical raw materials in order to balance economic development with the sustainable management of water resources. Full article

This study evaluated the effect of an integrated irrigation practice (IP), including regulated deficit irrigation (RDI), managed through an IoT-based platform, on a pear orchard (Pyrus communis L., cv. ‘Krystali’) compared to the farmer’s standard practice (FP). Tree response was evaluated through the measurement of tree water relations, leaf physiological functions, biochemical parameters, fruit growth and quality, production, and aerial multispectral NDVI imaging. IP achieved 15.8% water savings, significantly enhancing water-use efficiency and increasing yield per tree. However, IP trees exhibited higher crop water stress index (CWSI) values and lower midday stem water potential (Ψstem) than FP, particularly by late July, indicating progressive water stress. Leaf-level responses revealed morphological and biochemical alterations to drought, including increased leaf mass per area (LMA), dry matter content (DM), and accumulation of proline, alongside declines in chlorophyll pigments. Despite these stress indicators, gas exchange parameters were maintained in IP, possibly due to fruit load modulating source–sink relationships and surpassing stomatal limitations. IP reduced vegetative growth, as evidenced by lower winter pruning material mass, but this did not result in improved fruit quality. IP produced smaller fruit with lower antioxidant activity, polyphenolic content and soluble solids content/acidity ratio, although fruit firmness was improved. UAV-derived NDVI successfully detected changes in canopy structure following summer pruning but did not discriminate between irrigation treatments, indicating that moderate water stress affected tree physiology before producing measurable changes in canopy greenness. The study highlights the need for integrating irrigation management with fruit thinning and careful scheduling to optimize both water productivity and marketable fruit quality in water-scarce pear production areas. Full article

From the perspective of coordinating development and security for high-quality development in border regions, this paper focuses on the adaptation relationship between development and security functions in the Yunnan–Guangxi border region. The study aims to characterize the spatiotemporal evolution and spatial differentiation of these two functions and identify distinct types of functional adaptation and their spatial characteristics. Based on the development–security linkage perspective, a regional functional evaluation system incorporating specialized indicators, such as border trade development and national territorial security, is constructed. The CRITIC method, a functional adaptation model, and spatial statistical methods are then employed to examine the spatiotemporal evolution of the development and security functions and their adaptation in the Yunnan–Guangxi border region from 2002 to 2022, followed by a classification of regional functional adaptation types. By integrating development and security functions into a unified analytical framework, this study extends the research perspective on regional functions and the development–security relationship in border areas and provides a reference for coordinating development and security and implementing differentiated spatial governance. The results indicate the following: ① The overall regional functional level of the Yunnan–Guangxi border region increased steadily, although the growth was characterized by distinct stages, with rapid growth in the early period followed by stabilization in the later period. Regional disparities first narrowed and then widened. Both the development and security functions increased from low to medium or high levels. Specifically, high-value areas of the development function were concentrated in inland hub cities, whereas those of the security function were distributed along the border. ② The overall adaptation between the development and security functions was favorable, with the adaptation index increasing slightly. The adaptation level in the Guangxi border region was higher than that in Yunnan, while the spatial distribution of adaptation types shifted from relative clustering to dispersion. ③ The county-level administrative units in the Yunnan–Guangxi border region were classified into five functional adaptation types. During the study period, the transitional upgrading type accounted for the largest proportion, and the overall spatial pattern was characterized by “advancement along the border while maintaining stability in the hinterland.” Therefore, differentiated guidance and governance strategies should be implemented according to the characteristics of each functional adaptation type to promote the dynamic coordination between development and security functions, thereby supporting spatial governance and functional improvement in border regions. Full article

Accommodation establishments constitute a core component of tourism infrastructure, and their location choices directly affect water resource utilization, land pressure, and the spatial equilibrium of tourism development—issues that are particularly acute in vast arid regions. Yet the spatial organization of accommodation supply across extensive drylands characterized by fragmented oasis distribution, and the reasons why standard and non-standard accommodation follow divergent location logics, remain poorly understood. This study addresses three questions: (1) How are nine accommodation categories, differentiated by type and quality, distributed across Xinjiang? (2) Do directional spatial associations exist among categories that are consistent with hierarchical, path-dependent development? (3) Which factors drive these patterns, and do their effects exhibit the nonlinearity and threshold behavior predicted by location theory? Drawing on 12,073 accommodation establishments from the Ctrip platform, we construct a staged analytical framework in which each technique answers a specific question: the nearest-neighbor index and standard deviational ellipse characterize global patterns; kernel density estimation and OPTICS clustering identify local agglomerations; directional local co-location quotients measure asymmetric spatial associations; and XGBoost–SHAP isolates nonlinear drivers and threshold effects. Results reveal a highly concentrated “single-core, multi-center” structure anchored by Urumqi, Yining, and Kashgar, with rapid expansion toward the Ili Valley, Kashgar, and Altay since 2019. Standard accommodation tracks urban centrality and transport nodes, while non-standard accommodation tracks tourism resource endowments, consistent with location-theoretic expectations. Directional co-location analysis reveals hierarchical spatial associations among categories, and driving factors exhibit pronounced nonlinear threshold effects. From a sustainability perspective, the identified thresholds—elevation (1360 m), water-body proximity, and distance to rural tourism demonstration sites (3 km)—constitute quantifiable, spatially explicit sustainability indicators that can be incorporated into planning tools to monitor and steer accommodation development away from ecologically sensitive zones. Global Moran’s I diagnostics of model residuals (reduction of 83–99.7%) suggest that these findings are unlikely to be artifacts of spatial autocorrelation; this diagnostic, however, complements rather than replaces spatially blocked validation. The study contributes category-differentiated, spatially directed evidence for policies balancing tourism expansion against water security and ecosystem integrity, serving sustainable tourism development in arid-region destinations. Full article

As urban renewal shifts from expansion-led development toward quality improvement of existing urban areas, the restorative quality of urban village public spaces has become an important concern in high-density human settlements. Existing restorative environment research has focused mainly on parks, green spaces, waterfronts, and other settings with strong natural attributes, while audio–visual studies have often examined environmental perception, restorative appraisal, or physiological response as separate analytical components. Limited evidence therefore exists on how scene-level visual and acoustic characteristics, subjective sensory appraisal, perceived restoration, and short-term physiological responses are related within the same analytical framework in high-density urban village public spaces. This study investigated six selected public spaces in Shenzhen urban villages using a VR-based repeated-measures experiment involving 33 participants and 198 participant–scene observations, together with computer vision indicators, psychoacoustic analysis, subjective evaluation, EDA and HRV monitoring, linear mixed-effects models, and multilevel models of statistical indirect associations. Green view index (B = 0.322, p < 0.001) and color complexity (B = 0.422, p < 0.001) were positively associated with perceived restoration, whereas building enclosure (B = −0.271, p < 0.001) and sound roughness (B = −0.328, p < 0.001) were negatively associated with perceived restoration. Green view index showed a positive indirect association with perceived restoration through visual perception (ab = 0.386, 95% CI [0.304, 0.484]), whereas roughness showed a negative indirect association through soundscape perception (ab = −0.277, 95% CI [−0.385, −0.176]). In the full six-scene models, negative objective interaction estimates were compatible with acoustic constraints on favorable visual associations, but several interaction coefficients were sensitive to scene omission and should be regarded as exploratory; at the subjective level, soundscape perception and visual perception showed a positive interaction (B = 0.095, p = 0.028). Leave-one-scene-out analysis showed that several scene-level main-effect and objective interaction estimates were sensitive to the omission of S5 or S2, whereas the directions of the green-view-index and roughness indirect associations were retained. Perceived restoration was positively correlated with the reversed EDA recovery score (r = 0.416, p < 0.001), whereas HRV showed a negative association with LAeq (B = −0.150, p = 0.008), suggesting different short-term response patterns across subjective and physiological measures. The findings suggest that restorative responses in the examined urban village scenes were associated with both subjective sensory appraisal and audio–visual interactions. The study contributes by integrating scene-level visual and acoustic characteristics, subjective sensory appraisal, perceived restoration, and short-term physiological responses within a high-density urban village context. For renewal practice, the results support the coordinated consideration of adverse sound sources, visible greenness, and visual order; however, the observed relationships should be interpreted as context-specific associations rather than as universal causal mechanisms or validated design thresholds. Full article

Xinjiang’s distinctive geography and climate provide important habitats for Falconidae species, yet their climate-driven habitat shifts and conservation gaps remain poorly understood. Using 2731 validated occurrence records and 26 environmental predictors, including bioclimatic, land-use, topographic, hydrological, anthropogenic, and Normalized Difference Vegetation Index (NDVI) predictors, we applied an optimized Maximum Entropy (MaxEnt) framework to project suitable habitats for seven falconid species under current conditions and three Shared Socioeconomic Pathway scenarios (1–2.6, 2–4.5, and 5–8.5) for 2041–2060, 2061–2080 and 2081–2100. Barycenter migration analysis, the Habitat Quality module of the Integrated Valuation of Ecosystem Services and Tradeoffs framework, and protected-area overlays were further integrated to identify conservation priorities. All models showed high discriminatory performance, with mean areas under the receiver operating characteristic curve exceeding 0.90. Current suitable habitats were mainly concentrated along river corridors and mountain foothills in the southern Altai, central-western Tianshan and northern Kunlun regions. Future responses were strongly species-specific. By 2081–2100 under Shared Socioeconomic Pathway 5–8.5, suitable habitat increased by 154.6% for Falco peregrinus and 79.5% for Falco tinnunculus but declined by 81.1% for Falco vespertinus; Falco subbuteo also showed overall expansion, with its suitable-habitat barycenter shifting by up to 291.9 km. Mean relative habitat quality was 0.514 [standard deviation = 0.185], while suitable habitat outside protected areas ranged from 35,346 to 304,866 km² among species, and high-quality priority conservation gaps reached 102,489 km² for Falco cherrug. These results demonstrate that climatic suitability does not necessarily correspond to high habitat quality or adequate protection and support species-specific, climate-adaptive conservation strategies for falconids in Xinjiang. Full article

Fish farming can contribute to sustainable rural tourism when environmental performance and visitor expectations are considered jointly. This study aimed to evaluate fish farming as a strategy for sustainable tourism in Somondoco, Boyacá, Colombia, by integrating an environmental assessment of water quality with visitors’ perceptions of sustainable tourism. A case study was conducted at the “Los Lagos” fish farm, where physicochemical parameters were measured at the water supply and discharge points and the water quality index (WQI) was calculated. In parallel, a survey of 73 visitors was conducted to characterize perceptions of sustainable tourism and willingness to pay for more sustainable services. The WQI decreased from 0.75 (acceptable) at the water supply point to 0.60 (regular) at the discharge point, mainly associated with changes in electrical conductivity and chemical oxygen demand. From the tourism perspective, 93.1% of respondents considered sustainable tourism important, while 54.8% identified responsible management of natural resources as the main aspect to be addressed. In addition, 84.9% expressed willingness to pay an additional 10–20% for a more sustainable offering. The integration of environmental and tourism-perception results, complemented by a SWOT analysis, identified water management, environmental education, technological modernization, and community participation as priority areas for sustainable tourism development. These findings provide a case-based framework for linking aquaculture environmental performance with visitor expectations in the formulation of sustainable tourism strategies. Full article

Long-term exploitation of ion-adsorption rare earth deposits has played a vital role in ensuring the supply of strategic mineral resources. However, intensive mining activities have also resulted in severe ecological degradation, including vegetation loss, land degradation, and soil erosion. Although the Remote Sensing Ecological Index has been widely used for ecological environment assessment, it inadequately characterizes land degradation in ion-adsorption rare earth mining areas, while its fixed-weight framework is unable to effectively capture the influence of localized ecological limiting factors. To address these limitations, this study selected a typical ion-adsorption rare earth mining area in southern Jiangxi, China, as the study area. A Desertification Difference Index was incorporated into the conventional RSEI framework to establish a five-dimensional evaluation system consisting of greenness, wetness, dryness, heat, and desertification. Furthermore, a Dynamic Variable-Weight Remote Sensing Ecological Index (DV-RSEI) was developed by integrating variable-weight theory, enabling adaptive adjustment of indicator weights according to local ecological conditions. Using Landsat imagery from 2000, 2005, 2010, 2016, 2020, and 2023, the spatiotemporal evolution and spatial heterogeneity of ecological environmental quality were systematically investigated. The results indicate that: (1) ecological environmental quality exhibited a characteristic evolution process of mining disturbance–ecological degradation–comprehensive restoration–ecological recovery during 2000–2023, with an overall trend dominated by stability and improvement; (2) ecological environmental quality showed significant spatial clustering, with High–High clusters mainly distributed in areas with favorable ecological conditions, whereas Low–Low clusters were concentrated in regions strongly affected by mining activities; and (3) compared with the conventional RSEI, the DV-RSEI better characterized mining-related ecological degradation patterns and the spatial heterogeneity of ecological environmental quality. The proposed approach provides a scientific basis for dynamic ecological monitoring, evaluation of ecological restoration effectiveness, and the construction of green mines in ion-adsorption rare earth mining areas. Full article

Background: Medical students are vulnerable to sleep disturbance and nocturnal eating behaviors that may jointly increase psychiatric and metabolic morbidity. Comprehensive sleep-eating evaluations in Turkish medical students remain limited. To determine the prevalence of poor sleep quality and night eating syndrome (NES) risk and to examine their cross-sectional associations with insomnia, anxiety, emotional eating, restless legs symptoms, chronotype, and lifestyle factors. Methods: This cross-sectional study, conducted from March to December 2023, included 265 medical students who completed validated instruments assessing sleep quality (Pittsburgh Sleep Quality Index [PSQI]), night eating syndrome (NES) risk (a score of ≥25 indicating high risk), insomnia severity, daytime sleepiness (Epworth Sleepiness Scale [ESS]), anxiety, emotional eating, Restless Legs Syndrome (RLS) symptoms, and chronotype. Group comparisons, Spearman’s correlation analyses, and multiple linear regression were conducted. Results: Poor sleep quality (PSQI > 5) affected 50.2% of participants, and high NES risk affected 14.7%. PSQI correlated with NEQ (r = 0.301; p < 0.001), insomnia severity (r = 0.538), anxiety, and emotional eating. Mean NEQ was higher in the poor-sleep group (18.67 ± 8.00 vs. 15.38 ± 6.36; p < 0.001; Cohen’s d = 0.455). Females had higher PSQI and ESS scores, anxiety, and emotional eating scores; high NES risk was numerically more frequent in males (18.6% vs. 11.8%; p = 0.175). RLS symptoms (score > 0) were present in 34.7% (mild 22.6%; moderate 7.9%; severe 4.2%). In the primary multivariable model (PSQI and sex), PSQI was the strongest independent correlate of NEQ (standardized β = 0.325; p < 0.001); sensitivity analyses showed stable PSQI estimates after additional covariate adjustment, whereas sex coefficients were non-significant and unstable across models. A secondary model excluding PSQI identified alcohol use as a significant lifestyle correlate (standardized β = 0.167; p = 0.014). R² = 0.148 for the full covariate model and R² = 0.108 for the primary model. Conclusions: Sleep disturbance and NES risk are prevalent and cross-sectionally associated in Turkish medical students. Poor sleep quality was the strongest independent correlate of night eating scores. Integrated campus screening targeting sleep, eating behavior, anxiety, and comorbid sleep symptoms may facilitate prevention and referral. Full article

Background: Pain is a multidimensional experience shaped not only by nociceptive input but also by cognitive, emotional, and social processes. In musculoskeletal (MSK) rehabilitation, outcome variability among patients with similar clinical presentations suggests that determinants beyond tissue pathology may influence pain perception and recovery. Contextual factors (CFs)—communication, therapeutic relationship, patient expectations, and environmental cues—are increasingly recognized yet remain inconsistently integrated into routine practice. Objective: To map how CFs are represented in the physiotherapy literature indexed under that terminology, and to identify where empirical evidence in MSK rehabilitation is present and where it is absent. Methods: A narrative review with a systematic search strategy, reported following SANRA, was conducted in PubMed and Scopus, searched on 31 March 2026. Records were screened against predefined eligibility criteria, including publication from 2006 onwards and English language. Two reviewers independently screened records and resolved disagreements by consensus. Methodological quality was appraised using the Cochrane RoB2 tool for randomized controlled trials and an adapted Newcastle–Ottawa Scale for observational and cross-sectional studies. Conceptual publications were not formally appraised. Each publication was classified as direct clinical evidence (Tier A), indirect mechanistic or implementation-level evidence (Tier B), or conceptual contribution (Tier C). Results: Eight publications were included: no source provided direct clinical evidence in a musculoskeletal rehabilitation population (Tier A), five provided indirect mechanistic or implementation-level evidence (Tier B), and three were conceptual contributions (Tier C). The single randomised controlled trial retrieved was conducted in asymptomatic volunteers and was at high risk of bias for the between-group comparisons of all reported outcomes. Findings are organised as contextual domains, mediating mechanisms, and outcomes. No direct clinical evidence was retrieved; claims regarding expectations, therapeutic alliance, non-verbal communication, and the clinical environment rest on indirect or conceptual sources. Conclusions: CFs may contribute to pain and rehabilitation variability through cognitive, emotional, and relational pathways, complementing rather than replacing evidence-based care. The scarcity of direct clinical evidence within the literature indexed under this terminology is itself a finding. Construct-level searches and pragmatic trials are required to clarify the contribution of individual contextual domains. Full article

Coronary slow flow (CSF) is delayed distal contrast transit on angiography without flow-limiting stenosis; disturbed sleep may impair vascular control through autonomic, endothelial, inflammatory, and metabolic pathways. We evaluated Pittsburgh Sleep Quality Index (PSQI)-based sleep quality in relation to TIMI frame count (TFC)-defined CSF. This cross-sectional study enrolled 307 adults with nonobstructive coronary arteries undergoing angiography for chest pain; PSQI referenced the preceding month, and CSF was defined by corrected TFC > 27 frames in any major vessel; 132 participants had CSF and 175 normal flow. Global PSQI score was higher in CSF (median 7.0 vs. 5.0) and poor sleep quality (score > 5) was more frequent (75.8% vs. 49.7%; both p < 0.001). The global score correlated with mean TFC overall but not within flow groups. Each PSQI point independently raised CSF odds, including after STOP-Bang adjustment, although discrimination was modest. Sleep latency and short duration raised CSF odds; poor efficiency did not. Poorer sleep quality was independently linked to this angiographic slow-flow phenotype, mainly differentiating flow categories rather than tracking frame-count burden. Because coronary microvascular function was not measured directly, these hypothesis-generating findings should prompt systematic sleep assessment and prospective studies integrating objective sleep measures with invasive coronary physiology. Full article