Search Results (599)

Accurate and transferable soybean mapping is essential for agricultural monitoring and area verification, yet conventional Transformer models can be limited in modeling complex nonlinear phenological relationships and maintaining training stability. This study proposes an improved Transformer-KAN model for multi-temporal Sentinel-2 data. Temporal positional encoding, multi-head self-attention with relative positional bias, and a Pre-LayerNorm residual structure are introduced to strengthen phenological sequence modeling, while FastKAN replaces the conventional MLP-based feed-forward network to enhance nonlinear feature representation. The model was trained using 2023 samples from Hailun City and directly evaluated in Bozhou, McLean, and Cass without retraining or fine-tuning. Cross-year transferability was further evaluated by applying the Hailun-trained model to data from Bozhou and McLean from 2021 to 2025. The proposed model achieved overall accuracies of 0.975, 0.983, 0.958, and 0.966 in Hailun, Bozhou, McLean, and Cass, respectively, with corresponding Kappa coefficients of 0.895, 0.887, 0.883, and 0.916. Complexity analysis showed that Transformer-KAN required 0.8142 M parameters and 1.1967 M FLOPs, with an average inference time of 3.0191 ms per sample, compared with 0.6130 M parameters, 0.7971 M FLOPs, and 1.4009 ms per sample for the conventional Transformer, indicating that the improved feature representation was accompanied by increased computational complexity. Cross-year classification performance remained generally high from 2021 to 2025, although interannual variations were observed due to differences in crop growth conditions, phenological timing, and image acquisition quality. Discrepancies between remote-sensing-derived and officially reported soybean areas were mainly related to differences in statistical definitions and residual classification uncertainties, rather than model transferability. Overall, Transformer-KAN provides accurate and transferable soybean mapping and can serve as a spatially explicit complement to official agricultural statistics. Full article

Digital transformation in international physical distribution is often constrained by fragmented customer, documentary, operational, fleet, cost, and financial information in transport firms operating in emerging economies. Although ERP and CRM systems have been widely studied, their integration is rarely operationalized as a measurable decision-support capability for Lean–Agile logistics. This article addresses this gap by proposing a KPI-based ERP–CRM framework structured around process-fragmentation diagnosis, ERP–CRM functional architecture, KPI operationalization, scenario-based comparison of digital integration configurations, and sensitivity analysis. The framework is evaluated through a case-based design science research approach using aggregated and anonymized company records from January to December 2025. KPIs cover commercial, documentary, operational, fleet, cost, financial, and documentation-related dimensions, and scenarios range from S0 baseline to S5 ERP–CRM with alerts. Under the defined scenario assumptions, the global performance index increases from 100.0 to 132.9, quotation cycle time decreases from 18.50 to 12.76 h, and operating cost decreases from USD 3.05 to 2.35 million. ERP-focused configurations improve documentary control, fleet coordination, and cost visibility, while CRM-focused configurations strengthen quotation management and customer responsiveness. Overall, integrated ERP–CRM coordination produces a more balanced KPI performance pattern and strengthens logistics–financial visibility, while green implications remain limited to documentation-related process outcomes. Full article

Background: Variants of uncertain significance (VUS) in the LDLR gene remain a major barrier to the molecular diagnosis of familial hypercholesterolemia. Although computational approaches offer scalable prioritization, their clinical utility is limited by predictor discordance, incomplete annotations, and inflated performance arising from variant-type imbalance. We aimed to develop a calibrated, uncertainty-aware machine learning framework for LDLR VUS triage. Methods: We developed an end-to-end pipeline integrating multi-source variant annotations and 45 engineered features (expanded to 68 encoded features) to train RandomForest, XGBoost, and support vector machine models. The framework incorporates predictor concordance analysis, splice-aware annotation, and explicit uncertainty modeling. Models were trained using nested cross-validation and evaluated on an independent ClinGen FH-VCEP expert-panel dataset. Results: The XGBoost model achieved high discriminative performance (ROC-AUC up to 0.99 for all variants and ~0.97 for missense variants). Among 1092 LDLR VUS, 69% were assigned a directional classification, including 485 (44.4%) pathogenic-leaning and 268 (24.5%) benign-leaning variants. The remaining 31% were explicitly categorized as predictor-discordant (n = 170, 15.6%) or unresolved (n = 169, 15.5%), preserving uncertainty. Predictor discordance was particularly enriched among missense variants, indicating that naive aggregation of in silico predictors may lead to overclassification. Conclusions: This framework provides a scalable, transparent, and clinically aligned approach for LDLR VUS prioritization, generating ACMG/AMP-compatible computational evidence to support expert curation and downstream functional validation. Full article

Serum creatinine (sCr), blood urea nitrogen (BUN) and symmetric dimethylarginine (SDMA) reflect glomerular filtration only and are subject to non-renal confounders including lean body mass, limiting early detection of renal dysfunction in geriatric dogs. We evaluated serum cystatin C (sCysC) and the urinary N-acetyl-β-D-glucosaminidase-to-creatinine ratio (NAG index) as early renal markers in healthy geriatric dogs. Sixty-one neutered geriatric dogs, free of clinical disease and of extrarenal laboratory abnormalities, were stratified into three groups: controls (n = 36), subclinical (normal sCr, ≥1 elevated biomarker; n = 17) and azotaemic chronic kidney disease (CKD; sCr > 1.5 mg/dL; n = 8). sCysC was measured by a canine-specific ELISA and the NAG index by colorimetric assay. Of the 61 dogs, 17 (27.9%) had at least one elevated biomarker with normal sCr, and all 17 also had normal BUN, indicating pre-azotaemic changes identified predominantly by sCysC. The NAG index was elevated in 6/17 (35.3%) subclinical dogs and SDMA in none (0/17). Because sCysC status partly informed group allocation and no independent measure of glomerular filtration rate was obtained, these findings characterise an altered renal biochemical phenotype rather than establish diagnostic accuracy, and require prospective validation. Full article

Lean Construction and digital tools such as Building Information Modeling (BIM), common data environments (CDEs), and mobile applications are widely adopted in construction projects but are often implemented through parallel and disconnected workflows. Consequently, Lean production control continues to rely heavily on manual observations, meetings, and spreadsheets, while increasing volumes of digital project data remain underutilized for operational decision-making. This disconnect limits project teams’ ability to detect waste early, stabilize production flow, and learn systematically from recurring issues. This study develops a conceptual Digital Lean Construction (DLC) framework using a design-oriented methodology comprising three stages: synthesis of gaps in existing BIM–Lean integration research, examination of previously validated digital workflows for BIM Quality Control (QC), Quantity Takeoff (QTO), and digital twin monitoring, and integration of these components into a unified closed-loop architecture. The resulting framework organizes project information through four conceptual layers and six implementation components that connect BIM/Industry Foundation Classes (IFC4 × 3) models, schedules, issue and quality records, quantity data, field inputs, sensor information, and GIS-based spatial context. The framework assumes IFC4 × 3 because it provides enhanced support for infrastructure assets and linear referencing required for transportation and civil infrastructure projects. Rule-based analytical logic is formalized for seven Lean key performance indicators (KPIs): Percent Plan Complete (PPC), takt deviations, constraint age, rework cycles, waste event counts, QC status, and delay risk. The framework demonstrates how validated and location-aware project information can be transformed into actionable Lean performance intelligence and incorporated into weekly planning, daily huddles, problem-solving, and standardization routines. Several underlying data-generation components have been validated in previous studies; however, the integrated DLC framework itself remains conceptual and requires project-level empirical evaluation. As a conceptual framework grounded in prior literature and previously validated digital workflows, this study does not include empirical field validation. Instead, it proposes an operational architecture intended to guide future implementation and evaluation in real construction projects. The study contributes an implementable architectural foundation for moving from fragmented, retrospective reporting toward proactive, data-supported, and continuously improving production control. Full article

Groundwater ingress threatens the serviceability and durability of underground structures, particularly when hydrogeotechnical conditions and waterproofing details are considered separately. This study presents a diagnosis-driven assessment of a reconstructed underground shooting range tunnel where leakage persisted despite reconstruction and previous repairs. The objectives were to identify the cause-and-effect mechanism of water ingress and select a targeted, low-impact remediation strategy. The investigation combined archival analysis, three site inspections, ultrasonic testing at 24 locations, eight tomographic scans, targeted destructive verification, and three geotechnical boreholes extending to 7.5 m. Ultrasonic measurements indicated good concrete homogeneity, with a mean estimated compressive strength of 36.9 MPa and a coefficient of variation of 5.86%. Tomography indicated a 25 cm bottom slab and a 20 cm lean concrete layer, compared with the designed 30 cm and 10 cm, respectively. The original geotechnical investigation was too shallow, and the ground conditions should have been classified as difficult, corresponding to geotechnical category II. Finally, leakage was linked to groundwater underestimation, water accumulation in the backfilled excavation, absence of drainage, waterproofing discontinuities, and ineffective previous injections. Targeted reinjection and joint sealing were selected, demonstrating how integrated diagnostics can support proportionate remediation while limiting excavation, demolition, material use, and operational disruption. Full article

Background/Objectives: Obesity is a chronic, progressive, and relapsing disease that requires long-term, multidisciplinary management rather than episodic weight-loss treatment. Although novel incretin-based anti-obesity pharmacotherapies, including GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists, have markedly improved the clinical management of obesity, weight reduction alone does not fully capture treatment success. Body composition, lean mass preservation, physical function, nutritional adequacy, psychological well-being, adherence, and long-term weight-loss maintenance are increasingly recognized as essential therapeutic outcomes. This narrative review critically examines the role of lifestyle medicine as a co-therapeutic strategy during modern anti-obesity pharmacotherapy, with particular attention to physical activity, nutrition, behavioral support, and individualized monitoring. Methods: A narrative literature search was conducted in PubMed up to June 2026. The review included studies addressing adults with overweight or obesity and evidence related to anti-obesity pharmacotherapy, physical activity, nutrition, body composition, functional outcomes, eating behavior, quality of life, treatment tolerability, adherence, weight regain, and long-term maintenance. Results: Current evidence indicates that incretin-based therapies produce substantial and clinically meaningful weight loss, but pharmacological efficacy may be limited by reductions in lean mass, gastrointestinal adverse events, inadequate nutritional intake, treatment discontinuation, and weight regain after drug withdrawal. Physical activity should be considered a therapeutic component rather than only a tool for increasing energy expenditure, as aerobic exercise supports cardiometabolic health and cardiorespiratory fitness, while resistance training helps preserve muscle strength, bone health, and functional capacity. Nutritional strategies are equally important, particularly during appetite suppression, to maintain adequate protein, fiber, fluids, micronutrients, and diet quality. Behavioral factors, including sleep, stress, mood, stigma, self-regulation, and the food environment, may influence adherence and long-term outcomes. Conclusions: Novel anti-obesity drugs should not be viewed as replacements for lifestyle medicine but as powerful tools within an integrated chronic-care model. The goal of treatment should move beyond maximal body-weight reduction to durable improvements in body composition, metabolic health, physical function, nutritional status, quality of life, and weight-loss maintenance. Full article

Background/Objectives: The demand for reducing iodinated contrast agent (ICA) dose in cerebral CT angiography (CTA) for aneurysm detection has increased due to concerns over patient safety and image quality. The aim of this study is to systematically review the diagnostic accuracy, image quality, and dose efficiency of optimized ICA protocols in CTA for intracranial aneurysm detection. We also aimed to distinguish between direct diagnostic studies reporting aneurysm sensitivity/specificity and indirect technical studies, emphasizing patient-specific tailoring using cardiac output and lean body weight. Methods: Following PRISMA 2020 guidelines, PubMed, Scopus, and Web of Science were searched up to 2 June 2026. Two reviewers independently screened studies, extracted data, and assessed risk of bias using QUADAS-2 and the NIH tool. Due to clinical and technical heterogeneity, a narrative synthesis was performed. Results: Eleven studies comprising 716 patients were included. Low tube voltage (70–80 kVp) combined with reduced iodine load (8–30 mL, 3.2–9 gI) maintained diagnostic accuracy for aneurysms >3 mm compared to standard protocols. Iterative reconstruction and deep learning improved contrast-to-noise ratio by 23–45% at reduced dose. Technical studies showed feasibility of ultra-low-volume protocols but lacked aneurysm-specific DSA validation. Conclusions: Reduced-contrast and low-kVp CTA protocols may preserve diagnostic performance for intracranial aneurysm detection while lowering iodine exposure. However, current evidence is limited by small sample sizes and heterogeneous protocols. Prospective, aneurysm-specific validation is required before clinical implementation. Full article

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are transforming obesity management, yet landmark trials often incompletely measure and report a central mediator of response: dietary intake. Because GLP-1RAs promote weight loss primarily by suppressing appetite and reducing energy consumption, capturing changes in dietary intake is essential to interpreting efficacy, safety, and translation into clinical care. This perspective argues that failure to measure and report comprehensive dietary intake raises concerns under four core bioethical principles. It undermines autonomy by limiting evidence for shared decision-making across the treatment continuum. It challenges non-maleficence because inadequate energy, protein, and micronutrient intake may contribute to lean mass loss and nutrient deficiencies, particularly in vulnerable populations. It weakens beneficence because failing to report a measurable mediator diminishes the scientific value of research requiring substantial investment and participant burden. It raises justice concerns because the equitable distribution of assessment burden and access to resulting nutritional care cannot be evaluated without transparent reporting. To meet the ethical and scientific obligations of clinical research, future trials should preregister dietary intake as a key secondary or safety endpoint. Investigators should report total energy, macronutrient, and micronutrient distribution at baseline and serial follow-up alongside dietary assessment methods, food composition databases, and assessor training. Journal editors, funders, and regulatory bodies should support development of consensus-based, nutrition-specific reporting recommendations aligned with CONSORT principles and encourage preregistration of dietary trial endpoints. Registered dietitian nutritionists should be prospectively integrated into GLP-1RA trial teams from design through data interpretation. Advancing the standard of obesity care requires that the research community look beyond the scale and ground clinical translation in the nutritional context in which pharmacotherapy operates. Full article

Metabolic dysfunction-associated steatotic liver disease (MASLD) is linked to sarcopenia and frailty, but data on white populations remain limited. This study evaluated sarcopenia, physical performance and steroid hormone associations with frailty in European MASLD patients. A cross-sectional study included 245 white MASLD patients. Clinical, biochemical, hormonal and elastography data were collected. Sarcopenia was assessed using dual-energy X-ray absorptiometry alongside mid-arm muscle circumference (MAMC), while physical performance was assessed using the liver frailty index (LFI) and the short physical performance battery (SPPB). Mean age was 56.2 years, 45.7% were male, and median liver stiffness was 5.2 kPa; 76.3% and 33.9% of patients had low MAMC and Appendicular Lean Mass Index, while 13.5% had abnormal SPPB and 16% were frail (i.e., LFI > 4.4). Poor physical performance was linked to lower dehydroepiandrosterone sulfate (DHEAS) levels using both LFI (OR: 0.98, 95% C.I.: 0.96–0.99, p = 0.01) and SPPB (OR: 1.14, 95% C.I.: 1.003–1.22, p = 0.026). Frailty assessed by LFI was associated with increased liver stiffness (OR: 1.24, 95% C.I.: 1.047–1.482, p = 0.013). We concurrently evaluated muscle mass and frailty for the first time in a white MASLD cohort. Lower DHEAS levels were associated with impaired physical performance. Further studies are needed to confirm these findings and their possible therapeutic implications. Full article

Shoulder pain ranks among the leading causes of functional decline in older adults, affecting approximately one in five community-dwelling individuals and contributing to loss of independence and reduced quality of life. Despite its prevalence, shoulder pain in this population is frequently underreported and poorly understood beyond structural pathology, limiting early identification and targeted intervention. This narrative review synthesizes current evidence on the associations between four interrelated physical domains, body composition, grip and shoulder muscle strength, cervical–shoulder range of motion (ROM), and postural alignment, with particular emphasis on forward head posture and shoulder pain and disability in community-dwelling adults aged 60 years and older. A structured search of major electronic databases, including PubMed and Web of Science, was conducted using predefined eligibility criteria and keyword combinations linking shoulder pain and disability with each physical domain. Additional primary studies were identified through manual reference screening of key articles and citation tracking. Evidence was synthesized thematically, highlighting patterns of association, methodological inconsistencies, and contradictions across studies. Findings indicate that higher adiposity, reduced lean mass, shoulder and grip strength deficits, restricted glenohumeral and cervical ROM, and postural deviations are each associated with greater shoulder pain and disability. However, the evidence is not uniformly consistent: associations between Body Mass Index and shoulder ROM are largely absent at moderate adiposity levels, resting postural deviation does not reliably distinguish individuals with shoulder pain from those without, and the causal direction between strength deficits and postural deterioration remains debated. Despite these contradictions, emerging evidence suggests that these domains may interact with one another, and the literature collectively supports an integrated, multifactor assessment framework over single-variable approaches for the evaluation and management of shoulder dysfunction in community-dwelling older adults. Evidence quality was not formally assessed, and evidence for forward head posture specifically in older adults remains limited and largely indirect, drawn mainly from younger populations. Full article

Small- and medium-sized enterprises (SMEs) face significant challenges in adopting robotic solutions due to limited financial resources, insufficient technical expertise, and uncertainty regarding operational and economic outcomes. Existing automation approaches are often technologydriven and provide limited support for systematic decisionmaking. This study proposes the Agile Robotics Implementation Model (ARIM), an iterative framework integrating Lean Manufacturing, Lean Robotics, and Lean Startup principles. ARIM combines process assessment, key performance indicator (KPI)-based evaluation, and iterative experimentation within the Robotic Startup Cycle, supported by a decision-support software tool. The framework was developed using a Design Science Research (DSR) approach and validated through an industrial case study. Results demonstrate strong agreement between predicted and realized KPI values. The implemented solution achieved a 24.5% return on investment (ROI), with a payback period of approximately 2.1 years, reduced labor demand by 3900 h, and improved productivity, ergonomics, and quality. The findings indicate that ARIM supports reliable and data-driven robotics implementation in the studied SMEs; broader transferability requires validation across multiple cases. Full article

Background: Incretin-based therapies (IBTs), including glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonists (GIP/GLP-1 RAs), have transformed the management of obesity and type 2 diabetes mellitus (T2DM). Although these agents provide substantial metabolic and cardiometabolic benefits, their effects on skeletal muscle, particularly in older adults at increased risk of sarcopenia and functional decline, remain incompletely understood. Methods: This narrative review synthesizes evidence from randomized controlled trials (RCTs) and observational studies evaluating the effects of semaglutide and tirzepatide on skeletal muscle mass (SMM), muscle quality, strength, and physical performance. Current evidence on nutritional and exercise strategies aimed at preserving skeletal muscle during IBT was also reviewed. Results: Both semaglutide and tirzepatide induce substantial weight loss accompanied by reductions in lean body mass (LBM). However, current evidence indicates that LBM loss is generally proportional to the magnitude of weight loss and should not be interpreted as a direct surrogate for skeletal muscle loss or drug-induced myotoxicity. Tirzepatide appears to improve skeletal muscle composition by reducing muscle fat infiltration (MFI), whereas semaglutide shows more heterogeneous effects on muscle strength and physical performance, particularly in older or frail individuals. Emerging evidence highlights the importance of muscle quality, nutritional adequacy, and resistance exercise as key determinants of muscle preservation, although functional outcomes and data in older adults remain limited. Conclusions: The effects of incretin-based therapies (IBTs) on skeletal muscle are multifactorial and influenced by age, baseline muscle reserve, nutritional status, and physical activity. Preserving skeletal muscle health should be considered an integral component of obesity management through individualized nutritional care, adequate protein intake, resistance exercise, and regular functional assessment. Future research should prioritize the standardized evaluation of muscle quality and function and determine whether targeted nutritional interventions can improve the quality of weight loss and support healthy aging during IBT. Full article

Background/Objectives: Pediatric obesity is linked to adverse metabolic outcomes and altered growth trajectories. Conventional weight-reduction strategies often raise concerns regarding potential impairment of linear growth, highlighting the need for approaches that reduce adiposity while preserving physiological development. Methods: This real-world clinical study investigated children aged 7–16 years who were administered the herbal medicine Soagambi-tang for 2 weeks, followed by a follow-up evaluation 6 months post-treatment. Anthropometric measures, body composition, and growth velocity were evaluated. Network pharmacology and molecular docking analyses were employed to investigate potential molecular mechanisms. Results: Twenty-five participants were included. After treatment, the proportion of children classified as obese decreased from 60.0% to 36.0%, and 32.0% showed improvement in weight-status category without any worsening. Body fat percentage decreased consistently among participants with available body composition data, from 30.24 ± 4.52% to 25.95 ± 5.44% (p < 0.0001), and fat mass significantly decreased from 15.22 ± 5.60 kg to 14.28 ± 5.77 kg (p = 0.0496), whereas lean body mass increased from 36.12 ± 12.08 kg to 38.89 ± 12.70 kg (p < 0.001). BMI percentile significantly decreased from 93.7 ± 3.9 to 91.2 ± 6.1 (p = 0.008), while height z-score and height percentile significantly increased from 0.57 ± 0.99 to 0.77 ± 1.07 and from 64.5 ± 25.5 to 68.6 ± 25.0, respectively (both p < 0.001). Mean annual height velocity was 7.45 ± 2.43 cm/year, and height change was positively correlated with lean body mass change (r = 0.543, p = 0.005), reflecting a meaningful upward shift in growth trajectory. In silico network pharmacology and molecular docking analyses identified key bioactive compounds in Soagambi-tang that were predicted to be associated with pathways related to pediatric obesity and puberty-associated endocrine regulation. Conclusions: These findings suggest that Soagambi-tang treatment was associated with reduced adiposity and preserved linear growth in children with overweight or obesity. Given the study design and limited sample size, controlled prospective studies are required to confirm efficacy and safety. Full article

Neurological disorders drive demand for prolonged upper-limb rehabilitation, yet specialist access is uneven and assessment stays subjective. Marker-based and inertial measurement unit (IMU) systems are accurate but costly and impractical at home, while pose estimation pipelines mostly stop at keypoints, and many process video server-side, raising privacy concerns. We present a markerless pipeline that analyzes monocular RGB video entirely on-device in the browser, so it never leaves the machine. From 33 BlazePose keypoints, it derives five geometric metrics designed to limit body-size dependence—incomplete elbow extension, inter-limb asymmetry, shoulder girdle elevation, lateral trunk lean, and head tilt—compared against empirically calibrated, preliminary thresholds; a finite-state machine segments repetitions, and the flags are pooled into an unvalidated, exploratory quality score. Against an IMU reference over the 0–${62}^{\circ }$ range that the recordings cover, the image-plane angle showed a mean absolute error of ${2.18}^{\circ }$, below the pre-specified $5^{\circ }$ tolerance, a trajectory-averaged bias within $\pm 2^{\circ }$, and Lin’s concordance correlation coefficient of $0.956$; the difference is, however, proportional to the angle—about $4\%$ of the measured value—so the accuracy should not be extrapolated to larger elevations, and because that comparison was made offline, it does not include the timing error of the causal real-time path. On a single seated frontal-plane abduction task, with 18 healthy volunteers simulating the compensations and annotated by two independent clinicians blind to the instructed condition, compensation detection reached a macro-averaged $F_1$ of $0.75$ and $0.72$ against the individual raters. The five signs differ in maturity: near-expert for trunk lean and head tilt, moderate for incomplete elbow extension and inter-limb asymmetry, and weakest for shoulder elevation, which a single frontal view cannot fully disentangle from the abduction motion. Running at 22–30 frames per second on consumer laptops without relying on a discrete GPU, it offers an accessible, privacy-preserving proof-of-concept foundation for home telerehabilitation; generalization beyond this one exercise and effectiveness on genuine post-stroke compensations remain to be established. Full article