Search Results (200)

This paper examines how artificial intelligence (AI) can be strategically deployed to enhance urban planning and environmental livability in Riyadh by generating data-driven, people-centric design interventions. Unlike previous studies that concentrate primarily on visualization, this research proposes an integrative appraisal framework that combines AI-generated design with site-specific environmental data and native vegetation typologies. This study was conducted across key jurisdictional areas including the Northern Ring Road, King Abdullah Road, Al Rabwa, Al-Malaz, Al-Suwaidi, Al-Batha, and King Fahd Road. Using AI tools, urban scenarios were developed to incorporate expanded pedestrian pathways (up to 3.5 m), dedicated bicycle lanes (up to 3.0 m), and ecologically adaptive green buffer zones featuring native drought-resistant species such as Date Palm, Acacia, and Sidr. The quantitative analysis of post-intervention outcomes revealed surface temperature reductions of 3.2–4.5 °C and significant improvements in urban esthetics, walkability, and perceived safety—measured on a five-point Likert scale with 80–100% increases in user satisfaction. Species selection was validated for ecological adaptability, minimal maintenance needs, and compatibility with Riyadh’s sandy soils. This study directly supports the Kingdom of Saudi Arabia’s Vision 2030 by demonstrating how emerging technologies like AI can drive smart, sustainable urban transformation. It aligns with Vision 2030’s urban development goals under the Quality-of-Life Program and environmental sustainability pillar, promoting healthier, more connected cities with elevated livability standards. The research not only delivers practical design recommendations for planners seeking to embed sustainability and digital innovation in Saudi urbanism but also addresses real-world constraints such as budgetary limitations and infrastructure integration. Full article

Background and Objectives: Sesamoiditis is a painful and functionally limiting condition that affects the sesamoid bones of the hallux, frequently seen in athletic populations. Despite its clinical relevance, there are no standardised guidelines for its conservative management. This systematic review aims to evaluate the effectiveness of conservative treatments for sesamoiditis by summarising individual-level data from published studies. Materials and Methods: A comprehensive literature search was conducted in PubMed/MEDLINE, Scopus, ISI/Web of Science, and PEDro (Physiotherapy Evidence Database) up to December 2024 in accordance with PRISMA 2020 guidelines and following a protocol specifically devised for rare or underrepresented medical conditions. Eligible studies included case reports and case series involving patients aged ≥16 years who were conservatively treated for clinically and/or radiologically diagnosed sesamoiditis. Data on patient demographics, diagnosis, type and duration of treatment, pain- (Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS)) and function-related (Foot and Ankle Ability Measure (FAAM) and Foot and Ankle Outcome Score (FAOS)) outcomes, and return to activity were extracted. Study quality was assessed using Joanna Briggs Institute (JBI) critical appraisal tools. Pooled effect sizes were computed where applicable. Results: Out of 2380 initial records, 11 studies comprising 59 patients (29 females) were included. Treatments varied widely, including orthotics, corticosteroid injections, physical therapy, and biologic approaches such as concentrated bone marrow aspirate (CBMA). VAS scores improved in 66% of cases. NRS scores returned to baseline in some patients after initial improvement, revealing recurrence. FAAM and FAOS subscales showed functional improvements, particularly in sports-specific domains. Return to activity varied: in a case series, 45.4% resumed pain-free sports participation, while others remained symptomatic. Conclusions: Conservative treatment options for sesamoiditis showed variable effectiveness with promising outcomes in selected patients. Corticosteroid injections and orthotics appeared beneficial, but high recurrence and limited functional recovery persisted in some cases. Standardised treatment protocols and high-quality prospective studies are needed to improve clinical decision-making and optimise non-surgical management. Full article

This study is titled “Success Factors in Transport Interventions: A Mixed-Method Systematic Review (1990–2022)”. The purpose of the systematic review is to (1) identify effective interventions for transitioning individuals from private car reliance to sustainable transport, (2) summarise psychosocial theories shaping transportation choices and identify enablers and barriers influencing sustainable mode adoption, and (3) determine the success factors for interventions promoting sustainable transport choices. The last search was conducted on 18 November 2022. Five databases (Scopus, Web of Science, MEDLINE, APA PsycInfo, and ProQuest) were searched using customised Boolean search strings. The identified papers were included or excluded based on the following criteria: (a) reported a modal shift from car users or cars to less CO₂-emitting modes of transport, (b) covered the adoption of low-carbon transport alternatives, (c) comprised interventions to promote sustainable transport, (d) assessed or measured the effectiveness of interventions, or (e) proposed behavioural models related to mode choice and/or psychosocial barriers or drivers for car/no-car use. The identified papers eligible for inclusion were critically appraised using Sirriyeh’s Quality Assessment Tool for Studies with Diverse Designs. Inter-rater reliability was assessed using Cohen’s Kappa to evaluate the risk of bias throughout the review process, and low-quality studies identified by the quality assessment were excluded to prevent sample bias. Qualitative data were extracted in a contextually relevant manner, preserving context and meaning to avoid the author’s bias of misinterpretation. Data were extracted using a form derived from the Joanna Briggs Institute. Data transformation and synthesis followed the recommendations of the Joanna Briggs Institution for mixed-method systematic reviews using a convergent integrated approach. Of the 7999 studies, 4 qualitative, 2 mixed-method, and 30 quantitative studies successfully passed all three screening cycles and were included in the review. Many of these studies focused on modelling individuals’ mode choice decisions from a psychological perspective. In contrast, case studies explored various transport interventions to enhance sustainability in densely populated areas. Nevertheless, the current systematic reviews do not show how individuals’ inner dispositions, such as acceptance, intention, or attitude, have evolved from before to after the implementation of schemes. Of the 11 integrated findings, 9 concerned enablers and barriers to an individual’s sustainable mode choice behaviour. In addition, two integrated findings emerged based on the effectiveness of the interventions. Although numerous interventions target public acceptance of sustainable transport, this systematic review reveals a critical knowledge gap regarding their longitudinal impact on individuals and effectiveness in influencing behavioural change. However, the study may be affected by language bias as it only included peer-reviewed articles published in English. Due to methodological heterogeneity across the studies, a meta-analysis was not feasible. Further high-quality research is needed to strengthen the evidence. This systematic review is self-funded and has been registered on the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY; Registration Number INPLASY202420011). Full article

Background/Objectives: Vibration foam rolling (VFR) has emerged as a popular intervention in sports and rehabilitation settings to enhance recovery and flexibility. This systematic review aimed to evaluate the effects of VFR on pain, fatigue, and range of motion (ROM) in individuals experiencing exercise-induced muscle fatigue and to assess its clinical applicability. Methods: A systematic literature search was conducted across five databases: PubMed, Cochrane Library, Embase, Web of Science, and CINAHL. Studies were included if they involved participants with muscle fatigue, applied VFR as an intervention, and measured outcomes related to pain, fatigue, or ROM. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. Results: Eight studies published between 2019 and 2024 met the inclusion criteria. VFR showed beneficial effects in reducing delayed onset muscle soreness, improving pressure pain threshold, and lowering subjective fatigue. Several studies also reported increased ROM in specific joints, including the hip and knee. However, findings across studies were inconsistent, particularly in physiological markers such as muscle oxygen saturation and blood flow parameters, where statistically significant differences were not always observed. Conclusions: VFR may offer potential benefits for pain relief, fatigue recovery, and ROM improvement in fatigued individuals. Nonetheless, its effects remain difficult to isolate from those of mechanical pressure and friction associated with foam rolling. Future studies with standardized intervention protocols and long-term follow-up are needed to clarify the independent role of vibration in recovery outcomes. Full article

Background/Objectives:Tinnitus, the perception of sound without an external source, is a prevalent and often distressing condition with complex neurobiological and psychological underpinnings. A growing body of literature suggests a frequent co-occurrence between tinnitus and psychiatric symptoms such as anxiety, depression, and sleep disturbances. However, the extent to which these conditions are associated, and whether treatments targeting one domain impact the other, remains unclear. This scoping review aimed to (1) identify associations between tinnitus and mental health comorbidities, (2) evaluate whether tinnitus treatments affect psychiatric outcomes, and (3) explore whether psychiatric treatments influence tinnitus symptoms. Methods: A comprehensive search of PubMed, MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, and Google Scholar was conducted for articles published between January 2014 and May 2025. Eligible studies were written in English, French, or Spanish, focused primarily on tinnitus, included at least one co-occurring psychiatric condition, and described how tinnitus was evaluated. A total of 30 studies were included. Data were extracted and synthesized thematically. Study quality was assessed using the Mixed Methods Appraisal Tool and relevant Joanna Briggs Institute checklists. Results: Most studies reported significant associations between tinnitus and psychiatric symptoms, particularly anxiety, depression, stress, insomnia, and, in some cases, psychosis. Treatments aimed at tinnitus, such as eye movement desensitization and reprocessing and cognitive behavioral therapy, were sometimes associated with secondary improvements in mental health. Conversely, limited evidence suggested that psychiatric treatment, including antipsychotic medication and psychotherapy, may reduce tinnitus severity in selected cases. Conclusions: Tinnitus and psychiatric comorbidities frequently co-occur, and early evidence suggests that addressing one may benefit the other. Given the specific inclusion criteria, this review presents a selected subset of the broader literature, focusing only on studies that evaluated tinnitus alongside clinically measured psychiatric symptoms. Future research should prioritize integrated, longitudinal interventions to better understand these complex interactions. Full article

Background: Aging and its pathologies, particularly sleep problems, are increasingly affecting industrialized societies. This study aims to determine the effectiveness of different cognitive interventions for the treatment of insomnia or poor sleep quality in community-dwelling older people. Methodology: A systematic review was carried out from November 2023–July 2024 according to the standards of the Preferred Reporting Items for Systematic Review and Meta-Analyses in the databases. The following databases were consulted: Pubmed, Web of Science, and ClinicalTrials.gov. The studies included patients with sleep problems or insomnia over 60 years of age. To evaluate the quality of the studies, the Critical Appraisal Skills Program Spanish (CASPe) guide was used. Results: Nine clinical trials with intervention groups and control groups belonging to the last 10 years were selected. They were analyzed, and the results were verified via questionnaires, scales, sleep diaries, and objective measures. In general, the implementation of the interventions improved the quality of sleep and symptoms of insomnia. Conclusions: Cognitive interventions have been found to be safe and useful for the treatment of insomnia and poor sleep quality in older people. Furthermore, they are feasible in terms of cost effectiveness and can be easily implemented by primary care teams. Full article

Background: Different methods have been used to fabricate and measure marginal gap in all-metal crowns, yet a systematic review on this topic has not been conducted. Objective: To review the existing literature regarding the measurement methods employed for the in vitro marginal gap measurement of pre-cemented all-metal single crowns and examine the influence of crown fabrication method on the marginal gap. Materials and Methods: A systematic search was performed from December 2024 backwards across EBSCO Host, Scopus, PubMed, and Web of Science databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and predefined eligibility criteria. The quality of included articles was evaluated using the Joanna Briggs Critical Appraisal Checklist. Results: Ten studies, involving 180 crowns, assessed marginal gaps using computerised superimposition (102 µm), scanning electron microscopy (89 µm), profilometry (100 µm), photogrammetry (59 µm), impression replica techniques (124 µm), and direct view microscopy (35 µm). Marginal gaps varied across crowns constructed with cobalt–chromium (97 µm), titanium (56 µm), noble metals (127 µm), and base metal alloys (35 µm). No significant differences (t = 1.06, p = 0.315) were observed between CAD/CAM (103.21 ± 58.56 µm) and lost wax casting method (71.59 ± 43.94 µm) of crown fabrication when analysed using an independent t-test. Conclusions: Cobalt–chromium was the most used material for AMCs, while titanium alloys produced the lowest mean marginal gap per crown. No significant differences in reported marginal gaps were observed between crowns fabricated using lost wax casting and CAD/CAM techniques. However, the limited number of studies, variation in measurement methods, and inconsistency in methodological rigour restricted the generalisability of the findings. Full article

Background/Objective: Evaluating the measurement properties (MPs) of Clinician-Reported Outcome Measures (ClinROMs) is crucial for selecting appropriate instruments for vitiligo assessment. This review critically appraises the existing evidence on the MPs of the ClinROMs used in vitiligo. Methods: A systematic search was conducted in PubMed, Embase, and the Cochrane Library up to 20 February 2024, identifying validated ClinROMs in vitiligo. Studies were included if they provided original data on ClinROM development or analysis, excluding those solely validating other instruments. The assessment of ClinROM quality and risk of bias analysis followed COSMIN guidelines, and ClinROMs with the highest number of sufficiently rated MPs supported by a moderate/high Quality of Evidence (QoE) were identified per construct category (extent/repigmentation and evolution/activity). Results: This review included 22 studies evaluating 12 ClinROMs. For extent/repigmentation, the Vitiligo Area and Severity Index (VASI), Vitiligo Extent Score (VES), and VESplus each had four MPs rated sufficient with a moderate/high QoE. For evolution, the Vitiligo Disease Improvement Score (VDIS) and Vitiligo Disease Activity Score (VDAS) similarly had four MPs rated sufficient with a moderate/high QoE. For activity evaluated based on a single time point, the Vitiligo Signs of Activity Score (VSAS), the only validated ClinROM for visible signs of disease activity, had three MPs rated sufficient with a moderate/high QoE. Conclusions: Six ClinROMs demonstrated the highest quality ratings across two key constructs. However, none underwent a complete evaluation of all their MPs, highlighting the need for further validation and refinement. Full article

Deteriorating eyesight is increasingly prevalent in the digital age due to prolonged screen exposure and insufficient eye care, leading to reduced productivity and difficulties in maintaining focus during extended reading sessions. This systematic literature review, following PRISMA guidelines, evaluates 1782 articles, with 42 studies ultimately included, assessing their quality using the Mixed Methods Appraisal Tool (MMAT). The selected studies are categorised into eye metric classification, measuring comprehension, measuring attention, and typography and typesetting. Recent advances have demonstrated the potential of machine learning to enhance eye movement predictions, such as the classification of fixations and saccades, while other research utilises eye metrics to assess mental fatigue and attention levels. Additionally, modifications to typography have been explored as a means of improving focus and memory retention. The findings highlight the transformative role of eye-tracking technologies and machine learning in understanding reading behaviour, attention, and cognitive workload. However, challenges such as data scarcity, limited generalisability, and biases in existing methodologies persist. Addressing these gaps through standardised frameworks, diverse datasets, and advancements in synthetic data generation could enhance the accessibility, accuracy, and real-world applicability of eye-tracking solutions for improving reading comprehension and focus. Full article

Background/Objectives: Compliance with healthcare standards is an absolute must for every healthcare organization seeking accreditation. Several factors were found to affect compliance, and in Saudi Arabia, certain standards were observed for non-compliance. Therefore, this systematic review and meta-analysis seeks to identify the factors associated with non-compliance with healthcare accreditation in Saudi Arabia. Methods: This study adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The population, intervention, comparison, and outcome (PICO) model was used to refine the research question. The Peer Review of Electronic Search Strategies (Press) guidelines were used to improve the search strategy. The databases used for the search were PubMed, Web of Science, Scopus, and Google Scholar. The dates searched were from 1 January 2000 to 1 November 2024. We used a data extraction form for study characteristics and outcome data, which was piloted on five studies in this review. The risk of bias was assessed by using the Joanna Briggs Institute (JBI) tool and the Mixed Methods Appraisal Tool (MMAT). The analysis was carried out using the Fisher r-to-z transformed correlation coefficient as the outcome measure. A random-effects model was fitted to the data. Results: A total of ten studies were included for qualitative synthesis and five for quantitative synthesis. Several factors were observed for non-compliance, including insufficient training organization hurdles, a lack of implementation strategies, and the attitudes of healthcare providers. The estimated average correlation coefficient based on the random-effects model was 0.2568 (95% CI: −0.1190 to 0.6326). Conclusions: The dimension of quality in healthcare through pooled correlations from various studies highlighted a weak association among these dimensions. Full article

Wilderness medicine is a rapidly evolving field and has benefited from expanded research efforts. Moreover, with an escalating occurrence of severe and cataclysmic global climatologic events, human illness arising from interaction with wilderness and recreational environments warrants increasing consideration. Within the last decade, the Wilderness Medical Society (WMS) has aggregated research findings and created guidelines on prevention measures and therapeutic options for acute altitude illness, frostbite injuries, and avalanche and non-avalanche snow burials. As new research emerges, some guidelines have been updated to reflect the most current and sound scientific conclusions. In this review, we have synthesized the evidence-based guidelines and have reviewed the quality of the guidelines according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II framework. Further research efforts can expand the scope of evidence-based practice in travel medicine and ideally standardize the implementation of recommendations within both pre-travel and post-travel medical practices. Full article

Background: Adults with intellectual disabilities are a particularly inactive sub-population who experience disproportionally poorer health and social exclusion when compared with the wider general population. This systematic review aimed to identify whether community-based exercise interventions were theoretically underpinned, whether they had an active single- or multi-exercise component, and how the interventions were objectively and/or subjectively measured, as well as deducing if they improved the health of this population. Method: A systematic search of five databases was conducted up to May 2024. The study was registered in PROSPERO and followed PRISMA reporting guidelines. Study methodological quality was appraised using the Critical Appraisal Skills Programme. Risk of bias was determined using the Cochrane collaboration tools ROB 2 and ROB 2 CRT. Articles were eligible for inclusion if they recruited adults with intellectual disability, were community-based, had an active exercise component and measured physical activity (PA) levels as an outcome measure. Results: In total, 9034 records were identified, with five studies meeting the eligibility criteria. All studies used a feasibility RCT or RCT methodology and all focused on weight loss or PA levels as the primary outcome measure. Two studies focused on walking as a single exercise, two combined walking with nutrition/weight loss, and one combined walking with aerobics. One multi-component walking and aerobics intervention led to statistically significant improvements in PA. Multi-component community-based exercise interventions led to statistically significant improvements in body composition measures. No studies showed statistically significant improvements in quality of life. Risk of bias was rated moderate to high across all included studies. Conclusions: Caution should be taken in drawing firm conclusions due to the small number of included studies, small sample sizes and high risk of bias. Multi-component community-based interventions are more effective at improving PA levels in adults with intellectual disabilities than walking-only studies. Future studies should be theoretically underpinned and explore the use of peer and student models of social support. The use of fitness facilities such as leisure centres and gyms requires further exploration in this population. Full article

Individual attitudes and knowledge can predict pro-environmental behaviors. Public surveys, therefore, can provide precious information, which can guide sensitization interventions. In this systematic review, we searched Medline and Embase, with no language or date restrictions, for surveys designed to measure in the general population the level of knowledge about different types of plastics, the risks associated with plastic pollution, and awareness of actions to reduce them. Survey tools were analyzed following the guide of Burns and Kho, and study methodological quality was assessed via the Appraisal Tool for Cross-Sectional Studies. We included 17 articles published from 2019 to 2024, mostly concerning European populations. The tools comprised a median of 13 items (range 7–50), and very differently formulated questions. Overall, 13/17 (76.5%) study questionnaires received less than 50% (<3.5) of the maximum possible score. The remaining four questionnaires obtained intermediate scores (between 3.5 and 5.3) indicating moderate quality. Most studies did not employ the appropriate cross-sectional survey methodology, only two studies statistically justified sample sizes, only three reported a sampling frame, and only two described a selection process that appears to be representative. In most cases, the instruments were not validated, and the statistical significance of key variables was not provided. The many shortcomings highlighted in this review emphasize the urgent need for methodological rigor when conducting survey studies, which are essential tools for public health. Full article

Background: The prognosis of people with multiple sclerosis (MS) has improved substantially in recent decades due to advances in diagnosis and treatment. Due to the unpredictable course and heterogenous treatment response in MS, there is a clear need for biomarkers that reflect disease activity in the clinical follow-up of these patients. We conducted a systematic review with Bayesian network meta-analysis with the aim of analyzing the effects of physical exercise on neurofilaments (NfL) and glial fibrillary acidic protein (GFAP) levels in patients with MS. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, starting with a PICO (patient/population, intervention, comparison, and outcome) question: what are the clinical effects of physical exercise (with independence of the type) on NfL and/or GFAP levels in patients with MS compared with other interventions or no intervention whatsoever? A systematically comprehensive literature search was conducted from January to March 2024 to identify original studies that answered the PICO question, using the main data sources. The quality of the studies included was assessed using the Quality Index of Downs & Black. For studies included in the systematic review that followed a randomized controlled trial (RCT) design, the methodological quality of each paper was assessed using the Physiotherapy Evidence Database (PEDro) Scale. Risk of bias was also explored by two independent reviewers. Finally, all articles were classified according to the levels of evidence and grades of recommendation for diagnosis studies established by the Oxford Center for Evidence-Based Medicine. For continuous outcome measures with enough comparisons and a methodological quality greater than or equal to good according to the PEDro scale, a Bayesian network meta-analysis (NMA) was applied. The statistical analyses were performed in R (version 4.1.3, R Core Team 2023) using the “BUGSnet” and “gemtc” packages. Bayesian NMA can be used to obtain a posterior probability distribution of all the relative treatment effects, which allows us to quantify the uncertainty of parameter estimates and to rank all the treatments in the network. Results: Eight studies were included in this systematic review and six articles in the NMA, and they were appraised for quality. The characteristics of the included studies, types of training and described protocols, methodological quality, risk of bias, and clinical effects on the studied biomarkers were outlined. Qualitative synthesis, effects of different exercise modalities in NfL with the Bayesian NMA, selection of the final model and model assessment, and ranking of interventions are also shown. Conclusions: Our findings indicated that moderate-intensity exercise is more likely to reduce NfL concentration compared to high-intensity exercise, and, in turn, high-intensity exercise is more likely to reduce NfL concentration than low-intensity exercise. However, the effects of high-intensity exercise on GFAP levels were inconclusive. Full article

Background: Orthodontic problems can affect vital quality of life functions, such as swallowing, speech sound production, and the aesthetic effect. Therefore, it is important to diagnose and treat these patients precisely. The main aim of this study is to introduce new classification methods for skeletal class I occlusion (SCIO) and skeletal class II malocclusion (SCIIMO) among Arab patients in Israel. We conducted hierarchical clustering to detect critical trends within malocclusion classes and applied machine learning (ML) models to predict classification outcomes. Methods: This study is based on assessing the lateral cephalometric parameters from the Center for Dentistry Research and Aesthetics based in Jatt, Israel. The study involved the encoded records of 394 Arab patients with diagnoses of SCIO/SCIIMO, according to the individualized ANB of Panagiotidis and Witt. After clustering analysis, an ML model was established by evaluating the performance of different models. Results: The clustering analysis identified three distinct clusters for each skeletal class (SCIO and SCIIMO). Among SCIO clusters, the results showed that in the second cluster, retrognathism of the mandible was less severe, as represented by a lower ANB angle. In addition, the third cluster had a lower NL-ML angle, gonial angle, SN-Ba angle, and lower ML-NSL angle compared to clusters 1 and 2. Among SCIIMO clusters, the results also showed that the second cluster has less severe retrognathism of the mandible, which is represented by a lower ANB angle and Calculated_ANB and a higher SNB angle (p < 0.05). The general ML model that included all measurements for patient classification showed a classification accuracy of 0.87 in the Random Forest and the Classification and Regression Tree models. Using ANB angle and Wits appraisal only in the ML, an accuracy of 0.78 (sensitivity = 0.80, specificity = 0.76) was achieved to classify patients as SCIO or SCIIMO. Conclusions: The clustering analysis revealed distinguished patterns that can be present within SCIO and SCIIMO patients, which can affect the diagnosis and treatment plan. In addition, the ML model can accurately diagnose SCIO/SCIIMO patients, which should improve precise diagnostics. Full article