Search Results (14,877)

Understanding the services provided by coastal ecosystems is vital for their study, preservation, and restoration. Mangrove forests, in particular, provide key ecosystem services: they sequester carbon, support fisheries and biodiversity, and facilitate sustainable tourism. In the Caribbean and the Gulf of Mexico, mangrove-related services have been studied extensively, but often via fragmented approaches. This meta-analysis combines a literature review, bibliometric tools, and thematic mapping to identify emerging trends and long-standing gaps. We analyzed 61 peer-reviewed studies across 21 sovereign states and U.S. states, which highlighted shifting research priorities and a lack of convergence—defined herein as the failure of individual studies to examine multiple ecosystem service categories (regulating, cultural, supporting, and provisioning) simultaneously to assess potential trade-offs. While early research emphasized supporting services such as fishery nurseries, recent studies focus on regulating services, especially carbon sequestration. Stakeholder engagement remains limited, with only 18% of studies incorporating local perspectives. We argue for greater integration of stakeholder input and convergence across service categories to enhance the scientific basis for mangrove management and policy design. Full article

In the context of manufacturing logistics, this study sheds light on the difficult task of concurrently optimizing cost, time, influence on sustainability, and spatial efficiency. Specifically, this addresses the integrated challenge of material handling equipment selection and facility space allocation, a crucial decision-making domain where conventional single-objective methodologies frequently overlook vital considerations. While recent research predominantly relies on meta-heuristics and simulation-based solution methodologies, they do not guarantee a global optimum solution space. To effectively address this multifaceted decision environment, a Mixed-Integer Linear Programming (MILP) model is developed and resolved utilizing two distinct scalarization methodologies: the conventional ϵ-constraint method and the augmented ϵ-constraint method (AUGMECON2). The comparative analysis indicates that although both methods effectively identify the Pareto front, the AUGMECON2 approach offers a more robust assurance of solution efficiency by incorporating slack variables. The results illustrate a convex trade-off between capital expenditure and operational flow time, indicating that substantial reductions in time necessitate strategic investments in higher-capacity equipment fleets. Furthermore, the analysis underscores a significant conflict between achieving extreme operational efficiency and adhering to facility design standards, as reducing time or energy consumption beyond a specific point requires deviations from optimal space allocation policies. Ultimately, a “Best Compromise Solution” is determined that harmonizes near-optimal operational efficiency with strict compliance to spatial constraints, providing a resilient framework for sustainable manufacturing logistical planning. Full article

Salmonella Typhimurium is a major zoonotic pathogen, with pigs and chickens serving as key reservoirs for human infection, yet the genomic determinants of its host adaptation remain incompletely understood. This study integrated comparative genomics, genome-wide association studies (GWASs), and interpretable machine learning on 1654 high-quality genomes of swine- and chicken-origin S. Typhimurium isolates to identify host-associated genetic features. Phylogenetic analysis revealed host-preferred lineages and significantly lower genetic diversity within chicken-adapted subpopulations. Meta-analysis identified distinct host-associated profiles of antimicrobial resistance genes (e.g., higher prevalence of floR and bla_TEM-1 in swine) and virulence factors (e.g., enrichment of allB and the yersiniabactin system in chickens). GWASs pinpointed 1878 host-associated genes and multiple SNPs/indels, functionally enriched in metabolism, regulation, and cell processes. A two-stage Random Forest model, built using the most contributory features, accurately discriminated between swine and chicken origins (AUC = 0.974). These findings systematically revealed the genomic signatures of host adaptation in S. Typhimurium, providing a prioritized set of candidate markers for experimental validation. Full article

Patients with chronic obstructive pulmonary disease (COPD) commonly experience impaired lung function, reduced exercise tolerance, and respiratory muscle weakness. Owing to the unique properties of the aquatic environment, water-based exercise may provide rehabilitation benefits that differ from those of traditional land-based exercise. Objective: This systematic review and meta-analysis aimed to compare the effects of water-based versus land-based exercise on lung function, exercise capacity, and respiratory muscle function in patients with COPD, thereby providing evidence to inform the optimization of pulmonary rehabilitation exercise modalities. Methods: PubMed, Web of Science, CNKI, and other databases were systematically searched to identify randomized controlled trials comparing water-based and land-based exercise interventions in adults with COPD. Primary outcomes included lung function (FEV₁% predicted and FEV₁/FVC), exercise capacity (six-minute walk distance, 6MWD), respiratory muscle strength (maximal inspiratory pressure (MIP]) and maximal expiratory pressure (MEP). Meta-analyses were performed using Stata 17.0. Results: A total of 14 RCTs were included. Meta-analysis showed that, compared with land-based exercise, water-based exercise significantly improved FEV₁% predicted (WMD = 3.33, 95% CI: 0.02–6.64) and FEV₁/FVC (WMD = 4.00, 95% CI: 1.27–6.73). Regarding exercise capacity, water-based exercise significantly increased 6MWD (WMD = 47.81 m, 95% CI: 20.19–75.44), with more pronounced improvements observed in short-term interventions (≤8 weeks). Respiratory muscle function analyses demonstrated significant improvements in MIP (WMD = 14.22 cmH₂O, 95% CI: 7.75–20.69) and MEP (WMD = 14.40 cmH₂O, 95% CI: 4.92–23.89). Conclusions: Compared with land-based exercise, water-based exercise demonstrates consistent advantages in improving exercise capacity and respiratory muscle function in patients with COPD and shows additional benefits for lung function indices. Therefore, water-based exercise may serve as a valuable adjunct to land-based training within pulmonary rehabilitation programs. Full article

Mental health conditions have become an increasing concern among university students, particularly those pursuing health science disciplines such as pharmacy. Rigorous academic demands, high workloads, and sustained psychological pressure place pharmacy students at a high risk of mental health disorders, including depression, anxiety, stress, and suicidal ideation. This study aimed to systematically review and quantitatively synthesize existing evidence on the prevalence of mental health conditions among pharmacy students in Thailand and globally using a meta-analytic approach. A comprehensive literature search was conducted across the major academic databases, including PubMed, ScienceDirect, Scopus, and ThaiJo, using predefined search terms and stringent inclusion criteria to ensure methodological rigor and relevance. Data from eligible studies were extracted and analyzed using STATA software to ensure statistical precision and reliability of the pooled estimates. A total of 51 studies, comprising 17,717 pharmacy students across 16 countries, including the United States, Thailand, Brazil, Malaysia, Syria, Pakistan, Poland, France, Portugal, Nigeria, Saudi Arabia, Sudan, Lebanon, Egypt, the United Arab Emirates, and Vietnam, were included. The meta-analysis revealed pooled prevalence rates of 44.26% for depression (95% CI: 36.08–52.61), 52.01% for anxiety (95% CI: 42.86–61.09), 48.10% for stress (95% CI: 32.96–63.43), and 24.52% for suicidal ideation (95% CI: 14.10–36.70). These findings reflect a substantial mental health burden among pharmacy students, necessitating immediate and context-specific interventions. Considering these findings, academic institutions must develop and implement comprehensive mental health support strategies. Such initiatives should include early identification and screening programs, access to psychological counseling services, resilience-building interventions, and stress management workshops to effectively address the psychological needs of pharmacy students and enhance their academic and personal well-being. Full article

Background: Direct oral anticoagulants (DOACs) are now the preferred anticoagulant over vitamin K antagonists for patients with atrial fibrillation (AF) and venous thromboembolism (VTE). Variability in drug exposure raises concerns about bleeding and thrombotic events, highlighting the potential value of therapeutic drug monitoring (TDM). Methods: This systematic review and meta-analysis conducted a systematic search of PubMed, Embase, Web of Science, Scopus, Cochrane Library, and ClinicalTrials.gov (from inception to May 2025) and identified studies reporting DOAC levels and clinical outcomes. Two reviewers independently performed screening, data extraction, and risk-of-bias assessment (RoB 2.0, Newcastle–Ottawa Scale). Random-effects meta-analytical models generated pooled estimates, with meta-regression exploring potential sources of variability (DOAC type, drug levels) and exposure–response relationships. Results: Nineteen studies comprising 5770 patients were included in the review. The pooled event rates were 8% for major bleeding (95% CI: 0.05–0.11), 7% for thrombotic events (95% CI: 0.05–0.09), and 3% for mortality (95% CI: 0.03–0.04). Heterogeneity was substantial for bleeding and thrombotic events (I² = 95.6% and 87.3%, respectively) but negligible for mortality (I² = 0%). Meta-regression analyses showed no significant association between mean DOAC concentration and either major bleeding (β = −0.00021, p = 0.35, Adj R² ≈ 0%) or thrombotic events (β = 0.00005, p = 0.78, Adj R² ≈ 0%), indicating that variations in measured plasma levels did not meaningfully explain event rate differences across studies. Conclusions: In this systematic review and meta-analysis, measured DOAC concentrations show limited and inconsistent association with clinical outcomes. While the present synthesis does not demonstrate a statistically robust linear correlation between DOAC plasma concentrations and adverse outcomes, it highlights the multifactorial determinants of bleeding and thrombosis risk underscores the potential value of selective TDM in individualized care. Further prospective, standardized studies are needed to define clinically actionable thresholds and to validate TDM-guided strategies that optimize the delicate balance between safety and efficacy in DOAC therapy. Full article

In an era increasingly defined by the imperative for sustainable development, the construction sector faces significant challenges, including resource limitations, environmental pressures, and high uncertainty. Within this context, the organizational capabilities of construction projects are widely recognized as a critical endogenous driver, closely linked to sustainable performance outcomes. Yet, empirical research to date has produced inconsistent conclusions, and a systematic understanding of how distinct dimensions of capability influence sustainability remains surprisingly fragmented. To address this gap, we employ a meta-analysis to synthesize 11,881 independent samples from 64 quantitative empirical studies. We systematically examined the overall relationship between organizational capability in construction projects and sustainable performance. It further compares the differential effects of project capabilities and dynamic capabilities across economic, social, and environmental performance. Additionally, the study investigated the moderating effects of key contextual and methodological factors. Our analysis yielded several important findings: (1) A significant, moderately positive correlation exists between organizational capability in construction projects and sustainable performance. (2) Project capability exerts a stronger association with economic and social performance, whereas dynamic capability demonstrates a more pronounced effect on environmental performance. This underscored distinct pathways through which different capability dimensions operate. (3) Moderation analysis revealed that the relationship between organizational capability and sustainable performance is stronger in emerging economies and collectivist cultural contexts. Methodologically, structural equation modeling tended to produce larger effect sizes compared to regression analysis. Although no significant moderation effect emerges across research time points, post-2015 studies generally showed slightly stronger effects. The findings enrich the application of the Resource-Based View and Dynamic Capability Theory within construction project contexts, emphasizing the multidimensional nature of organizational capabilities and their differentiated roles across triple-bottom-line performance. Consequently, this research offers valuable pathways for capability development and a strategic foundation for enhancing managerial practice in construction project management. Full article

Background/Objectives: Breast cancer is one of the most common malignancies, but its heterogeneous molecular subtypes make treatment decision-making complex and patient-specific. Both the pathology reports and the electronic medical record (EMR) play a critical role for an appropriate treatment decision. This study aimed to develop an integrated clinical decision support system (CDSS) that combines a large language model (LLM)-based pathology analysis with deep learning-based treatment prediction to support standardized and reliable decision-making. Methods: Real-world data (RWD) obtained from a cohort of 5015 patients diagnosed with breast cancer were analyzed. Meta-Llama-3-8B-Instruct automatically extracted the TNM stage and tumor size from the pathology reports, which were then integrated with EMR variables. A multi-label classification of 16 treatment combinations was performed using six models, including Decision Tree, Random Forest, GBM, XGBoost, DNN, and Transformer. Performance was evaluated using accuracy, macro/micro-averaged precision, recall, F1 score, and AUC. Results: Using combined LLM-extracted pathology and EMR features, GBM and XGBoost achieved the highest and most stable predictive performance across all feature subset configurations (macro-F1 ≈ 0.88–0.89; AUC = 0.867–0.868). Both models demonstrated strong discrimination ability and consistent recall and precision, highlighting their robustness for multi-label classification in real-world settings. Decision Tree and Random Forest showed moderate but reliable performance (macro-F1 = 0.84–0.86; AUC = 0.849–0.821), indicating their applicability despite lower predictive capability. By contrast, the DNN and Transformer models produced comparatively lower scores (macro-F1 = 0.74–0.82; AUC = 0.780–0.757), especially when using the full feature set, suggesting limited suitability for structured clinical data without strong contextual dependencies. These findings indicate that gradient-boosting ensemble approaches are better optimized for tabular medical data and generate more clinically reliable treatment recommendations. Conclusions: The proposed artificial intelligence-based CDSS improves accuracy and consistency in breast cancer treatment decision support by integrating automated pathology interpretation with deep learning, demonstrating its potential utility in real-world cancer care. Full article

Background/Objectives: To evaluate the incidence, characteristics, and clinical outcomes of intraocular inflammation (IOI) associated with intravitreal faricimab (IVF) in patients with neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME). Methods: Following PRISMA guidelines, a comprehensive search of PubMed, Web of Science, Scopus, Embase, and CENTRAL databases was performed from their inception to February 2025. Using the random-effects model, weighted proportions, standardized mean differences, and weighted log odds ratios (OR) were pooled and calculated. A two-tailed p-value of <0.05 was considered statistically significant. The χ² (z) test and the Higgins I² test were used to assess studies heterogeneity. Results: We conducted a systematic review and meta-analysis of 24 studies (4761 patients; 5652 eyes). The most common diagnoses were nAMD (n = 4782, 94.6%) and DME (n = 845, 37.1%). The pooled proportion for IOI incidence in eyes receiving IVF was 3.0% (95% CI: 1.0–6.0). The odds of developing IOI did not differ significantly between the DME and nAMD groups (OR: 1.13, p = 0.78). Unspecified IOI was the most common sign (n = 210, 2.9% [95% CI: 1.2–7.3]), followed by anterior uveitis (n = 80, 1.9% [95% CI: 0.1–34.8]), vitritis (n = 63, 2.9% [95% CI: 0.2–32.1]), retinal hemorrhage (n = 27, 0.7% [95% CI: 0.0–15.3]), and endophthalmitis (n = 8, 0.5% [95% CI: 0.3–1.1]). Conclusions: While IVF demonstrates therapeutic efficacy, our findings highlight a clinically relevant risk of IOI. We, therefore, recommend vigilant clinical monitoring in patients receiving this therapy. Full article

Background: Cancer-related fatigue (CRF) is one of the most common and burdensome symptoms faced by patients with cancer, yet effective drug-based treatments remain limited. In recent years, phytotherapeutic agents have drawn attention as complementary options, supported by plausible anti-inflammatory, antioxidant, and immunomodulatory mechanisms. Methods: We performed a systematic review and meta-analysis to quantitatively synthesize randomized controlled trial evidence on the efficacy of phytotherapeutic interventions for cancer-related fatigue and to assess the certainty of evidence. Databases were searched from inception, with the final search update completed in October 2025. Eligible studies included adults with CRF and compared herbal interventions with placebo controls. Standardized mean differences (SMDs) were pooled using a DerSimonian–Laird random-effects model. We also evaluated risk of bias (RoB 2), publication bias, and certainty of evidence using GRADE. This systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 guidelines. Results: Fourteen trials were included, studying agents such as Paullinia cupana, Panax ginseng, multi-herbal Traditional Chinese Medicine formulations, and other botanical extracts. Overall, phytotherapy provided a modest improvement in CRF (SMD = 0.31; 95% CI, 0.08–0.53; p = 0.022), though heterogeneity was substantial (I² = 56.7%). In subgroup analyses, only the group of “other formulations” demonstrated significant benefit; ginseng and guaraná did not demonstrate statistically significant effects. Most trials had high or unclear risk of bias, and the certainty of evidence was rated very low. Conclusions: Current evidence does not firmly support phytotherapeutic agents as effective treatments for CRF, hindered largely by methodological weaknesses, heterogeneous interventions, and imprecise effect estimates. Even so, the biological rationale and the variability in clinical responses point toward an opportunity for the emerging field of precision herbal oncology. Well-designed, multicenter trials are essential to determine whether phytotherapy can meaningfully contribute to CRF management. Full article

Breast cancer continues to be the most frequently diagnosed cancer among women worldwide and remains a leading cause of cancer-related mortality. Despite advances in imaging and biopsy-based approaches, current diagnostic methods are invasive, costly, and often insufficient to capture the molecular heterogeneity of tumors. Extracellular vesicles (EVs) have emerged as promising non-invasive biomarkers owing to their role in intercellular communication and their enrichment with tumor-specific cargo. This study conducted a systematic review and meta-analysis of published literature to investigate proteomic alterations in EVs derived from breast cancer samples. From an initial 1097 records screened, four eligible studies were identified, reporting 628 differentially expressed proteins, of which 38 were consistently observed across multiple datasets. Functional enrichment analyses revealed predominant localization of these proteins to vesicle-associated compartments and significant involvement in biological processes related to cell growth, immune regulation, and tumor progression. Pathway analysis further highlighted integrin-mediated interactions, platelet activation, and hemostasis pathways as key molecular mechanisms represented within breast cancer EVs. Overall, the findings reveal a distinct EV proteomic signature in breast cancer that could support early detection and patient monitoring through minimally invasive testing. Future large-scale and standardized studies are needed to validate these candidate proteins and advance EV proteomics toward clinical application in breast cancer management. Full article

This paper presents a systematic review conducted under the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework, analyzing 286 scientific articles focused on vibration-based predictive maintenance strategies for wind turbines within the context of advanced Prognostics and Health Management (PHM). The review combines international standards (ISO 10816, ISO 13373, and IEC 61400) with recent developments in sensing technologies, including piezoelectric accelerometers, microelectromechanical systems (MEMS), and fiber Bragg grating (FBG) sensors. Classical signal processing techniques, such as the Fast Fourier Transform (FFT) and wavelet-based methods, are identified as key preprocessing tools for feature extraction prior to the application of machine-learning-based diagnostic algorithms. Special emphasis is placed on machine learning and deep learning techniques, including Support Vector Machines (SVM), Random Forest (RF), Convolutional Neural Networks (CNN), Long Short-Term Memory networks (LSTM), and autoencoders, as well as on hybrid digital twin architectures that enable accurate Remaining Useful Life (RUL) estimation and support autonomous decision-making processes. The bibliometric and case study analysis covering the period 2020–2025 reveals a strong shift toward multisource data fusion—integrating vibration, acoustic, temperature, and Supervisory Control and Data Acquisition (SCADA) data—and the adoption of cloud-based platforms for real-time monitoring, particularly in offshore wind farms where physical accessibility is constrained. The results indicate that vibration-based predictive maintenance strategies can reduce operation and maintenance costs by more than 20%, extend component service life by up to threefold, and achieve turbine availability levels between 95% and 98%. These outcomes confirm that vibration-driven PHM frameworks represent a fundamental pillar for the development of smart, sustainable, and resilient next-generation wind energy systems. Full article

Objectives: This study aimed to evaluate adherence to therapy in hypoparathyroidism and related endocrine–metabolic disorders and to assess its association with biochemical outcomes, hypocalcemia episodes, and health-related quality of life (HRQoL). Methods: In accordance with PRISMA 2020 guidelines, PubMed, Scopus, Google Scholar, and the Cochrane Library were searched until September 2025. The eligible studies were randomized controlled trials, cohort, case–control studies, cross-sectional, and observational studies that reported adherence to calcium/vitamin D or recombinant parathyroid hormone therapy. Results: twenty-three studies were included in the qualitative synthesis, and 11 studies were included in the quantitative meta-analysis. Pooled medication adherence compliance was 70–82% and improved with simplified regimens and the use of recombinant PTH. Additionally, this was also associated with an improvement in HRQoL (p < 0.0001) and a lower risk of hypocalcemia (p < 0.0001). Conversely, multifactorial regulation was observed as the level of adherence had no significant effect on serum calcium levels (p = 0.7116). Sensitivity analyses demonstrate the strength of findings and indicate no significant publication bias. Conclusions: Medication adherence is a key factor in determining patient-centered outcomes in hypoparathyroidism. Better adherence is linked to a higher quality of life and fewer episodes of hypocalcemia, while its effect on biochemical parameters seems minimal. Educational programs, simple treatment regimens, and wider access to rhPTH therapy can be used to improve patient management of the disease over time. Full article

The fall armyworm (FAW) Spodoptera frugiperda is a polyphagous pest that causes significant damage to various crops and rapidly develops resistance to insecticides. Broflanilide, a novel meta-diamide insecticide, has shown effectiveness against lepidopteran pests, but the risk of resistance and associated fitness costs in FAW remain unclear. This study evaluated the development of resistance to broflanilide over nine generations of selection using the diet incorporation method at the 70% lethal concentration (LC₇₀) concentration. Following nine generations of selection, the LC₅₀ value increased from 0.134 mg/kg to 0.232 mg/kg, showing a 1.73-fold increase in resistance ratio (RR). The calculated heritability of resistance (h²) was 0.084, which suggested that resistance of FAW against broflanilide is evolving at a slow rate. Based on the projected rate of resistance progression, a 10-fold increase in LC₅₀ would take between 30.1 and 66.4 generations, assuming selection mortality rates of 90% and 50%, respectively. Fitness costs were evaluated using age-stage, two-sex life table analysis, revealing reduced fecundity and pupal weight in the broflanilide-selected (Brof-SEL) strain compared to the wild-type. The relative fitness of the Brof-SEL strain was 0.38, indicating trade-offs in biological traits. These findings suggested a low risk of rapid resistance development against broflanilide. However, effective integrated pest management strategies against FAW require the judicious use of this insecticide in combination with biological control measures, including the deployment of parasitoids and predators, to promote a more environmentally sustainable approach. Full article

Tuberculosis (TB) remains a global public health emergency, with multidrug-resistant TB (MDR-TB) and rifampicin-resistant TB (RR-TB) posing critical challenges. Conventional longer regimens are characterized by suboptimal effectiveness, high toxicity, and poor tolerability. Consequently, there is an urgent demand for more effective, safer, shorter regimens with enhanced tolerability to replace traditional treatments. The present study aimed to systematically assess the effectiveness and safety of bedaquiline-containing modified shorter regimens (adaptations of the WHO-recommended 9–12-month bedaquiline-containing shorter regimen, with ethionamide, ethambutol, isoniazid, and pyrazinamide partially or fully substituted by linezolid, cycloserine/terizidone, and/or delamanid) for MDR/RR-TB. Databases (PubMed, Cochrane Library, Embase, and Web of Science) were searched up to 17 December 2025. Data on treatment success, adverse events, and patient characteristics were extracted. Heterogeneity was assessed using Cochrane Q test and I² statistic. Eleven studies involving 8166 patients were included. The pooled treatment success rate was 78.5% (95% CI: 0.69~0.87, I²: 98.45%; p = 0.00). The incidence of serious adverse events was 10.0%. Bedaquiline-containing modified shorter regimens may offer a potentially viable treatment option for MDR/RR-TB patients, giving an option for patients who are ineligible for standardized regimens. In order to verify these findings, further large-scale trials are required. Full article