Search Results (477)

Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are neurodevelopmental disorders with lifelong functional implications. Their potential role as emerging risk factors for cardiovascular diseases (CVDs) is increasingly acknowledged. The aim of this study was to conduct a comprehensive evaluation and meta-analysis of Mendelian Randomization (MR) studies exploring the causal effects of ADHD and ASD on various cardiovascular outcomes and vice versa. Three databases were searched, study quality was evaluated using a STROBE-MR checklist, and relevant data were extracted. In total, 14 studies revealed genetic associations between ADHD or ASD susceptibility and selected CVDs and vice versa. Notably, genetic markers for ADHD were linked to an increased risk of coronary artery disease, heart failure, and various types of stroke. Genetic predisposition to ASD raised the likelihood of atrial fibrillation and heart failure. Atrial fibrillation showed a causal relationship with elevated ADHD risk. Interestingly, hypertension was not associated with ADHD or ASD at the genetic level. Further efforts are needed to fully elucidate the basis of causal links from a mechanistic perspective. Overall, the results highlight the need for cardiovascular risk assessment and management in the clinical care of individuals with ADHD and ASD. Full article

Given that participating in or spectating sports events plays a vital role in enhancing individuals’ mental health, understanding the key factors that promote continued participation and attendance in sports events is of significant theoretical and practical importance within the context of sports tourism. From this perspective, the service quality of sports events and the image of the host destination have been identified as major determinants of sustained engagement among sports tourists. However, a review of the literature reveals that findings on the influence of sports event service quality and host destination image on the behavioral intentions of sports tourists have been inconsistent. Therefore, the purpose of this study is to employ a meta-analytic structural equation modeling (MASEM) approach to synthesize data from 39 independent studies comprising 16,335 participants, which were collected up to 30 September 2024, thereby providing generalizable conclusions. The results indicate that, first, host destination image is the most critical factor in enhancing visitor satisfaction. Additionally, the service quality of sports events significantly influences visitor satisfaction, which in turn impacts their future behavioral intentions. Second, tourist satisfaction fully mediates the relationship between event service quality and behavioral intentions, and it partially mediates the relationship between host destination image and behavioral intentions. Third, under the moderating effect of event scale (small scale vs. mega scale), host destination image and physical environment quality are more important in small-scale sports events than in mega-scale sports events. Furthermore, under the moderating effect of cultural context (Eastern vs. Western), service quality dimensions are more influential in Western cultural settings, whereas host destination image is more important in Eastern cultural settings. The significance of this study lies in its integration of previously disparate findings into a unified model, offering a more comprehensive understanding of the relationships among the variables. The results provide broad implications for future academic research and practical insights for sports tourism practitioners. Full article

Alzheimer’s disease (AD) and ischemic stroke (IS) are prevalent neurological disorders that frequently co-occur in the same individuals. Recent studies have demonstrated that AD and IS share several common risk factors and pathogenic elements, including an overlapping genomic architecture. However, the relationship between IS risk gene polymorphisms and AD has been less extensively studied. We aimed at determining whether IS risk gene polymorphisms were associated with the risk of AD and the severity of AD in AD patients. We utilized data of AD patients and normal controls (NCs) sourced from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort. IS risk single nucleotide polymorphisms (SNPs) were identified through the most recent and largest IS genome-wide association study (GWAS) meta-analysis. Subsequently, we conducted SNP-based association analysis of IS-risk SNPs with the risk of AD, along with amyloid, tau, and neuroimaging for AD. The generalized multifactor dimensionality reduction (GMDR) model was used to assess the interactions among IS-risk SNPs and apolipoprotein E (ApoE) ε4. Protein–protein interactions (PPIs) of the IS-risk genes product and APOE were explored using the STRING database. Seven IS-risk SNPs were involved in the study. Five SNPs were found to be associated with at least one measurement of cerebrospinal fluid (CSF) levels of amyloid-beta 1–42 (Aβ₄₂), total tau (t-tau), and phosphorylated tau 181 (p-tau₁₈₁), as well as the volumes of the hippocampus, whole brain, entorhinal cortex, and mid-temporal regions. After multiple testing corrections, we found that T allele of rs1487504 contributed to an increased risk of AD in non-ApoE ε4 carriers. The combination of rs1487504 and ApoE ε4 emerged as the optimal two-factor model, and its interaction was significantly related to the risk of AD. Additionally, C allele of rs880315 was significantly associated with elevated levels of CSF Aβ₄₂ in AD patients, and A allele of rs10774625 was significantly related to a reduction in the volume of the entorhinal cortex in AD patients. This study found that IS risk SNPs were associated with both the risk of AD and AD major indicators in the ADNI cohort. These findings elucidated the role of IS in AD from a genetic perspective and provided an innovative approach to predict AD through IS-risk SNPs. Full article

This paper presents a meta-analysis of social research on water, offering a novel methodological contribution to the study of emerging interdisciplinary research fields. We propose and implement a mixed methods framework that integrates quantitative network analysis with qualitative research, aiming to enhance both to give access to new emerging empirical fields and enhance the analytical depth of empirical social research. Drawing on a dataset of publications from the Web of Science over four distinct time intervals, we identify thematic clusters through keyword co-occurrence networks that reveal the evolving structure and internal dynamics of the field. Our findings show a clear trend toward increasing interdisciplinarity, responsiveness to global events, and contemporary challenges such as the emergence of COVID-19 and the continued centrality of topics related to water management and evaluation. By uncovering latent structures, our approach not only maps the field’s development but also lays the foundation for targeted qualitative analysis of articles representative of identified clusters. This methodological design contributes to the broader discourse on mixed methods research in the social sciences by demonstrating how computational tools can enhance the transparency and reliability of qualitative inquiry without sacrificing its interpretive richness. Furthermore, this study opens new avenues for critically reflecting on the epistemic culture of social water research, particularly in relation to its proximity to applied science and governance-oriented perspectives. The proposed method holds potential relevance for both academic researchers and decision makers in the water sector, offering a means to systematically access dispersed knowledge and identify underrepresented subfields. Overall, the study showcases the potential of mixed methods designs for navigating and structuring complex interdisciplinary research landscapes. Full article

Artificial intelligence (AI) is one of the most influential and rapidly developing phenomena of our time. New fields of study are being created at universities, and managers are constantly introducing new AI solutions for business management, marketing, and advertising new products. Unfortunately, AI is also used to promote dangerous political parties and ideologies. The research problem that is the focus of this work is expressed in the following question: How does the symbiotic relationship between artificial and natural intelligence manifest across three dimensions of human experience—philosophical understanding, educational practice, and pastoral care—and what hermeneutical, phenomenological, and critical realist insights can illuminate both the promises and perils of this emerging co-evolution? In order to address this issue, an interdisciplinary research team was established. This team comprised a philosopher, an educator, and a pastoral theologian. This study is grounded in a critical–hermeneutic meta-analysis of the existing literature, ecclesial documents, and empirical investigations on AI. The results of scientific research allow for a broader insight into the impact of AI on humans and on personal relationships in Christian communities. The authors are concerned not only with providing an in-depth understanding of the issue but also with taking into account the ecumenical perspective of religious, social, and cultural education of contemporary Christians. Our analysis reveals that cultivating a healthy symbiosis between artificial and natural intelligence requires specific competencies and ethical frameworks. We therefore conclude with practical recommendations for Christian formation that neither uncritically embrace nor fearfully reject AI, but rather foster wise discernment for navigating this unprecedented co-evolutionary moment in human history. Full article

Teacher mental health is a growing concern in educational and public health systems worldwide. This meta-analysis systematically examines the relationship between teacher self-efficacy—a core construct in social cognitive theory—and job satisfaction, both considered crucial indicators of occupational well-being. A total of 39 studies involving teachers across 18 countries were analyzed, yielding a significant positive correlation between self-efficacy and job satisfaction (r = 0.41, p < 0.001), with notable heterogeneity (I² = 97%). Subgroup analyses revealed that the relationship was significantly stronger among teachers in high school and post-secondary contexts, and in studies conducted in Southern Hemisphere countries, highlighting the role of contextual and systemic moderators such as educational level and geographic inequality. The findings underscore the need for school- and policy-level interventions that bolster teachers’ self-efficacy through professional development, emotional support, and improved working conditions. Such interventions are essential not only for enhancing job satisfaction and reducing attrition but also for promoting the psychological resilience and well-being of the global teaching workforce. The study provides evidence-based insights into education and health policymakers aiming to support teacher retention and mental health through scalable, targeted initiatives. Full article

Objective: The present review aims to compare the oral microbial profile (OMP) of patients undergoing fixed orthodontic therapy (OT) versus clear aligner therapy (CAT) for the treatment of malocclusions. Methods: Clinical studies were included. Case-reports/-series, letters to the editor, reviews, perspectives, and expert opinions were excluded. Indexed databases (MEDLINE/PubMed, Embase, Scopus, and Web of Science) were searched up to the end point of May 2025, without time and language barriers. The study was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias (RoB) and quality of evidence were assessed. Results: Three randomized clinical trials (RCTs) and seven non-RCTs were included. In all RCTs and five non-RCTs, OMP was assessed using subgingival plaque samples. Periodontopathogenic bacteria and Gram-negative anaerobic microbes were more often identified in patients undergoing fixed OT than CAT. The biofilm mass was higher in patients undergoing fixed OT than CAT. In two RCTs, periodontopathogenic bacteria were dominant among patients undergoing fixed OT than CAT. All RCTs and two non-RCTs had a high RoB. The certainty of evidence was “moderate” in 70% of the studies. Conclusions: Due to a high RoB, variability in study designs, and lack of power analysis, direct comparisons remain limited. Full article

Background/Objectives: Cutaneous melanoma is one of the aggressive forms of skin cancer originating from melanocytes. The high incidence of melanoma metastasis continues to rise, partly due to the complex nature of the molecular mechanisms driving its progression. While melanomas generally arise from melanocytes, we investigated whether aberrant keratinocyte differentiation pathways—like cornified envelope formation—discriminate primary melanoma from metastatic melanoma, revealing novel biomarkers in progression. Methods: In the present study, we retrieved four datasets (GSE15605, GSE46517, GSE8401, and GSE7553) associated with primary and metastatic melanoma tissues and identified differentially expressed genes (DEGs). Thereafter, an integrated meta-analysis and functional enrichment analysis of the DEGs were performed to evaluate the molecular mechanisms involved in melanoma metastasis, such as immune cell deconvolution and protein-protein interaction (PPI) network construction. Hub genes were identified based on four topological methods, including ‘Betweenness’, ‘MCC’, ‘Degree’, and ‘Bottleneck’. We validated the findings using the TCGA-SKCM cohort. Drug-gene interactions were evaluated using the DGIdb, whereas structural druggability was assessed using the ProteinPlus and AlphaFold databases. Results: We identified a total of eleven hub genes associated with melanoma progression. These included members of the keratin gene family (e.g., KRT5, KRT6A, KRT6B, etc.). Except for the gene CDH1, all the hub genes were downregulated in metastatic melanoma tissues. From a prognostic perspective, these hub genes were associated with poor prognosis (i.e., unfavorable). Using the Human Protein Atlas (HPA), immunohistochemistry evaluation revealed mostly undetected levels in metastatic melanoma. Additionally, the cornified envelope formation was the most enriched pathway, with a gene ratio of 17/33. The tumor microenvironment (TME) of metastatic melanomas was predominantly enriched in NK cell–associated signatures. Finally, several hub genes demonstrated favorable druggable potential for immunotherapy. Conclusions: Through integrated meta-analysis, this study identifies transcriptional, immunological, and structural pathways to melanoma metastasis and highlights keratin family genes as promising biomarkers for therapeutic targeting. Full article

Humans are inherently social beings, and the quality of their interactions is essential for maintaining physical and mental health. Effective social interaction involves understanding not just people’s visible behavior but also the underlying factors like thoughts and emotions. This review investigates the convergence and divergence of meta-analytic brain activation for mentalizing, empathy, and social interaction engagement. To achieve this, we re-analyzed data from our prior meta-analysis on mentalizing and empathy using the same methodology as an existing meta-analysis on social interaction engagement. The comparison of brain activation maps focused on the question of whether the co-activation of cognitive and affective brain systems is an overarching characteristic of intermediate mentalizing/empathy tasks and social interaction engagement. Our findings support the general assumption that social interaction engagement co-recruits cognitive and affective brain systems also implicated in mentalizing and empathy. However, we found little direct overlap of brain activation for intermediate mentalizing/empathy tasks and social interaction engagement. Finally, applying a network neuroscience perspective, we suggest that social interaction engagement, affective/empathy, and intermediate mentalizing/empathy tasks are collectively characterized by co-recruitment of the default mode network and control networks. Full article

Objectives: An aging population and declining birth rates are among the challenges that smart cities currently face and will continue to face in the near future. In light of the above, this article seeks to answer the following question: Are older people (seniors) taken into account and described in the literature on smart cities, and if so, how? Methods: To answer this research question, a systematic literature review was conducted using the Bibliometrix package in R. In the process of systematizing the publications, the authors additionally used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method and qualitative text analysis. Findings: The research shows that relatively little attention is paid to seniors in smart cities in the literature on the subject. Among the few publications on smart aging, the technological trend dominates, in which researchers present the possibilities of using IT and ICT to improve medical and social care for seniors, and to improve their quality of life (Smart Living, Smart Mobility). In the non-technological trend, most analyses focus on the determinants of quality of life and the distinguishing features of senior-friendly cities. Implications: There is a clear lack of a “human” perspective on aging in smart cities and publications on Smart Governance and Smart People that would provide guidelines for making elderly people full and equal stakeholders in smart cities. It is also necessary to develop practical documents and procedures that define a comprehensive and long-term urban policy for elderly adults. The analyses contribute to diagnosing current and determining further directions of research on smart aging in smart cities. The results clearly imply the need to intensify social, humanistic, and governance research on the role of seniors in smart cities. 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

In bulk liquid or on solid surfaces, nanobubbles (NBs) are gaseous domains at the nanoscale. They stand out due to their extended (meta)stability and great potential for use in practical settings. However, due to the high energy cost of bubble generation, maintenance issues, membrane bio-fouling, and the small actual population of NBs, significant advancements in nanobubble engineering through traditional mechanical generation approaches have been impeded thus far. With the introduction of the electric field approach to NB creation, which is based on electrostrictive NB generation from an incoming population of “electro-fragmented” meso-to micro bubbles (i.e., with bubble size broken down by the applied electric field), when properly engineered with a convective-flow turbulence profile, there have been noticeable improvements in solid-state operation and energy efficiency, even allowing for solar-powered deployment. Here, these innovative methods were applied to a selection of upstream and downstream activities in the oil–water–fuels nexus: advancing core flood tests, oil–water separation, boosting the performance of produced-water treatment, and improving the thermodynamic cycle efficiency and carbon footprint of internal combustion engines. It was found that the application of electric field NBs results in a superior performance in these disparate operations from a variety of perspectives; for instance, ~20 and 7% drops in surface tension for CO₂- and air-NBs, respectively, a ~45% increase in core-flood yield for CO₂-NBs and 55% for oil–water separation efficiency for air-NBs, a rough doubling of magnesium- and calcium-carbonate formation in produced-water treatment via CO₂-NB addition, and air-NBs boosting diesel combustion efficiency by ~16%. This augurs well for NBs being a potent agent for sustainability in the oil and fuels sector (whether up-, mid-, or downstream), not least in terms of energy efficiency and environmental sustainability. Full article

Background and Objectives: Breast cancer remains a significant global health burden, demanding continuous innovation in diagnostic and prognostic tools. This meta-analysis and systematic review aims to synthesize evidence from 2015 to 2025 regarding the diagnostic utility of artificial intelligence (AI) in mammography and the prognostic value of the Systemic Immune-Inflammation Index (SII) in breast cancer patients. Materials and Methods: A systematic literature search was conducted in PubMed, Google Scholar, EMBASE, Web of Science, and Scopus. Studies evaluating AI performance in mammographic breast cancer detection and those assessing the prognostic significance of SII (based on routine hematologic parameters) were included. The risk of bias was assessed using QUADAS-2 and the Newcastle–Ottawa Scale. Meta-analyses were conducted using bivariate and random-effects models, with subgroup analyses by clinical and methodological variables. Results: Twelve studies were included, five assessing AI and seven assessing SII. AI demonstrated high diagnostic accuracy, frequently matching or surpassing that of human radiologists, with AUCs of up to 0.93 and notable reductions in radiologist reading times (17–91%). Particularly in dense breast tissue, AI improved detection rates and workflow efficiency. SII was significantly associated with poorer outcomes, including reduced overall survival (HR ~1.97) and disease-free survival (HR ~2.07). However, variability in optimal cut-off values for SII limits its immediate clinical standardization. Conclusions: AI enhances diagnostic precision and operational efficiency in mammographic screening, while SII offers a cost-effective prognostic biomarker for systemic inflammation in breast cancer. Their integration holds promise for more personalized care. Nevertheless, challenges persist regarding prospective validation, standardization, and equitable access, which must be addressed through future translational research. Full article

Background: Hormone receptor-positive (HR+) breast cancer, which accounts for approximately 70% of all breast cancer cases, is primarily treated with endocrine therapies as monotherapy or in combination with other targeted therapies and traditional cytotoxic therapy. While these therapies have significantly improved survival outcomes, resistance often develops, especially in metastatic disease where treatment options are limited. Immunotherapy, particularly immune checkpoint inhibitors, has emerged as a promising adjunct to traditional therapies in triple negative breast cancer. However, its role in HR+ breast cancer is not well established yet and is under active investigation. In addition, a deeper understanding of the tumor microenvironment (TME) and its role in immune evasion has spurred interest in immune modulators as additional potential therapeutic strategies for HR+ breast cancers. Objective: This review aims to synthesize the current evidence on the role of immunotherapy in HR+ breast cancer, with a focus on its clinical application in both localized and metastatic disease. It also explores the impact of immune modulators within the TME, highlighting their potential to improve the efficacy of immunotherapy in this subtype of breast cancer. Methods: A thorough review of recent clinical trials, preclinical studies, and meta-analyses was conducted. Studies published from 2015 to 2024 were included to provide the most up-to-date perspectives. Key Findings: While immune checkpoint inhibitors like pembrolizumab and atezolizumab have shown promising results in combination with chemotherapy for triple negative breast cancer, their efficacy in HR+ breast cancer has generally been modest. However, recent studies indicate that such therapies may help overcome endocrine resistance in metastatic disease. Furthermore, immune modulators, including cytokines and myeloid-derived suppressor cell inhibitors, are being investigated for their ability to reshape the TME, potentially enhancing the immune response and improving treatment outcomes. Despite these advances, challenges remain in identifying predictive biomarkers and managing immune-related adverse events. Conclusions: Immunotherapy holds potential for improving outcomes in HR+ breast cancer, particularly in metastatic settings where treatment options are limited. The integration of immune modulators to enhance therapeutic efficacy in HR+ breast cancer, along with ongoing research into biomarkers, promises to refine patient selection and improve clinical outcomes. Full article

The dynamic nature of infectious diseases introduces inherent challenges to the design of vaccine clinical trials, which consequently makes vaccine indirect treatment comparisons (ITCs) and meta-analyses (MAs) more challenging compared with regular pharmaceuticals. However, comparisons of efficacy and safety between vaccines are being frequently required in vaccine decision making due to a low number of head-to-head clinical trials in the vaccine landscape. The introduction of the European Union Health Technology Assessment (HTA) Regulation (EU HTAR) aims to harmonize HTA efforts across Europe. However, the EU HTAR could also escalate existing challenges for conducting vaccine MAs and ITCs. Such challenges include generating efficacy evidence in time for Joint Clinical Assessment (JCA), incorporating high levels of heterogeneity due to infectious disease-specific characteristics, and tackling a high number of PICOs per submission—likely driven by heterogeneity in the available data and differences in national vaccine calendars. Opportunities to tackle these challenges include introducing a stepwise approach to vaccine assessment in JCA, best-practice recommendations for conducting/interpreting vaccine MAs and ITCs, and condensing the number of PICOs to create larger ‘catch-all’ ITC networks. This perspective article explores these challenges and opportunities further. Full article