Search Results (1,426)

Youth are increasingly struggling with mental health, yet many lack access to formal care. Evidence indicates that building coping skills can improve mental health and wellbeing. School personnel may be well-positioned to help youth build these coping skills by delivering discrete evidence-based ingredients in their everyday interactions and relationships with students. This scoping review synthesizes the literature on social-emotional evidence-based ingredients delivered by paraprofessionals and explores their potential application in school behavioral health. We searched PsycINFO and PubMed, screened 200 titles/abstracts and 46 full-texts, and yielded 19 studies from which we synthesized data using the RE-AIM framework. We identified 17 evidence-based ingredients, with the most common being mindfulness, relaxation, psychoeducation, exposure, and cognitive restructuring. These were delivered in various formats and settings by different paraprofessionals (e.g., graduate students, teachers, caregivers), with most paraprofessionals receiving some training and supervision. Thirteen studies showed significant improvements in at least one outcome (i.e., anxiety, depression, suicidality, wellbeing). Six studies examined long-term effects, with mixed findings. Despite variation in delivery and training, paraprofessionals appear to feasibly and effectively deliver evidence-based ingredients. These findings support task-shifting ingredients as a scalable approach for supporting youth mental health within school behavioral health systems. Full article

Background/Objectives: Regular physical exercise is strongly recommended for individuals with type 1 diabetes mellitus (T1DM) because of its beneficial effects on cardiovascular fitness, insulin sensitivity, metabolic control, and overall health. Nevertheless, participation in physical activity remains limited, largely due to the fear of exercise-induced hypoglycemia and glycemic instability. Glycemic responses to exercise in T1DM are influenced by the interaction between exercise modality, circulating insulin levels, nutritional status, and diabetes technologies. Continuous aerobic exercise, resistance training, high-intensity interval exercise, and mixed intermittent activities elicit distinct metabolic and hormonal responses, resulting in heterogeneous glycemic trajectories. This narrative review aimed to provide a clinically oriented synthesis of the physiological mechanisms underlying exercise-related glycemic fluctuations in T1DM and to discuss integrated insulin- and carbohydrate-based strategies to support safer participation in physical activity in the context of modern diabetes technologies. Methods: A structured narrative review was conducted using PubMed/MEDLINE, Scopus, and complementary searches in Google Scholar to identify experimental studies, observational studies, systematic reviews, consensus statements, and clinical guidelines focused on exercise-related glycemic responses in individuals with T1DM. Only articles published in English were considered. Evidence was selected and synthesized according to relevance to exercise modality, insulin therapy strategies, carbohydrate management, and diabetes technologies, including continuous glucose monitoring, continuous subcutaneous insulin infusion, and automated insulin delivery systems. The final narrative synthesis was based on 44 selected studies, reviews, consensus statements, and guidance documents considered most relevant to the objectives of this narrative review. Results: Available evidence indicates that continuous moderate-intensity aerobic exercise is most consistently associated with progressive glucose declines and increased risk of hypoglycemia, particularly when performed in the presence of elevated insulin on board. In contrast, resistance exercise and short-duration high-intensity or anaerobic exercise more frequently induce stable glycemia or transient hyperglycemia through adrenergic stimulation and increased hepatic glucose output. Mixed and intermittent exercise modalities often produce more variable responses depending on exercise sequencing, nutritional status, and insulin exposure. Across studies, integrated adjustment of basal and prandial insulin doses together with individualized carbohydrate supplementation emerged as the most effective strategy to reduce exercise-related glycemic instability. Continuous glucose monitoring and insulin pump technologies improved glucose trend awareness and management flexibility; however, physical exercise remains a challenging condition for current automated insulin delivery algorithms and still requires active user-driven decision-making. Conclusions: Exercise management in T1DM should be based on an individualized interpretation of exercise modality, glucose trends, insulin exposure, and nutritional context rather than on fixed glucose thresholds alone. Combining anticipatory insulin adjustments, tailored carbohydrate strategies, and appropriate use of diabetes technologies may substantially reduce glycemic variability and improve confidence toward physical activity participation. Structured education and individualized clinical guidance remain essential to translate physiological knowledge into effective real-world exercise management. Full article

The day-ahead scheduling of multi-stack Power-to-X (PtX) plants must simultaneously cope with stack degradation under variable loading and with compound uncertainty in renewable generation and electricity prices. Existing scheduling frameworks address these two challenges in isolation, since degradation-aware models remain deterministic and stochastic models treat the electrolyser as a constant-efficiency device. This work develops a degradation-aware two-stage stochastic mixed-integer linear programming (MILP) framework that closes this gap. First-stage binaries fix the commitment and startup decisions of every stack, while second-stage scenario-indexed variables capture the dispatch, the hydrogen output, the shortfall, and the load-dependent and start–stop cycling degradation cost monetised at the stack level through a piecewise linear epigraph. Joint wind price uncertainty is represented by a Gaussian copula fitted on empirical CDF marginals and reduced to twenty representative scenarios via k-medoids clustering. The framework is fully implemented in MATLAB R2024a with the Optimization Toolbox, using the built-in intlinprog and linprog solvers. On a 100 MW reference plant with ten heterogeneous PEM stacks, out-of-sample evaluation against four formal benchmarks demonstrates the lowest LCOH at EUR 24/kg, the highest demand reliability at 85.0%, the highest hydrogen delivery at 7.68 t/day, and up to 50% total cost reduction over deterministic baselines, with end-to-end runtime under two minutes on standard workstation hardware. Full article

The accelerated development of Israel’s construction and infrastructure sectors, driven by rapid demographic growth, has led to significant increases in construction waste and surplus soil. Despite formal policy commitments to sustainability and circular economy principles, waste management in Israel remains characterized by fragmented governance, infrastructure gaps, and insufficient enforcement. This study analyzes Israel’s public policy for regulating surplus soil and construction waste through a mixed-methods approach combining policy document analysis and quantitative data from government reports. Findings reveal a persistent gap between policy goals and implementation outcomes, reflected in rising waste volumes, limited treatment capacity, and ongoing illegal dumping. Although recent years show improvement in waste delivery to authorized facilities and recycling rates, treatment infrastructure remains insufficiently distributed, enforcement resources limited, and institutional coordination weak. A national economic assessment demonstrates that full adoption of circular economy practices could yield significant annual savings primarily by reducing reliance on landfilling and decreasing natural resource extraction. Using a multilevel governance, adaptive policy, and circular economy lens, the study identifies systemic barriers and highlights the need for integrated planning, strengthened cross-agency cooperation, digital monitoring, and economic incentives. The findings contribute to the literature on environmental policy and sustainable planning, offering actionable recommendations for enhancing regulatory capacity and transitioning from reactive waste management to a proactive, resource-efficient model aligned with long-term national sustainability goals. Full article

Storage location assignment in automated warehouses strongly affects order-processing efficiency. Existing co-occurrence-based approaches often rely on pointwise mutual information (PMI) statistics or direct frequency co-occurrence. This paper compares two deliberately chosen representation families for storage assignment in automated warehouses operated under Multi-Agent Pickup and Delivery (MAPD) constraints: Pointwise Positive PMI (PPPMI), representing direct pairwise co-occurrence, and Latent Dirichlet Allocation (LDA), representing latent-topic smoothing. The purpose is not to benchmark every possible representation space, but to make the pairwise-versus-latent contrast interpretable under a fixed execution pipeline consisting of task construction, visit-order selection, path planning, and collision avoidance. The broader research setting is motivated by real warehouse order data in which SKU co-occurrence structure is present, but such logs mix latent-topic effects, explicit family-based co-occurrence, noise, and demand variation. We therefore use two controlled abstractions of order structure: one generator with latent-topic mixtures and one generator with more direct family co-occurrence. We embed the proposed LDA representation and the PPPMI baseline in constrained-clustering and simulated-annealing placement methods and evaluate them against frequency-based, load-balancing, and random baselines. Evaluation is conducted in a fixed extended MAPD simulator that explicitly models orientation-aware motion, turning costs, service times, dynamic task release, and collision avoidance. In the latent-topic regime, LDA-based methods tended to form the leading group in average finite-horizon makespan, computed over completed combinations of random seeds and operating conditions. In the supplementary direct-co-occurrence condition, PPPMI was competitive in the plain representation comparison, while LDA-driven local search on top of a frequency-based initial layout remained strong. These results do not imply that LDA is universally superior; rather, they indicate that the relative suitability of PPPMI and LDA depends on the order structure and on how the representation interacts with the placement optimizer. The controlled generators are useful for isolating those effects, but they do not replace external validation on real warehouse logs. Full article

The teaching and assessment of veterinary professionalism are essential components of veterinary degree curricula. The content of veterinary professionalism education programs has been informed by multiple stakeholders including educators, practitioners, and regulatory bodies. Since student perceptions also represent a powerful force in shaping the curriculum, the aim of this study was to explore the perspectives of final-year veterinary students on professionalism teaching and learning within their veterinary program. A mixed-methods study was conducted across three veterinary schools (Massey University–New Zealand; Murdoch University–Australia; University of Nottingham–United Kingdom). An online survey captured final-year veterinary students’ opinions on professionalism teaching and the suitability of their current professionalism curricula. Subsequent focus groups explored perceptions in greater depth. Of 81 survey respondents, 66% perceived professionalism instruction to be essential, 79% agreed that their current professionalism instruction included appropriate content, and 58% perceived the instruction to represent adequate preparation for interaction with clients and professional colleagues. Only 39% of respondents, however, agreed that professionalism teaching was well integrated into the rest of the program. Three themes were identified following thematic analysis of the transcripts from the 11 focus groups conducted: ‘the challenges associated with teaching and assessing professionalism’, ‘the influence of clinical teaching faculty on student professionalism development’, and ‘the importance of adopting effective teaching methods to teach professionalism’. Findings from both studies showed that students placed the greatest value on learning and assessing professionalism within an authentic clinical context, while also appreciating interactive teaching formats and group work. Educators should, therefore, consider integration, authenticity, and interactive delivery as they continue to develop their veterinary professionalism curricula. Full article

Unmanned aerial vehicles (UAVs) are increasingly employed for parcel logistics while simultaneously serving as aerial communication platforms. However, jointly optimizing pickup-and-delivery operations and wireless communication raises a large-scale mixed-integer nonlinear programming problem due to the coupling of binary logistics decisions, trajectory planning, time allocation, user scheduling, and transmit-power control. This paper proposes a two-phase optimization framework that enables a dual-purpose UAV mission by jointly considering parcel pickup-and-delivery and downlink communication within a single framework. The key strength of the proposed approach is that it separates the logistics-dominated delivery stage from the communication-oriented service stage, thereby reducing the difficulty of directly handling the highly coupled MINLP while exploiting the residual mission time for communication enhancement. In Phase 1, a pickup-and-delivery optimization problem is formulated to minimize the delivery completion time by determining the UAV trajectory, time-slot lengths, and item handling sequence, where the binary pickup/drop-off decisions are relaxed and progressively enforced through a penalty convex–concave procedure. In Phase 2, communication performance is enhanced by optimizing user scheduling and transmit power over the entire mission horizon, together with residual flight trajectory refinement after delivery completion using successive convex approximation and block coordinate descent. Simulation results show that the proposed algorithm substantially improves the minimum average spectral efficiency among ground nodes while achieving early completion of logistics tasks. Compared with baseline strategies, the proposed method delivers consistent performance gains under various system parameters. In particular, it improves the minimum average spectral efficiency by up to $15\%$ compared with the baseline that removes the proposed post-delivery trajectory refinement, demonstrating the benefit of exploiting the residual flight trajectory for communication enhancement after delivery completion. Full article

Objective: Sporopollenin exine capsules (SpECs) have been used to encapsulate active pharmaceutical agents for oral drug delivery. This study investigated whether fragrance encapsulated within SpECs prolonged perceived fragrance intensity compared with fragrance oil alone. Methods: A double-blind, placebo-controlled, randomized pilot study was conducted (clinical trial number: NCT07383337); ten healthy female participants (mean age 35.4 ± 5.6 years) received fragrance with SpEC-encapsulated fragrance (SpECs) on one wrist and fragrance alone (control) on the contralateral wrist. The fragrance intensity was assessed using a visual analogue scale (0–10) by both the participants and an independent blinded reviewer at baseline and after 2, 4 and 8 h. Paired Wilcoxon signed-rank tests and linear mixed-effects models were used for analysis. In vitro cytotoxicity was assessed using an ATP viability assay in human bronchial epithelial (BEAS-2B) cells exposed to SpECs or raw Lycopodium clavatum spores. Results: There were no significant differences between the formulations at baseline. From 2 h onward, SpECs was associated with significantly a higher fragrance intensity compared with the control for both participant-rated (p = 0.03 at 2 and 4 h; p = 0.005 at 8 h) and reviewer-rated assessments (p = 0.02 at 2 h; p = 0.01 at 4 h; and p = 0.008 at 8 h). Mixed-model analyses suggested a greater decline in intensity for control at 8 h for reviewer-rated assessments. In vitro, raw spores significantly reduced cell viability (as an indicator of potential allergenicity), whereas SpECs did not differ from control. Conclusions: Fragrance encapsulation within SpECs significantly prolongs measured fragrance intensity with no evidence of cytotoxicity. These findings support the potential of SpECs as a safe and effective sustained-release platform for topical fragrance formulations. Full article

Background/Objectives: Telemedicine-enabled medication dispensing and delivery was formally regulated in Jordan in 2025, but the Jordan Pharmacists Association publicly rejected the pharmacy-related provisions because of concerns about safety, liability, and the pharmacist’s professional role. This study evaluated community pharmacists’ acceptance of the regulated model and identified perceived patient safety risks, implementation barriers, and required safeguards. Methods: A convergent mixed-methods design was used. A cross-sectional online survey was completed by 350 licensed community pharmacists (response rate 83.3%). The questionnaire assessed willingness to participate, perceived patient safety risks, implementation barriers, and facilitators using 5-point Likert scales. Multivariable logistic regression examined predictors of willingness. Semi-structured interviews were conducted with 22 purposively sampled pharmacists until thematic saturation. Quantitative and qualitative findings were integrated using joint displays. Results: Only 28.3% of pharmacists were willing to participate under current conditions, 46.9% were unwilling, and 24.9% expressed conditional acceptance; 52.0% opposed national implementation. Patient safety concerns were great (mean 4.4 ± 0.6/5), especially regarding remote patient assessment (91.4%) and medication errors (88.9%). Implementation barriers were severe (mean 4.5 ± 0.5/5), mainly regulatory ambiguity (92.0%) and unclear liability (89.7%). Facilitators were strongly endorsed (mean 4.7 ± 0.4/5), particularly mandatory pharmacist verification (94.6%) and clear legal protections (93.4%). Qualitative findings reinforced pharmacists’ role as the “final safety checkpoint” and showed acceptance depended on strong safeguards. Conclusions: Jordanian pharmacists showed principled resistance to the current model. Acceptance depends on pharmacist oversight, legal clarity, and infrastructure readiness. Full article

Significance: This study addresses critical industrial and biomedical applications including glass blowing (thermal management of shrinking sheets), polymer sheet extrusion (controlled cooling), magnetic drug delivery (nanoparticle targeting), and nuclear reactor cooling (enhanced heat transfer). Aim: We present a novel nonlinear analysis of magnetohydrodynamic (MHD) boundary layer flow of a Jeffery Al₂O₃ nanofluid over a shrinking permeable plate with convective boundary conditions, uniquely integrating mixed convection, Ohmic dissipation, heat generation, Brownian motion, and thermophoresis within a non-Newtonian nanofluid framework. Methodology: The governing partial differential equations are transformed using similarity transformations and solved via the Adomian decomposition method (ADM). Comprehensive validation against RK4, RK45, and bvp4c demonstrates excellent agreement with maximum relative errors below $5\times {10}^{-4}$. Key Contribution: (i) Normal velocity decreases by 15–25% as the Biot number increases from $Bi=0.4$ to $0.6$; (ii) tangential velocity decreases by 20–30% as the magnetic parameter increases from $M=5$ to 15; (iii) temperature increases by 30–40% as the Eckert number increases from $Ec=0.5$ to $2.5$; (iv) ADM converges within 12–15 terms with $L_2$ errors $<{10}^{-5}$; (v) skin friction coefficient increases from $C_f=3.02713$ to $3.90082$ as $Q_0$ increases from 1 to 4; (vi) Nusselt number values: $Nu/\sqrt{Re}=0.4621$ at $Pr=0.7$, $0.8954$ at $Pr=2$, $3.2890$ at $Pr=20$. These quantitative findings provide design guidelines for engineers in thermal management and biomedical applications. Full article

Background/Objectives: The efficacy of topical therapies in dermatology is often limited by the barrier function of the stratum corneum, which restricts drug penetration. Iontophoresis is a non-invasive transdermal delivery technique that uses a low-intensity electrical current to enhance the transport of charged and polar molecules across the skin. It has emerged as a strategy to improve local drug bioavailability while minimizing systemic exposure. We systematically reviewed the clinical evidence on the efficacy, safety, and pharmacologic performance of iontophoresis-assisted topical drug delivery in dermatologic diseases. Methods: This systematic review followed PRISMA guidelines and was prospectively registered in PROSPERO (CRD420251234877). PubMed, Embase, Web of Science, CENTRAL, and ClinicalTrials.gov were searched through 19 November 2025 without language restrictions. Records were screened against predefined eligibility criteria, and data were extracted on study design, participants, dermatologic indications, intervention/comparator, iontophoresis parameters, efficacy outcomes, and adverse events. The risk of bias was assessed using RoB 2 for randomized trials and the JBI checklist for non-randomized studies. Because of substantial clinical and methodological heterogeneity, the findings were synthesized narratively and no meta-analysis was performed. Results: Twenty-one studies published between 1990 and 2025 met the inclusion criteria, including 15 randomized and 6 non-randomized studies. Investigated conditions included psoriasis, eczema, melasma, post-inflammatory hyperpigmentation, herpes labialis, onychomycosis, chronic ulcers, systemic sclerosis-related digital ulcers, acne scarring, and actinic keratosis. Across studies, findings were mixed. The most consistent signals of benefit were observed in pigmentary disorders and infectious diseases, whereas results were more heterogeneous in inflammatory dermatoses and some studies did not show superiority over active comparators. Tolerability was generally favorable, with adverse events limited to mild, reversible local reactions such as erythema, tingling, burning, or transient irritation. No serious treatment-related adverse events were reported. Conclusions: Iontophoresis may represent a useful non-invasive delivery-enhancement strategy in selected dermatologic settings, particularly when topical efficacy is limited by anatomical or physicochemical barriers. However, heterogeneity in protocols, formulations, outcomes, and clinical indications limits direct comparison and does not support broad conclusions of efficacy across all dermatologic conditions. Larger, standardized trials are needed to clarify its therapeutic role, long-term efficacy, and indication-specific benefit. Full article

Rural logistics faces persistent challenges such as high distribution costs, dispersed demand, and limited transport infrastructure, which hinder efficient last-mile delivery. To address these issues, this study proposes a bus–heterogeneous drone collaborative delivery system that integrates the fixed-route coverage of rural buses with the flexibility of multiple types of drones. The proposed system enables synchronized operations between buses and drones, where buses serve as mobile depots for drone launching and recovery along predefined routes. A mixed-integer programming (MIP) model is developed to jointly optimize bus schedules and drone routing under spatiotemporal synchronization constraints, considering drone endurance, payload capacity, energy consumption, and bus departure times. Due to the NP-hard nature of the problem, an Improved Genetic Algorithm (IGA) is designed, incorporating a three-layer encoding scheme, adaptive crossover and mutation operators, and a local search repair mechanism to enhance convergence and solution feasibility. A real-world case study from Baihe County, Shaanxi Province, China, is conducted to evaluate the performance of the proposed model and algorithm. Comparative experiments under the reported case-study setting show that the proposed bus–heterogeneous drone system achieves notable cost reduction and improved overall delivery performance. Sensitivity analyses further confirm the robustness of the model with respect to drone endurance, drone payload capacity, and bus stop quantity. This research contributes to the literature by bridging the methodological gap between truck–drone coordination and bus-based collaborative delivery, offering an innovative framework for sustainable rural logistics and multi-modal last-mile optimization. Full article

Introduction: Orthobiologics such as Platelet-Rich Plasma (PRP) and Injectable Platelet-Rich Fibrin (i-PRF) have emerged as promising tools in regenerative medicine. However, the lack of methodological standardization and the still limited comparative characterization between these products represent significant barriers to their optimized clinical application. This comparative laboratory study aimed to characterize and differentiate PRP and i-PRF, focusing on their cellular composition, obtained volume, and total Platelet-Derived Growth Factor (PDGF-BB) content. Materials and Methods: This study was conducted with 34 individuals meeting standard blood donation criteria. Peripheral blood samples were collected from all participants. PRP was obtained using a modified double-spin centrifugation protocol, whereas i-PRF was prepared using a modified low-speed centrifugation technique. Cellularity (platelet and leukocyte counts), final produced volume, and total PDGF-BB content were assessed using complete blood count analysis and an enzyme-linked immunosorbent assay (ELISA), respectively. Statistical analysis was performed using Linear Mixed Models (LMMs). Results: Both protocols resulted in significant increases in platelet and leukocyte concentrations compared to baseline values. PRP showed significantly higher platelet and leukocyte concentrations compared with i-PRF, as well as markedly higher PDGF-BB levels. In contrast, i-PRF yielded a substantially greater final volume and enabled a higher absolute delivery of total leukocytes, whereas PRP delivered a greater absolute number of platelets. In exploratory analyses, female sex, the presence of comorbidities, and increased abdominal circumference were associated with variations in product volume and cellular composition. Discussion: These findings indicate that PRP and i-PRF exhibit distinct biological profiles in terms of cellularity, volume, and total PDGF-BB content. Whether these laboratory differences translate into distinct clinical outcomes remains unknown. The results should therefore be viewed as hypothesis-generating: they suggest that PRP and i-PRF may not be interchangeable, and that future randomized clinical trials are needed to define product-specific indications based on the target tissue and desired biological mechanism. Full article

Piezo-driven active vibrating mesh devices are increasingly being used across a variety of applications. These include respiratory drug delivery and inhaled vaccine delivery, as well as multiple industrial processes such as coating, improving the efficiency of chemical reactions through mixing and 3D printing in low gravity. The adoption of this technology shall continue to rise as its reliability, the scalability of manufacturing, and the functionalisation of active vibrating mesh assemblies advance. Early-stage design and development of these complex electromechanical devices can be a costly and time-consuming process. Finite element analysis (FEA) allows us to simulate these devices and analyse their input parameter interactions and design optimisation without the expense of costly prototyping, while also reducing time to market. A review of the state of the art in FEA techniques has identified piezoelectric coupling, modal analysis, harmonic response, fluid–structure interaction, acoustic–structural coupling, and thermal analysis as the recommended simulation tools for dry (no liquid present) and wet (with liquid present) state simulations. Theoretical and empirical validation techniques have given us confidence in these tools for vibrating mesh device design iterations and optimisation. This review summarises the current state of the art for the application of these techniques in the development of active vibrating mesh devices intended for use in respiratory drug delivery. Full article

Background/Objectives: Online adaptive radiotherapy (oART) generates plans at each fraction by exploiting AI-assisted optimization engines without explicit user control over modulation. This process challenges quality assurance since measurement-based Patient Specific Quality Assurance (PSQA) cannot be performed daily. This study aimed: (i) to characterize plan complexity in IOE-generated plans for prostate cancer using a reproducible set of PCMs, including the decomposition of inter-patient and intra-patient variability sources; (ii) to evaluate the association between PCMs and delivery accuracy within a cohort-informed SPC framework validated through leave-one-patient-out cross-validation; (iii) to investigate whether inter-fraction anatomical variations explain the observed plan complexity patterns, or whether complexity is predominantly an intrinsic signature of the AI-assisted optimizer. Methods: Twenty-one prostate cancer patients treated on a CBCT-based oART platform were retrospectively analyzed across three anatomical targets: prostatic bed (PrB), prostate (Pr), and prostate with seminal vesicles (PrSV). Six PCMs, namely MU/cGy, Modulation Complexity Score (MCS), Aperture Area Variability (AAV), Leaf Sequence Variability (LSV), Average Leaf Gap (ALG) and Plan Irregularity, were extracted. Additionally, five anatomical metrics (AMs) were computed from daily contours. Linear mixed-effects models (LMEMs) compared reference/online plans, decomposed variance via intraclass correlation coefficients (ICCs), and assessed PCM–gamma passing rate (GPR) associations. Leave-one-patient-out cross-validation (LOPO-CV) evaluated SPC threshold stability. The relationships between PCMs and AMs were investigated using LMEMs. Results: The AI-assisted optimization engine generated plans characterized by elevated monitor unit demand (average MU/cGy ≥ 6.8 ± 0.9) and narrow MLC apertures (ALG ≤ 17.7 mm ± 1.9 mm). No complexity differences emerged between offline and online-adapted plans, nor between anatomical targets. All PCMs showed significant associations with global GPR (p ≤ 0.027), though marginal R² remained low (≤0.122). Notably, GPR dispersion increased systematically at higher complexity values, indicating that highly modulated plans exhibit reduced delivery predictability. LOPO-CV demonstrated stable tolerance/action limits. Anatomical variations explained less than 35% of the total variance in PCMs. Conclusions: Plan complexity in oART reflects the optimization paradigm and patient-specific anatomy rather than daily adaptation. PCMs can serve as surveillance indicators flagging high-risk fractions to support SPC-based monitoring. Full article