Search Results (323)

Traditional olive groves are widely recognised as providers of landscape, environmental and cultural public goods in Mediterranean rural areas, but their long-term economic viability remains uncertain. This study assesses the income gap between traditional, intensive and super-high-density (SHD) olive-growing systems in a representative hill olive-growing area in Tuscany (central Italy), characterised by physical and structural conditions typical of traditional Mediterranean systems. Using a discounted cash-flow framework, the analysis compares long-term financial performance through standard investment appraisal indicators and uses the Equivalent Annual Value (EAV) as a policy-relevant benchmark for calibrating support. The results reveal a clear structural divergence: while intensive and SHD systems achieve higher profitability and faster capital recovery, the traditional system exhibits a persistent income disadvantage under market conditions. The estimated EAV gap amounts to approximately 950 €/ha relative to the intensive system and 3104 €/ha relative to the SHD system—values that represent the additional annual support required to preserve traditional olive groves and prevent abandonment. These values can also be interpreted as the annual private opportunity cost of maintaining traditional olive landscapes rather than converting them to more financially competitive systems. Break-even analysis further shows that the traditional system requires an oil price of at least 9.6 €/kg to achieve economic viability without public support, compared to 6.97 €/kg and 4.13 €/kg for the intensive and SHD systems, respectively. The findings highlight a structural misalignment between private profitability and social value, suggesting that the conservation of traditional olive landscapes cannot rely on market mechanisms alone and requires targeted, evidence-based policy instruments. Full article

This systematic review investigates the application of computer-vision technologies for automated monitoring of personal protective equipment compliance in industrial environments. This review followed the PRISMA 2020 guidelines and covered studies published between 2010 and 24 February 2026. It provides a structured synthesis of advances in deep learning-based object detection models, with particular emphasis on different YOLO variants, two-stage detectors such as Faster R-CNN, and emerging transformer-based and vision–language models. Model effectiveness, reported performance metrics, and dataset characteristics are comparatively examined, including their performance under practical operating conditions. Special attention is given to performance variability in real-world scenarios affected by illumination changes, occlusion, viewing angle variation, worker movement, computational constraints, and large-scale deployment requirements. The review also appraises the reporting quality and risk of bias of the included studies and identifies current research trends, methodological limitations, and the gap between laboratory validation and industrial implementation. It also outlines future directions for improving the reliability, cost-effectiveness, and practical application of computer vision-based personal protective equipment compliance systems. Full article

Background/Objectives: Effective clinical leadership is a critical driver of healthcare quality, patient safety, and organisational performance. However, evidence on the leadership competencies of healthcare professionals in formal management roles remains fragmented. It is dispersed across professional groups, healthcare contexts, and conceptual frameworks, limiting opportunities for synthesis and cumulative knowledge development. This systematic review examined three questions: how clinical managers perceive their leadership competency; what challenges they encounter in exercising leadership roles; and what development mechanisms the literature identifies. Methods: A systematic review was conducted following PRISMA 2020 guidelines and registered in PROSPERO (CRD420261305279). Four databases were searched: Ovid MEDLINE, CINAHL, EMCARE, and Web of Science from January 2010 to February 2026. Two reviewers independently screened studies; methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Reported competencies were mapped to the five domains of the Clinical Leadership Competency Framework (CLCF) using narrative integrative synthesis. Results: Forty-nine studies were included across quantitative, qualitative, and mixed-methods designs from 24 countries. Competencies in the Working with Others and Demonstrating Personal Qualities domains were reported as strengths across the largest number of included studies. Competencies in Managing Services, Improving Services, and Setting Direction were reported as areas of weakness or developmental need across multiple studies. Leadership challenges included inadequate preparation, role ambiguity, limited authority, and organisational constraints. Development needs spanned formal training, strategic competency building, mentoring, and sustained organisational support. Conclusions: Clinical leadership competency is unevenly distributed across CLCF domains. This pattern reflects not only individual developmental gaps but also the organisational and contextual conditions that shape how leadership is enacted in practice. The findings support a contextual-relational model of clinical leadership. Both individual capability and enabling organisational conditions must be addressed to strengthen leadership effectiveness across healthcare systems. Full article

Background: Intracranial pressure (ICP) monitoring remains the cornerstone of neurocritical care in severe traumatic brain injury (TBI), yet its prognostic value as a standalone metric is limited. The Pressure Reactivity Index (PRx), a continuous measure of cerebrovascular reactivity derived from ICP and arterial blood pressure, may offer additional or complementary prognostic information. This systematic review aimed to compare the prognostic performance of PRx-derived metrics versus standard ICP monitoring for mortality and functional outcome in patients with TBI. Methods: A systematic search of PubMed, Web of Science, and Scopus was conducted for studies published between January 2000 and December 2025. Studies were eligible if they included adult TBI patients with continuous multimodal monitoring and reported comparative prognostic data for PRx- and ICP-based metrics. Risk of bias within the studies was appraised via the QUIPS tool, and the GRADE system was used to rate the strength of the evidence. Due to methodological heterogeneity, findings were synthesized narratively. Results: Nine studies were included. Applying a maximum-cohort estimation to account for overlapping registries, the pooled sample comprised a minimum of 1240 unique patients. In the majority of included studies, direct within-cohort head-to-head comparisons demonstrated that specific PRx-derived metrics—such as the individualized ICP threshold (iICP), Longest Continuous Duration of Autoregulatory Impairment (LCAI), Lower Limit of Reactivity (LLR), and time-integrated burdens (%Time > Threshold)—yielded stronger prognostic discrimination compared to standard ICP thresholds for both mortality (PRx: AUC 0.747–0.648 and ICP: AUC 0.660–0.614) and functional outcome. When added to established predictive models, PRx-derived metrics provided clinically meaningful incremental improvements in prognostic accuracy, with descriptive incremental AUC gains ranging from +0.039 to +0.170 across the six studies reporting model augmentation. Due to heterogeneity in baseline models, PRx-derived metrics, and patient populations, these findings are presented strictly as a descriptive range. Conclusions: PRx and PRx-derived cerebrovascular reactivity metrics-namely iICP, LCAI, LLR, and time-integrated burdens of autoregulatory failure—show potential to offer additive prognostic value beyond standard ICP monitoring in severe TBI. However, because current evidence is strictly observational and likely influenced by institutional confounders, it cannot currently support definitive clinical recommendations. Further prospective, multicenter studies utilizing standardized thresholds are necessary to confirm these associative findings and isolate their true prognostic value. Full article

Background: Endometriosis is a chronic estrogen-dependent inflammatory disease estimated to affect up to 190 million women of reproductive age worldwide based on clinical and population-based estimates, although only 22.3 million prevalent cases were formally documented—a gap that itself reflects substantial under-diagnosis. Despite an exponential increase in systematic reviews (SRs) and meta-analyses (MAs), the evidence base remains fragmented across clinical domains. An umbrella review provides the methodologically highest level of evidence synthesis and allows critical appraisal and hierarchical classification of published SRs and MAs. Objective: The aim of this study was to conduct a comprehensive critical synthesis of published SRs and MAs on the epidemiology, pathogenesis, diagnosis, treatment, and long-term consequences of endometriosis and to assess their methodological quality using AMSTAR-2. Methods: Systematic searches were conducted in PubMed, Embase, Cochrane Library, and Scopus (2016–2026). Eligibility: SRs with or without MA covering any clinical aspect of endometriosis in women were considered eligible. Quality was assessed using AMSTAR-2. Association strength was classified as convincing (Class I), highly suggestive (Class II), suggestive (Class III), weak (Class IV), or non-significant (NS). Results: Fifty-two SRs and MAs were included (total sample > 6,000,000 participants). AMSTAR-2 quality: high 25% (n = 13), moderate 40% (n = 21), low 29% (n = 15), critically low 6% (n = 3). Class I evidence: short menstrual cycle (<27 days) associated with endometriosis risk (OR 1.68; 95% CI 1.48–1.89). Class II: post-operative dienogest reduces recurrence by 70% (OR 0.30; 95% CI 0.18–0.53); the risks of anxiety (RR 2.82; 95% CI 1.69–4.68) and depression (RR 2.78; 95% CI 1.63–5.25) are markedly elevated. Diagnostic delay persists at 4–12 years globally. Multi-biomarker platforms and AI-assisted imaging (e.g., PromarkerEndo and IMAGENDO) have shown promising preliminary diagnostic performance (reported AUCs of 0.997 and 0.906, respectively) in initial validation studies, although external validation in larger and more diverse cohorts is required before clinical implementation can be recommended. Conclusions: Endometriosis is a systemic, chronically under-diagnosed disease requiring a multidisciplinary approach. The available evidence supports dienogest as one of the preferred options for post-operative maintenance therapy, identifies multi-biomarker platforms as a promising—though not yet clinically validated—avenue for non-invasive diagnosis, and underscores the importance of incorporating psychological assessment into multidisciplinary management. Full article

Background: Vasomotor symptoms (VMS), particularly hot flashes and night sweats, are highly prevalent during the menopausal transition and have been increasingly associated with adverse cardiometabolic profiles. Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a major manifestation of systemic metabolic dysregulation and is rising globally. Emerging evidence suggests a potential overlap between menopausal symptom severity and MASLD risk; however, this relationship remains insufficiently characterized. Method: A scoping review was conducted in accordance with PRISMA-ScR guidelines to map the existing evidence on the association between VMS and MASLD. A comprehensive search of PubMed, Scopus, CINAHL, Cochrane Library, and MEDLINE was performed for English-language studies published between January 2015 and December 2025. Eligible studies included original research assessing both MASLD and menopausal symptoms. Data were extracted and synthesized narratively. Methodological quality was appraised using the CASP Cross-Sectional Studies Checklist. Results: Of 690 identified records, five cross-sectional studies met the inclusion criteria, comprising 106 to 5995 participants from Korea, Greece, and the United States. Across studies, moderate-to-severe VMS were consistently associated with increased MASLD prevalence or higher surrogate indices of hepatic steatosis. Women with more severe VMS demonstrated unfavorable metabolic profiles, including greater insulin resistance and elevated liver enzyme levels. Although adjustments for body mass index and hypertension attenuated some associations, the overall trend remained positive. Heterogeneity was observed in diagnostic tools and symptom assessment methods. Conclusions: Current evidence indicates a consistent association between VMS severity and MASLD in peri- and postmenopausal women. While causality cannot be inferred due to cross-sectional designs, VMS may represent a clinical marker of underlying metabolic and hepatic dysfunction. Longitudinal and mechanistic studies are warranted to clarify directionality and inform integrated screening strategies in midlife women. Full article

Artificial intelligence (AI) is increasingly embedded in development systems, enabling new capabilities for poverty prediction, social protection targeting and service delivery optimisation. However, the implications of these technologies for poverty governance—the institutional mechanisms for designing and delivering poverty reduction strategies—remain fragmented in the literature. This study conducted a PRISMA 2020-guided systematic review of peer-reviewed journal articles and scholarly book chapters published between 2015 and 2025 and retrieved from Scopus, Web of Science and DOAJ. Following title/abstract screening, full-text eligibility assessment and quality appraisal, 48 studies were selected, thematically identifying cross-cutting patterns related to system performance, implementation processes, governance considerations and contextual constraints. The reviewed literature indicates that AI can improve poverty governance through multimodal data integration, enhanced targeting accuracy and automated administrative processes. However, persistent challenges include biased datasets, infrastructural limitations, regulatory gaps and ethical risks such as algorithmic bias and digital exclusion, which may reinforce structural inequalities. The review contributes an integrated evidence base and introduces a conceptual framework for understanding AI in poverty governance, highlighting that developmental gains depend on robust data governance, inclusive digital infrastructure, context-sensitive design, algorithmic transparency and institutional capacity. Future research should prioritise impact evaluation, fairness-aware AI, participatory design and scalable approaches for low-resource environments. Full article

Cardiopulmonary exercise testing (CPET) is the reference method for the objective assessment of exercise capacity because it provides an integrated appraisal of cardiovascular, respiratory and metabolic responses to exertion. However, CPET alone quantifies the magnitude of functional impairment without fully resolving the central and peripheral mechanisms that determine exercise intolerance. The integration of CPET with exercise stress echocardiography and near-infrared spectroscopy (NIRS) has therefore emerged as a clinically relevant multimodal strategy. Stress echocardiography provides real-time information on ventricular reserve, filling pressures, pulmonary pressure response, valvular function, pulmonary congestion and dynamic outflow obstruction, whereas NIRS provides continuous insight into skeletal muscle oxygen delivery, extraction and utilization. This narrative review summarizes the physiological rationale, practical workflow, methodological limitations and clinical applications of combined CPET, stress echocardiography and NIRS across heart failure, pulmonary hypertension, peripheral artery disease, cardiomyopathies and sports cardiology. By linking systemic gas exchange, central hemodynamics and peripheral oxygen handling, this approach may move exercise evaluation from a descriptive measure of performance toward a mechanism-based framework for phenotyping, risk stratification and individualized therapeutic decision-making. Further studies are needed to harmonize protocols, validate reproducible multimodal indices and demonstrate incremental prognostic value over conventional testing. Full article

Background/Objectives: Natural disasters and climate-related emergencies increasingly disrupt maternal healthcare systems, placing growing demands on the midwifery workforce. While midwives play a critical role in maintaining continuity of care, evidence on how workforce preparedness influences service delivery remains limited. This systematic review aimed to synthesize evidence on determinants of midwives’ disaster preparedness and examine their association with continuity of maternal care. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Searches were performed in PubMed, Embase, CINAHL, Scopus, and Web of Science from inception to March 2026. Eligible studies examined midwives or midwifery-led care in natural disasters or climate-related emergencies. Data were extracted independently by two reviewers, and methodological quality appraised using the Mixed Methods Appraisal Tool (MMAT). Due to substantial methodological and clinical heterogeneity across study designs, populations, and outcomes, a meta-analysis was not feasible and findings were synthesized narratively. Results: Nine studies met the inclusion criteria, with the evidence base consisting predominantly of qualitative and cross-sectional studies, alongside one cohort study. Evidence was mainly derived from earthquake-affected settings. Preparedness was influenced by individual, professional, organizational, and psychosocial factors. Insufficient disaster-specific training, role ambiguity, and limited institutional preparedness were linked to reduced response capacity and disruptions across antenatal, intrapartum, and postnatal care. Conclusions: The evidence suggests that midwifery workforce preparedness is an important determinant of continuity of maternal care during disasters and climate-related emergencies. Strengthening disaster education, integrating midwives into emergency planning, and enhancing organizational support are essential to improve health system resilience. Further longitudinal and intervention-based research across diverse disaster contexts is needed to strengthen the evidence base. However, the findings should be interpreted cautiously due to the limited number and heterogeneity of included studies. Full article

Radon (222Rn) is a naturally occurring radioactive gas. It is colourless, odourless, and tasteless, produced through the spontaneous decay of uranium in soil and rocks. Among school-aged children, exposure to radon is a major public health concern because, during school hours, learners spend an average of 6–8 h daily inside school buildings, often on the ground floor or in basement classrooms, where radon levels tend to be highest. This study aims to contextualize radon exposure among children in educational settings, with a focus on the associated risk factors. A systematic review of the literature on radon exposure in classrooms among schoolchildren was conducted, analysing associated risk factors and methods of radon measurement. A literature search was performed across reputable databases to ensure compliance with systematic review standards. The quality of the evidence was appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. A total of 32 studies met the inclusion criteria and were analyzed. Radon levels measured in classrooms exhibit variability based on geographic location. Certain classrooms in Continental Europe and North America exceed the WHO reference limit of 100 Bq/m³, as well as regional thresholds, including the European Union limit of 300 Bq/m³ and the United States Environmental Protection Agency (EPA) limit of 148 Bq/m³. Indoor radon exposure in classrooms is a worldwide concern because children are particularly vulnerable during their formative years. Those attending daycare centers and kindergartens are at greater risk due to their nascent respiratory systems. Full article

Sustainability targets in contemporary construction projects are increasingly defined through embodied carbon limits, circular material obligations, waste diversion benchmarks, and energy performance requirements. However, a persistent gap remains between the establishment of these commitments during policy and design stages and their effective verification throughout project delivery and post-handover operation. Although Building Information Modelling (BIM), digital twins, and associated digital monitoring systems are widely discussed in sustainable construction research, their collective role in enabling continuous sustainability compliance assurance within construction management remains insufficiently synthesised. This study addresses this gap through a PRISMA-guided systematic review and structured comparative thematic synthesis of 117 peer-reviewed studies published between 2016 and 2026. A structured analytical coding matrix, MMAT-informed methodological quality appraisal, and descriptive evidence mapping were used to evaluate dominant digital technologies, sustainability compliance domains, lifecycle verification gaps, and study validation approaches. The findings indicate that current research remains concentrated around BIM-enabled design modelling and isolated operational analytics, with comparatively limited attention to integrated multi-stage sustainability verification during procurement, construction, commissioning, and operation. Four recurring sustainability compliance domains requiring stronger construction management control are identified, including embodied carbon verification, material reuse traceability, waste diversion monitoring, and energy performance validation. In response, the study proposes a Digital Sustainability Compliance Framework that conceptually integrates sustainability targets, PMBOK-aligned project control functions, BIM information models, digital twins, sensor systems, and centralised construction data platforms within a continuous lifecycle verification architecture. The study repositions digital technologies as governance-oriented infrastructures for more transparent, auditable, and continuously monitored sustainability compliance assurance while highlighting the need for future empirical validation. Full article

Background: Locally advanced rectal cancer (LARC) management has evolved, but surgery (total mesorectal excision, TME) remains the curative cornerstone. Total neoadjuvant therapy (TNT) and organ preservation (OP) have emerged as response-adaptive strategies. We conducted a state-of-the-art systematic review to critically appraise TNT efficacy, trade-offs, OP feasibility, and emerging biomarkers. Methods: Following PRISMA 2020 guidelines, we searched PubMed, MEDLINE, Scopus, and EMBASE (1990–March 2026) plus ASCO/ESMO abstracts (2020–2026). We included phase II/III randomised controlled trials and major prospective studies evaluating neoadjuvant strategies in non-metastatic LARC. Risk of bias was assessed using RoB 2. Given heterogeneity, a narrative synthesis was performed (PROSPERO: CRD420251252675). Results: From 2847 records, 45 publications (30 trials) were included. For high-risk LARC (cT4, cN2, EMVI+, MRF+, tumour deposits), TNT improves disease-free survival and reduces distant metastases versus standard chemoradiotherapy (RAPIDO, PRODIGE 23, STELLAR, TNTCRT). However, TNT increases locoregional recurrence risk with short-course radiotherapy (RAPIDO: 10% vs. 6%; Polish II: no sustained overall survival benefit). Organ preservation is achievable in expert centres (OPRA: 54% 5-year TME-free survival; OPERA; CAO/ARO/AIO-16), but surgery remains the durable standard for most patients. De-escalation (PROSPECT, CONVERT, FOWARC, OCUM) avoids radiotherapy in low-risk (mrMRF−) patients without compromising local control. Lateral pelvic lymph node involvement (LPLN+) remains a negative prognostic factor even after TNT. Immunotherapy added to TNT (UNION, STELLAR II, SPRING-01, PRECAM) increases pCR rates (40–60%) but remains investigational. ctDNA-guided adaptation (CINTS-R) is feasible but requires mature data. Conclusions: Surgery (TME) is the definitive curative treatment for LARC. TNT is a preferred intensification strategy for high-risk patients, but trade-offs between systemic and local control must be individualised. Organ preservation is safe only for selected patients in expert centres. Immunotherapy-TNT combinations and ctDNA guidance are promising but not yet standard. This review provides an evidence-based roadmap for integrating these advances without losing sight of surgery’s central role. Full article

Phytoestrogens are plant-derived phenolic compounds that structurally resemble endogenous estrogens and can exert both estrogenic and anti-estrogenic effects in animals. In ruminant nutrition, the main classes of phytoestrogens (isoflavones, lignans, stilbenes, coumestans and selected flavonoids) are supplied predominantly by legume forages and soybean-based feeds, in which concentrations can reach several mg/g of dry matter. After ingestion, these compounds are extensively metabolized by the rumen microbiota to derivatives with altered biological potency, such as equol and p-ethyl-phenol, which influence endocrine, immune and metabolic pathways. Experimental and field studies in cattle, sheep and goats indicate that dietary phytoestrogens may improve nitrogen utilization, immune competence, growth performance, antioxidant status and milk yield. However, they can also impair fertility, modify hormone profiles and compromise embryo survival in a compound-, dose-, and species-dependent manner. In this review, we summarize current knowledge on the botanical and nutritional sources, ruminal metabolism and transfer of phytoestrogens in ruminants, and critically examine their effects on blood metabolites, immune responses, growth and carcass traits and lactational performance and reproductive function. A structured literature search based on PRISMA principles was used to identify and appraise experimental and observational studies in both grazing and intensive production systems up to 2025. Remaining knowledge gaps and practical implications for the safe use of phytoestrogen-rich feeds in livestock production are highlighted. Full article

Depression is a critical global public health challenge, and the demand for accurate automated detection methods has generated considerable research interest in Transformer-based models. Despite their substantial promise, a comprehensive investigation into their architectural efficacy, intrinsic mechanisms, and barriers to practical implementation remains lacking. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, this systematic review was conducted across six databases (IEEE Xplore, Elsevier, Springer, MDPI, PubMed, and arXiv). The final search was performed in October 2025, covering English-language empirical studies published between 2020 and 2025 that employed Transformer-based architectures for depression detection. Risk of bias and methodological quality were independently appraised by two authors using a six-dimension structured rubric, with disagreements resolved by a third author. Findings were narratively synthesized given substantial cross-study heterogeneity. This systematic review analyzed 46 studies and provided the first comprehensive, mechanism-level, architecturally stratified comparison of encoder-only, decoder-only, hybrid, and multimodal fusion paradigms, examining self-attention dynamics and transfer learning strategies. Since 2019, these frameworks have evolved from text-centric approaches to advanced multimodal systems. Encoder-only models show consistently strong results in high-throughput text-based screening, decoder-only models demonstrate stronger few-shot learning capabilities, hybrid architectures show the highest observed median performance in clinical interview settings across the reviewed studies, and multimodal fusion systems offer complementary advantages when heterogeneous signal integration is critical. These trends are task-contextualized and should not be interpreted as unconditional rankings, given heterogeneity in evaluation metrics and tasks across studies. Nonetheless, four principal challenges hinder clinical translation: overreliance on self-reported data, cross-linguistic bias, absence of uncertainty quantification, and substantial computational overhead. Future efforts should shift from incremental benchmark improvements toward clinical utility through standardized psychiatric validation, uncertainty-aware architectures, fairness-enforced training across diverse populations, and the integration of Transformer-based models with wearable and mobile health data to improve detection stability and reduce translational risk. This systematic review was registered on the Open Science Framework (OSF; DOI: 10.17605/OSF.IO/SYF9N). This research was funded by the Faculty of Information Science and Technology and by Universiti Kebangsaan Malaysia under Grant TAP-K014364. Full article

Coronary artery bypass grafting (CABG) using the autologous saphenous vein (SV) remains widely performed for obstructive atherosclerosis; however, vein graft disease drives recurrent ischaemia through early thrombosis and progressive intimal hyperplasia, and accelerated atherosclerosis developing within the grafts. Extracellular vesicles (EVs) are membrane-bound particles that transfer proteins, lipids, and microRNAs between cells. They modulate endothelial dysfunction, vascular smooth muscle cell phenotypic switching, inflammation, and coagulation, which are core processes in vein graft remodelling. Arterialisation exposes the vein to abrupt rises in shear stress, cyclic stretch, and intraluminal pressure. These forces increase EV release and reshape EV cargo in experimental systems, suggesting a potential mechanism for amplifying early graft injury which warrants direct investigation in vein tissue. This review synthesises current evidence for cell-specific EV contributions from ECs, vascular smooth muscle cells, platelets, and macrophages, and appraises EV-associated microRNAs with biomarker potential relevant to graft failure pathways. We also review therapeutic strategies that may modulate EV signalling including antiplatelet therapy, statins, KCa3.1 inhibition, and pro-reparative mesenchymal stromal cell-derived EVs. No published clinical studies evaluate EV-based biomarkers specifically for saphenous vein graft patency, and none prospectively predict saphenous graft failure. CABG provides a well-defined time zero event that enables longitudinal sampling and risk stratification. Prospective studies linking EV phenotypes and miRNA signatures to imaging-defined graft outcomes are needed to support clinical translation. Full article