Search Results (323,644)

Background: Infertility is increasingly recognized as a significant global public health concern. A thorough understanding of the diverse causes of infertility and their influence on treatment outcomes is essential for optimizing therapeutic strategies and improving success rates. Methods: In this study, we analyzed data from 9132 couples who underwent IVF treatment at a fertility center in Istanbul, Turkey, between 2010 and 2020. Results: Female factor infertility was the most prevalent among all participants (35.4%), followed by male infertility (26.4%), combined infertility (22.3%), and unexplained infertility (15.8%). Diminished ovarian reserve was found to be the most common indication in the female and combined infertility groups. Embryo transfer (ET) was performed in 7485 cases. Within this cohort, the antral follicle count was higher in the combined and unexplained infertility groups compared with the female and male infertility groups. The highest number of MII oocytes was found in the unexplained infertility group. Pregnancy rates varied significantly across groups, being higher in the male infertility and unexplained infertility groups than in the female infertility and combined infertility groups. Live birth rates also varied significantly across groups. The highest rate was observed in the unexplained infertility group. Conclusions: The distribution of infertility etiologies and their association with ICSI outcomes underscore the necessity to enhance the efficacy of ART protocols and to adopt evidence-based approaches to treatment strategies. Female factor infertility remains a significant clinical challenge, whereas unexplained infertility presents relatively favorable outcomes. Full article

The article establishes a measurement and modeling framework to quantify carbon sequestration in pocket forests as part of a multi-year research program. Pocket forests are multi-layered native planting initiatives inspired by the Miyawaki method of afforestation, adapted for small-scale regenerative applications in urban and peri-urban contexts. In this study, a pocket forest is treated as a repeatable 10 m² unit that can be distributed across small parcels and scaled through a network. The project examines how species composition and diversity affect above- and below-ground carbon storage under controlled field conditions. Twenty-one experimental plots were established with consistent soil preparation, planting density, plot geometry, and environmental exposure, while species diversity was varied from full capacity to reduced mixes and low-diversity reference conditions. The setup allows comparison of carbon-related performance across diversity levels and supports the development of a modeling framework linking proxy indicators and carbon sequestration potential. The initial phase focuses on system architecture, design criteria, baseline characterization, indicator selection, measurement integrity, sampling regime, and key parameter definition. Future phases will report temporal data and modeled outcomes to guide adaptive engineering of carbon-positive, self-sustaining landscapes. Full article

Introduction: Esophagogastric junction outflow obstruction (EGJOO) is a heterogeneous manometric pattern requiring symptoms and supportive evidence to establish clinical relevance. Timed barium esophagography (TBE) provides functional radiologic assessment of esophageal emptying through timed imaging, quantitative barium column measurements, and morphologic evaluation. Methods: This single-center retrospective study included 42 patients referred for TBE for suspected EGJOO between June 2024 and December 2025. TBE was performed upright after ingestion of low-density barium suspension. Positivity required a continuous residual esophageal barium column with craniocaudal height ≥ 2 mm at 1′ after bolus ingestion. Minimal mucosal coating, non-columnar traces, and contrast confined to a hiatal hernia were recorded qualitatively but not considered positive. Quantitative measurements, clearance patterns, morphology, interobserver reliability, and exploratory concordance with Chicago Classification v4.0-adjudicated categories were assessed. Results: TBE was positive in 12/42 patients (28.6%). Mean age was 58.0 ± 13.9 years; 26/42 patients were female. In positive studies, mean column height and width were 122.9 ± 65.4 mm and 31.1 ± 17.8 mm at 1 min, and 89.0 ± 54.6 mm and 28.2 ± 18.2 mm at 2 min. Persistent 5 min retention occurred in two patients. Interobserver reliability was excellent (ICC 0.90). Morphologic abnormalities were frequent in positive examinations, supporting overall radiologic phenotype-based interpretation. In the EGJOO-focused subset, exploratory concordance metrics were 41.7%, 100%, 100%, and 46.2% for sensitivity-like, specificity-like, positive predictive, and negative predictive concordance, respectively. Conclusions: In this small exploratory cohort, standardized TBE provided functional and morphologic information on esophageal bolus transit. Positive TBE findings showed exploratory concordance with clinically relevant EGJOO, whereas a negative study did not exclude it. These findings require validation in larger prospective cohorts. Full article

To promote the high-value utilization of construction and industrial solid wastes, this study prepared an all-solid-waste-based flowable solidified soil (FSS) using soft clay and recycled fine aggregate (RFA) as the main constituents. The binder system comprised ground-granulated blast-furnace slag (GGBS), carbide slag (CS), and desulfurization gypsum (DG), while fly ash (FA) was incorporated to improve workability. The primary objective was to identify an appropriate RFA content for this FSS system through a combined evaluation of workability, mechanical performance, durability, and microstructural characteristics. The results showed that increasing the RFA content increased flowability and shortened the setting time. Unconfined compressive strength (UCS) and ultrasonic pulse velocity (UPV) both increased initially and then decreased as the RFA content increased, and relatively favorable mechanical performance was observed at RFA contents of 40–60%. In the durability tests, the mixture containing 40% RFA exhibited the lowest mass loss and UCS loss after both wetting–drying and freeze–thaw cycles within the investigated range. X-ray diffraction (XRD) and scanning electron microscopy (SEM) analyses suggested that a moderate RFA content was associated with the development of C-(A)-S-H-gel-related phases and ettringite (AFt), together with a denser and more continuous microstructure. The improved strength and durability at moderate RFA contents were therefore interpreted as the combined results of hydration-product development and the physical skeleton effect provided by RFA. By contrast, the performance decline at excessive RFA contents appeared to be related to a less favorable internal structure, as indicated by SEM observations. Overall, when workability, mechanical performance, durability, and microstructural observations are considered together, 40% RFA is recommended as the most suitable content for the material system and test conditions investigated in this study. These findings demonstrate the potential of RFA to regulate the performance of all-solid-waste-based FSS and to improve the resource efficiency of multiple solid-waste streams. Full article

Digital transformation has emerged as one of the most influential drivers of contemporary socio-economic change, shaping development trajectories, social resilience, and the capacity of societies to adapt to external shocks. Despite the growing body of research on digital transformation, relatively little attention has been devoted to societal digitalization as a distinct analytical category. Existing approaches remain largely focused on technological infrastructure, economic performance, or organizational transformation, while the social dimension of digital development is frequently treated as secondary. Addressing this gap, the present study conceptualizes societal digitalization as an autonomous dimension of digital transformation and advances a human-centred perspective that emphasizes digital capabilities and meaningful technology use rather than mere access to technological resources. The study examines the digital development trajectories of Indonesia, Malaysia, and Thailand (ASEAN-3) between 2016 and 2023, with particular attention to the transformative effects of the COVID-19 pandemic. To this end, an original Digital Development of Society (DDS) Index was developed and applied. The index is grounded in a hierarchical framework encompassing three interrelated dimensions: Access, Skills, and Use. The findings reveal substantial cross-country differences in both the level and structure of societal digitalization. More importantly, they provide empirical evidence of a second-level digital divide, demonstrating that improvements in digital access do not automatically translate into higher levels of digital competence or more advanced forms of technology utilization. The results further indicate that a structural shift in digital development—moving the focus from connectivity towards digital skills and meaningful use—accelerated during the 2020–2023 period. Consequently, human capital emerges as a more decisive determinant of digital maturity than infrastructure alone. The study contributes to the literature by offering a new conceptual framework for understanding societal digitalization and by introducing a multidimensional measurement tool capable of identifying structural bottlenecks in socio-digital development. Furthermore, the findings extend the policy debate on digital transformation by providing a diagnostic framework that enables policymakers to identify structural bottlenecks in national digital ecosystems and to align infrastructure investments with human capital development and meaningful digital participation. Full article

Background and Objectives: Unilateral biportal endoscopic (UBE) decompression has become an increasingly popular minimally invasive technique for the treatment of lumbar spinal stenosis. Although irrigation management is a critical component of this procedure that may influence operative efficiency and irrigation-related complications, comparative evidence regarding irrigation systems remains limited. Therefore, this study aimed to compare gravity-based and pump-assisted irrigation systems in patients undergoing UBE decompression for lumbar spinal stenosis with respect to clinical and functional outcomes, operative efficiency, and complication rates. Materials and Methods: This retrospective study included 107 patients who underwent single-level UBE decompression for lumbar spinal stenosis between 1 June 2023 and 1 January 2026. Patients were allocated to either the gravity-based (n = 51) or pump-assisted (n = 56) irrigation group according to the availability of the pump-assisted irrigation device at the time of surgery. Pain and functional outcomes were evaluated using the Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI). Operative time, bleeding control time, and perioperative complications were compared between the groups. A mixed-design ANCOVA was used to analyze the changes in clinical outcomes over time. Multivariable linear and logistic regression analyses were performed to identify the independent factors associated with operative time and complications. Results: Significant improvements in the NRS and ODI scores were observed in both groups during follow-up (time effect, p < 0.001 for both), with no significant differences between the irrigation methods (group effect, p > 0.05). Operative and bleeding control times were significantly shorter in the pump-assisted irrigation group (both p < 0.001). Multivariable linear regression analysis demonstrated that pump-assisted irrigation independently reduced operative time by approximately 8 min (p < 0.001), whereas bilateral decompression independently increased operative time by approximately 24.5 min (p < 0.001). Although the overall complication rate was lower in the pump-assisted irrigation group (12.5% vs. 27.5%), the difference was not statistically significant (p = 0.052). Multivariable logistic regression analysis also demonstrated a trend toward a lower risk of complications with pump-assisted irrigation (OR = 0.408, p = 0.096). Conclusions: Pump-assisted irrigation improved operative efficiency by reducing operative and bleeding control times while providing clinical and functional outcomes comparable to those of gravity-based irrigations. Although the reduction in complication rates did not reach statistical significance, pump-assisted irrigation may represent an effective irrigation strategy that improves operative efficiency and may contribute to surgical safety in UBE decompression surgery. Full article

Machine learning (ML) models for alkali-activated concrete (AAC) are almost universally evaluated with random train–test splits, yet the literature-compiled datasets are strongly clustered by source study, and the reliability of such evaluations has rarely been quantified. The novelty of this study is a systematic quantification of out-of-campaign generalisation—via Leave-One-Study-Out (LOSO) cross-validation—for ML models trained on the largest curated public AAC dataset (1630 mixtures compiled from 106 published sources), together with model interpretation and an exploratory strength–carbon analysis. Four models (Linear Regression, Random Forest, Gradient Boosting, and optimised extreme gradient boosting, XGBoost) were benchmarked for predicting 28-day compressive strength (CS₂₈). XGBoost performed best under conventional random splitting, with test-set coefficient of determination R² = 0.801 and root-mean-square error (RMSE) = 7.21 MPa (5-fold cross-validation R² = 0.758 ± 0.050). Under LOSO validation across 85 study folds, however, the median R² collapsed to −0.328, with 49 of 85 folds negative: random-split metrics on literature-compiled AAC datasets are substantially inflated by within-study clustering, and study-stratified evaluation should become standard practice in this field. Within these limits, SHapley Additive exPlanations (SHAP) identified ground granulated blast-furnace slag (GGBFS) content, specimen geometry, CaO fraction, curing time, and sodium silicate (Na₂SiO₃) content as the five most influential predictors; because the oxide descriptors are derived from the declared binder proportions and the carbon-footprint values are inherited estimates from the source dataset, these attributions are associational rather than causal. No practically meaningful overall linear association was observed between estimated CO₂ footprint and CS₂₈ (Pearson r = −0.113, 95% CI [−0.175, −0.050], R² = 0.013), and a Pareto analysis identified 14 candidate low-carbon, high-strength formulations for further experimental and life-cycle assessment. The developed models are suitable for within-dataset feature attribution and exploratory screening restricted to the represented feature domain; they should not be used as external mix-design tools without validation on independent experimental campaigns. Full article

Sudden collapse accidents in mine roadways occur frequently, and post-disaster emergency rescue faces major challenges in terms of safety and efficiency. Therefore, efficient demolition equipment and intelligent prediction methods are urgently needed. Abrasive waterjet technology has considerable potential for complex disaster environments owing to its high efficiency, environmental friendliness, and cold-cutting characteristics. However, its cutting performance is affected by multiple coupled factors, including jet parameters, material properties, and environmental conditions. This makes accurate prediction difficult, especially under extreme or unseen operating conditions where available samples are limited. To address this problem, this study proposes a zero-shot learning-based multi-physics coupling prediction framework for the “jet–material–environment–effect” relationship. The framework is designed to predict abrasive waterjet cutting performance under unseen working conditions. First, a multi-factor cutting-performance dataset is constructed through a hierarchical experimental design. A generative adversarial network (GAN) is then introduced to expand the sample space and compensate for the discrete nature and limited distributional coverage of the experimental data. Second, a lightweight self-attention mechanism is employed to model high-dimensional input features globally, thereby improving the model’s ability to capture complex feature interactions. Finally, a joint loss function is designed to collaboratively optimize the generation and prediction processes. The experimental results show that the proposed model achieves a prediction accuracy of 98.3% on the test set, with a coefficient of determination R² of 0.967, outperforming WOA-SVM, BP neural network, EML, and Transformer models. The inference response time is approximately 3.2 s, indicating good engineering applicability. The results demonstrate that GAN effectively expands the sample space and improves model generalization, while the LightTransformer structure provides advantages in modeling high-dimensional coupled inputs. The proposed method can provide theoretical support and technical reference for intelligent demolition rescue and cutting-depth prediction under mine disaster conditions. Full article

The diagnosis of cervical spondylotic myelopathy (CSM) relies mainly on clinical symptoms and structural imaging, highlighting the need for objective functional biomarkers. This study investigated alterations in resting-state magnetoencephalography (MEG) functional connectivity in CSM and evaluated whether multiband weighted phase lag index (wPLI) features could distinguish CSM patients from healthy controls (HCs). Eyes-closed resting-state MEG data were acquired from 31 CSM patients and 32 HCs. Region-of-interest-level wPLI connectivity was calculated in the theta, alpha, beta, and gamma bands and used to train multiple machine learning classifiers. Model performance was assessed using nested group cross-validation, and SHapley Additive exPlanations (SHAP) were used to interpret the best-performing model. Patients with CSM exhibited frequency-specific connectivity alterations, particularly in the theta and gamma bands. Logistic regression achieved the best overall discriminative performance, and SHAP analysis indicated that classification was driven mainly by long-range theta-band connections and gamma-band connections involving the frontal pole. These findings suggest that CSM is associated with measurable reorganization of large-scale cortical networks and that resting-state MEG connectivity combined with explainable machine learning may provide a promising framework for exploring candidate neurophysiological biomarkers of CSM. Full article

The interest in dietary prebiotics in rabbit production has increased as a consequence of the search for natural alternatives to antibiotic growth promoters. This study was conducted to evaluate the individual and combined effects of gum Arabic and mannan oligosaccharides on growth performance, physiological health, meat quality and cecal bacterial populations of growing New Zealand White rabbits. Eighty rabbits (5 weeks of age) were randomly allocated to four dietary treatments, for a period of 8 weeks: basal diet (control), basal diet supplemented with gum Arabic (2 g/kg), mannan oligosaccharides (2 g/kg) or their combination (2 + 2 g/kg). The dietary supplementation significantly improved the final body weight, body weight gain, feed conversion ratio, carcass yield, serum protein profile, selected serum biochemical indicators related to hepatic and renal status, lipid profile, antioxidant status, immune response, meat quality and cecal microbial balance as compared to the control group. The combined treatment always produced the best improvements with better growth performance, less abdominal fat, higher antioxidant enzyme activity, higher immunoglobulin concentrations, better water-holding capacity and cooking characteristics of meat, higher populations of beneficial Lactobacillus and lower Escherichia coli counts. The combined treatment produced the most favorable responses for several measured variables, although the magnitude and statistical significance of the response varied among traits. These findings suggest that GA and MOS may have potential as dietary supplements for modulating selected productive, physiological, meat-quality, and cecal bacterial parameters in growing rabbits. Full article

Background: Sudden contamination of the pediatric oropharynx by regurgitated material, emesis, or blood is a time-critical airway emergency. Rapid clearance may be required to restore laryngeal visualization and permit ventilation and tracheal intubation. Comparative data for commonly available suction devices in anatomically constrained infant airways remain limited. We evaluated how airway anatomy and fluid consistency affect the performance of a rigid Yankauer suction tip and a 14 French (Fr) flexible suction catheter. Methods: This pilot simulation study used two complementary models: an anatomically constrained infant airway mannequin and an unconstrained open-container model. Water, whole milk, and plain yogurt (50 mL) represented contaminants of increasing consistency. Both devices were tested at a standardized wall-suction pressure of −200 mmHg, selected as a high-vacuum emergency bench condition rather than as a recommended pressure for routine pediatric suctioning. In the mannequin, suction time, evacuated pharyngeal volume, residual pharyngeal/esophageal volume, and recovered lung volume were measured. In the container model, time to complete evacuation was recorded. Results: In the infant airway mannequin, the Yankauer evacuated greater pharyngeal volumes for all three fluids. Suction time was shorter with the Yankauer for water but did not differ significantly for milk or yogurt. After yogurt contamination, residual pharyngeal/esophageal volume was greater with the Yankauer, while recovered lung volumes did not differ significantly between devices. In the unconstrained model, the Yankauer evacuated water and milk more rapidly and cleared all yogurt samples; the 14 Fr catheter did not completely evacuate yogurt within the five-minute limit in any trial. Conclusions: Under the standardized high-vacuum conditions of this simulation, relative device performance differed between the two experimental models and across fluids of differing consistency. The Yankauer provided greater bulk removal, whereas the flexible catheter left less residual yogurt in the anatomically constrained model. These bench findings do not establish the safety or clinical superiority of either device at recommended pediatric suction pressures and support further evaluation at lower pressures and during simulated laryngoscopy. Full article

Dynamic difficulty adjustment in Serious Games remains challenging because most adaptive approaches respond primarily to performance variables and insufficiently incorporate the player’s psychophysiological state in real time. Prior studies have shown the potential of biofeedback and heart rate variability based adaptation; however, many proposals rely on isolated indicators, limited temporal integration, or mechanisms that do not explicitly stabilize state transitions before modifying gameplay. In response, this article proposes a dynamic difficulty adjustment mechanism based on cardiac signals and Cellular Automata for Serious Games. The novelty of the proposal lies in combining individualized instantaneous heart rate ranges, time and frequency domain heart rate variability features, a hybrid multilayer caching for resolving discrepancies between short and longer window estimates, and a Cellular Automaton that introduces temporal inertia before applying adaptive changes to game parameters. Methodologically, the study follows a design and implementation research process in which the mechanism is integrated with a Polar H10 sensor, structured as a modular architecture, and evaluated through functional and architectural, including real time tests of arousal band assignment, adaptive response, and trace level coherence. The engine assigns three classes of operational arousal bands, defining individualized low, target, and high BPM/HRV control regions for DDA actuation. The results demonstrate technically stable operation and effective real time adaptation, with an average response latency of approximately two seconds, supporting the feasibility of the proposed mechanism. Overall, the findings indicate that cardiac signal driven adaptation combined with Cellular Automata based transition control constitutes a technically viable approach for Serious Games. Full article

Background/Objectives: Assessment of Internet Gaming Disorder (IGD) relies on retrospective self-reports and clinical interviews, which may be affected by recall and social desirability biases and may be insensitive to behavioral change. This study evaluated an artificial intelligence (AI)-enabled, privacy-preserving digital phenotyping framework for personalized IGD risk stratification under controlled simulation assumptions. Methods: A synthetic dataset of 1000 virtual user profiles was generated with a 20% elevated-risk prevalence and 5% balanced stochastic label noise. Four aggregated telemetry features were modeled: average session duration, sessions per week, Late-Night Index, and application-switching rate. Random Forest, Logistic Regression, and Gradient Boosting classifiers were evaluated using a stratified 80:20 hold-out split, five-fold cross-validation, playtime-only baselines, label-noise sensitivity analysis, and 200 synthetic realizations. Results: The primary Random Forest model achieved a balanced accuracy of 0.850, a sensitivity of 0.800, a specificity of 0.900, an area under the receiver operating characteristic curve (ROC-AUC) of 0.909, an average precision (AP) of 0.779, and a Brier score of 0.089. As an internal consistency check under the pre-specified synthetic signal structure, all-feature models showed higher performance than playtime-only baselines, and feature importance analyses recovered the encoded signal hierarchy. Performance declined with increasing label noise. Across 200 realizations, mean ROC-AUC values for the three all-feature models ranged from 0.888 to 0.904, with overlapping empirical 95% intervals. Conclusions: The framework demonstrates the methodological feasibility of transforming aggregated telemetry into interpretable risk signals while avoiding content-level monitoring. These findings are hypothesis-generating and do not establish clinical validity or diagnostic performance. Longitudinal validation in clinically characterized cohorts is required before deployment. Full article

Water deficit stress poses significant challenges to chickpea production, affecting plant growth, physiological parameters, and overall crop yield. This study aimed to identify drought-tolerant chickpea genotypes and evaluate the potential of grape by-product amendments to alleviate water deficit stress. Two trials were conducted. The first one investigated the agronomic evaluation of eight chickpea genotypes (G1–G8) cultivated in three different soils to identify drought-tolerant genotypes and the poorest soil. Three chickpea cultivars, G2 (Nour), G3 (Rebha), and G4 (Bochra), were selected for their identified moderate drought tolerance and their status as widely available commercial genotypes in Tunisia. In the second trial, two grape by-product amendments were tested for their ability to enhance the drought tolerance of the selected chickpea genotypes in the poorest-performing soil. Under water deficit conditions, the stalk amendment increased the relative water content (RWC) of the drought-tolerant genotype Nour by approximately 61% compared with the non-amended treatment and a 90% improvement in SPAD chlorophyll readings in Nour under water deficit conditions. Among the tested genotypes, Nour maintained the highest photosynthetic efficiency under drought, with Fv/Fm reaching approximately 0.62 following stalk amendment, indicating improved preservation of PSII functionality. Polyphenol profiling indicated that both drought stress and soil amendments modulated the accumulation of phenolic compounds. Enhanced polyphenol levels, particularly under stalk amendment and water deficit, suggest activation of antioxidant and protective metabolic pathways involved in plant stress defense. Thus, grape by-products, especially stalk residues, demonstrate potential as sustainable soil amendments to mitigate drought stress effects in chickpea through improvements in plant–water status, photosynthetic efficiency, and stress-responsive metabolism. Full article