Search Results (3,680)

Objective: Due to the increasing esthetic demand among pediatric patients and different restorative materials, we focused on analyzing which of the options of restorations may provide superior clinical outcomes. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using PubMed and Cochrane databases. Results: Five articles met all inclusion criteria from an initial pool of 359 articles identified in the initial search. Greater bond strength was observed when pulpotomized teeth were restored with Biodentine^® and resin composites compared to resin-modified glass ionomer cements (RMGICs). When comparing pulpotomies in primary teeth with MTA and Biodentine^®, the fracture resistance values were higher in the pulpotomized teeth with Biodentine^® than with MTA. Additionally, following a narrative synthesis in MTA-treated teeth, a higher risk of failure was observed using RMGICs or composite instead of stainless-steel crowns (SCCs) as the final restorative material. Conclusions: Variables such as the type of final restoration can affect the survival of primary teeth after pulpotomy reconstruction. Regardless of the pulp material, survival with SSCs is higher, but resin composites appear to be a viable restorative material after Biodentine^® application. Full article

Climate change poses an escalating threat to cultural heritage (CH), driven by intensifying climate-related hazards and systemic vulnerabilities. In response, risk assessment frameworks and methodologies (RAFMs) have emerged to evaluate and guide adaptation strategies for safeguarding heritage assets. This study conducts a state-of-the-art (SotA) review of 86 unique RAFMs using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided systematic approach to assess their scope, methodological rigor, alignment with global climate and disaster risk reduction (DRR) frameworks, and consistency in conceptual definitions of hazard, exposure, and vulnerability. Results reveal a growing integration of Intergovernmental Panel on Climate Change (IPCC)-based climate projections and alignment with international policy instruments such as the Sendai Framework and United Nations Sustainable Development Goals (UN SDGs). However, notable gaps persist, including definitional inconsistencies, particularly in the misapplication of vulnerability concepts; fragmented and case-specific methodologies that challenge comparability; and limited integration of intangible heritage. Best practices include participatory stakeholder engagement, scenario-based modeling, and incorporation of multi-scale risk typologies. This review advocates for more standardized, interdisciplinary, and policy-aligned frameworks that enable scalable, culturally sensitive, and action-oriented risk assessments, ultimately strengthening the resilience of cultural heritage in a changing climate. Full article

The uncertainties arising from high renewable energy penetration on both the generation and demand sides pose significant challenges to distribution network security. Smart microgrids are considered an effective way to solve this problem. Existing studies exhibit limitations in prediction accuracy, Alternating Current (AC) power flow modeling, and integration with optimization frameworks. This paper proposes a closed-loop technical framework combining high-confidence interval prediction, second-order cone convex relaxation, and robust optimization to facilitate renewable energy integration in distribution networks via smart microgrid technology. First, a hybrid prediction model integrating Variational Mode Decomposition (VMD), Long Short-Term Memory (LSTM), and Quantile Regression (QR) is designed to extract multi-frequency characteristics of time-series data, generating adaptive prediction intervals that accommodate individualized decision-making preferences. Second, a second-order cone relaxation method transforms the AC power flow optimization problem into a mixed-integer second-order cone programming (MISOCP) model. Finally, a robust optimization method considering source–load uncertainties is developed. Case studies demonstrate that the proposed approach reduces prediction errors by 21.15%, decreases node voltage fluctuations by 16.71%, and reduces voltage deviation at maximum offset nodes by 17.36%. This framework significantly mitigates voltage violation risks in distribution networks with large-scale grid-connected photovoltaic systems. Full article

Road traffic accidents are a leading cause of injury and death among adolescents, making road safety education crucial. This study assesses the performance of and users’ opinions on the Route 2 School (R2S) traffic safety education program, designed for secondary school students (13–17 years) in Belgium. The program incorporates gamified e-learning modules containing, among others, podcasts, interactive 360° visuals, and virtual reality (VR), to enhance traffic knowledge, situation awareness, risk detection, and risk management. This study was conducted across several cities and municipalities within Belgium. More than 600 students from school years 3 to 6 completed the platform and of these more than 200 students filled in a comprehensive questionnaire providing detailed feedback on platform usability, preferences, and behavioral risk assessments. The results revealed shortcomings in traffic knowledge and skills, particularly among older students. Gender-based analysis indicated no significant performance differences overall, though females performed better in risk management and males in risk detection. Furthermore, students from cities outperformed those from municipalities. Feedback on the R2S platform indicated high usability and engagement, with VR-based simulations receiving the most positive reception. In addition, it was highlighted that secondary school students are high-risk groups for distraction and red-light violations as cyclists and pedestrians. This study demonstrates the importance of gamified, technology-enhanced road safety education while underscoring the need for module-specific improvements and regional customization. The findings support the broader application of e-learning methodologies for sustainable, behavior-oriented traffic safety education targeting adolescents. Full article

Refractory full-thickness macular holes (rFTMHs) present a significant challenge in vitreoretinal surgery, with reported incidence rates of 4.2–11.2% following standard vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade. Risk factors include large hole size (>400 µm), chronicity (>6 months), high myopia, incomplete ILM peeling, and post-operative noncompliance. Multiple surgical techniques exist, though comparative evidence remains limited. Current options include the inverted ILM flap technique, autologous ILM transplantation (free flap or plug), lens capsular flap transplantation (autologous or allogenic), preserved human amniotic membrane transplantation, macular subretinal fluid injection, macular fibrin plug with autologous platelet concentrates, and autologous retinal transplantation. Closure rates range from 57.1% to 100%, with selection depending on hole size, residual ILM, patient posturing ability, etc. For non-posturing patients, fibrin plugs are preferred. Residual ILM cases may benefit from extended peeling or flap techniques, while large holes often require scaffold-based (lens capsule, amniotic membrane) or fibrin plug approaches. Pseudophakic patients should avoid posterior capsular flaps due to lower success rates. Despite promising outcomes, the lack of randomized trials necessitates further research to establish evidence-based guidelines. Personalized surgical planning, considering anatomical and functional goals, remains crucial in optimizing visual recovery in rFTMHs. Full article

We introduce a novel portfolio optimization framework—Distributionally Robust Multivariate Stochastic Cone Order (DR-MSCO)—which integrates partial orders on random vectors with Wasserstein-metric ambiguity sets and adaptive cone structures to model multivariate investor preferences under distributional uncertainty. Grounded in measure theory and convex analysis, DR-MSCO employs data-driven cone selection calibrated to market regimes, along with coherent tail-risk operators that generalize Conditional Value-at-Risk to the multivariate setting. We derive a tractable second-order cone programming reformulation and demonstrate statistical consistency under empirical ambiguity sets. Empirically, we apply DR-MSCO to 23 Borsa Istanbul equities from 2021–2024, using a rolling estimation window and realistic transaction costs. Compared to classical mean–variance and standard distributionally robust benchmarks, DR-MSCO achieves higher overall and crisis-period Sharpe ratios (2.18 vs. 2.09 full sample; 0.95 vs. 0.69 during crises), reduces maximum drawdown by 10%, and yields endogenous diversification without exogenous constraints. Our results underscore the practical benefits of combining multivariate preference modeling with distributional robustness, offering institutional investors a tractable tool for resilient portfolio construction in volatile emerging markets. Full article

The growing popularity of Personal Light Electric Vehicles (PLEVs), such as e-scooters, has revolutionized urban mobility by offering compact, cost-effective, and environmentally friendly transportation solutions. However, safety concerns, including inadequate infrastructure, poor protective measures, and high accident rates, remain critical challenges. This paper presents the design and development of an innovative self-balancing microvehicle under the H2020 LEONARDO project, which aims to address these challenges through advanced engineering and user-centric design. The vehicle combines features of monowheels and e-scooters, integrating cutting-edge technologies to enhance safety, stability, and usability. The design adheres to European regulations, including Germany’s eKFV standards, and incorporates user preferences identified through representative online surveys of 1500 PLEV users. These preferences include improved handling on uneven surfaces, enhanced signaling capabilities, and reduced instability during maneuvers. The prototype features a lightweight composite structure reinforced with carbon fibers, a high-torque motorized front wheel, and multiple speed modes tailored to different conditions, such as travel in pedestrian areas, use by novice riders, and advanced users. Braking tests demonstrate deceleration values of up to 3.5 m/s², comparable to PLEV market standards and exceeding regulatory minimums, while smooth acceleration ramps ensure rider stability and safety. Additional features, such as identification plates and weight-dependent motor control, enhance compliance with local traffic rules and prevent misuse. The vehicle’s design also addresses common safety concerns, such as curb navigation and signaling, by incorporating large-diameter wheels, increased ground clearance, and electrically operated direction indicators. Future upgrades include the addition of a second rear wheel for enhanced stability, skateboard-like rear axle modifications for improved maneuverability, and hybrid supercapacitors to minimize fire risks and extend battery life. With its focus on safety, regulatory compliance, and rider-friendly innovations, this microvehicle represents a significant advancement in promoting safe and sustainable urban mobility. Full article

Background/Objectives: Excessive sugar intake through sugar-sweetened beverages (SSBs) has raised global concerns due to its association with various health risks. This study evaluates the effectiveness of nudges—in the form of order placement, variety expansion, and a combination of both—in promoting non-SSB purchases at self-service kiosks, a key environment for SSB consumption. Methods: This study was conducted using a real-world kiosk at food and beverage outlets in South Korea from 28 May to 12 July, 2024. A total of 183 consumers aged 19 to 29 participated in this study. A single kiosk device was used with four screen layouts, each reflecting a different nudge strategy. Participants were unaware of these manipulations when making their purchases. After their purchases, participants completed a survey. All data were analyzed using IBM SPSS Statistics for Windows, Version 29.0. Results: Females reported significantly higher positive attitudes, preferences, and perceived necessity regarding nudges compared to males. In particular, both the single (variety) and combination (order and variety) nudges received positive responses from females (p < 0.001). The combination nudge significantly increased non-SSB purchases compared to the control (p < 0.05) and single (order) nudge groups (p < 0.01), which suggests that combination nudge is effective in promoting healthier beverage choices. Females were also more likely to purchase non-SSBs than males (p < 0.05). Conclusions: The findings suggest that the combination nudge strategy effectively promotes healthier beverage choices in real kiosk settings. Notably, females demonstrate significantly higher positive attitudes, preferences, and perceived necessity regarding nudges compared to males, and are also more likely to purchase non-SSBs. These findings offer valuable insights for real-world applications aimed at encouraging healthier consumption behaviors. Full article

Background: To diagnose prostate cancer, a prostate biopsy is required. Two methods are commonly used for biopsy: transrectal and transperineal. The transperineal approach, particularly the “freehand” technique under local anesthesia, offers better access to the anterior prostate, lower infection risk, and higher detection rates. Methods: This retrospective study examined the records of 1674 patients who underwent ultrasound-guided prostate biopsies between 2015 and 2022. Of these, 1161 patients had transperineal biopsy using the “freehand” method, and 513 had transrectal biopsy. All the biopsies were carried out under local anesthesia, with a combined systematic and targeted approach for patients with MRI-identified lesions. Results: This study demonstrates that the transperineal biopsy approach significantly increased the detection rate of clinically significant prostate cancer compared with the transrectal method, with detection rates of 65.7% and 59.4%, respectively. Notably, the transperineal technique also achieved superior detection of anteriorly located tumors (94.1% vs. 43.1%), supporting its use as the preferred biopsy strategy, particularly in anatomically challenging regions. Moreover, patients who underwent transperineal biopsy demonstrated more favorable diagnostic outcomes, characterized by a higher detection rate for clinically significant cancers and a reduced incidence of clinically insignificant cases. The transperineal method outperformed the transrectal approach, especially among younger patients and those presenting with lower PSA values. These results highlight the diagnostic superiority and broader clinical applicability of the transperineal biopsy technique across various patient subgroups. Full article

Objectives: To assess the clinical and inflammatory outcomes of patients with calcified coronary arteries treated with rotational atherectomy (RA), compared to those with other intervention procedures. Methods: We conducted a systematic search of PubMed (Medline) and Embase. This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and applied the PICO criteria. Results: A total of 110 articles were analyzed, comprising 2,328,417 patients with moderate to severe coronary calcified lesions treated with RA, conventional percutaneous coronary intervention (PCI), or other advanced interventions. The pooled incidence of short- to mid-term major adverse cardiovascular events (MACEs) was 6% (95% CI 4–7%), increasing to 17% (95% CI 15–21%) at 6 months. Mortality was 2% (95% CI 1–3%) within 6 months, rising to 7% (95% CI 6–9%) thereafter. RA significantly increased the risk of long-term MACEs, mortality, total lesion revascularization (TLR), bleeding, and fluoroscopy time, and was borderline associated with an increased risk of short-term myocardial infarction and a reduced risk of coronary dissection. RA and other invasive procedures showed similar risks for short-term MACEs, mortality, total vascular revascularization (TVR), stent thrombosis, heart failure, stroke, and inflammation. Conclusions: RA is linked to higher long-term risks of MACEs, mortality, TLR, bleeding, and fluoroscopy time compared to other interventions. While RA shows comparable outcomes for short-term MACEs and mortality with other procedures, it may slightly reduce the risk of coronary dissection. These findings underscore the importance of careful patient selection and weighing long-term risks when considering RA for calcified coronary lesions. Full article

Background/Objectives: International students pursuing higher education in the United States face unique challenges that increase their risk of food insecurity, including limited financial resources, employment restrictions, and cultural barriers. While food insecurity among domestic students has been widely studied, limited research focuses on the lived experiences of international graduate students. This study explores the challenges, perceptions, and coping strategies related to food insecurity among international graduate students at a large public university in North Texas. Methods: This qualitative, ethnographic study involved 20 semi-structured interviews with international graduate students who were clients of the university’s food pantry. Participants were recruited using purposive convenience sampling. Interviews focused on students’ experiences with food access, financial constraints, campus resources, and cultural food preferences. Data were analyzed using thematic coding in MAXQDA. Two standardized food insecurity measures—the USDA and FAO scales—were also administered and analyzed using SPSS. Results: Findings revealed that 85% of participants experienced limited access to nutritious and culturally appropriate foods, with 70% reporting hunger due to financial constraints. Themes included lack of cooking skills, limited campus food options, difficulty accessing familiar groceries, and limited job opportunities. Students expressed that food insecurity significantly impacted their physical health, mental well-being, and social lives, though many continued to prioritize academics over personal nourishment. Conclusions: Food insecurity among international graduate students is multifaceted, shaped by financial, cultural, and institutional barriers. Addressing this issue requires culturally sensitive interventions, improved access to diverse food options, tailored student support services, and institutional efforts to better understand and meet the needs of international students. Full article

Objective: Craniopharyngioma recurrence risk studies comparing gross total resection (GTR) vs. subtotal resection (STR) with radiotherapy (XRT) provide inconclusive or contradictory results. This may be an effect of the small group sizes and diversity in the approaches used. Currently, the endoscopic endonasal approach (EEA) is preferred in craniopharyngioma management. Here, we aimed to perform a meta-analysis comparing recurrence risk after GTR vs. STR plus XRT in patients treated with the EEA regimen. Methods: We performed a systematic literature search of original English language papers on craniopharyngioma management published in the PubMed, Web of Science, and Scopus databases up to 18 October 2023. Eleven articles included data on recurrence rate after EEA: GTR vs. STR with XRT. We extracted the year of publication, number of patients, surgical approach, extent of resection, and follow-up duration. We used meta-analysis for the odds ratio (OR) in fixed and random effects models and Egger’s and Begg’s tests to assess heterogeneity and publication bias. Follow-up duration and time to recurrence were additionally included in Kaplan–Meier curves with log-rank test analysis. Results: We observed a lower recurrence rate in patients after GTR (10%) as compared to STR with XRT (30%), OR = 0.299, p < 0.001. To increase data reliability, we limited our analysis to studies with at least five patients in each subgroup and also observed lower recurrence in patients after GTR (12%) as compared to STR with XRT (27%), OR = 0.376, p = 0.011. Survival analysis confirmed significant differences in recurrence-free survival percentages between these groups (p = 0.008). Conclusions: To date, this is the largest meta-analysis evaluating the recurrence risk in patients undergoing EEA for craniopharyngioma resection, comparing outcomes between those treated with GTR and those treated with STR plus XRT. The results suggest that GTR significantly reduces recurrence risk. Full article

Under China’s “Rural Revitalisation” strategy, contract farming faces challenges including farmers’ limited access to advanced technologies and high operational risks for agricultural support enterprises. The collaborative involvement of scientific research institutions offers potential solutions but remains underexplored. This study employs Stackelberg game theory to model a contract farming supply chain under two agricultural assistance modes: enterprise-led (EL) and collaborative assistance with scientific research institutions (CI). We further propose two government subsidy mechanisms: subsidies to enterprises and subsidies to scientific research institutions. The models analyze optimal decisions, supply chain performance, and subsidy efficiency, validated through numerical experiments. Key findings reveal the following: (1) The CI mode enhances agricultural output and farmer revenue but may reduce enterprise profits, deterring collaboration. (2) Government subsidies incentivize enterprise–institution collaboration. Subsidizing scientific research institutions typically improves agricultural productivity and economic benefits more effectively than subsidizing enterprises. (3) Synergistic effects exist among the government subsidy coefficient, cost coefficient of technical assistance, consumer preferences for agricultural quality, and profit-sharing ratio. The latter three parameters significantly influence subsidy model selection. This research provides policy insights for enhancing agricultural assistance efficiency and sustainable contract farming development. Full article

Background/Objectives: Given the heterogeneous nature of long COVID, its treatment and management remain challenging. This study aimed to investigate whether poor pre-pandemic sleep quality, its deterioration during the peak of the pandemic, and circadian preference increase the risk of long COVID symptoms. Methods: An online survey was conducted between 9 October and 12 December 2022, with 384 participants who had recovered from COVID-19 at least three months prior to data collection. Participants were categorized based on the presence of at least one long COVID symptom. Logistic regression models assessed associations between sleep-related variables and long COVID symptoms. Results: Participants with long COVID symptoms reported significantly poorer sleep quality, higher perceived stress, greater somatic and cognitive pre-sleep arousal, and elevated levels of post-traumatic stress symptoms, anxiety, depression, and aggression. Fatigue (39.8%) and memory problems (37.0%) were the most common long COVID symptoms. Sleep deterioration during the pandemic peak was reported by 34.6% of respondents. Pre-pandemic poor sleep quality, its deterioration during the pandemic, and poor sleep at the time of the survey were all significantly associated with long COVID. An extreme morning chronotype consistently predicted long COVID symptoms across all models, while an extreme evening chronotype was predictive only when accounting for sleep quality changes during the pandemic. COVID-19 frequency, severity, financial impact, and somatic pre-sleep arousal were significant predictors in all models. Conclusions: Poor sleep quality before the pandemic and its worsening during the pandemic peak are associated with a higher likelihood of long COVID symptoms. These findings underscore the need to monitor sleep health during pandemics and similar global events to help identify at-risk individuals and mitigate long-term health consequences, with important clinical and societal implications. Full article

Canine morbillivirus (CDV), the cause of canine distemper, is a pathogen affecting many hosts. While modified live virus (MLV) vaccines are crucial for controlling the disease in dogs, cases of vaccine-related infections have been found in both domestic and wild animals. Specifically, the America-1 and Rockborn-like vaccine genotypes are concerning due to their spread and ability to transmit between different species. This study conducted a review and analysis of molecular detections of these strains in various carnivores (domestic, captive, synanthropic, and wild species). This study used a conceptual model considering host ecology and the domestic–wild interface to evaluate plausible transmission connections over time using Linear Directional Mean (LDM) and Weighted Mean Centre (WMC) methods. Statistical analyses examined the relationship between how likely a strain is to spread and factors like host type and vaccination status. The findings showed that the America-1 genotype spread in a more organised way, with domestic dogs being the main source and recipient, bridging different environments. Synanthropic mesocarnivores also played this same role, with less intensity. America-1 was most concentrated in the North Atlantic and Western Europe. In contrast, the Rockborn-like strain showed a more unpredictable and restricted spread, residual circulation from past use rather than ongoing spread. Species involved in vaccine-related infections often share characteristics like generalist behaviour, social living, and a preference for areas where domestic animals and wildlife interact. We did not find a general link between a host vaccination status and the likelihood of the strain spreading. The study emphasised the ongoing risk of vaccine-derived strains moving from domestic and synanthropic animals to vulnerable wild species, supporting the need for improved vaccination approaches. Mapping these plausible transmission routes can serve as a basis for targeted surveillance, not only of vaccine-derived strains, but of any other circulating genotype. Full article