Search Results (16,669)

This paper is aimed at landscape managers and designers. It looks at 123 real-world coastal landscape projects and organizes them into clear design categories, i.e., wetland restoration, hybrid infrastructure, or urban green spaces. We looked at how these projects were framed (whether they focused on climate adaptation, flood protection, or other goals) and how they tracked performance. We are hoping to bring some clarity to a very scattered field, helping us to see patterns in what is actually being carried out in terms of landscape interventions and increasing sea levels. We are hoping to provide a practical reference for making better, more climate-responsive design decisions. Coastal cities face escalating climate-driven threats from increasing sea levels and storm surges to urban heat islands. These threats are driving increased interest in nature-based solutions (NbSs) as green adaptive alternatives to traditional gray infrastructure. Despite an abundance of individual case studies, there have been few systematic syntheses aimed at landscape designers and managers linking design typologies, project framing, and performance outcomes. This study addresses this gap through a meta-synthesis of 123 implemented coastal landscape interventions aimed directly at landscape-oriented research and professions. Flood risk reduction was the dominant framing strategy (30.9%), followed by climate resilience (24.4%). Critical evidence gaps emerged—only 1.6% employed integrated monitoring approaches, 30.1% provided ambiguous performance documentation, and mean monitoring quality scored 0.89 out of 5.0. While 95.9% of the projects acknowledged SLR as a driver, only 4.1% explicitly integrated climate projections into design parameters. Community monitoring approaches demonstrated significantly higher ecosystem service integration, particularly cultural services (36.4% vs. 6.9%, $p<0.001$), and enhanced monitoring quality (mean score 1.64 vs. 0.76, $p<0.001$). Implementation barriers spanned technical constraints, institutional fragmentation, and data limitations, each affecting 20.3% of projects. Geographic analysis revealed evidence generation inequities, with systematic underrepresentation of high-risk regions (Africa: 4.1%; Latin America: 2.4%) versus concentration in well-resourced areas (North America: 27.6%; Europe: 17.1%). Full article

Paratuberculosis is a chronic zoonotic bacterial infection, primarily affecting ruminants. This review examines the disease in the Arabian Peninsula, focusing on distribution, molecular diversity, prevalence, and associated risk factors. Following PRISMA guidelines, a systematic search was conducted in PubMed, Scopus, and Web of Science. After duplicate removal and eligibility screening, data extraction, analysis, and quality assessment were performed. Pathogen sequences were retrieved from NCBI GenBank for phylogenetic analysis. The review included a total of 31 published articles from 1997 to 2025, of which 23 were used in the meta-analysis. Most studies (n = 12) were published between 2011 and 2015, predominantly from Saudi Arabia (n = 22), with no reports from Qatar, Bahrain, or Yemen. The majority of the studies involved camels and sheep (n = 16 on each species), followed by cattle (n = 9), goats (n = 7), humans (n = 2), and buffalo (n = 1). Phylogenetic analysis delineates two major clades—Type S and Type C—suggesting greater genetic diversity in Type S. The estimated pooled seroprevalence and pathogen prevalence in livestock ruminants were 8.1% and 22.4%, respectively. Herd-level estimated pooled seroprevalence was 26.9%. Small ruminants (19.3%) were more sero-prevalent than large ruminants (7.4%), with goats (28.7%) significantly (p < 0.01) more affected than sheep (21.5%), camel (9.8%), and cattle (6.6%). Clinical signs in ruminants included chronic diarrhea, emaciation, anorexia, alopecia, wry neck, and dehydration. The reviewed study patterns and findings suggest high pathogen diversity and a significant risk of transboundary transmission at the human–animal interface in this region. A One Health surveillance approach is crucial, particularly on farms with diarrheic and emaciated animals. Establishing a national surveillance plan and phased (short-, intermediate-, and long-term) control programs is essential to mitigate economic losses, limit transmission, overcome the cultural barrier, and protect public health. Full article

Background and Objectives: Transcatheter Aortic Valve Replacement (TAVR) has revolutionized the management of severe aortic stenosis (AS), offering a less invasive alternative to surgical replacement, which is particularly beneficial for elderly and high-risk populations. This narrative review aims to summarize current evidence regarding TAVR’s clinical outcomes, patient selection, the role of cardiac remodeling, and the impact of geriatric syndromes on procedural success. Materials and Methods: This review is based on a comprehensive analysis of the peer-reviewed literature indexed in major scientific databases. We included relevant studies addressing TAVR in older adults, focusing on cardiac biomarkers, imaging, patient stratification, and geriatric syndromes, such as frailty, delirium, and sarcopenia. Results: Evidence indicates that TAVR significantly improves survival and quality of life in elderly patients with severe AS. Advanced cardiac imaging and biomarkers contribute to improved risk stratification and post-procedural management. Geriatric syndromes are prevalent in this population and strongly influence clinical outcomes. Tailored prehabilitation and multidisciplinary approaches are increasingly recognized as critical components of TAVR care. Conclusions: TAVR is an effective and safe option for older adults with severe AS. Optimal outcomes depend not only on procedural expertise but also on recognizing and addressing the complex interplay between cardiac pathology and geriatric vulnerabilities. A holistic, patient-centered approach is essential to maximize the therapeutic benefits in this growing patient population. Full article

Pursuing quality and sustainability concerns in construction activities is not new. However, the construction sector continues to face criticism for the outcome of many interventions, and significant progress is still required to realise both objectives. This is particularly pressing in sectors essential for quality of life and wellbeing, such as housing, and in areas frequently neglected in research and practice, such as existing buildings. This paper provides insights into the assessment of quality and sustainability in existing buildings, clarifying these concerns, exploring their interrelationship, emphasising the critical role of the design phase, and synthesising relevant methodologies focused on each objective. Furthermore, a novel methodology is proposed to minimise the risk of poor quality in building rehabilitation processes. Methodologically, the paper includes a review of concepts associated with quality and sustainability in building rehabilitation, a synthesis of existing evaluation tools and methods, and the development of the proposed methodology. The main findings include a definition of construction quality, identification of strong correlations between quality and sustainability, and the recognition that using accessible, flexible, and collaborative tools during the design phase is crucial to achieving both objectives, especially in the context of existing buildings, where practical and operational outcomes remain limited. Full article

Background/Objectives: Recurrent meningiomas remain difficult to manage due to the absence of effective systemic therapies and comparatively high treatment failure rates, particularly in high-grade tumors. Stereotactic radiosurgery (SRS) offers a minimally-invasive and precise option, particularly for tumors in surgically complex locations. However, the risks associated with re-irradiation, and recent changes in the WHO classification of CNS tumors highlight the need for more personalized and strategic treatment approaches. This systematic review evaluates the safety, efficacy, and clinical considerations for use of SRS for recurrent meningiomas. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature search was conducted using the PubMed, Scopus, and Web of Science databases for studies reporting outcomes of SRS in recurrent, pathologically confirmed intracranial meningiomas. Studies were excluded if they were commentaries, reviews, case reports with fewer than three cases, or had inaccessible full text. The quality and risk of bias of the included studies were assessed using the modified Newcastle-Ottawa Scale. Data on patient and tumor characteristics, SRS treatment parameters, clinical outcomes, adverse effects, and statistical analysis results were extracted. Results: Sixteen studies were included. For WHO Grade I tumors, 3- to 5-year progression-free survival (PFS) ranged from 85% to 100%. Grade II meningiomas demonstrated more variable outcomes, with 3-year PFS ranging from 23% to 100%. Grade III tumors had consistently poorer outcomes, with reported 1-year and 2-year PFS rates as low as 0% and 46%, respectively. SRS performed after surgery alone was associated with superior outcomes, with local control rates of 79% to 100% and 5-year PFS ranging from 40.4% to 91%. In contrast, tumors previously treated with radiotherapy, with or without surgery, showed substantially poorer outcomes, with 3- to 5-year PFS ranging from 26% to 41% and local control rates as low as 31%. Among patients with prior radiotherapy, outcomes were particularly poor in Grade II and III recurrent tumors. Toxicity rates ranged from 3.7% to 37%, and were generally higher for patients with prior radiation. Predictors of worse PFS included prior radiation, older age, and Grade III histology. Conclusions: SRS may represent a reasonable salvage option for carefully selected patients with recurrent meningioma, particularly following surgery alone. Outcomes were notably worse in high-grade recurrent meningiomas following prior radiotherapy, emphasizing the prognostic significance of both histological grade and treatment history. Notably, the lack of molecular and genetic data in most existing studies represents a key limitation in the current literature. Future prospective studies incorporating molecular profiling may improve risk stratification and support more personalized treatment strategies. Full article

Background: Thyroid dysfunction and psychiatric disorders often coexist, raising interest in their potential interplay. In particular, the relationship between thyroid-stimulating hormone (TSH) levels and schizophrenia has been investigated, though findings remain inconsistent. We performed a systematic review and meta-analysis to clarify whether TSH levels differ in patients with schizophrenia compared with healthy controls. Methods: A systematic search of PubMed/MEDLINE, Scopus, and Web of Science was conducted up to May 2025. Eligible studies were selected based on predefined criteria according to the PICO framework: What are the TSH levels in first-episode, drug-naïve patients diagnosed with schizophrenia compared with healthy subjects, and do TSH levels influence different psychiatric phenotypes? PRISMA guidelines were followed. Study quality and risk of bias were assessed using QUADAS-2. Results: Of 2068 records screened, 35 studies met the inclusion criteria. Quality assessment revealed a generally unclear risk of bias, with few studies showing a high risk. The meta-analysis included 3669 patients and 1391 controls from ten Asian, eight European, and three North American studies. TSH levels were similar between patients and controls (SMD = –0.059 mIU/L; 95% CI: –0.260 to 0.141), with substantial heterogeneity (I² = 84%, p < 0.001). Conclusions: This meta-analysis found no significant association between TSH levels and schizophrenia, despite decades of research and methodological diversity. Full article

Obesity represents a significant global public health challenge, which not only elevates the risk of mortality but also increases the likelihood of chronic diseases. The ongoing obesity epidemic has led to a growing recognition of the detrimental effects of excessive adipose tissue accumulation on male reproductive health. Substantial evidence indicates that obesity adversely affects sperm quality, thereby impairing male fertility. Specifically, obesity is associated with compromised spermatogenesis, erectile dysfunction, and detrimental effects on offspring fertility parameters. These effects are mediated through various mechanisms, including alterations in the hypothalamic–pituitary–gonadal axis, inflammation within the reproductive system, localized caloric excess in reproductive tissues, epigenetic modifications, disruptions in gut microbiota, and heightened oxidative stress levels. While the molecular alterations associated with obesity have been extensively documented, the precise mechanisms by which obesity influences male reproductive function remain inadequately understood. This article aimed to review the classification and distribution of adipose tissue in obesity, the impact of obesity on male fertility, and the potential mechanisms through which obesity affects male reproductive health, thereby offering insights into the prevention and treatment of obesity-related male fertility issues. Full article

Osteoporosis is a common disease characterized by a reduction in bone mineral density (BMD), leading to an increased risk of pathological fractures and even mortality. Although menopause is a major risk factor, osteoporosis can also occur in premenopausal women. The aim of this study was to identify genetic variants associated with the development of osteoporosis in Korean premenopausal women. Subjects were recruited from the Anseong and Ansan cohorts of the Korean Genome and Epidemiology Study (KoGES). Clinical and epidemiological characteristics were assessed, and participants were classified based on BMD values measured at the distal radius and mid-shaft tibia. Individuals with confounding risk factors such as low body weight, smoking, high alcohol consumption, steroid/hormone therapy, or relevant medical history were excluded. A total of 247 healthy controls and 57 osteoporosis patients were included. Genotyping was performed using the Illumina Infinium HumanExome BeadChip and the Affymetrix Axiom Exome Array. Data were analyzed using the SNP and Variation Suite and PLINK, with quality control thresholds set at MAF ≥ 0.05 and HWE p ≥ 0.01. Functional annotation and protein structure predictions were performed using PolyPhen-2, SIFT, and PROVEAN. Genome-wide association analyses identified 113 single-nucleotide polymorphisms (SNPs) in 69 genes significantly associated with osteoporosis (p < 0.05) in both platforms, with 18 SNPs showing high cross-platform consistency (p < 0.01). Several of these genes were implicated in bone metabolism (e.g., ESRRG, PECAM1, COL6A5), vitamin D metabolism (e.g., NADSYN1, EFTUD1), skeletal muscle function (e.g., PACSIN2, ESRRG), and reproductive processes (e.g., CPEB1, EFCAB6, ASXL3). Notably, the CPEB1 rs783540 SNP exhibited the strongest association (p < 0.001) in both analyses. Our findings suggest that genetic polymorphisms in pathways related to bone metabolism, vitamin D signaling, muscle–bone interaction, and reproductive hormone regulation may contribute to the development of osteoporosis in Korean premenopausal women. These results provide a genetic basis for early identification of at-risk individuals and warrant further functional studies to elucidate the underlying mechanisms. Full article

Background: Circus arts are gaining popularity across the globe and lifespan. Despite growing participation rates, there is limited high-quality evidence describing the physical therapy evaluation and management of injury within this population. The purpose of this scoping review was to identify and summarize evidence related to the injury characteristics and management of circus artists. Methods: With a research librarian, computerized searches were developed and performed using online databases (PubMed, CINAHL, Scopus, SPORTDiscus and Cochrane), gray literature and non-medical databases. Two authors independently voted on article inclusion with a third author blinded to previous voting used in case of conflict. Concept mapping identified five primary themes related to circus injuries and physical therapy treatment. Data was extracted from each article based on content relevant to the classification. Results: In total, 1095 titles were retrieved from electronic searches, of which 49 studies were included. Overall, 20 studies related to injury characteristics, 10 to risk factors, 9 to each psychosocial variables and interventions, and 8 to screening. Acrobats with required ground elements were the most commonly injured discipline, particularly at the shoulder, ankle and spine. Intrinsic and extrinsic risk factors were identified and numerous psychosocial and lifestyle contributing factors were reported. Literature guiding treatment is limited. Conclusions: This scoping review mapped and synthesized evidence related to the evaluation and management of circus artist injuries. While injury patterns and characteristics are generally understood, the treatment of this population is poorly described. Clear gaps in screening, injury prevention strategies, and interventions for this group were identified. Full article

Synergizing soil quality improvement and greening for increased yields are essential to ensuring grain security and developing sustainable agriculture, which has become a key issue in agricultural cultivation. This study considers a contract farming supply chain composed of a risk-averse farmer and a risk-neutral firm making green and efficient technology (GET) investments, which refers to the use of technology monitoring to achieve fertilizer reduction and yield increases with yield uncertainty. Based on the CvaR (Conditional value at Risk) criterion, the Stackelberg game method is applied to construct a two-level supply chain model and analyze different cooperation mechanisms. The results show that when the wholesale price is moderate, both sides will choose the cooperative mechanism of cost sharing to invest in technology; the uncertainty of yield and the degree of risk aversion have a negative impact on the agricultural inputs and GET investment, and when yield fluctuates greatly, the farmer invests in GET to make higher utility but lowers profits for the firm and supply chain. This study provides a theoretical basis for GET investment decisions in agricultural supply chains under yield uncertainty and has important practical value for promoting sustainable agricultural development and optimizing supply chain cooperation mechanisms. Full article

Background/Objectives: Low back pain is considered one of the leading causes of disability. Up to 90% of cases are classified as non-specific, which, if prolonged for at least 12 weeks, is considered non-specific chronic low back pain (NSCLBP). Physical exercise is one of the selected treatments for NSCLBP. Interest in the use of remote interventions has recently emerged. The main objective was to analyze the effect of home exercise interventions to reduce pain intensity and functional disability in individuals with NSCLBP. Methods: A systematic review was conducted in April 2024. Both multivariate and univariate meta-analysis was performed with the difference before and after treatment, adjusting both models with a meta-regression that included the covariates age and body mass index (BMI). Heterogeneity was analyzed with Cochran’s Q test as well as with the I² estimator, and effect size was calculated with Hedges’G. Results: A total of six studies, with moderate–high methodological quality and a heterogeneous risk of bias, were included. There was a statistically significant pre-/post-treatment effect on functional disability (moderate effect: Hedge’s g = 0.69, p = 0.018) and pain intensity (large effect: Hedge’s g = 1.11, p = 0.007) in both univariate and multivariate (moderate effect: Hedge’s g = 0.77) meta-analyses when comparing unsupervised home exercise with supervised in-person exercise, in favor of the latter. This effect was significantly moderated by BMI (p = 0.003 for both outcomes) negatively. Conclusions: Unsupervised home exercise appears to be less effective than supervised in-person exercise in effectively reducing pain intensity and functional disability in the short term in individuals with NSCLBP. Full article

Obesity (lipotoxicity) results from a chronic imbalance between energy intake and expenditure. It is strongly associated with type 2 diabetes mellitus (T2DM, glucotoxicity) and considered a major risk factor for the development of metabolic complications. Their convergence constitutes “diabesity”, representing a major challenge for public health worldwide. Limited treatment efficacy highlights the need for novel, multi-targeted therapies. Non-shivering thermogenesis (NST), mediated by brown and beige adipose tissue and skeletal muscle, has emerged as a promising therapy due to its capacity to increase energy expenditure and improve metabolic health. Also, skeletal muscle plays a central role in glucose uptake and lipid oxidation, further highlighting its relevance in diabesity. This review explores current and emerging knowledge on physiological stimuli, including cold exposure, physical activity, and fasting, as well as bioactive ingredients and drugs that stimulate NST in thermogenic tissues. Special emphasis is placed on melatonin as a potential regulator of mitochondrial function and energy balance. The literature search was conducted using MEDLINE and Web of Science. Studies were selected based on scientific relevance, novelty, and mechanistic insight; prioritizing human and high-quality rodent research published in peer-reviewed journals. Evidence shows that multiple interventions enhance NST, leading to improved glucose metabolism, reduced fat accumulation, and increased energy expenditure in humans and/or rodents. Melatonin, in particular, shows promise in modulating thermogenesis through organelle-molecular pathways and mitochondrial protective effects. In conclusion, a multi-target approach through the activation of NST by physiological, nutritional, and pharmacological agents offers an effective and safe treatment for diabesity. Further research is needed to confirm these effects in clinical practice and support their use as effective therapeutic strategies. Full article

The incentive mechanism functions as a core safeguard to ensure the efficient execution of consortium-based Public–Private Partnership (PPP) projects and the realization of value-added outcomes. The heterogeneity of consortium members, their reciprocal preferences, and the collaborative dynamics of the team collectively contribute to the formation of project alliances characterized by resource synergy, complementary advantages, and risk sharing. However, these same factors also contribute to the multi-layered structure of principal–agent relationships and the inherent complexity of incentive pathways and mechanisms in consortium-based PPP settings. Drawing upon the team collaboration effect and reciprocal preferences among consortium members, this study incorporated the member heterogeneity and developed three incentive models for such projects, such as the Dual-Performance (DP) mode, the Total-Performance (TP) mode, and the Individual-Performance (IP) mode. This study examined the conditions under which these incentive modes were established, the relationship between incentive intensity and optimal effort levels of consortium members, and the influence of reciprocal preferences on incentive effectiveness. Further, the selection criteria and appropriate application scenarios for each of the three incentive models were analyzed according to a comparative analysis, thereby putting forward effective suggestions for improving the effort levels of private investors in consortium-based PPP projects. The study results indicate that team synergy effects play an imperative role in improving the optimal effort levels under all three modes, whereas reciprocity preferences exhibit a negative relationship with effort in the DP and TP modes. When reciprocity remains within a moderate range, the DP mode achieves highest aggregate effort levels, whereas the IP mode induces positive incentive effects only under extreme reciprocity conditions. Thus, the application of dual incentive coefficients can enhance operational adaptability and allocative efficiency and governments should establish a multidimensional collaborative incentive for consortium-based PPP projects to strengthen effectiveness and project quality. This comprehensive evaluation provides crucial insights for policymakers, emphasizing the strategic selection of incentive mechanisms to enhance the sustainability and effectiveness of consortium-based PPP Projects. Full article

Background/Objectives: The assessment of motor development in early ages is considered fundamental for the early identification of alarm signs that indicate the possibility of a child suffering from a developmental disorder. To this end, it is necessary to use reliable evaluation tools that have been specifically validated in the target population. The main aim of the current review was to examine the existing motor development assessment tools validated in Spanish populations of children aged 0–18 months. Methods: A systematic review was carried out following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) declaration criteria, and it was registered in PROSPERO. A bibliographic search was conducted in the PubMed, Scopus, Web of Science, and Cochrane databases, using terms related to motor development, assessment tools, and validation. The COSMIN verification list was employed to evaluate the quality of the included scales, and the QUADAS-2 instrument was used to analyse the quality of the included studies. Results: A total of 7 studies were included in the review, all of which were validation studies of motor development assessment tools in Spanish populations of children aged 0–18 months. Moreover, they all show heterogeneity with respect to their characteristics, such as target population, sample size, and metric properties. Conclusions: The present systematic review provides relevant information about the characteristics and methodological quality of motor development assessment tools validated in Spanish populations. There are currently very few of these evaluation tools, as well as limitations in regard to theories that support them, their metric properties, and the methodological quality of their validation studies. Therefore, we confirm the need for validating updated motor development tools to improve the detection, prognosis, and evaluation of children with developmental disorders or at risk of suffering from them. Full article

Objective: This umbrella review aims to analyze the effectiveness of exercise therapy for low back pain through an analysis of systematic reviews that evaluate pain reduction, quality of life improvement, and functional outcomes. Methods: This review adhered to PRISMA guidelines and systematic review of review recommendations by searching across PubMed, Scopus, and the Cochrane Library. This study searched for systematic reviews alongside meta-analyses that evaluated exercise interventions in treating low back pain (LBP). This study included reviews that examined exercise therapy for LBP patients and presented data regarding their pain intensity, disability, and quality-of-life outcomes. Data extraction and quality assessment were performed independently by several reviewers. The methodological quality of the included systematic reviews was assessed using the AMSTAR 2 tool. Results: This research yielded 88 systematic reviews from 997 evaluated records. Reduction of pain emerged as the primary measured outcome in systematic reviews (81.8%, n = 72), and these studies showed significant improvement rates of 83.0%. The proportion of studies that concluded no change was 9.1%. The most frequently studied exercises were strengthening, aerobic, and mind–body exercises. The reviews reported quality of life improvements in 27.3% (n = 24), but most reviews (68.2%) did not assess this outcome. No studies indicated worsening outcomes. Exercise interventions demonstrated various forms that effectively contribute to LBP management, according to the study results. Conclusions: This umbrella review of 88 systematic reviews highlights that exercise therapy is a safe, effective, and commonly used strategy for managing low back pain. However, key limitations include the low methodological quality of several included reviews, risk of bias, imprecision, limited reporting of adverse effects, and confounding from multicomponent interventions. While there is limited certainty that any one type of exercise is more effective than others, individualized approaches and patient adherence appear to be critical factors in optimizing outcomes. Full article