Search Results (13,400)

Background: Proton pump inhibitors (PPIs) are widely used to prevent acid-related complications, yet concerns persist about infectious harm. Observational studies have linked PPIs to Clostridioides difficile infection (CDI) and pneumonia whereas randomized controlled trials (RCTs) consistently show reductions in upper gastrointestinal bleeding. We therefore conducted a systematic review and meta-analysis restricted to randomized controlled trials to evaluate whether PPIs increase the risk of CDI, and to assess pneumonia and gastrointestinal bleeding to contextualize net clinical benefit. Methods: A comprehensive search of randomized controlled trials (RCTs) was conducted using several databases including PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and SCOPUS until July 2025. All published English-language RCTs that met the inclusion criteria were included. Random-effects models were utilized to calculate pooled odds ratios (ORs) with 95% confidence intervals. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 Tool, and heterogeneity was quantified using I² statistics. Analysis was performed using STATA version 18 and RevMan 5.3. Results: Across eight RCTs (n = 30,019), PPIs did not increase C. difficile infection versus placebo (OR 1.29, 95% CI 0.82–2.02; p = 0.27; I² = 16%) with leave-one-out (LOO) analyses showing stable estimates. In six trials reporting pneumonia, there was no significant difference between groups (OR 1.00, 95% CI 0.92–1.09; p = 0.99; I² = 0%). For clinically important upper GI bleeding (seven trials), PPIs were associated with a statistically significant lower risk when compared to placebo (OR 0.51, 95% CI 0.27–0.94; p = 0.03; I² = 56%). Conclusions: Across randomized trials with follow-up ranging from 30 days to 3 years, PPI prophylaxis significantly reduced upper gastrointestinal bleeding without increasing the risk of CDI or pneumonia. These findings support the use of PPIs for prophylaxis when clinically indicated, while recognizing that larger trials are needed to better assess rare adverse events. Full article

The existing fruit tree yield prediction methods mainly rely on fruit period images or long-term meteorological and soil data, which make it difficult to meet the needs of early yield prediction. In addition, the flowering period images contain complex spatial distribution and severe overlap between flowers, which makes it challenging to directly extract stable structural indicators related to yield. Most existing research has focused on simple statistical indicators such as the number of flowers, while the spatial clustering structure of flowers and their relationship with yield have not been fully explored. Therefore, this article proposes an early apple yield prediction based on flowering stage image thinning simulation characteristics. In this study, blossom images and fruit maturity yield data from 100 apple trees were collected, with flower mask images extracted through standardized image processing. First, the traditional DBSCAN clustering algorithm was enhanced by integrating a KDTree acceleration structure and an adaptive multi-scale mechanism, forming the adaptive multi-scale clustering algorithm (AMS-DBSCAN) to achieve efficient identification of flower clusters and individual flowers. Based on this, two flower thinning simulation strategies based on density and spatial uniformity were designed to model artificial thinning rules and construct multi-dimensional, interpretable phenotypic features. Then, the original statistical features were fused with strategy-generated features and optimized using Lasso. We compared multiple models including XGBoost, BPNN, and SVR for yield prediction. The experimental results showed that XGBoost achieved good predictive performance under the hybrid feature set (R² = 0.856, RMSE = 3.098), which was further improved to R² = 0.900 after feature optimization with Lasso. The results demonstrate that the proposed method enables reliable early yield estimation, providing a new reference for precision management and early decision-making in fruit tree cultivation. Full article

Background: Nutritional status and lifestyle factors are increasingly recognized as relevant modulators of women’s reproductive health. However, data remain limited on the relationship between body composition, dietary habits, and menstrual cycle characteristics in apparently healthy young women. This study aimed to assess nutritional status, body composition, and lifestyle behaviors in young women and to explore their associations with menstrual cycle regularity. Methods: This cross-sectional study included 49 apparently healthy women aged 19–30 years. Anthropometric measurements and body composition were assessed using bioelectrical impedance analysis. Dietary habits were evaluated through a simplified food frequency questionnaire, and adherence to the Mediterranean diet was assessed using the PREDIMED score. Physical activity was estimated using MET values based on the Compendium of Physical Activities. Menstrual cycle characteristics were collected via questionnaire. Group comparisons were performed between women with regular and irregular menstrual cycles. Results: The sample was predominantly normal-weight (mean BMI 22.36 ± 4.26 kg/m²). Anthropometric and bioelectrical impedance parameters did not differ significantly between women with regular and irregular cycles. Women with irregular cycles showed higher resistance and extracellular water and lower phase angle and body cell mass, although differences were not statistically significant. A significant association was found for meat consumption, which was lower in women with irregular cycles (p = 0.007). No associations were observed for other dietary variables, physical activity, or meal frequency. Conclusions: Menstrual regularity in young women was not associated with major anthropometric differences but may be linked to subtle aspects of nutritional status and dietary habits. Lower meat consumption emerged as a potential dietary factor associated with menstrual irregularity. Although associations were modest, these findings support the relevance of nutritional and lifestyle factors in menstrual health. Larger longitudinal studies are needed to clarify these relationships. Full article

Hyperspectral imagery (HSI) offers rich spectral signatures and fine-grained spatial structures for remote sensing, but practical HSI classification is often constrained by scarce labels and complex geometric disturbances, including translation, rotation, scaling, and shear. Existing deep models are typically developed under Euclidean assumptions and rely on data-hungry training pipelines, which makes them brittle in the few-shot regime. To address this challenge, we propose EMNet, a Lie-group-based Equivariant Manifold Network for few-shot HSI classification that explicitly encodes geometric invariance and improves discriminative accuracy. EMNet couples an SE(2)-based Equivariance-Guided Module (EGM) to enforce equivariance to translations and rotations with an affine Lie-group-based Characteristic Filtering Convolution (CFC) that models scaling and shearing on the feature manifold while adaptively suppressing redundant responses. Extensive experiments on WHU-Hi-HongHu, Houston2013, and Indian Pines demonstrate state-of-the-art performance with competitive complexity, achieving OAs of 95.77% (50 samples/class), 97.37% (50 samples/class), and 96.09% (5% labeled samples), respectively, and yielding up to +3.34% OA, +6.01% AA, and +4.14% Kappa over the strong DGPF-RENet baseline. Under a stricter 25-samples-per-class protocol with 10 repeated random hold-out splits, EMNet consistently improves the mean accuracy while exhibiting lower variance, indicating better stability to sampling uncertainty. On the city-scale Xiongan New Area dataset with extreme long-tail imbalance (1580 × 3750 pixels, 256 bands, and 5.925 M labeled pixels), EMNet further boosts OA from 85.89% to 93.77% under the 1% labeled-sample protocol, highlighting robust generalization for large-area mapping. Beyond point estimates, we report mean ± SD/SE across repeated splits and provide rigorous statistical validation by computing Yule’s Q statistic for class-wise behavior similarity, performing the Friedman test with Nemenyi post hoc comparisons for multi-method ranking significance, and presenting 95% confidence intervals together with Cohen’s d effect sizes to quantify practical improvement. Full article

Informal public transportation remains the backbone of urban mobility in many developing cities. While these systems offer flexible and affordable services, they are often associated with safety issues, unreliability, congestion, and environmental impacts. Consequently, transitioning travelers toward formal public transportation is a key objective for sustainable transport planning. This study investigates travelers’ willingness to shift from their current travel modes to a proposed Metro system in Alexandria, Egypt. The analysis uses stated preference data collected through interviews that presented respondents with multiple service scenarios. A correlated random parameters bivariate probit model with heterogeneity in means is estimated to capture interdependence between responses. The results reveal strong and statistically significant cross-equation error correlations, confirming that decisions are not independent and supporting the use of a joint modeling approach. Empirical results indicate that willingness to shift is influenced by socio-demographic characteristics, trip attributes, and current travel conditions. Female travelers are more sensitive to waiting time, while low-income and older individuals are less likely to shift across scenarios. Physical accessibility, especially walkability to and from stations, emerges as the most influential factor in encouraging adoption. These findings provide policymakers with actionable insights for designing inclusive, accessible, and sustainable public transportation systems. Full article

Background: Tuberculosis (TB) has long been suspected to contribute to lung carcinogenesis through chronic inflammation and immune dysregulation. However, contemporary controlled evidence quantifying this association remains limited. We aimed to systematically evaluate the relationship between prior TB and subsequent lung malignancy, using recent observational studies and complementary case reports. Methods: A systematic review and random-effects meta-analysis were conducted, including controlled cohort and case–control studies published from 2020 onward. Adjusted effect estimates were converted to the logarithmic scale for pooling. Heterogeneity and small-study effects were assessed using standard meta-analytic techniques. Additionally, published case reports were descriptively analyzed to explore clinicopathological patterns. Results: Across eligible studies, prior TB was consistently associated with an increased risk of subsequent lung cancer (LC). The pooled estimate demonstrated a statistically significant positive association, despite moderate heterogeneity. Larger nationwide cohorts contributed greater statistical weight, while smaller studies showed wider variability. Case reports revealed heterogeneous temporal patterns, including long-latency scar-associated carcinoma and concurrent inflammatory–malignant presentations. Conclusions: Contemporary controlled evidence supports an association between prior tuberculosis and increased risk of subsequent lung malignancy. However, despite strong biological plausibility and the abundant literature on cancer-associated tuberculosis, modern longitudinal studies specifically evaluating tuberculosis as a preceding independent risk factor remain limited. The small number of eligible post-2020 investigations identified in this meta-analysis highlights a significant contemporary research gap and underlines the need for well-designed prospective studies to clarify causality and guide surveillance strategies in TB-exposed populations. Full article

Huber regression serves as a prominent robust alternative to ordinary least squares (OLS), particularly in the presence of heavy-tailed error distributions. While the asymptotic relative efficiency (ARE) of Huber regression is well documented for the standard normal distribution, its worst-case efficiency across the class of all continuous and symmetric error distributions remains an important theoretical question. In this paper, we establish positive lower bounds for the ARE of Huber regression relative to OLS. By strategically selecting the robustification parameter based on the moments or quantiles of the error distribution, we first prove that the ARE is uniformly bounded away from zero across all continuous and symmetric error distributions. This result guarantees a baseline level of efficiency for Huber regression, sharing a similar theoretical spirit with the celebrated lower bound of the Wilcoxon rank estimator. Utilizing the empirical process theory, we further establish that the relative efficiency of Huber regression remains unchanged if the theoretical tuning parameter is replaced by an estimator with a suitable convergence rate. Simulation studies are conducted to examine the performance of Huber regression under the proposed tuning strategies. Full article

Background: Short-term facilitation (STF) is a key form of synaptic plasticity driven by activity-dependent increases in presynaptic release probability. However, estimating core synaptic parameters—quantal size ($q$), vesicle pool size ($N$), and release probability ($p_i$)—remains challenging due to nonlinear dynamics and unobservable presynaptic states, limiting the applicability of conventional methods. Methods: We developed a fast analytical framework based on first- and second-order statistical moments of evoked EPSCs, including mean, variance, and cross-stimulus covariance. By constructing composite moment relationships, latent variables were algebraically eliminated, yielding closed-form estimators of synaptic parameters. To improve robustness under strong facilitation, a Tsodyks–Markram (T–M) model-based calibration step was introduced to refine $N$ and $p_i$ using the estimated $q$ as a constraint. Results: Applied to hippocampal CA3–CA1 synapses, the method produced accurate and stable estimates of q across varying noise and sampling conditions. Incorporation of cross-stimulus covariance enabled effective characterization of structured variability that is neglected in classical approaches. While direct estimates of $N$ and $p_i$ showed dispersion, T–M calibration significantly improved stability and physiological consistency. Compared with mean–variance analysis, the proposed method achieved superior performance under facilitating conditions. Conclusions: This hybrid framework enables rapid and reliable estimation of synaptic parameters in STF synapses by exploiting second-order statistical structure. It provides a practical tool for investigating presynaptic mechanisms and may facilitate quantitative studies of synaptic dysfunction in neurological and psychiatric disorders. Full article

This study presents a comprehensive multi-parameter analysis of seismo-ionospheric responses to the Mw 7.7 Myanmar earthquake on 28 March 2025, using GNSS-based Total Electron Content (TEC) data, seismic b-value trends, and acoustic gravity wave (AGW) signatures. A significant negative TEC anomaly (~30 TECU below the statistical threshold) was detected on 25 March, three days before the mainshock under geomagnetically quiet conditions, indicating a lithospheric origin. Concurrent variations in the Ionospheric Disturbance Index (IDI) and Rate of TEC Index (ROTI) indicate pronounced background departures and enhanced short-term variability during the preparation phase. Temporal b-value analysis shows a consistent decline from 1.12 to 0.58 across the 30-year to 6-month windows, with the lowest values clustering near the epicenter, indicating progressive stress accumulation. Spatial b-value mapping further reveals a low b-value zone overlapping the region of TEC depletion, while the Relative Seismic Hazard Index (RSHI) highlights high-hazard zones aligned with the epicentral area. Kernel density estimation (KDE) supports this coupling by showing a dominant low-b, low-vTEC cluster, consistent with linked lithospheric stress and ionospheric depletion. Overall, the integrated GNSS and seismic analyses demonstrate the value of multi-domain observations for characterizing earthquake preparation processes, highlighting a coherent physical linkage between crustal stress accumulation and ionospheric depletion that can enhance short-term seismic hazard assessment. Full article

Background/Objectives: This study evaluates the efficacy of hypoglossal nerve stimulation as an alternative intervention for pediatric patients with obstructive sleep apnea (OSA) unresponsive to standard therapies and examines the uniformity of therapeutic outcomes across different patient cohorts. Methods: An extensive systematic search was performed across four principal databases (PubMed, EMBASE, Cochrane Library, and Web of Science) utilizing keywords associated with pediatric OSA and hypoglossal nerve stimulation, encompassing studies up to July 2025 that provided objective polysomnographic metrics (e.g., apnea-hypopnea index [AHI] values) to enable the quantitative assessment of pre- and post-intervention effects in children. The primary outcome measured was the ratio of means (ROM), determined from pre–post data in single-group studies, with summary estimates obtained using the fixed-effects model. Results: The systematic review included nine eligible studies with a total of 140 pediatric subjects, the majority of whom were adolescents with Down syndrome. AHI meta-analysis outcomes indicated a marked improvement in OSA severity, yielding an overall ROM of 0.57 [95% confidence interval: 0.49–0.65]. The therapeutic benefit demonstrated a high degree of uniformity across cohorts, as indicated by minimal statistical heterogeneity (I² = 16%, p = 0.30). Funnel plot assessment showed no statistically significant evidence of systematic publication bias. Conclusions: Current evidence suggests that hypoglossal nerve stimulation therapy is a safe, effective, and valuable alternative for pediatric OSA patients who do not respond to conventional therapies. Full article

Background and Objectives: Invasive lobular carcinoma (ILC) is a breast cancer subtype with a controversial surgical management due to its diffuse infiltrative growth pattern and increased tendency for multicentricity. This study aimed to compare the effects of breast-conserving surgery (BCS) and mastectomy on long-term overall survival (OS) and progression-free survival (PFS) in patients diagnosed with ILC. Materials and Methods: In this single-center, retrospective, observational study, 255 patients with histopathologically confirmed ILC between 2017 and 2025 were included. Patients who underwent surgical treatment were divided into two groups according to the surgical approach: BCS (n = 94) and mastectomy (n = 141). Survival analyses were performed using the Kaplan–Meier method, and comparisons between groups were assessed with the log-rank test. Factors affecting survival were evaluated using Cox regression analysis. Results: The median age of the patients was 53 years (range, 28–85), and the median follow-up duration was 31.8 months. Of the cases, 76.9% were classic-type ILC and 70.9% had stage I–II disease. The rate of negative surgical margins was 87.6%. No statistically significant differences were observed between the BCS and mastectomy groups in terms of estimated median PFS (87.4 months vs. 86.7 months; p > 0.05) or estimated median OS (87.7 months vs. 115.7 months; p > 0.05). Multivariable analyses demonstrated that the type of surgery was not an independent prognostic factor for survival. Conclusions: This study shows that, with appropriate patient selection and adequate surgical margin control, BCS provides oncologic survival outcomes comparable to mastectomy in ILC. The choice of surgical approach should be individualized based on tumor biology, stage, and multidisciplinary evaluation rather than histological subtype alone. Full article

Sewerage systems are a main element of a city’s infrastructure. Roughness coefficients are fundamental parameters for sewage system operation. The intermittent nature of the flow leads to the appearance of deposits that become an integral part of the sewerage systems. Deposited material not only leads to the loss of hydraulic capacity and decreases the concentration of dissolved oxygen (which is found in direct relation to all quality parameters), but it also results in more transported particles being intercepted. In the design calculations, the roughness coefficient is estimated rather than calculated. It has been demonstrated that the estimation of stress within and above roughness elements improves the predictive capability for the concentration of suspended sediment. In this study, we focused on a local evaluation of the roughness coefficient when the flow velocity is below the minimum self-cleansing velocity. Some authors consider the selection of the most reliable method for estimating bed shear stress to be the main challenge. Other authors have suggested that all possible methods should be applied simultaneously to achieve a reliable bed shear stress estimation, knowing that the roughness coefficient can be determined through the shear boundary stress. We calculate the local roughness coefficient in Manning’s equation using a laboratory model, considering clear water flowing over a solid boundary with consolidated deposits, represented by artificial roughness elements (calibrated hemispheres). The European standard EN 752:2017 specifies a minimum average cross-sectional velocity of 0.7 m/s for pipe self-cleansing. This study established the range of possible roughness coefficient values when the minimum velocity design criterion is not met. The second criterion was to consider acceptable a sediment deposit occupying between 1% and 2% of the collector diameter. Velocity distributions around artificial roughness and statistical parameters of the turbulent flow were obtained using a PIV system. Five methods were implemented and the range of roughness coefficient values varied between 0.007 and 0.023. This variation is closely related to sewer performance. We selected the dissipation method as the primary reference for this study, as it is most closely aligned with the underlying physics of flow over roughness elements. This approach allows for robust validation by correlating multiple characteristic mechanisms of the turbulent cascade. Full article

Peatlands cover approximately 10% (640,000 ha) of Latvia’s territory, of which about 51,000 ha is officially classified as degraded due to peat extraction and related activities. This study assesses the current status of peat extraction site recultivation in Latvia and evaluates future after-use requirements under contrasting policy pathways using a review of scientific literature, project reports, national statistics, and updated peat extraction licence records. A simple allocation model was applied to estimate recultivation trajectories for the nationally defined degraded peatland area under two scenarios: (i) a licence-expiry baseline scenario and (ii) an accelerated immediate-stop-peat-mining scenario. The results show that full recultivation would require average annual efforts of approximately 1500 ha yr⁻¹ under the baseline scenario and around 2000 ha yr⁻¹ under the accelerated scenario. Although European Union-funded projects and corporate initiatives have demonstrated the potential of rewetting, paludiculture, and renewable energy integration, only a limited number of sites have been officially recognised as fully recultivated or restored. Because ecological recovery of peatland functions may take decades, administrative closure alone does not guarantee climate or biodiversity benefits. A phased recultivation strategy linked to licence expiry and prioritising degraded and self-regenerating sites emerges as the most pragmatic pathway for Latvia, balancing European Union climate objectives, institutional capacity, and socio-economic constraints. Full article

This study investigates how historical variability in construction materials influences the seismic fragility of reinforced concrete (RC) buildings in Bucharest. Mechanical properties of reinforcing steels (OB37, TOR47, and PC52) and concretes used between 1950 and 2000 are statistically characterized using archival records and experimental data. The analysis highlights significant discrepancies between prescribed and in situ concrete strengths, as well as substantial differences in ductility, overstrength, and strength variability among historical steel types. To evaluate structural implications, a representative 11-storey pre-1970 RC building is modeled using nonlinear static and incremental dynamic analysis. The results show markedly lower capacity and higher fragility in the transversal direction. Time-dependent deterioration is examined by incorporating carbonation-induced reinforcement corrosion using FIB-based formulations. Even moderate corrosion leads to measurable reductions in stiffness, ductility, and lateral capacity, producing higher fragility across all considered damage states. Seismic loss estimations further demonstrate an increase in expected annual losses for both principal directions when corrosion is considered. The findings underscore the need for era-specific material models and deterioration mechanisms to achieve accurate seismic vulnerability assessments of Bucharest’s aging RC building stock. Full article

Objectives: To evaluate extrusion-free survival following glaucoma drainage device (GDD) surgery using EverPatch Plus^® (EPP) and to compare outcomes with conventional scleral patch grafts using propensity score-based survival analysis. Methods: This retrospective case series included 19 eyes that underwent GDD implantation with EPP and 105 control eyes that received conventional scleral patch grafts. To adjust for baseline differences between groups, a propensity score for EPP use was estimated using multivariable logistic regression incorporating age, neovascular glaucoma, prior glaucoma surgery, preoperative intraocular pressure, number of glaucoma medications, quadrant of patch placement, and insertion site. Stabilized inverse probability of treatment weighting was applied. Because follow-up in the EPP group did not exceed 12 months, all survival analyses were performed with administrative censoring at 12 months. Extrusion-free survival was evaluated using Kaplan–Meier analysis and Cox proportional hazards modeling. Results: Within 12 months, patch extrusion occurred in 3 of 19 eyes in the EPP group and in 12 of 105 eyes in the scleral patch graft group. After inverse probability weighting, estimated 12-month extrusion-free survival was 83.5% in the EPP group and 88.4% in the scleral patch graft group, indicating no statistically significant difference between groups (log-rank test, p = 0.498). In an inverse probability-weighted Cox model, EPP use was not significantly associated with extrusion risk (hazard ratio ≈ 1.3; 95% confidence interval ≈ 0.4–4.0). Conclusions: After adjustment for baseline covariates and restriction of follow-up to 12 months, extrusion-free survival following glaucoma drainage device surgery using EPP was comparable to that achieved with conventional scleral patch grafts. Full article