Search Results (340)

Background: Anterior cruciate ligament reconstruction (ACLR) is the standard of care for ACL injuries, and graft choice may influence the recovery of function assessed with vertical jump tests. Objective: To evaluate the effect of graft type on vertical jump performance in adults after ACLR and to synthesise the differences between grafts. Material and Methods: This systematic review was conducted in accordance with the PRISMA 2020 and SWiM guidelines. The following databases were searched: Scopus, Web of Science, PubMed, MEDLINE and SPORTDiscus (EBSCOhost), up to 31 January 2026. Studies with an unambiguously defined graft type and objective jump tests (CMJ, SL CMJ/SL VJ, DVJ/DJ, SJ) were included. Risk of bias was assessed using the RoB 2, ROBINS-I, JBI and MINORS tools, and the certainty of evidence using the GRADE approach. Because of substantial clinical and methodological heterogeneity, a structured narrative synthesis was performed in accordance with the SWiM guidelines; no pooled analysis was undertaken. Results: Forty-seven studies (>3400 participants) were included. BPTB was associated with greater eccentric-phase asymmetry in the bilateral CMJ in the early/intermediate phase compared with HT, with equalisation after 9–12 months. QT provided jump height comparable to HT but a more favourable dynamic valgus profile. Autograft and allograft did not differ in jump performance. Deficits followed a biphasic course: normalisation of symmetry after approximately 2 years, with reduced height/power for up to 5 years. Conclusions: Forty-two of the studies (89.4%) were non-randomised, and the certainty of evidence was low for one clinical question and very low for all others. Studies comparing BPTB with HT showed an association suggesting greater eccentric-phase asymmetry in the bilateral CMJ in the early and intermediate phase after BPTB, but findings were inconsistent and two studies reported no difference. Evidence suggesting that these differences equalise after 9–12 months derives from between-study comparisons. Jump height did not differ between QT and HT; a single study of 26 patients reported smaller dynamic valgus after QT. Autograft and allograft did not differ in vertical jump performance. Registration: This review was registered in the PROSPERO database and is available under the number CRD420261386307. Full article

Background and Objectives: Topical diclofenac is recommended over oral non-steroidal anti-inflammatory drugs (NSAIDs) for osteoarthritis, particularly in older adults and those with comorbidities, on the assumption that low systemic absorption limits renal effects. Whether this presumed safety extends to patients already at increased risk of kidney injury has not been systematically evaluated. This review assessed the evidence on renal outcomes of topical diclofenac in adults. Materials and Methods: We conducted a systematic review (PROSPERO CRD420261393454) of studies reporting renal outcomes after topical diclofenac exposure. PubMed, Embase, Web of Science, and Scopus were searched from inception to 19 April 2026. Studies were stratified a priori into increased-renal-risk and general populations and synthesised separately, without pooling. Risk of bias was assessed with RoB 2, ROBINS-I, and JBI tools, certainty with GRADE, and synthesis followed the SWiM framework. Results: Eighteen studies, contributing data from more than 500,000 participants, were included; 14 underwent primary risk-of-bias appraisal (three at low, three at serious or high risk). In general populations, topical diclofenac produced little to no change in serum creatinine or creatinine clearance and smaller renal effects than oral diclofenac, providing high-certainty evidence of a favourable profile. In increased-renal-risk populations, one adjusted cohort reported higher acute kidney injury (AKI) risk among topical NSAID users, although exposure was predominantly to non-diclofenac agents; within the same cohort, topical NSAIDs carried lower risk than systemic NSAIDs. No study evaluated early renal injury biomarkers; certainty was moderate owing to indirectness. Conclusions: Relative to oral diclofenac, topical diclofenac shows a favourable renal safety profile, with high-certainty evidence in general populations. In adults at increased renal risk, moderate-certainty evidence derived from predominantly non-diclofenac exposure over short observation windows cannot exclude a modest excess of any-stage AKI; renal risk therefore appears reduced rather than absent. Diclofenac-specific studies in chronic kidney disease using sensitive biomarkers and longer follow-up are needed. Full article

The Smart Readiness Indicator (SRI) provides a European framework for assessing the capacity of buildings to optimise operation, respond to occupants and interact with energy grids. Its current catalogue covers nine domains: heating, cooling, domestic hot water, ventilation, lighting, dynamic envelope, electricity, electric vehicle charging, and monitoring and control. This Perspective argues that this boundary is too narrow for complex buildings, where services such as lifts, security, fire safety, swimming pools, irrigation, outdoor lighting, kitchens, laundries, refrigeration, laboratories, and information and communication technology (ICT) rooms may significantly affect energy use, water use, safety, resilience, maintenance and user experience. The paper proposes five additional service families for SRI 2.0: mobility and accessibility; safety and security; water and outdoor environmental services; outdoor and site infrastructure; and special energy-intensive and facility services. These should be introduced as optional, building-type-specific modules assessed through familiar SRI functionality levels. This would make the SRI more realistic, actionable and relevant. Full article

Background: Iron deficiency anemia (IDA) is among the most prevalent nutritional disorders worldwide and a growing public health concern among women in Saudi Arabia. Available Saudi evidence remains fragmented, with single-center studies that vary by population, region, and diagnostic criteria. This review evaluated the prevalence of anemia in Saudi Arabia, assessed gender-related differences across the lifespan, and highlighted local determinants and prevention strategies relevant to women. Methods: Eight cross-sectional studies (26,412 participants) reporting anemia prevalence in Saudi individuals aged ≥13 with both-sex data were identified across five databases (2007–2024), excluding chronic-disease and under-13 studies. Quality was appraised with the JBI checklist, and because of substantial heterogeneity, findings were synthesized narratively by population group (SWiM guideline) rather than pooled. Results: Anemia was consistently more prevalent in women than men across all population groups and regions. Female prevalence ranged from about 18–22% in older and community adults to over 65% in female university students, whereas male prevalence ranged from none detected to 28% in a hospital-based sample. The lowest mean hemoglobin (10.4 g/dL) occurred in young women. Between study heterogeneity was considerable (I² > 99%) and persisted within sex subgroups, so findings were synthesized by population group rather than pooled into a single estimate. Conclusions: Anemia remains a significant public health challenge among women in Saudi Arabia, shaped by an interacting set of dietary, sociocultural, hereditary, and health-system determinants specific to the local context. Beyond confirming the female burden, this review consolidates fragmented national evidence, appraises its quality, and translates the findings into targeted recommendations: dietary counseling to address local inhibitors of iron absorption, screening during peak-risk periods, and integration with existing premarital screening and food-fortification infrastructure. Full article

Background and objectives: Cerebrovascular strokes and transient ischemic attacks (TIAs) remain leading causes of global mortality and long-term disability. Emerging evidence suggests that pre-existing structural brain frailty—driven by chronic cerebral small vessel disease (CSVD)—critically limits neuroplastic compensation and determines overall recovery potential. This systematic review aims to synthesize current evidence evaluating brain frailty as an independent determinant of functional and cognitive outcomes. Methods: Following PRISMA and Cochrane SWiM guidelines, a comprehensive literature search was conducted across PubMed, Web of Science, Embase, and Scopus. Methodological quality was evaluated using the Newcastle–Ottawa Scale (NOS). Due to anticipated clinical and methodological heterogeneity, data were synthesized via a structured narrative approach. A total of 15 studies comprising more than 18,000 participants met the inclusion criteria, including prospective cohorts, retrospective cohorts, registry analyses, pooled cohort studies, and post hoc analyses of randomized controlled trials. Results: Structural disconnection burden emerged as one of the strongest predictors of post-stroke cognitive impairment, demonstrating remarkably large effect sizes at both 6 months (OR 9.96, 95% CI 2.21–52.40) and 36 months (OR 12.27, 95% CI 2.80–63.40). Additionally, blood–brain barrier (BBB) leakage was significantly associated with longitudinal cognitive decline (β −3.62 to −0.16, p < 0.001). Pre-existing brain frailty was also consistently associated with poorer functional recovery following acute ischemic stroke, even among patients undergoing advanced reperfusion strategies such as endovascular thrombectomy or intravenous thrombolysis. Conclusions: Brain frailty should be integrated into clinical prognostic frameworks as a key marker for predicting long-term cognitive function and functional independence in stroke patients. However, the substantial methodological and clinical heterogeneity observed across the included literature must be acknowledged as a key limitation of the current evidence base. Large-scale, prospective, multicenter longitudinal studies are required to better standardize brain frailty metrics and validate their utility in clinical practice. Full article

Electromagnetic underwater communications are strongly limited by water conductivity and depth, particularly at ISM frequencies above 900 MHz. Although LoRa technology has been widely adopted in low-power wireless sensor networks, experimental studies of LoRa-based underwater-to-overwater (UW2OW) links at 915 MHz in real freshwater environments remain scarce. This work presents an experimental evaluation of a 915 MHz LoRa UW2OW communication link conducted in three freshwater scenarios with different conductivity conditions: a controlled swimming pool and two natural lakes. The experimental campaign analyzes the influence of water depth and horizontal distance on key performance metrics, including received signal strength indicator (RSSI), signal-to-noise ratio (SNR), packet loss rate, and end-to-end latency. Measurements were carried out at depths between 0.25 m and 0.8 m. Multiple spreading factors were evaluated in the pool scenario, while SF12 was selected for the natural-lake experiments. The results demonstrate that short-range UW2OW communication is feasible, achieving effective distances of up to 13 m at shallow depths. However, increased depth and higher water conductivity lead to significant performance degradation, with packet loss rates exceeding 80% at longer distances. The obtained results provide empirical insights and practical design criteria for short-range freshwater underwater wireless sensor networks based on LoRa technology. Full article

Reactions between nitrogen-containing compounds and free chlorine in swimming pools produce several undesirable by-products, with trichloramine (TCA) being especially problematic due to its odor and hazardous properties, causing respiratory symptoms and skin and eye irritation for swimmers and personnel. To address this issue, this study investigates electrochemical oxidation as a potential technique for reducing TCA concentrations in various pool water environments. Specifically, the results show that electrolysis, using a mixed metal oxide (MMO) electrode as the anode, affects the amount of free chlorine and significantly reduces TCA in synthetic pool water containing urea and sodium hypochlorite. This approach is further validated in large-scale systems with real swimming pool water. In two long-term experiments, TCA released from the pool water falls from a baseline of 1.42 mg/m³ to 0.94 mg/m³ in a 680 m³ pool, a reduction of 34% ($p<0.001$), and from 0.77 mg/m³ to 0.35 mg/m³ in an 85 m³ pool, a reduction of 55% ($p<0.001$). Water from a third pool was used to map the potential dependence. Importantly, the anode potential is critical for TCA reduction, with 1.8 V vs. RHE identified as optimal and a working window of 1.7–1.9 V. The system operates at approximately 1 A/m² and 2 W/m². Overall, this electrolysis process reduces the trichloramine burden of swimming pool water, which is expected to lower airborne trichloramine in swimming halls and thereby improve conditions for users and personnel. Full article

Tourism development in coastal Mediterranean regions has posed a significant pressure on water local resources, particularly the extensive use of water-intensive recreational infrastructures. This study investigates the spatial distribution and water consumption of public and private swimming pools in the Kassandra peninsula, Halkidiki, Greece. Using Geographic Information Systems (GIS) and high-resolution satellite imagery from 2016 and 2024, the research quantified changes in pool density and estimated associated water losses from evaporation and filter backwashing. Our findings reveal a significant increase in swimming pools and related water demand, intensifying water scarcity during the tourist season. Growth was particularly strong among small private and tourism-related pools, which increased by 192.4% overall and by more than 400% in some districts. This trend reflects a shift from mass hotel-based tourism toward decentralized and flexible tourism models. Furthermore, cartographic outputs and thematic mapping highlight spatial concentrations of water consumption near environmentally sensitive coastal zones. The applied geospatial approach identifies interactions between tourism infrastructure and vulnerable ecosystems, offering an integrated geographic perspective on environmental pressures in coastal areas. Our results emphasize the urgent need for sustainable water management policies, including water reuse practices and strategies to improve the resilience of tourism-dependent regions under climate stress. Full article

This study was developed within the framework of the GOLL (Green Olympic Living Lab and Environment Change) project, promoted by the Municipality of Coimbra, Portugal. The project uses the Mário Mexia Multisport Pavilion (MMMP) and the Olympic Swimming Pools Complex (OSPC) as living lab case studies for sustainability-oriented sports infrastructure management. The study combines a review of best practices in sustainable sports facilities with an applied case study focusing on infrastructure characterisation and the identification of intervention requirements (InRs). The review addresses the environmental, economic, and social dimensions of sustainable sports facilities, including energy and water efficiency, digital technologies, renewable energy integration, waste management, mobility, certification systems, and user inclusion. The adopted methodology integrates a literature review, technical inspections, and the analysis of building systems and resource consumption. The findings highlight the significant potential for improving operational performance, resource efficiency, and overall sustainability by adopting more integrated maintenance and management approaches. However, practical implementation remains dependent on overcoming challenges related to costs, data integration, and stakeholder engagement. The paper also discusses the potential adoption of integrated maintenance approaches, including the potential adoption of tailored digital management solutions and certification schemes, which may support more structured and proactive management. Within the GOLL living lab environment, this contributes to more informed technical, operational, and policy decision-making for the sustainable rehabilitation and management of sports facilities. Full article

This article analyses pneumatic (inflatable) objects as used in the work of four contemporary European artists from diverse disciplinary backgrounds: choreographers Adrienne Hart and Gabriella Engdahl, and visual artists Michael Shaw and Bambí Benkö. Deployed across deconsecrated churches, swimming pools, theatres, galleries and streets, these works demonstrate a broad spectrum of engagement with inflatables, ranging from formalist to existential, social and political-activist purposes—all implicating choreography in an expanded sense. Informed by theories from the visual arts, dance studies and sociology, as well as interviews with the artists themselves, the analysis adopts a multi-methodological approach attuned to this diversity. Overarching concerns about spectatorship, site and materiality centre on how inflatables’ precarious properties—porous seams requiring continual reinflation—engender playful instability and encourage interaction with audiences. Proposing ‘whimsy’ as a critical lens, the essay reimagines contemporary inflatables as cultural-choreographic objects that question disciplinary boundaries. The artists’ practices both extend a 1960s legacy of pneumatic experiments and redirect their utopian-critical impulses toward twenty-first-century issues. Full article

Background: Epidemiological data link hard and chlorinated water to atopic dermatitis (AD), but experimental evidence on their effect and on dermocosmetic benefit remains limited. Objectives: We aimed to compare the effects of soft, hard, and chlorinated water on atopic skin and assess whether a dermocosmetic routine mitigates these effects. Methods: In a 3-day, open-label, intra-individual study, 66 adults with atopic skin underwent repeated forearm immersions (five cycles/day) in soft, hard, or chlorinated water. One forearm received a cleansing-oil and moisturising-balm routine after each cycle; the contralateral forearm served as untreated control. TEWL, hydration, and global discomfort were assessed. In a 21-day real-life study, adults with AD regularly exposed to hard domestic or swimming-pool water used the routine daily. Discomfort and quality of life were recorded. Results: Water immersion induced modest, inconsistent TEWL changes, increased hydration and slightly reduced discomfort, without differences between water types. The routine reduced TEWL, increased hydration, and decreased discomfort for all water types. In real life, it produced immediate and sustained improvements in discomfort and quality of life. Conclusions: Under controlled exposure, soft, hard, and chlorinated water exert comparable, limited effects on atopic skin. The dermocosmetic routine consistently improves barrier-related parameters and comfort, independently of water type. Full article

Indoor swimming pools are energy- and water-intensive facilities. Advanced technologies enable water recovery and eliminate heat consumption by recirculating water used for filter backwashing. The aim of this article is to assess the water and energy savings resulting from the use of backwash water from swimming pool filters through the implementation of a modern technological system. The results of the analyses allow for an assessment of the benefits depending on the assumptions adopted in the national regulations regarding swimming pools in two neighboring countries: Poland and the Czech Republic. The temperature of the water supply to the swimming pool system has a significant impact on heat consumption, as a 7 °C difference between water temperatures in Poland and the Czech Republic causes a 50% increase in heat consumption. The high efficiency of the recycling systems allows for water savings of up to 30 m³ per day. In the case of pools with a water temperature of 26 °C, the energy savings range from 645 to 967 GJ per year, depending on the fresh water temperature. Implementing the system has enormous benefits in the decarbonization process, reducing CO₂ emissions by 80%. Full article

Decarbonizing HVAC in hot–arid regions is challenging for natatoriums because year-round cooling must be delivered alongside stringent dehumidification and occasional heating under high ambient temperatures. In this paper, a fully renewable system has been developed and evaluated for an indoor swimming pool located in Abu Dhabi with a 679 m² swimming pool hall designed to accommodate 200 pool users. The hybrid system includes a high-temperature linear Fresnel reflector (LFR) solar field, stratified thermal energy storage (TES), a single-effect LiBr–H₂O absorption chiller for cooling, a water-to-water heat pump as a backup system for the stability of cooling and heating rates, and a photovoltaic (PV) system to offset the ancillary equipment power input of the hybrid system. The system performance was simulated and validated by using hourly data from Abu Dhabi. Optimization of design/operation parameters was carried out by a multi-objective genetic algorithm to achieve the maximum coefficient of performance (COP) and the minimum levelized cost of cooling (LCOE). The initial COP and LCOE were 0.701 and 0.037 $/kWh, respectively. They were optimized to 0.825 and 0.0254 $/kWh, respectively. The annual energy balance revealed a synergistic operation of the solar field, TES, and heat pump. The lifecycle assessment was utilized to compare the proposed hybrid system with the conventional vapor-compression systems in terms of energy, cost, and CO₂ emissions, in which the proposed system proved superior over conventional systems with a positive net present value (NPV) and net zero carbon emissions. Full article

Introduction: Caffeine is a widely consumed adenosine receptor antagonist with well-documented effects on arousal and performance, but its time-resolved neurophysiological signature across stages of information processing remains fragmented across event-related potential (ERP) paradigms. Objectives: This systematic and mechanistic review aimed to (i) identify and catalog human ERP studies testing caffeine effects, (ii) synthesize findings by task domain and ERP component family, and (iii) evaluate moderators including dose, timing, abstinence/withdrawal control, sleep status, and habitual use. Methods: Following PRISMA 2020 and PRISMA-S, we searched multiple databases (PubMed/MEDLINE, Embase, APA PsycINFO, Web of Science Core Collection, Scopus, IEEE Xplore, and Cochrane Central Register of Controlled Trials) from inception to 28 November 2025 and conducted a structured narrative synthesis using SWiM (Synthesis Without Meta-analysis, no prespecified quantitative pooling). Risk of bias was assessed using RoB-2 (Risk of Bias 2, including crossover extension) and ROBINS-I (Risk Of Bias In Nonrandomized Studies of Interventions). Of 761 records, 63 controlled human studies met the inclusion criteria. The evidence most consistently supported stage- and context-dependent modulation. Within the P3 family, target-related P3b/P300 latency was frequently shortened, or fatigue-related slowing was prevented, often without parallel increases in amplitude. P300 amplitude findings were mixed and context-dependent: amplitude was often unchanged in rested or low-demand paradigms, but increased or was restored when caffeine counteracted fatigue, sleep loss, sustained attention demands, or high workload. Preparatory activity (CNV/slow negativity) showed selective effects, while early sensory components were comparatively stable in many paradigms; higher doses (approximately 200–400 mg) were associated with weaker early auditory sensory gating in some studies. Conclusions: Across heterogeneous paradigms, caffeine was associated with context-dependent ERP changes rather than a uniform amplification of ERP amplitudes. The most consistent pattern was shorter or preserved latency of late positive ERP components, particularly in tasks requiring stimulus evaluation or target detection. In some fatigue, sleep deprivation, sustained attention, or high-demand paradigms, caffeine was also associated with larger or restored P300/P3b amplitudes. These findings are compatible with state-dependent changes in attentional engagement or stimulus evaluation, but mechanistic interpretation remains limited by heterogeneity in task paradigms, ERP definitions, dosing, abstinence procedures, and participant caffeine use profiles. Methodological heterogeneity, small samples, inconsistent control of habitual use and withdrawal, and the predominance of healthy young adult samples limit generalizability, particularly to children, older adults, clinical populations, and long-term high-dose caffeine users. Full article

Background/Objectives: Acute health impacts and longer-term sequelae of sport-related concussion (SRC) are recognized concerns in football (soccer), warranting investigation of interventions to reduce the incidence. The purpose of this study was to identify, synthesize and evaluate interventions used in preventing sport-related concussion (SRC) in adult soccer players. Methods: Five databases (MEDLINE, CINAHL, Embase, SPORTDiscus, PsycINFO) were searched on 6 September 2024 and updated on 17 December 2025 for concussion prevention intervention studies involving adult footballers. Study quality was assessed with the Modified Downs and Black Checklist. A narrative synthesis of all included studies followed Synthesis Without Meta-Analysis (SWiM) guidelines. Results: From 3463 records, five studies met inclusion criteria: three reported rule changes and two reported head-neck training interventions. The low volume of studies discovered were non-randomized and rated fair or poor on quality assessment. Whilst these interventions were grounded in sound and well-reasoned mechanisms to mitigate SRC risks, none reported statistically significant directional effects. This, combined with high heterogeneity, prevented data pooling and no firm conclusions could be drawn about the effectiveness of any intervention. Conclusions: Sparce, preliminary, heterogeneous evidence represents research to reduce SRC in adult soccer players, and this is limited to investigating rule changes and head-neck training and interventions. A larger volume of primary research is needed to determine meaningful practice recommendations of these and other conceivable interventions. Full article