Search Results (163)

Background: Childhood obesity is a major public health concern associated with adverse metabolic outcomes later in life. Despite increased awareness, unhealthy lifestyle behaviors—including suboptimal diet quality, physical inactivity, insufficient sleep, and unfavorable body composition—remain prevalent in pediatric populations. Effective, child-centered educational tools for early prevention are still limited. Methods: We developed the Lifestyle Tridimensional Pyramid, an educational model integrating nutrition, physical activity, and sleep within a single, three-dimensional framework. The model also addresses body composition by emphasizing the balance between skeletal muscle and adipose tissue and the interdependence of lifestyle behaviors. This narrative review is supported by an umbrella review of 17 systematic reviews and meta-analyses published between 2010 and 2025, synthesizing evidence on lifestyle behaviors of pediatric obesity. Results: High- to moderate-quality evidence indicates that adherence to Mediterranean-style dietary patterns, regular moderate-to-vigorous physical activity, adequate sleep duration, and a healthier body composition might prevent the development of obesity and improved cardiometabolic profiles in children and adolescents. The pyramid provides a structured, visually accessible tool to support lifestyle counseling in pediatric outpatient settings and is adaptable to school- and community-based health promotion. Conclusions: Although prospective validation studies are warranted, the Lifestyle Tridimensional Pyramid represents a practical, evidence-informed framework to support integrated lifestyle education and improve primary and secondary prevention of pediatric obesity. Full article

Background/Objectives: Although many studies have examined the determinants and management of dental anxiety (DA), its broader placement as a potential bottleneck along oral–systemic health pathways, from the determinants of DA to consequences through dental avoidance, oral outcomes, psychosocial impacts, and possible systemic health outcomes, has not been mapped across the review literature. This review aimed to conceptually map how existing DA reviews are distributed across this pathway, whether this broad framing changed across 5-year periods, and how systemic health outcomes were framed. Methods: We conducted a conceptual mapping review of DA-focused review articles published between 2005 and 2025. PubMed and Scopus were searched for English-language narrative, systematic, scoping and umbrella reviews and meta-analyses addressing the determinants or consequences of DA. One reviewer screened records, extracted review characteristics, and classified each review into predefined domains using binary framed/not framed coding rules. A structured AI-assisted prompt was used only to support full-text evaluation across domains; all final coding decisions were made by the reviewer. Results: The search identified 851 records; after removing 426 duplicates, 425 unique records were screened, and 39 reviews met the inclusion criteria. Framing concentrated on environmental and psychological determinants and on the pathway from DA to avoidance and poor oral health, whereas broader consequences, including shame, OHRQoL, and systemic health outcomes, were less consistently framed. Across 5-year periods, the broad pattern of framing remained relatively stable. Systemic health outcomes were framed in only a minority of reviews. Conclusions: Future research should test hypothesized pathways from DA to broader health consequences using clearly specified bridge mechanisms and appropriate temporal designs. Full article

Background: Systemic arterial hypertension (SAH) shows a high prevalence among postmenopausal women and represents an important public health concern. Objective: To evaluate factors associated with SAH in postmenopausal women participating in a resistance training program. Methods: This observational, cross-sectional study included 55 postmenopausal women (66.0 ± 4.9 years) recruited from the “More Active Women” research project, an umbrella experimental and longitudinal study involving resistance training interventions. Cross-sectional data were collected during the baseline assessment (April–May 2025). Sociodemographic variables, nutritional status (body mass index and waist circumference), and behavioral and health-related variables obtained through structured interviews and anthropometric assessments were analyzed. Associations were tested using Pearson’s chi-square test or Fisher’s exact test, with effect size estimated by Phi or Cramer’s V when appropriate, and binary logistic regression was performed for adjusted analyses. Results: Significant associations were observed between SAH and elevated BMI (p = 0.03; φ = 0.30), waist circumference > 88 cm (p = 0.006; φ = 0.40), and lower educational level (p = 0.003; V = 0.47). In the adjusted analysis, waist circumference ≤ 88 cm was associated with a lower likelihood of SAH (OR = 5.54; 95% CI: 0.965–31.872; p = 0.007), whereas lower educational level was associated with a higher likelihood of hypertension (OR = 13.98; 95% CI: 1.505–129.833; p = 0.004). Conclusion: Excess central adiposity and lower educational level are associated with SAH in postmenopausal women, highlighting the importance of integrated health promotion strategies that address both cardiometabolic risk factors and social determinants of health during aging. Full article

Background: Dental fear and anxiety are highly prevalent in children, resulting in avoidance or incomplete dental treatment; sedation emerges as a possible behavioral management strategy. This umbrella review aimed to provide a structured and critical synthesis of the available knowledge on sedative single-agent efficacy and routes of administration employed for achieving sedation (excluding deep sedation/general anesthesia) during dental procedures in children for behavior management, as well as to evaluate acceptability and satisfaction for child, caregiver, and provider, and to assess the influence of clinical setting and provider. Methods: In line with the PRISMA statement, the protocol was registered on PROSPERO (CRD420251043738), and 18 systematic reviews were included and synthesized qualitatively. Results: Single-agent sedation was safe and effective for managing behavior in children during dental procedures, with midazolam and nitrous oxide being the most studied agents. Different routes of administration showed distinct characteristics in onset, recovery time, adverse effects and cooperation, while agent selection appeared influenced by clinical setting and provider type. However, data on acceptability and satisfaction from children, caregivers, and providers remains limited. Conclusions: Evidence suggests potential effectiveness of selected agents and routes in appropriately monitored settings, but data heterogeneity precludes strong comparative recommendations. Further studies are therefore needed to address the existing gaps in pediatric dental sedation. Full article

Eye diseases, such as glaucoma, diabetic retinopathy, and age-related macular degeneration, drive the growing need for reliable and scalable analyses of fundus and optical coherence tomography (OCT) images. Deep learning performs strongly in ocular structure segmentation. However, it typically relies on dense pixel-wise annotations, which are costly and difficult to obtain at scale. Weakly supervised learning (WSL) can reduce this burden by leveraging coarse labels, limited strong annotations, and unlabeled data. This systematic umbrella review synthesizes survey and review articles on weakly supervised deep learning for image segmentation, with a focus on ocular imaging (fundus and OCT/OCTA). After analyzing twenty-one secondary studies, the main finding reveals an “empty intersection”: WSL-focused segmentation surveys are often modality-agnostic. Conversely, ocular reviews are predominantly fully supervised and seldom offer quantitative evidence on annotation-effort savings or direct comparisons between weak and fully supervised methods on identical datasets. Across the included reviews, label-efficient strategies cluster around CAM/MIL formulations, sparse supervision (points/scribbles/boxes), pseudo-labelling/self-training, and semi-/self-supervised learning, implemented mainly with U-Net/DeepLab families and increasingly Transformer or hybrid backbones. These results provide a structured map of available WSL mechanisms and, critically, identify reproducible reporting gaps that currently prevent fair benchmarking in ocular segmentation. Therefore, this review supports the development of ocular-specific benchmarks and minimum reporting practices that link segmentation performance to annotation effort. Full article

Reinforced concrete conical shell silo roofs continue to present construction challenges, despite the widespread adoption of slip-form technology for silo walls. This study introduces a novel combined temporary support system for cast-in-place conical shell silo roofs, validated through an engineering case in Suiping. The proposed system consists of (i) an umbrella-type conical shell combined support structure and (ii) a cross-type vertical core-tube support. Focusing on the umbrella subsystem, a shell–truss framework is developed based on the geometry of cylindrical–conical shell roofs. Special structural components, along with prestressed reinforcement techniques, are introduced following the principles of structural and elastic mechanics. The traditional inclined-beam shoring concept is incorporated into an arched load path: inclined members are circumferentially connected at nodes to form a shell–arch support mechanism, thereby improving force transfer efficiency and reducing flexural demands. Finite element analyses of representative construction stages are conducted to evaluate displacement and stress responses. The results show that the proposed combined support system meets strength and stiffness requirements during roof construction and provides an efficient and practical solution for large-span conical shell silo roofs. Full article

Pseudomonas aeruginosa is considered a priority pathogen by the World Health Organization due to its resistance to antibiotics. Isolates resistant to ciprofloxacin (CPFX), a bactericide commonly used against P. aeruginosa, usually carry the mutations T83I or D87N in the GyrA subunit of the DNA gyrase. Yet, the molecular mechanisms by which these mutations confer CPFX-resistance to P. aeruginosa are unknown. Here we solved the crystal structure of the P. aeruginosa gyrase catalytic cleavage core and used it to carry out molecular dynamic (MD) simulations of CPFX-gyrase binding in the wild-type as well as the T83I and the D87N mutant systems. Our results show that DNA plays the most prominent stabilizing role once CPFX is bound, with relatively minor contributions from Thr83 or Asp87. Interestingly, we found a solvent cavity adjacent to these residues that may provide CPFX access to the active site. Interaction energy analysis using Umbrella Sampling indicates that Thr83 and Asp87 may influence CPFX trajectory during binding. In the mutant systems, the repulsive potential increases at the cavity site, which may hinder CPFX accessing the binding site. These results shed light on P. aeruginosa resistance to CPFX and may help provide a methodology to identify new therapeutic agents to target fluoroquinolone resistant bacteria. Full article

Digital transformation offers significant potential to reshape supply chains; however, implementation efforts remain fragmented, technology-centric, and insufficiently aligned with strategic, organizational, and sustainability goals. Existing frameworks and maturity models tend to emphasize the technological dimension, offering limited guidance on how digital transformation should be integrated with people, processes, culture, and sustainability at the supply network level. Building on evidence synthesized through an umbrella review of the state of the art, this paper proposes the Agile and Sustainable Supply Network Compass, a holistic and actionable framework designed to support organizations in advancing toward agile and sustainable supply networks. The Compass incorporates three structural dimensions—Strategy, Processes, and Capabilities (related to digitalization and sustainability)—as foundational pillars for transformation. We hypothesize that an effective transformation requires the joint alignment of strategy, cross-functional processes, and capabilities, as well as the explicit identification of a reduced supply network, a focal firm, and its critical linkages. The results show that positioning agility and sustainability as shared strategic objectives at the supply network level enables coherent decision-making, targeted capability development and improved coordination across interconnected actors. Rather than prescribing specific technologies, the proposed framework provides a guiding methodological logic that explains how digitalization and sustainability can co-evolve within supply networks. This work contributes to both theory and practice by bridging conceptual gaps in the literature and establishing the groundwork for future maturity models and empirical applications. Full article

Gender discrimination is a pervasive and multifaceted phenomenon rooted in cognitive, emotional, and social mechanisms that operate across individual, interpersonal, and structural levels. This umbrella review synthesizes systematic reviews and meta-analyses published between 2013 and 2024 examining the relationship between gender, stereotypes, and discrimination. Following PRISMA 2020 guidelines, searches were conducted across PubMed/MEDLINE, Scopus, and Web of Science, yielding 22 eligible reviews after screening 684 records. Thematic synthesis identified two overarching domains: manifestations of discrimination and health and professional outcomes. Discrimination emerged as structural, interpersonal, and implicit, operating through institutional barriers, microaggressions, and stereotyping mechanisms. These dynamics were found to significantly affect mental health, and particularly anxiety, depression, and psychological distress, as well as physical health, including cardiovascular outcomes and maternal morbidity. Professional and social functioning were also impaired, with gender-based inequalities documented in pay, promotion, and role allocation across multiple occupational contexts. Despite consistent evidence of harm, the literature revealed limited consensus in conceptualization and a lack of longitudinal and intervention research. Collectively, findings underscore that gender discrimination constitutes both a public health concern and a systemic social mechanism that shapes individual cognition, emotion, and behaviour, demanding multi-level psychological and policy responses. Full article

Vascular endothelial growth factor 165 (VEGF₁₆₅) stands out as a pivotal isoform of the VEGF-A protein and is critically involved in various angiogenesis-related diseases. Consequently, it has emerged as a promising target for diagnosing and treating such conditions. Structurally, VEGF₁₆₅ forms a homodimer, and each of its constituting monomers comprises a receptor-binding domain (RBD) and a heparin-binding domain (HBD). These two domains are linked by a flexible linker, and thus the overall structure of VEGF₁₆₅ remains incompletely understood. Aptamers are known as potent drugs that interact with VEGF₁₆₅, and dimeric aptamers that can simultaneously interact with two distant domains are frequently adopted to improve the potency. However, designing such aptamer dimers faces challenges in regard to determining the appropriate length of the linker connecting the two aptamer fragments. To gain insight into this distance information, we here employ biased molecular dynamics (MD) simulations with the umbrella sampling method, with the distance between the two HBDs serving as a reaction coordinate. Our simulations reveal an overall preference for compact conformations with HBD-HBD distances below 3 nm, with the minimum of the potential of mean force located at 1.1 nm. We find that VEGF₁₆₅ with the optimal HBD-HBD distance forms hydrogen bonds with its receptor VEGFR-2 that well match experimentally known key hydrogen bonds. We then try to computationally design aptamer homodimers consisting of two del5-1 aptamers connected by various linker lengths to target VEGF₁₆₅. Collectively, our findings may provide quantitative guidelines for rationally designing high-affinity aptamers for targeting VEGF₁₆₅. Full article

Background/Objectives: Soroseris hookeriana, a Tibetan medicinal plant endemic to the high-altitude Qinghai–Tibet Plateau, possesses significant pharmacological value but lacks fundamental genomic characterization. This study aims to generate and comparatively analyse its complete chloroplast genome. Methods: Total DNA was sequenced, assembled with GetOrganelle, annotated with CPGAVAS2, and compared with eight Asteraceae species; phylogenetic placement was inferred with IQ-TREE from 21 complete plastomes. Results: The circular chloroplast genome is 152,514 bp with a typical quadripartite structure (LSC 84,168 bp, SSC 18,528 bp, two IRs 24,909 bp each). It contains 132 unique genes (87 protein-coding, 37 tRNA, 8 rRNA; 18 duplicated in IRs yield 150 total copies). Twenty-three genes harbour introns; clpP and ycf3 have two. Overall GC content is 37.73%, elevated in IRs (43.12%). Codon usage shows strong A/U bias at the third position; 172 SSRs and 39 long repeats are detected. IR-SC boundaries exhibit the greatest inter-specific variation, notably in ycf1 and ndhF. Conclusions: The complete plastome robustly supports S. hookeriana and Stebbinsia umbrella as sister species (100% bootstrap) and provides essential genomic resources for species identification, population genetics, and studies of high-altitude adaptation. Full article

In this paper, the influence of the novel design of a ladle shroud (LS) on the liquid steel flow structure inside the working volume of a two-strand slab tundish was assessed, determining the best solutions for LS use to achieve the optimal level of active flow zones and protect the tundish lining. A 0.33 scale water model was used for physical experiments. Numerical simulations were carried out in the Ansys-Fluent 12.1 software for a 1:1 scale tundish. The effect of the influence of LS type, LS immersion depth, LS side ports position, LS misalignment and casting speed was examined. Finally, the use of the “umbrella” ladle shroud allows stable hydrodynamics to be maintained even with shroud misalignment. Moreover, the “umbrella” ladle shroud effectively decreases the average velocity of liquid steel inside the tundish and significantly decreases shear stresses and dynamic pressure at the tundish lining in the tundish pouring area. Full article

Background/Objectives: Patients with advanced non-malignant chronic conditions experience illness burdens and palliative care needs comparable to those of oncology patients, yet palliative care is often introduced late. Identifying individuals with potential palliative care needs is complex, and although multiple tools exist, the most appropriate approach for assessing needs in this population remains unclear. This umbrella review aimed to identify and evaluate tools used to systematically assess palliative care in adults with advanced non-malignant chronic conditions, with a specific focus on their content, structure, and psychometric properties. Methods: An umbrella review of systematic reviews was conducted in accordance with the Joanna Briggs Institute (JBI) guidance. Four electronic databases (Cochrane Library, CINAHL, PubMed, and PsycINFO) were searched from inception to 30 June 2025. Eligible systematic reviews were screened, critically appraised, and synthesized narratively. Results: Seven systematic reviews met the inclusion criteria, collectively identifying 35 unique needs-assessment tools. Five tools (SPICT, GSF-PIG, QUICK GUIDE, NECPAL, and P-CaRes) incorporated both general and disease-specific palliative care indicators. At the same time, four (PC-NAT, SPEED, NAT, and IPOS) addressed needs across physical, psychological, social, and spiritual domains. Psychometric data were available for six tools across three reviews. The original NAT and SPICT demonstrated good reliability; however, the Dutch version of the NAT showed poor validity. SPEED and one unnamed palliative care tool showed good reliability, whereas the Surprise Question demonstrated unclear validity. Italian-SPICT and Israeli-NECPAL exhibited strong content validity. Conclusions: Despite limited evidence, the NAT: PD-HF shows particular promise for identifying palliative care needs in patients with heart failure. Tools such as SPICT and NECPAL are widely used and adapted for advanced non-malignant chronic conditions, but further psychometric evaluation is required. Additional studies are needed to clarify the clinical utility of these tools for broader implementation in assessing palliative care needs. Full article

Background/Objectives: Breast cancer is the most common malignancy among women globally, with survival rates improving due to earlier detection and better treatment. As a result, cancer survivors now constitute a growing segment of the population, and addressing their long-term health and well-being is a public health priority. Diet and nutrition represent modifiable factors that may influence recurrence, comorbidities, and quality of life (QoL), yet clear evidence-based guidance remains limited. This umbrella review thus synthesized evidence from published reviews on the effects of dietary and nutrition interventions among breast cancer survivors. Methods: Following a prospectively registered protocol in PROSPERO (CRD420251185022), six databases (PubMed, EMBASE, Scopus, Cochrane Library, PsycINFO and CINAHL) were systematically searched for systematic reviews/meta-analyses evaluating dietary or nutrition interventions in adult breast cancer survivors. Eligible reviews reported anthropometric, metabolic, psychosocial, or survival outcomes. Methodological quality was appraised using the AMSTAR-2 tool, and findings were narratively synthesized. Results: Nine systematic reviews encompassing more than 10,000 breast cancer survivors were included. Interventions ranged from general dietary counselling and structured weight-management programmes to Mediterranean-style dietary patterns, dietitian-led primary care, multiple health behaviour change interventions, mobile nutrition apps, and broader lifestyle programmes incorporating diet. Across reviews, interventions consistently improved diet quality and fruit–vegetable intake, produced modest but meaningful reductions in weight, body mass index, and body fat, and enhanced several QoL domains (e.g., fatigue, physical functioning, body image). Higher adherence to Mediterranean-style diets was associated with lower all-cause and non–breast cancer mortality, though certainty was limited by observational designs. However, evidence for long-term maintenance, survival endpoints, and ethnically diverse or low- and middle-income populations remains sparse. Conclusions: Dietary and nutrition interventions, particularly structured, dietitian-supported, and Mediterranean-style approaches, contribute to improved diet quality, sustainable weight control, and enhanced QoL among breast cancer survivors. Integrating nutrition care into survivorship pathways should be the focus of future research. Full article

This paper addresses the issue of stress redistribution in surrounding soil during the construction of shallow-buried, large-section loess tunnels. Using the Luochuan Tunnel as a case study, we employ the FLAC 3D numerical simulation method to investigate the effects of advanced pipe roof support on the stability of the surrounding soil. The results demonstrate that advanced pipe umbrella reduces the stress release amplitude at the vault by 50% compared to the unsupported condition, due to a “pre-support-load bearing mechanism”, while promoting orderly stress recovery. The “longitudinal beam effect” and “transverse arch effect” of soils effectively suppress the plastic zone area of the surrounding soil from 413.3 m² (unsupported) to 95.0 m², achieving a reduction exceeding 77%. Furthermore, the pipe umbrella support facilitates the formation of a more efficient “active soil arch”, which exhibits distinct symmetrical characteristics. The arch’s stress distribution and spatial structure both follow symmetrical patterns, significantly enhancing the self-stabilizing capacity of the surrounding soil. As a result, the height of the stress release zone at the tunnel excavation face and the surrounding soil stability areas is reduced by 45.9% and 63.3%, respectively, compared to the unsupported condition. This study also establishes a Pasternak elastic foundation beam model that accounts for the spatiotemporal effects of support, elucidating the mechanism of pipe umbrella support and providing a theoretical foundation for the design and construction risk control of shallow large-section loess tunnels. Full article