Search Results (1,402)

Digital transformation is reshaping industries, business models, and investment opportunities, creating new challenges for international portfolio management. The European communication services sector has become a strategic component of the digital economy, driven by advances in artificial intelligence (AI), digital platforms, 5G infrastructure, cloud computing, cybersecurity, and data-driven business models. Despite its importance, limited evidence exists regarding the effectiveness of portfolio optimisation strategies within digitally transforming sectors. This study investigates international portfolio optimisation using constituent firms of the MSCI Europe Communication Services 35/20 Capped Index. Drawing upon Modern Portfolio Theory and the Treynor–Black framework, an actively managed portfolio is constructed and evaluated against the SPDR^® MSCI Europe Communication Services UCITS ETF and an equal-weight portfolio. Using daily market data, the analysis estimates asset returns, alpha and beta coefficients, portfolio weights, and risk-adjusted performance measures, including the Sharpe and Treynor ratios. Paired-samples t-tests are employed to assess the statistical significance of performance differences among investment strategies. The findings show that the Treynor–Black portfolio generated the highest annual return (27.32%), outperforming both the benchmark and equal-weight portfolios, and the highest percentage of Sharpe ratios (1.2159), suggesting that diversification benefits outweighed the advantages of active security selection. Hypothesis testing indicates no statistically significant difference between the Treynor–Black and equal-weight portfolios, and no statistically significant difference exists between the proposed and benchmark portfolios. The study extends the international portfolio management literature by applying the Treynor–Black model to a digitally transforming sector. The findings suggest that portfolio performance is influenced not only by firm-level financial characteristics but also by broader digital and institutional environments. Firms operating within digitally advanced and well-governed economies appear better positioned to exploit technological innovation and generate sustainable long-term value. Overall, the results demonstrate that successful international portfolio optimization requires balancing active security selection with diversification while recognizing the role of digital transformation, governance quality, and innovation ecosystems in shaping investment performance within the digital economy. Full article

Background/Objectives: Chronic post-surgical pain (CPSP) affects 25–60% of women after breast cancer surgery. Prospective data from the Middle East and North Africa (MENA) region remain scarce. This study estimated 3-month CPSP incidence in a Moroccan cohort, developed two internally validated prediction models, and quantified the mediated effects of regional anaesthesia and ketamine through prevention of severe acute postoperative pain. Methods: Prospective cohort of 862 women undergoing curative breast cancer surgery (Institut National d’Oncologie, Rabat; NCT04676438). CPSP was defined as a visual analogue scale (VAS) ≥ 3/10 AND Brief Pain Inventory (BPI) interference ≥ 3/10 at three months. Two logistic regression models were developed (Model A: 7 preoperative variables; Model B: 11 perioperative variables) and internally validated by 1000-bootstrap optimism correction. Counterfactual mediation analysis quantified effects mediated through severe acute pain. Results: CPSP incidence was 39.1% (95% confidence interval (CI) 35.9–42.4%), with 22.6% neuropathic-predominant. Model A showed limited discrimination (area under the curve (AUC) 0.58), with pain catastrophising as the dominant predictor. Model B demonstrated superior performance (AUC 0.694; Brier score 0.209) with net clinical benefit across the 15–55% range of clinically plausible decision thresholds. In counterfactual mediation analysis, an estimated 58.2% and 53.7% of the RA and ketamine effects, respectively, were mediated through severe acute pain, under the framework’s no-unmeasured-confounding assumption. Perioperative ketoprofen independently reduced chronification risk (adjusted odds ratio (aOR) 0.66). Conclusions: In this single-centre Moroccan cohort, 39% of women developed CPSP at three months. Two validated models enable risk stratification at distinct clinical decision points. Regional anaesthesia and ketamine were associated with lower CPSP risk, in a pattern consistent with mediation through prevention of severe acute pain under the model’s assumptions; ketoprofen was independently associated with lower chronification risk. These observational findings are hypothesis-generating and require confirmation before informing changes to analgesic protocols. Full article

Obstructive sleep apnea (OSA) is associated with increased cardiovascular, respiratory, and all-cause mortality, yet the long-term survival impact of continuous positive airway pressure (CPAP) remains contested, and treatment is usually analysed as a binary exposure rather than by the quality of the response achieved. In a single-centre cohort of 4368 adults referred for polysomnography and followed for 8–20 years (prespecified subgroup with apnea–hypopnea index [AHI] ≥ 15, n = 2304), we applied cause-specific Cox and Fine–Gray competing-risks models, together with machine-learning classifiers, to characterise all-cause, cardiovascular, and pulmonary mortality. CPAP was associated with reduced all-cause (hazard ratio [HR] 0.75), cardiovascular (HR 0.75), and pulmonary mortality (HR 0.54), with the benefit confined to severe OSA (HR 0.66) and absent in moderate disease (HR 0.95). Good responders showed a significant 34% reduction in all-cause mortality (HR 0.66), whereas poor responders showed no significant reduction. Nocturnal desaturation (time with oxygen saturation < 90%) was the dominant independent predictor of pulmonary mortality, and baseline features predicted response category only moderately (macro-averaged AUC 0.76). Long-term CPAP confers a severity- and response-dependent survival benefit; nocturnal hypoxaemia is a key, modifiable driver of respiratory death. Full article

Most public investment feasibility studies rely on the linear assumption model (LAM), which assumes constant growth in revenues and costs and may overlook the underlying production structure. This study develops a Production Function-Based Financial Feasibility Model (PFFM) by integrating a Cobb–Douglas production function into cash flow analysis. It also applies the model to a 15-year electric bus project operated by the Khon Kaen Provincial Administrative Organization, covering three routes and a total investment of THB 285.05 million. The analysis uses deterministic projections based on expert-validated growth assumptions. Ordinary least squares estimation yields an energy elasticity of 0.990; however, because energy consumption is derived from a fixed rate per kilometre, this coefficient primarily reflects the internal consistency of the projections rather than an independently estimated behavioural relationship. Returns to scale are statistically indistinguishable from unity (RTS = 1.006; p = 0.95). Based solely on farebox and advertising revenues, both the LAM and PFFM indicate that the project is financially infeasible, with base-case NPVs of −THB 271.74 million and −THB 271.61 million, respectively, B/C ratios of approximately 0.54, and unattainable IRRs. This conclusion remains unchanged under a 30% increase in electricity prices. Although the two models produce similar results because RTS is close to unity, the PFFM provides a more transparent decomposition of fixed and marginal costs and clearer diagnostic insights into production technology and cost risk. In addition, an SROI analysis covering environmental, health, safety, and time-saving benefits, together with net-impact adjustments, yields a ratio of 3.45, indicating that the project generates substantial social value despite its financial infeasibility. The proposed framework therefore provides public agencies with a more comprehensive basis for investment decisions, subsidy design, and public service obligation policies. Full article

Camel milk (CM), which is produced by both Camelus dromedarius and Camelus bactrianus, is gaining increasing popularity as a value-added functional dairy product, but the science of managing its shelf life has progressed more slowly than its commercial expansion. Unlike bovine milk, CM lacks β-lactoglobulin (β-LG), has a unique casein (CN) micelle structure with a high β-CN-to-αs1-CN ratio, and low κ-CN protein content, and contains an unusually rich bioactive protein fraction including lactoferrin (LF), immunoglobulin G (IgG), lysozyme (LZ), and peptidoglycan recognition protein (PGRP). These compositional characteristics imbue CM with both significant inherent antimicrobial benefits and place it at risk of processing weaknesses that do not have direct analogs in bovine dairy science. The review discusses three key areas of CM shelf life science that have not been sufficiently addressed in the published literature. The first relates to physicochemical mechanisms of deterioration, including lipid oxidation of polyunsaturated fatty acids (PUFA), destabilization of CN micelles in the structural absence of β-LG, and Maillard browning during thermal treatment and storage of powder. The second addresses the fate of bioactive proteins, with the majority being lactoferrin (LF), immunoglobulin G (Igs), and heavy chain-only antibodies (HCAbs), under both thermal and non-thermal processing conditions. The third looks at new non-thermal preservation methods, such as high-pressure processing (HPP), pulsed electric field (PEF), ultrasonication, ultraviolet irradiation, cold plasma, and electromagnetic (EM) field treatment, and functional packaging innovations, which contribute to longer shelf life. Of the non-thermal options examined, HPP at 200–400 MPa today provides the most mechanistically proven evidence for camel-specific microbial deactivation with satisfactory quality preservation. The latest primary CM research also indicates that processing with EMs in the 850 mT range can potentially be as effective as conventional pasteurization in microbial control and may be more effective than pasteurization in retaining desirable bioactive markers, although this result needs to be independently replicated before more responsible conclusions can be drawn. The review ends with four priority research gaps: standardized kinetic shelf life modeling frameworks, systematic characterization of bioactive protein stability under commercial processing conditions, life cycle assessment of preservation chains across the camel dairy supply continuum, and the urgent validation of camel-specific pasteurization adequacy indicators to replace bovine alkaline phosphatase, which remains active in CM after conventional high-temperature short-time (HTST) pasteurization. Full article

Urban parks can mitigate residents’ mental health risks. Although bamboo landscapes are widespread in Chinese parks, evidence for their stress-relief benefits remains limited, and current evaluation media are constrained. This study assessed the feasibility of virtual reality 180° (VR180) for landscape evaluation and examined the stress-relief benefits of bamboo landscapes in urban parks. A pilot study (n = 232) compared perceptual realism and psychological perception across four presentation modes (on-site scene, binocular 3D video, binocular 3D photograph, and two-dimensional photograph). A main experiment (n = 280) examined the stress-relief benefits of six bamboo landscape types (bamboo–terrain, bamboo–architecture, bamboo–environmental furniture, bamboo–pavement, bamboo–water, and bamboo–plant landscapes) using pre- and post-viewing changes in skin conductance level (SCL), heart rate variability indices, including high-frequency power (HF) and the LF/HF (low-frequency/high-frequency) ratio, and systolic and diastolic blood pressure (SBP and DBP), with urban block landscapes as the control. VR180 outperformed two-dimensional photographs in perceptual realism and psychological perception and showed relatively high substitutability for on-site evaluation, with binocular 3D videos performing better than binocular 3D photographs. Urban park bamboo landscapes generally elicited stress-relief benefits, whereas urban block landscapes showed the opposite pattern. Bamboo–water and bamboo–plant landscapes showed the most favorable overall responses, with bamboo–water ranking higher, whereas bamboo–pavement ranked lowest. Overall, bamboo landscapes combined with naturalized elements tended to produce more favorable stress-relief responses, while hard elements may partly influence these benefits through cultural expression. This study provides a methodological option for landscape evaluation in small-scale scenes and offers physiological evidence for understanding the health value of urban park bamboo landscapes. Full article

Background: Post-stroke recovery varies widely, and pharmacological options to enhance rehabilitation outcomes remain limited. MLC601/MLC901 (NeuroAiD), a natural neurorestorative product, has been evaluated as an adjunct to standard care to improve functional and motor recovery after ischaemic stroke. This systematic review and meta-analysis assessed its efficacy using validated outcome measures. Methods: A systematic PubMed search identified randomised controlled trials comparing MLC601/MLC901 with placebo or active comparators in adults with ischaemic stroke. Functional outcomes included modified Rankin Scale (mRS), Barthel Index (BI), and Diagnostic Therapeutic Effects of Apoplexy (DTER) item 8 scores. Motor outcomes included Fugl–Meyer Assessment (FMA), DTER motor items, and National Institutes of Health Stroke Scale (NIHSS) motor scores. Data were pooled using fixed- and random-effects models. Odds ratios (ORs) and standardised mean differences (SMDs) were calculated. Risk of bias was assessed using the Cochrane RoB 1.0 tool. Results: Six publications reporting seven randomised clinical studies were included in the meta-analysis. Of the 7 studies, 5 were assessed as having a low risk of bias, while 2 were assessed as having an unclear risk. Altogether, 1535 participants for functional outcomes and 1774 for motor outcomes were analysed. Functional recovery significantly favoured MLC601/MLC901 at 1 month (OR 2.61; p = 0.004), 6 months (OR 1.38; p = 0.002), 12 months (OR 1.33; p = 0.03), and end-of-study (OR 1.40; p = 0.007), with benefits persisting up to 24 months. Motor recovery was assessed at months 1, 2 and 3 and at the end of the study. It also improved consistently over time, with the greatest effects during the first two months. Benefits were most evident in patients with moderately severe stroke (NIHSS 8–14). Clinical studies consistently indicate that NeuroAiD is safe and well-tolerated as an adjunct to standard ischaemic stroke care. Conclusions: MLC601/MLC901 is associated with improved functional independence and motor recovery after ischaemic stroke. Benefits appear within 1 month and may persist for up to 2 years, supporting early use alongside rehabilitation to optimise recovery. Full article

Background/Objectives: Non-suicidal self-injury (NSSI) in adolescence is associated with emotion dysregulation, experiential avoidance, psychiatric morbidity, and later suicidal risk. Interventions based primarily on acceptance and commitment therapy (ACT) target psychological flexibility, acceptance, cognitive defusion, and values-based action, whereas emotion regulation individual therapy for adolescents (ERITA) and internet-delivered emotion regulation individual therapy for adolescents (IERITA) principally target emotion dysregulation while incorporating selected acceptance-related and ACT-consistent components, making these approaches theoretically relevant to adolescent NSSI. Methods: We conducted a systematic review and exploratory meta-analysis informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. PubMed, Scopus, Web of Science, and EBSCO were searched on 10 April 2026. Eligible studies included adolescents or predominantly adolescent samples in which NSSI was the central clinical target or NSSI-specific outcomes were separately extractable and evaluated primarily ACT, ACT-informed, acceptance-based, ERITA, or IERITA interventions. Quantitative syntheses were restricted to controlled studies with extractable data. Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), trial registries, and dedicated regional or gray literature sources were not searched; 15 reports remained unretrieved, so the evidence base may be incomplete. Results: Six full-text primary adolescent NSSI intervention studies met inclusion criteria: two controlled primarily ACT studies, one randomized ERITA feasibility trial, two uncontrolled ERITA feasibility/open studies, and one randomized IERITA trial. The strongest single-study evidence came from therapist-guided IERITA, which reduced masked assessor-rated NSSI frequency more than treatment as usual, with an incidence rate ratio of 0.34 (95% confidence interval [CI] 0.20 to 0.57). Two-study exploratory random-effects syntheses yielded estimates in the direction of benefit for continuous NSSI outcomes, Hedges’ g = −0.45 (95% CI −0.85 to −0.05; k = 2), and process outcomes, Hedges’ g = 1.25 (95% CI 0.83 to 1.68; k = 2). These estimates are hypothesis-generating and imprecise as estimates of a generalizable treatment effect because each synthesis contained only two clinically and methodologically heterogeneous studies. Although I² was 0% in both syntheses, these estimates are highly uncertain with only two studies and should not be interpreted as evidence of true homogeneity. Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, certainty was moderate for the single masked clinician-rated IERITA outcome and very low for the pooled continuous NSSI and process-outcome evidence. Conclusions: Primarily ACT, ERITA, and IERITA interventions may be promising for adolescent NSSI, but the evidence remains preliminary and mostly of very low certainty. The pooled estimates are exploratory, hypothesis-generating, and imprecise and should not be interpreted as evidence of treatment efficacy. The strongest single-study evidence concerns therapist-guided IERITA and was rated as moderate in certainty, whereas the evidence for primarily ACT interventions and pooled process outcomes was very low in certainty and requires confirmation in larger preregistered randomized trials with standardized outcomes, longer follow-up, active comparators, and process measures. Full article

Respiratory medicine is transitioning from symptom-driven, standardized care to a more precise, patient-specific approach guided by molecular profiling. This evolution is being enabled by advances in liquid biopsy, multiomics, and artificial intelligence (AI) analytics. Fractional exhaled nitric oxide (FeNO) and blood eosinophils, the two commonly used markers in asthma, are now being joined by more precise airway markers such as galectin-10, which could aid clinicians in making more informed decisions for biological treatments. In chronic obstructive pulmonary disease (COPD) similar progress is underway, with treatment now emphasizing inflammation endotypes, especially eosinophilic patterns, to direct therapeutic choices. Alongside these developments, routine blood-based ratios (e.g., platelet-to-lymphocyte and neutrophil-to-lymphocyte) are being explored as predictors of exacerbation risk, and forced oscillation testing (FOT) is proving useful for picking up early disease shifts. In more severe conditions, biomarkers are linked to an early and better prognosis, enabling timely intervention. Markers like Matrix metalloproteinase-7 (MMP-7) and CC chemokine ligand 18 (CCL18) have proven to be reliable indicators of mortality and disease progression in idiopathic pulmonary fibrosis. Meanwhile, in lung cancer, liquid biopsies, especially those measuring circulating tumor DNA and micro-RNA (miRNA) panels, are enhancing screening accuracy while helping to cut down on the high false-positive rates seen with low-dose computerised tomography (CT). Other respiratory conditions such as bronchiectasis, pulmonary embolism, pneumonia, and acute respiratory distress syndrome (ARDS) are also benefiting from biomarker advances. At the same time there is a growing push to standardize how these biomarkers are measured. AI-based clinical decision support systems are also playing an increasingly important role in the translation of all these complicated data into actionable clinical insights. Together these developments pave the way for improved respiratory care that is precise and responsive to individual patient needs. Full article

Background/Objectives: Hallux valgus is a common forefoot deformity whose surgical correction generally yields favorable functional outcomes. However, postoperative complications remain a clinically relevant concern, and the contribution of preoperative risk factors has not been comprehensively characterized in the context of the Spanish population. This study aimed to analyze the relationship between preoperative risk factors and the occurrence of complications after hallux valgus surgery, and to assess whether their accumulation follows a dose–response pattern of increased postoperative risk. Methods: A retrospective observational study was conducted in 123 consecutive patients who underwent hallux valgus surgery between 1 January 2017 and 31 December 2018, with a mean follow-up of 12 months. Variables analyzed included age, sex, deformity severity, active smoking, diabetes mellitus, and antiplatelet or anticoagulant therapy. An accumulated risk factor index based on three clinical risk factors was constructed. Statistical analysis included descriptive statistics, the Cochran–Armitage trend test, and multivariate logistic regression. Results: The mean age was 57.4 years; 82.1% were female. Active smokers accounted for 31.7%, 14.6% had diabetes mellitus, and 13.0% were receiving antithrombotic therapy. The overall complication rate was 20.3%, comprising recurrence (12.2%), chronic residual pain (6.5%), joint stiffness (4.1%), and infection (4.1%). Complication frequency increased progressively from 15.9% in patients without risk factors to 50.0% in those with three concurrent factors (p-trend = 0.038). In multivariate analysis, male sex (odds ratio [OR] 5.39; 95% confidence interval [CI] 1.41–21.19; p = 0.014) and diabetes mellitus (OR 8.37; 95% CI 1.42–63.60; p = 0.026) were independently associated with a higher risk of complications. Conclusions: Hallux valgus surgery generally has a favorable prognosis; however, the presence of preoperative risk factors significantly influences postoperative risk. Diabetes mellitus and the accumulation of risk factors identify patients who could benefit from more rigorous preoperative evaluation, metabolic optimization, and closer postoperative follow-up. Full article

Background: Friedreich’s ataxia (FRDA) is a neurodegenerative disorder driven by frataxin deficiency, resulting in mitochondrial dysfunction and reduced nuclear factor erythroid 2-related factor 2 (Nrf2) signaling. Pharmacologic trials have yielded inconsistent results, prompting an updated synthesis of evidence. Methods: We searched MEDLINE/PubMed, Google Scholar, Cochrane CENTRAL, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) from database inception to 29 June 2025. Embase, Scopus and Web of Science were not searched due to institutional access limitations. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Random-effects meta-analyses were conducted, and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used. Primary outcomes were modified Friedreich Ataxia Rating Scale (mFARS)/Friedreich Ataxia Rating Scale (FARS); safety outcomes included adverse events (AEs) and serious AEs. Secondary outcomes were Scale for the Assessment and Rating of Ataxia (SARA), International Cooperative Ataxia Rating Scale (ICARS), Nine-Hole Peg Test, and the Timed 25-Foot Walk. Results: Sixteen studies (17 reports, n = 351) met inclusion criteria. Omaveloxolone was the only agent showing a statistically significant improvement in mFARS (mean difference (MD) −2.40; 95% confidence interval (CI) −4.24 to −0.56; p = 0.014), supported by low-certainty evidence. Other therapies showed no consistent benefit. Overall AE risk was comparable to control (risk ratio (RR) 1.00; 95% CI 0.98–1.03). Apparent subgroup differences by therapeutic class or age likely reflected drug-specific effects and small samples. Conclusions: Omaveloxolone was the only agent to reach statistical significance for mFARS and is the most promising and best-supported therapy among those reviewed; however, this rests on low-certainty evidence and needs confirmation in larger trials. No clear difference in overall adverse events was observed between intervention and control groups; however, available safety evidence remains limited by imprecision, small sample sizes, and short follow-up durations. Longer, standardized, and age-stratified randomized controlled trials (RCTs) are needed. Full article

Postoperative radiotherapy (RT) improves survival in glioblastoma, and its role in standard management is not disputed. The randomized trials establishing this benefit, however, were conducted before computed tomography, magnetic resonance imaging (MRI), molecular classification, and temozolomide (TMZ), in heterogeneous populations of “operated malignant glioma” treated with whole-brain or large-field RT versus best supportive care. Their pooled survival benefit (risk ratio 0.81; 95% CI 0.74–0.88) robustly answers the historical question they were designed to address. Since then, advances in surgery, imaging, molecular diagnostics, and systemic therapy have created a modern best-prognosis subgroup—young patients with excellent performance status, MRI-confirmed complete or supramaximal resection of an IDH-wildtype glioblastoma, and median survival approaching or exceeding three years—for whom no clearly defined historical counterpart exists. This perspective provides a structured appraisal of the directness of the landmark randomized evidence using GRADE concepts and translates that appraisal into a graded roadmap for future de-escalation trial designs. Across population, intervention, comparator, and outcomes, the historical trials exhibit substantial indirectness, while the only randomized RT-versus-no-RT evidence from the modern era derives from elderly patients representing the opposite prognostic extreme. This is not an argument against RT. The infiltrative biology of glioblastoma, predominantly in-field recurrence, and radioresistant stem-cell populations strongly support continued benefit. Rather, the unresolved question concerns the magnitude of benefit after maximal contemporary therapy and whether selected de-escalation strategies merit prospective evaluation. Our thesis is one of collective scientific equipoise regarding an unresolved evidence question rather than individual clinician equipoise or refutation of current standard care. Full article

Background/Objectives: Antenatal corticosteroids (ACSs) form the basis of prenatal care for women at risk of preterm birth, primarily due to their proven benefits in reducing neonatal mortality and short-term morbidity. However, there are growing concerns about the potential long-term consequences of fetal exposure to ACSs. The aim of the meta-analysis was to assess the relationship between exposure to corticosteroids administered during the prenatal period and long-term effects. Methods: PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials were searched for studies published up to 28 January 2026. Randomized controlled trials and observational studies reporting long-term outcomes after exposure to ACSs were included. A random effects model was used to calculate effect sizes. Results: Among the neurological disorders analyzed, our meta-analysis showed an increased risk of 17% of suspected neurocognitive disorder (RR = 1.17; 95% CI [1.13; 1.21]; p < 0.0001, I² = 10%), 18% of hearing impairment (RR = 1.18; 95% CI [1.13; 1.24]; p < 0.0001, I² = 41%), 3% of visual impairment (RR = 1.03; 95% CI [1.01; 1.05]; p = 0.0012, I² = 0%), 25% of autism spectrum disorders (RR = 1.25; 95% CI [1.09; 1.42]; p = 0.001, I² = 43%) and 25% of any mental or behavioral disorder (RR = 1.25; 95% CI [1.1; 1.43]; p = 0.0008, I² = 77%). The results of other neurological disorders, as well as other analyzed outcomes, were not statistically significant (p > 0.05). Conclusions: Although this meta-analysis suggests an increased risk of certain long-term neurological outcomes following prenatal exposure to corticosteroids, these findings should be interpreted with caution in light of the well-documented short-term benefits for newborns and the need for a careful assessment of the benefit–risk ratio and further long-term observational studies. Full article

Maritime unmanned aerial vehicle (UAV) missions such as ship inspection, search and rescue, environmental monitoring, and emergency response often involve multi-wave task releases, time-sensitive deadlines, constrained support vessel positions, and spatially heterogeneous risk. These factors couple task allocation with path planning and make fixed dispatching rules fragile under changing mission profiles. This study develops a hierarchical cooperative planning framework for multiple UAVs over a maritime risk field. A risk-cost A* layer generates feasible routes from support vessels to task points and estimates path length, risk exposure, and sortie duration. A rolling scheduler constructs feasible UAV task candidates, while a scenario-switching-aware LinUCB hyper-heuristic selects online among deadline-first, distance-first, risk-aware, and endurance-balancing rules. A forgetting-update, one-step look-ahead, scenario memory, and lightweight switching detection are used to improve adaptation to mission profile changes. Simulations on a 28 × 40 maritime grid with two support vessels, six UAVs, 40 tasks, and nine release waves show that the proposed framework achieves the highest average effective reward (370.18), the lowest average value regret (0.61), and a best reward ratio of 0.46 over 24 random scenarios. The results should be interpreted as evidence from an idealized simulation benchmark. The main benefit is improved reward robustness under non-stationary and high-risk profiles, rather than uniform gains across all metrics or direct field-deployment validation. Full article

Background: Percutaneous left atrial appendage occlusion (LAAO) is an established nonpharmacologic strategy for stroke prevention in atrial fibrillation (AF). Its comparative effectiveness and safety relative to contemporary medical therapy, including direct oral anticoagulants (DOACs), remain uncertain following recent large randomized controlled trials (RCTs). Methods: We performed a systematic review and meta-analysis of RCTs comparing catheter-based LAAO with medical therapy in AF patients. PubMed, CENTRAL, and ScienceDirect were searched from inception through May 2026. Dichotomous outcomes were pooled as risk ratios (RRs) with 95% confidence intervals (CIs) using random-effects models. The primary outcome was the composite primary endpoint. Secondary outcomes included all-cause death, cardiovascular death, all stroke/TIA, ischemic stroke/TIA, systemic embolism, major bleeding, and nonprocedural major bleeding. Risk of bias was assessed using ROB 2. Results: Six RCTs were included, contributing 7073 participants (3729 LAAO; 3344 medical therapy). LAAO was not associated with significant differences in the composite endpoint (RR 1.02; 95% CI 0.85–1.23), all-cause death (RR 1.02; 95% CI 0.79–1.31), cardiovascular death (RR 0.93; 95% CI 0.67–1.29), all stroke/TIA (RR 1.06; 95% CI 0.81–1.38), ischemic stroke/TIA (RR 1.24; 95% CI 0.88–1.76), systemic embolism (RR 0.76; 95% CI 0.12–4.77), or total major bleeding (RR 0.93; 95% CI 0.77–1.13). LAAO significantly reduced nonprocedural bleeding (RR 0.54; 95% CI 0.46–0.63; p < 0.0001; I² = 0.0%). Heterogeneity was low to moderate across outcomes. Conclusions: No significant differences were observed between LAAO and medical therapy for the composite endpoint, mortality, or thromboembolic outcomes; however, confidence intervals for ischemic stroke/TIA and systemic embolism remained wide and cannot exclude a clinically meaningful excess of thromboembolic events after LAAO. LAAO was associated with a substantial and consistent reduction in nonprocedural bleeding. These findings suggest LAAO may be considered an individualized alternative to oral anticoagulation for selected patients with high bleeding risk or anticoagulation intolerance, weighing upfront procedural risk against this bleeding benefit, while uncertainty for rare thromboembolic outcomes remains to be resolved. Full article