Search Results (7,165)

Background: Childhood obesity is on the rise in South Africa and adolescents spend a substantial amount of time in the school food environment (SFE), which plays a role in shaping their food choices and provides a critical setting to improve diets. Objective: To investigate South African adolescent school-going learners’ knowledge and understanding of healthy and unhealthy foods and the drivers of their food choices in their (SFE). Design: Qualitative participatory research methods including workshops, photovoice and focus group discussions (FGDs). Setting: Two urban public high schools, one non-metropolitan and one metropolitan, in two separate provinces (Eastern Cape and Gauteng) in South Africa. Participants: Adolescents 14–18 years (n = 42). Results: Unhealthy ultra-processed foods (UPFs) were found to be rampant in the SFE, and healthy foods were scarce, limiting learners’ choices. Taste preference was a major driver of adolescent food choices as were satiety, value for money, affordability, convenience, visual appeal and seeming “cool or “rich” by purchasing branded franchise fast foods. Learners had some general nutrition knowledge, but this did not translate into healthy food choices. Banning unhealthy foods in the SFE and providing affordable and satiating healthy foods were proposed as solutions. Conclusions: UPFs such as packaged foods and fast food were considered tasty but unhealthy, yet were preferred. Interventions are needed to promote healthy diets by changing the SFE, and eventually adolescent food choices. This will require government regulation banning the sale of unhealthy food and beverages (F&Bs) in the SFE and subsidising healthy satiating foods to change dietary behaviour. Full article

Many ant species play a relevant role in the successional patterns of insects colonizing human and animal corpses. Although feeding behavior in ants depends on the trophic preferences of each taxon, these insects are often reported in several studies as predators of eggs, larvae, and adults of necrophagous insects. Among ants, some species are known to cause damage on human and animal dermis, known as post-mortem skin artifacts. The extensive activity of worker ants on corpses may hinder forensic pathological investigations aimed at determining the cause and location of death, as well as the assessment of entomologists in estimating the minimum post-mortem interval. We report for the first time a case of skin lesions on a human corpse found in a suburban area of the city of Cosenza (Calabria, Southern Italy), caused by the ant Pheidole pallidula (Hymenoptera: Formicidae). During the autopsy, numerous individuals (major and minor workers) were observed feeding on the corpse, but no other insects were found on it. We discuss the appearance of skin artifacts caused by P. pallidula and provide an overview of the genus Pheidole in forensic entomology. Full article

Introduction: Urinary incontinence (UI) is one of the most common pelvic floor disorders after childbirth and depends on hormonal changes, anatomical damage that occurs after childbirth, muscle and connective tissue weakness, fascia and nerves. UI is distinguished into three subtypes, including stress urinary incontinence (SUI), urgent urinary incontinence (UUI) and mixed urinary incontinence (MUI). Aim: The purpose of this review is to collect and summarize the results of studies related to the risk factors of urinary incontinence, to disseminate this information to scientists so that this major issue can be prevented, identified and managed. Methodology: This review followed the methodology of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and PECO eligibility criteria were used. We included studies published up to 2025 and not before 2019. The review was limited to studies published within the last six years in order to reflect contemporary diagnostic criteria, assessment tools and current postpartum care practices related to urinary incontinence. We searched PubMed, Google Scholar and Scopus for studies concerning the relationship between risk factors and postpartum UI. Results: A total of 1321 citations were identified. Following our exclusion criteria, 36 papers were selected to identify the risk factors for UI. All the research focused on the associated factors of any type of urinary incontinence. Vaginal and instrumental delivery, obesity, maternal age and the neonate’s birth weight were the main risk factors. The multiparity and incontinence symptoms before and during pregnancy were also strong risk factors. Heterogeneity across studies in assessment tools, in outcome measures and timing of postpartum assessment are some of the limitations of the study. Restriction to English-language publications and the absence of protocol registration were some of the additional limitations of the study. Conclusions: This problem affects the inclusion of women in society, the family, limits social activities and even their ability to work. Detection of the type of urinary incontinence by healthcare professionals, lifestyle modifications, monitoring women’s body weight and encouraging them to follow a program of pelvic floor muscle exercises should be a priority for professionals. The strategy of developing prognostic models in the coming years will be the only way to ensure the early identification and follow-up of women at high risk for urinary disorders. Full article

This paper develops a theoretical model analyzing the optimal timing of switching from fossil-fuel-based energy to cleaner technologies in a stochastic environment. The economy consists of two interacting sectors: a backstop-production sector (e.g., solar panels), which uses both fossil fuels and backstop energy, and a consumption sector that initially relies exclusively on fossil fuels but can adopt a hybrid (cleaner) technology by incurring a fixed, irreversible investment cost. Both pollution accumulation and backstop accumulation are assumed to be stochastic. Our results indicate that the optimal timing for switching is significantly influenced by technological parameters, particularly the dependence on fossil fuels in post-switch production and the extent of technological gains in backstop manufacturing. Specifically, reducing fossil-fuel reliance and improving backstop technology both accelerate the adoption of cleaner technologies. We also find that uncertainty can either accelerate or delay adoption, depending on technological progress and intertemporal substitution preferences. These findings underscore the importance of policies that decrease fossil fuel dependence while fostering innovation in renewable energy technologies. Full article

Background: The heterogeneity of immune-related adverse events (irAEs) in real-world evidence highlights the need to identify patterns, knowledge gaps, and priorities for future research. Objectives: To assess in labels the expected irAEs associated with immune checkpoint inhibitors (ICIs) in lung cancer, melanoma, breast cancer, and colon cancer and evaluate their incidence, clinical characteristics, management, and outcomes in real-world studies. Methods: Medicine Agency data sources (Food and Drug Administration and European Medicines Agency) were assessed for labeled irAEs associated with ICIs, and a comprehensive literature review according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines for scoping review was performed by retrieving observational and target trial emulation studies conducted using data collected in administrative healthcare databases (AHDs) and in spontaneous reporting systems (SRSs) concerning the drugs and tumors of interest from PubMed. irAEs’ incidence, onset, management, and outcomes were retrieved. Results: ICI combination therapy increases irAE occurrence, and inter-agency differences emerged. From PubMed, 49 observational studies were included, 22 on SRSs and 27 on AHDs. The ICIs most frequently evaluated were pembrolizumab and nivolumab, and the irAEs most reported were “lower respiratory tract disorders (excluding obstruction and infection)” (SRSs) and “epidermal and dermal conditions” (AHDs) for both drugs. Missing information on survival analysis, therapy dechallenge and rechallenge, concomitant therapies, comorbidities, time to onset, and duration of irAEs were highlighted. Conclusions: This scoping review highlights the complex, multi-organ irAEs from ICIs, underlining the need for tailored monitoring and management based on both regulatory and real-world evidence. Full article

Background: Effective dental isolation is crucial for successful restorative procedures in pediatric patients; however, its potential impact on patient stress remains underexplored. This investigation comprised two independent pilot sub-studies evaluating salivary cortisol responses to dental isolation techniques: one comparing cotton roll isolation (CRI) and the Isolite system (IS), and a second comparing cotton roll isolation (CRI) and the DryShield isolation system (DSI). The sub-studies were reported together due to a shared clinical context and outcome measure. Methods: Pediatric patients underwent sealant placement using CRI, IS, or DSI, depending on sub-study assignment. Salivary cortisol samples were collected for each procedure. In the CRI–IS sub-study, pulse rate was recorded at three time points, and participants completed subjective preference surveys. Cortisol analyses were conducted separately within each sub-study, with pulse rate and preference outcomes evaluated only for the CRI–IS cohort. Results: DSI produced a significant increase in salivary cortisol from pre- to post-procedure compared with CRI (p = 0.0001), indicating a higher acute stress response. In contrast, CRI and IS did not differ significantly in cortisol levels, but heart rate did significantly increase from pre- to post-procedure when CRI was used (p = 0.035). Of the 15 participants in the CRI–IS comparison, 9 provided subjective feedback, with most preferring the IS. Gender was not associated with differences in stress markers in either sub-study. Conclusions: These findings suggest that while CRI and IS produce comparable physiological stress responses, DSI may be associated with heightened cortisol reactivity. Although IS was subjectively preferred, biological stress measures showed no definitive difference from CRI. Clinicians may therefore select CRI or IS based on clinical judgment and patient comfort, while considering the potential for increased stress when using DSI in pediatric populations. Full article

The aim of this study is to develop a digital twin hierarchy that fully examines the design and manufacturing processes of an automotive component for metal additive manufacturing. Initially, a lighter model was obtained that was more resistant to static, dynamic, and fatigue loads under various operating conditions. This step improved product strength and resulted in a 28.5% mass reduction. After the product was validated, the orientation of the part direction and the generation of support structures were performed for the manufacturing process. These processes were implemented with the criterion of minimizing production time. Finally, the manufacturing process was digitally implemented using the selective laser melting method and Ti6Al4V material. The design of the experiment was created using the three most frequently preferred values for each of the three important process parameters. After performing process simulations with thermomechanical analyses, Taguchi and ANOVA were applied to the process parameters. The optimum process parameters for layer thickness, hatch spacing, and scanning speed were found to be 30 µm, 50 µm, and 1200 mm/s, respectively. Full article

Kombucha’s growing popularity worldwide has been accompanied by a growing consumer interest in exploring new flavors and adopting healthier diets. In this preliminary consumer-driven study, we investigated the application of white hibiscus (WH) calyces in the development of novel kombucha beverages. Kombuchas were made from 100% black tea (BT), 100% WH, and 50% BT/WH blend infusions, then their pH, total titratable acidity (TTA), ethanol content, sucrose, glucose, and fructose concentrations were measured. Untrained sensory participants (N = 97) rated the kombuchas using a 9-point hedonic scale, described them using a check-all-that-apply list of attributes, and answered a willingness-to-pay (WTP) question. Tea infusion and fermentation time had a significant effect on pH, TTA, ethanol, sucrose, fructose, and glucose content (p < 0.05). High residual sugar levels observed in the WH kombucha indicated sluggish fermentation. Kombuchas differed significantly in overall-liking, color, aroma, flavor, and mouthfeel liking, and WTP (p < 0.05). Overall, BT kombucha was preferred over the WH kombuchas (100% and blend). Sensory attributes “refreshing”, “floral”, “hibiscus”, “fruity”, and “sweet” were positive drivers of acceptability, while “pungent” and “astringent” were negative drivers. Results suggest that blends containing less than 50% WH may provide more appealing sensory attributes to consumers, and that further study is needed. Full article

Sub-Saharan Africa’s cereal yields remain ~60% below global benchmarks, while unmanned aerial vehicle (UAV) adoption in smallholder systems averages below 2–3% across major economies, revealing a performance–adoption disconnect that requires systematic investigation. This Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 synthesis of 127 sources quantifies the performance of UAV sensors and identifies mechanisms that constrain their adoption across regional agricultural systems. Random-effects meta-analysis synthesized evidence from 81 quantitative studies, yielding 101 total observations. Pooled detection accuracy was estimated from 49 studies contributing 52 observations (mean 90.2%, 95% confidence interval (CI): 89.8–92.6%). Yield prediction performance was assessed from 32 studies contributing 49 observations (pooled coefficient of determination (R²) = 0.841, 95% CI: 0.827–0.855), validating technical feasibility. Cost-effectiveness analysis reveals significant performance–price differentiation: red-green-blue (RGB) sensors achieve 89.4% accuracy at United States Dollar (USD) 16.50 per percentage point versus hyperspectral systems at 93.7% accuracy but at USD 132.17 per point, resulting in a 25.6 times cost differential. Yield prediction models demonstrate robust performance (R² = 0.81; cereal crops R² = 0.82). Barrier analysis identifies economic constraints as the primary limiter, with capital requirements reaching 0.8–3.1 times the annual smallholder income. Infrastructure deficits impose secondary constraints, particularly in rural electrification, below 50%. Case study synthesis reveals that coordinated interventions addressing multiple barriers simultaneously—cooperative ownership, off-grid infrastructure, and streamlined regulation—achieve substantially higher adoption than isolated approaches. Engineering economics positions RGB platforms for individual deployment and multispectral systems for cooperative scales (20–50 farmers), establishing feasible deployment pathways for tens of million regional smallholder operations. Full article

The present study evaluates the performance of hotel companies in Romania using Data Envelopment Analysis (DEA) integrated with a hybrid weighted TOPSIS model (Technique for Order Preference by Similarity to the Ideal Solution). This approach captures both technical efficiency and multidimensional competitiveness. The DEA included an output-oriented Variable Returns to Scale (VRS) model (with four inputs and one output). It was followed by TOPSIS aggregation with hybrid entropy weights to obtain a composite performance index. The research used cross-sectional financial data for 2023, specific to hotels in Romania, and allowed interpretation across five territorial categories based on predominant relief. The results show that the 852 analyzed hotels have a relatively homogeneous structure and moderate variations in performance scores. At the same time, top-performing units are strongly concentrated in economically or touristically dynamic counties. The integrated DEA–TOPSIS results indicate that high-performing hotels tend to cluster spatially, with plain counties hosting the largest number of hotels at the national level and also a substantial share of high-performance hotels relative to major urban centers; thus, their performance structure is not uniform but strongly polarized. In contrast, the other geographical areas show pronounced clustering, with top hotels concentrated around consolidated leisure destinations, such as Brașov, Sibiu, Constanța, and Prahova. Overall, research using the DEA–TOPSIS method highlights significant spatial disparities that influence both managerial decision-making and regional development policies, affecting the long-term sustainable performance and competitiveness of the Romanian hotel sector. Full article

(1) Background: Hudson first described the procedure that includes en-block removal of an ovarian tumor fixed in the pelvis with the whole pelvic peritoneum and invaded surrounding structures. However, sometimes pelvic peritonectomy (PP) with or without shaving of the bowel serosa is not enough to achieve complete cytoreduction, and en-block rectosigmoid resection (RR) is necessary. This study aims to investigate the impact of bowel surgery on survival rates and morbidity of patients with advanced ovarian cancer. (2) Methods: We retrospectively analyzed patients with advanced ovarian cancer with cul-de-sac involvement that underwent debulking surgery at the 1st Department of Obstetrics—Gynecology of “Papageorgiou” General Hospital, from 2017–2022. The primary outcomes were the survival rates and morbidity between PP and RR. (3) Results: A total of 93 patients met the inclusion criteria. Patients were categorized into two groups: Group A (34 patients) with RR and Group B (59 patients) with PP. There was no statistically significant difference in the majority of patients’ characteristics and oncological outcomes. On the other hand, patients with RR had a significantly higher surgical complexity score (SCS), peritoneal cancer index (PCI), ICU admission, rate of postoperative complications, longer surgery duration and hospital stay. When comparing the duration of surgery, the RR group has significantly higher operation time during primary compared to interval debulking surgery. Concerning survival rates, there was no significant difference in progression-free (PFS) (p = 0.22) and overall survival (OS) (p = 0.85) between the two groups, while residual disease and postoperative complications were identified as independent prognostic factors for PFS and OS; (4) Conclusions: The modified Hudson procedure with RR is a safe and reproductible technique, but when complete gross resection can be achieved with PP, this technique is preferred in order to avoid increased patient’s morbidity. Full article

Background: Robot-assisted partial nephrectomy (RAPN) can be done using either a three-arm or four-arm configuration. However, the evidence comparing the perioperative, functional, and oncological outcomes between these two approaches is inconsistent. Therefore, we aimed to quantitatively compare the outcomes of three-arm versus four-arm RAPN. Methods: A comprehensive search of multiple databases, including PubMed, Embase, Scopus, Web of Science, and Cochrane, was conducted, adhering to the PRISMA guidelines. Studies comparing three-arm and four-arm RAPN were included. Continuous outcomes were assessed using mean differences (MD), and dichotomous outcomes were evaluated using risk ratios (RR). The ROBINS-I tool was used to determine the risk of bias. Results: Five studies that met the selection criteria were included in the final review and analysis. The pooled analyses demonstrated no significant difference in estimated blood loss, warm ischemia time, transfusion rates, overall complications, major complications, or positive surgical margins between the three-arm and four-arm RAPN. Although the initial primary analysis showed a shorter length of stay within the three-arm RAPN technique, the sensitivity analysis did not reflect this finding. Conclusions: The three-arm and four-arm RAPN demonstrated comparable perioperative, functional, and oncologic outcomes. As both techniques appear to be effective, the choice of configuration may be decided by the institutional resources, case complexity, and the surgeon’s preference. Full article

In contemporary practice, dental implants are widely recognized as a reliable and effective solution for rehabilitating edentulous patients. Nevertheless, implant placement in the atrophied maxilla presents considerable challenges, with treatment planning influenced by various factors such as patient demographics, anatomical constraints, and economic considerations. Advances in imaging technology have positioned cone-beam computed tomography (CBCT) as the preferred modality for enhancing implant placement accuracy. By producing high-resolution three-dimensional radiographic images, CBCT facilitates precise assessment of maxillary anatomy at the proposed implant site—including bone height, width, length, and angulation—thereby optimizing surgical planning and improving the predictability and success rates of implant integration. Moreover, the timing of implant placement must account for the necessity of maxillary augmentation to ensure implant stability and reduce the risk of postoperative complications. This review discusses the clinical utility of CBCT as a diagnostic tool for preoperative assessment, focusing on the identification of critical anatomical landmarks and the determination of indications for bone augmentation, thereby highlighting its crucial role in enabling accurate treatment planning, minimizing surgical risks, and promoting the long-term survival of dental implants. Full article

Metabolic profiling enables comprehensive characterisation of the small molecules that are part of the biochemical composition of biological fluids. The most widely profiled biofluids include serum and plasma. Additionally synovial fluid provides a direct reflection of the metabolomic environment of joints and holds promise for biomarker discovery in arthropathies. However, the reproducibility of metabolomics data is highly sensitive to pre-analytical variation, and at the present time, standardised protocols for synovial fluid remain underdeveloped. This review aims to identify and evaluate the existing literature on effects of biofluid pre-analytical handling treatments on metabolic profiles. This review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A search was carried out to identify studies employing LC-MS, GC-MS, and NMR spectroscopy for the investigation of factors including sample collection variables, pre-centrifugation conditions, centrifugation parameters, post-centrifugations conditions, sample storage conditions, and freeze/thaw cycling. Best practice recommendations emerging from this review include the use of additive free serum and heparin plasma tubes, the centrifugation of samples within two hours of collection, immediate storage of samples at −80 °C, and avoidance of repeated freeze/thaw cycling. However, while pre-analytical influences have been extensively characterised for plasma and serum, evidence for synovial fluid remains limited. Overall, the findings highlight the existing recommendations for plasma and serum and demonstrate the need for standardised pre-analytical protocols and validation of quality control markers to advance synovial fluid metabolomics. Full article

Vehicle repositioning is essential for improving efficiency and service quality in ride-sharing platforms, yet existing approaches typically optimize proxy rewards that fail to reflect human-centered preferences such as wait time, service coverage, and unnecessary empty travel. We propose the first two-stage Bilevel Reinforcement Learning (RL) from Human Feedback (RLHF) framework for preference-aligned vehicle repositioning. In Stage 1, a value-based Deep Q-Network (DQN)-RLHF warm start learns an initial preference-aligned reward model and stable reference policy, mitigating the reward-model drift and cold-start instability that arise when applying on-policy RLHF directly. In Stage 2, a Kullback–Leibler (KL)-regularized Proximal Policy Optimization (PPO)-RLHF algorithm, equipped with action masking, behavioral-cloning anchoring, and alternating forward–reverse KL, fine-tunes the repositioning policy using either Large Language Model (LLM)-generated or rubric-based preference labels. We develop and compare two coordination schemes, pure alternating (PPO-Alternating) and k-step alternating (PPO-k-step), demonstrating that both yield consistent improvements across all tested arrival scales. Empirically, our framework reduces wait time and empty-mile ratio while improving served rate, without inducing trade-offs or reducing platform profit. These results show that human preference alignment can be stably and effectively incorporated into large-scale ride-sharing repositioning. Full article