Search Results (1,841)

The purpose of this study is to examine the relationship between green entrepreneurial orientation and sustainable firm performance. In order to examine this relationship, a meta-analysis method was used, and analyses were carried out with a Comprehensive Meta-Analysis Software (CMA) v4 package program. In the study, a sample of 23 articles, 42 effect sizes, and 6666 enterprises was reached through a systematic literature review. The studies included in the research were accessed by searching the keywords “green entrepreneurial orientation” and “sustainable firm performance” from Web of Science, EBSCO Host, Scopus, and Google Scholar databases, and only articles without any year limit were included. Throughout the study, statistical analyses were performed on Fisher z values and conducted under the random effects model. The effect size, heterogeneity, and publication bias analyses of green entrepreneurial orientation and sustainable firm performance and its sub-dimensions were tested separately, and the findings were interpreted by converting them into correlation coefficients. As a result of the analyses, it was found that the relationship between green entrepreneurial orientation and sustainable firm performance is positive and highly significant (p < 0.05). In addition, the relationship between financial, environmental, social, sustainable, entrepreneurial, and green innovation performance, which is the sub-dimensions of sustainable firm performance, and green entrepreneurial orientation, was found to be high and significant (p < 0.05). However, it was concluded that there is no significant relationship between green innovation performance, which is another dimension of sustainable firm performance, and green entrepreneurial orientation. Moderator analyses revealed that sector and continent have a moderating effect on the relationship between green entrepreneurship orientation and sustainable firm performance. Full article

Introduction: Opening the incubator side wall to insert a non-sterile length-measuring device carries the risk of microbial contamination and thermal instability for preterm infants. To reduce this inconvenience, a laser-based length-measuring board is proposed to measure body length from outside the incubator. Methods: This device has two laser-line-shaped cursors which can be pointed to opposite ends of a segment to be measured. It is attached to the outer side of one of the incubator’s side walls in such a manner as to ensure that its axis is parallel to the longitudinal axis of the segment. To validate the measurements made with this model, a calibrated caliper consisting of a conventional rigid length-measuring board with a resolution of 0.05 mm was constructed to serve as a reference. Crown–heel length was measured in a sample of 45 infants, including 32 preterm and 13 term infants of corrected gestational age at the time of measurement. Results: Good intra-observer variability was obtained. Near-perfect statistical agreement was found between measurements with both devices, with concordance correlation coefficients of 0.994 (95% CI: 0.990; 0.996) in preterm infants and 0.994 (95% CI: 0.988, 0.998) in infants at term. The clinical relevance of the agreement between measurements was assessed by a Bland–Altman plot, and the difference may reach clinical relevance (up to 1 cm) but without evidence of proportional bias. Conclusion: The proposed validated laser-based length-measuring board offers a suitable alternative to conventional length-measuring boards for contactless measurement of infant body length. Full article

Introduction: Colorectal cancer is the third most common malignancy, with around half of patients developing liver metastases. Hepatectomy is the preferred treatment, but its success depends on several factors, including surgical margins. Various surgical margins have been suggested to achieve optimal results. This systematic review and meta-analysis aim to explore the impact of negative surgical margins ranging from 1 to 10 mm, and >10 mm on survival, with the objective of identifying optimal surgical margins. Methods: A systematic literature search was conducted on the MEDLINE, Scopus, and Cochrane databases. The six included studies that examined the effect of surgical margins at the aforementioned distances on patient survival. Studies were assessed for risk of bias using the Quality in Prognosis Studies tool. Statistical analysis was performed using SPSS software. Results: The results of the meta-analysis revealed the superiority of wider surgical margins (>10) on overall survival compared to smaller margins (1–10 mm), as the HR was calculated to be 1.38 [1.10; 1.73]. Specifically, negative margins between 1 and 10 mm are linked to a 38% increased risk of mortality compared to margins larger than 10 mm. The low heterogeneity indicates consistent findings across studies, and the statistically significant hazard ratio underscores the importance of aiming for larger surgical margins to enhance patient outcomes. In the subgroup that included only studies in which patients received neoadjuvant therapy, the HR was 1.48 [1.06; 2.07], further emphasizing the importance of ensuring negative surgical margins in today’s era. Conclusions: In summary, this systematic review and meta-analysis highlights the impact of surgical margin width on the survival of patients with colorectal liver metastases, as well as the importance of margin optimization in surgical management strategies. Full article

Ischemic stroke is a serious cerebrovascular disease, highlighting the urgent need for reliable biomarkers for early diagnosis. Recent reports suggest that long non-coding RNAs (lncRNAs) can be potential biomarkers for ischemic stroke. Therefore, our study seeks to investigate the potential diagnostic value of lncRNAs for ischemic stroke by analyzing existing research. A comprehensive literature search was conducted across the PubMed, ScienceDirect, Wiley Online Library, and Web of Science databases for articles published up to July 10, 2024. Statistical analyses were performed using Stata 17.0 software to calculate pooled sensitivity, specificity, positive likelihood ratio (PLR), diagnostic odds ratio (DOR), negative likelihood ratio (NLR), and area under the curve (AUC). Heterogeneity was explored with the Cochran-Q test and the I² statistical test, and publication bias was assessed with Deeks’ funnel plot. A total of 44 articles were included, involving 4302 ischemic stroke patients and 3725 healthy controls. Results demonstrated that lncRNAs H19, GAS5, PVT1, TUG1, and MALAT1 exhibited consistent trends across multiple studies. The pooled sensitivity of lncRNAs in the diagnosis of ischemic stroke was 79% (95% CI: 73–84%), specificity was 88% (95% CI: 77–94%), PLR was 6.63 (95% CI: 3.11–14.15), NLR was 0.23 (95% CI: 0.16–0.33), DOR was 28.5 (95% CI: 9.88–82.21), and AUC was 0.88 (95% CI: 0.85–0.90). Furthermore, the results of subgroup analysis indicated that lncRNA H19 had superior diagnostic performance. LncRNAs demonstrated strong diagnostic accuracy in distinguishing ischemic stroke patients from healthy controls, underscoring their potential as reliable biomarkers. Because most of the articles included in this study originate from China, large-scale, high-quality, multi-country prospective studies are required to further validate the reliability of lncRNAs as biomarkers for ischemic stroke. Full article

Background: The relationship between obesity, physical activity, and cancer has not been well studied across different countries. The age-standardized rate of cancer in the UK is double–triple that in the Gulf Cooperation Council Countries (GCCCs). Here, we study the association between obesity, physical activity, and cancer incidence with the aim to elucidate cancer epidemiology and risk factors in two geographically, ethnically, and climatically different parts of the world. Methods: Our systematic search (from 2016 to 2023) in PubMed, EMBASE, Scopus, and APA PsycINFO databases resulted in 64 studies totaling 13,609,578 participants. The Cochrane risk of bias tool, GRADE, R programming language, and the meta package were used. Results: Significant associations between obesity and cancer were found in both regions, with a stronger association in the UK (p ≤ 0.0001) than the GCCCs (p = 0.0042). While physical inactivity alone did not show a statistically significant association with cancer incidence, the pooled hazard ratio analysis revealed that the presence of both obesity and physical inactivity was associated with a significantly higher cancer incidence. The most common types of cancer were breast cancer in the UK and colorectal cancer across the GCCCs. Conclusion: Although both regions share similarities, advanced healthcare systems, genetic characteristics, dietary habits, and cultural practices may influence cancer incidence and types. Full article

Remote sensing (RS)-based forest inventories are becoming increasingly common in forest management. However, practical applications often require subsequent optimisation steps. One of the most popular RS-based forest inventory methods is the two-phase inventory with regression estimator, commonly referred to as the area-based approach (ABA). There are many sources of variation that contribute to the overall performance of this method. One of them, which is related to the core aspect of this method, is the spatial co-registration error between ground measurements and RS data. This error arises mainly from the imperfection of the methods for positioning the sample plots under the forest canopy. In this study, we investigated how this positioning accuracy affects the area-based growing stock volume (GSV) estimation under different forest conditions and sample plot radii. In order to analyse this relationship, an artificial co-registration error was induced in a series of simulations and various scenarios. The results showed that there were minimal differences in ABA inventory performance for displacements below 4 m for all stratification groups except for deciduous sites, where sub-metre plot positioning accuracy was justified, as site- and terrain-related factors had some influence on GSV estimation error (r up to 0.4). On the other hand, denser canopy and spatially homogeneous stands mitigated the negative aspects of weaker GNSS positioning capabilities under broadleaved forest types. In the case of RMSE, the results for plots smaller than 400 m² were visibly inferior. The BIAS behaviour was less strict in this regard. Knowledge of the actual positioning accuracy as well as the co-registration threshold required for a particular stand type could help manage and optimise fieldwork, as well as better distinguish sources of statistical uncertainty. Full article

Background: Cueing interventions, which utilize external auditory, visual, or somatosensory stimuli, are increasingly used to improve motor performance in individuals with Parkinson’s disease (PD). This review explores the effectiveness of cueing on gait, balance, and quality of life outcomes in PD. Methods: A scoping review of six studies was conducted, focusing on the impact of cueing interventions on gait parameters, balance stability, and functional outcomes in PD patients. Studies were evaluated for methodological quality using the PEDro scale, and risk of bias was assessed with RoB 2. Results: Cueing interventions consistently improved gait parameters, with five studies showing significant increases in step length. The results for walking speed were more varied, with some studies reporting statistically significant gains while others found non-significant or mixed outcomes. Balance improvements were noted in dynamic balance measures, though static balance effects were less consistent. Two studies observed long-term benefits at follow-up, particularly when interventions were structured and supervised. The quality of life improvements were limited, with only one study measuring this outcome and showing no significant changes. Conclusions: Cueing interventions demonstrate potential for enhancing gait and dynamic balance in PD, though effects on quality of life remain uncertain. Early and structured implementation of cueing, especially with auditory stimuli, may support functional gains in PD management. Further research is required to establish optimal cueing protocols and long-term benefits. Full article

A single-center, randomized, double-blind, and placebo-controlled clinical trial assessed the efficacy in improving body composition and in weight management of a dietary supplement consisting of 400 mg of a standardized extract of the persimmon fruit (Diospyros kaki L.f.) in adult subjects with a BMI between 25 and 34.99 kg/m² administered for 120 consecutive days. In total, 36 participants were assigned to the placebo group and 35 to the experimental group (registered at ClinicalTrials.gov (NCT05750342)). Primary analysis focused on overweight subjects (placebo, n = 26; experimental, n = 23). In this group, fat mass expressed in kg and percentage evaluated by both dual-energy X-ray absorptiometry (DEXA) and bioelectrical impedance analysis (BIA) decreased significantly (between-group differences p < 0.001) in those receiving the persimmon extract as compared with the placebo. No significant reduction in lean mass was observed, suggesting that the muscle mass was maintained during fat loss. The use of the investigational product improved classic anthropometric parameters to a statistically significantly greater extent than the placebo, including body weight, BMI, and waist and abdominal circumference (p < 0.001), in the overweight group. In the overall population, similar improvements were observed, with significant between-group differences (p < 0.001) in fat mass reduction and improvements in body composition. Changes in the biochemical lipidic, glycemic, and anti-inflammatory profile were not found, except for between-group significant differences (p < 0.001) in decreases in tumor necrosis factor-alpha (TNFα) and increases in total antioxidant capacity (TAC) in favor of the experimental condition. There was a significant increase in fecal fat excretion in the experimental group at the end of the study in subjects with low fecal fat (9%) at baseline. Consumption of the investigational product vs. placebo improved the quality of life, with significantly greater scores in the total score and the mental health component of the SF-12 questionnaire. The persimmon extract was safe and well tolerated. Full article

Objectives: To determine whether a closed dressing protocol reduces the surgical site infections (SSI) rate compared to conventional closing techniques. Methods: Patients who underwent lumbar spine surgery at two neurosurgical centers were retrospectively included from June 2015 to December 2019. Data on patients, general risk factors, and surgical risk factors for SSI were collected. Patients were subdivided into two groups: a Closed Protocol where the Dermabond^® ± Prineo^® dressing system was used, and a Conventional Protocol, namely sutures or staples. Statistical analysis was undertaken to compare the infection rates among the different closure techniques. Results: Altogether, 672 patients were included. In the whole cohort, 157 (23.36%) underwent skin closure with staples, 122 (18.15%) with sutures, 98 (14.58%) with intracutaneous sutures, 78 (11.61%) with Dermabond^®, and 217 (32.29%) with Demabond^® + Prineo^®. The overall infection rate was 2.23% (n = 15). Skin suture had the highest infection rate (4.10%), while the lowest was Dermabond^® (1.28%) and Dermabond^® + Prineo^® (1.4%), though the difference was not significant. Risk factors for SSI included higher BMI (29.46 kg/m² vs. 26.96 kg/m², p = 0.044), other sites infection (20.00% vs. 2.38%, p = 0.004), and a higher national nosocomial infections surveillance score (p = 0.003). Conclusions: This study showed that a closed protocol with the use of adhesive dressing with or without mesh had a slight tendency to lower infection rates compared to conventional protocol with sutures or staples, although no statistically significant difference was found between the closure techniques. Larger randomized studies are needed to investigate this potential benefit avoiding selection bias. Full article

Accurate shear capacity estimation for reinforced concrete (RC) beams without stirrups is essential for reliable structural design. Traditional code-based methods, primarily empirical, exhibit variability in predicting shear strength for these beams. This paper assesses the effectiveness of mechanics-based and optimized machine learning (ML) models for predicting shear strength in stirrup-less, slender beams using a dataset of 784 tests. Seven ML models—artificial neural network (ANN), support vector machine (SVM), decision tree (DT), random forest (RF), AdaBoost, gradient boosting (GBR), and extreme gradient boosting (XGB)—were compared against three mechanics-based models: the Tran’s NLT Model (2020), the Multi-Action Shear Model (MASM), and the Compression Chord Capacity Model (CCC). Among the ML models, XGB and GBR demonstrated the highest predictive accuracy, with coefficients of determination (R²) of 0.974 and 0.966, respectively, indicating strong correlation with experimental data. Performance metrics such as mean absolute error (MAE) and root mean squared error (RMSE) showed that XGB and GBR consistently outperformed other models, yielding lower error margins. Statistical analysis revealed minimal bias and variability in the predictions of XGB and GBR, with a coefficient of variation (CoV) of 14%, ensuring high reliability. The NLT model, the most accurate of the mechanical-based models, achieved a mean of 1.02 and a CoV of 16% for its model error, demonstrating reasonable prediction reliability but falling behind XGB and GBR in accuracy. With Shapley additive explanations (SHAPs), the beam width and depth were identified as primary predictors of shear strength, providing critical insights for enhancing design and construction practises. Full article

Background/Objectives: This systematic review aimed to compare the tunnel technique for pre-implant bone regeneration with traditional flap techniques also involving a crestal incision, in terms of procedure success, graft healing, postoperative course, patient satisfaction, and implant follow-up. Methods: A systematic search was conducted on MEDLINE/PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials following PRISMA guidelines, searching for comparative prospective and retrospective studies in English, published between January 2002 and April 2024. The population of interest consisted of patients with edentulous ridge atrophy requiring pre-implant bone regeneration. The primary outcome was the success of the procedure. The secondary outcomes included complications, patient comfort, graft resorption, bone gain, primary implant stability, implant success/survival, peri-implant bone level change, and operative time. The risk of bias was assessed using RoB2 and ROBINS-I. Results: The search and selection process yielded one randomized controlled trial and three comparative observational studies, all with serious/high risk of bias. A narrative synthesis was conducted due to the small number of studies and the heterogeneity in key features. The tunnel technique might provide some advantages in terms of the success of the procedure, but the findings were not statistically significant. Conflicting findings or non-significant differences were reported in terms of the secondary outcomes. Conclusions: This review suggested some potential advantages of the tunnel technique for bone augmentation over traditional techniques involving a crestal incision, but the limited quality and amount of data precluded any definitive conclusions. Full article

Background: Non-muscle-invasive bladder cancer (NMIBC) comprises about 75% of all bladder cancers. Although NMIBC is treatable, it poses significant costs and burdens to patients due to high recurrence rates. We conducted an updated meta-analysis of studies that evaluated the efficacy of and outcomes after treatment with mitomycin C (MMC), gemcitabine (GEM), and docetaxel (DOCE) for NMIBC recurrence and progression. Methods: We searched the PubMed and Cochrane databases for observational cohort studies and randomized clinical trials (RCT) conducted between 2009 and 2022 that assessed the efficacy of GEM, DOCE, or MMC, alone or in combination, regarding NMIBC outcomes. A total of 49 studies that met the inclusion criteria were reviewed for their quality, sample size, outcomes, and potential for bias, and relevant data were extracted for the meta-analysis. Separate meta-analyses were performed to assess the risks of recurrence or progression when comparing GEM/DOCE or MMC vs. other treatments. Study heterogeneity was assessed by I² statistics. Results: Among 31 studies comparing GEM or MMC to other treatments for NMIBC recurrence, there were statistically significant risk reductions of 24% for GEM (pooled relative risk (RR) of 0.76; 95% confidence interval (CI) 0.64–0.87) and 37% for MMC (pooled RR = 0.63; 95% CI 0.58–0.68). Recurrence-free survival (RFS) for GEM or MMC alone was 69.5% (95% CI 66.6–72.3%) and 67.2% (95% CI 66.2–68.2%), respectively. Studies assessing the combination of treatments had a pooled RFS of 44.6% (95% CI 40.4–48.7%). Fewer studies examined the risk of NMIBC progression, with large variability and inconclusive results across them. Conclusions: Our findings corroborate recent guidelines indicating that both GEM and MMC are effective treatments that reduce tumor recurrence and improve survival of NMIBC, although with large variability across the studies. Fewer studies evaluated DOCE treatment, with inconclusive results. Women and minorities were generally underrepresented, raising concerns about the generalizability of the findings and highlighting the importance of including a broader patient population in future RCTs. Full article

Background: Melasma is a challenging, acquired hyperpigmentary disorder. The gold standard treatment is Kligman’s formulation, which contains hydroquinone, tretinoin, and dexamethasone, but its long-term use is limited by the risk of exogenous ochronosis. Cysteamine, a tyrosinase inhibitor, reduces melanocyte activity and melanin production, showing strong depigmenting effects in patients resistant to Kligman’s formulation. Nonetheless, clinical studies have yielded inconsistent efficacy results. This meta-analysis aimed to assess the efficacy of cysteamine in treating melasma and to identify potential factors that may impact its therapeutic outcomes. Methods: A systematic search of PubMed, Embase, Web of Science, and CENTRAL, from the earliest record until August 2024, was conducted. Randomized controlled trials and quasi-randomized design studies related to topical cysteamine on melasma patients were included. The primary outcome was MASI or mMASI assessment after treatments. The current meta-analysis was conducted with a random-effects model. Subgroup analyses and meta-regressions were performed based on baseline MASI, disease duration of melasma, patient age, and sample size of the included studies. Funnel plots and Duval and Tweedie’s trim and fill method were adopted to assess the publication bias. Results: Eight studies were included for quantitative analysis. The analysis of MASI after topical cysteamine demonstrated a significant decrease compared to the placebo (p = 0.002). Compared to other melasma treatments, cysteamine did not show superior efficacy in mMASI (p = 0.277). The treatment efficacy of hydroquinone, modified Kligman’s formula, and tranexamic acid mesotherapy for melasma was not statistically different when compared to cysteamine (p = 0.434). Further analyses showed no benefit when allowing extended cysteamine application time (p < 0.0001). The meta-regression revealed the efficacy of cysteamine decreased as the duration of melasma increased (coefficient = 0.38, p = 0.0001, R² = 0.99). The funnel plot displayed some asymmetry. The trim and fill method suggested the adjusted effect size was 0.607 (95% CI = −0.720 to 1.935). Conclusions: Cysteamine exhibited efficacy in treating melasma patients; however, its depigmentation effect was comparable to hydroquinone-based regimens, tranexamic acid mesotherapy, and modified Kligman’s formula. Using cysteamine in patients with a short duration of melasma may result in better efficacy. Full article

The relationship between fixed orthodontic treatment and the development of temporomandibular disorders (TMDs) in adolescents has been a topic of considerable debate. This systematic review and meta-analysis aimed to evaluate the impact of fixed orthodontic treatment on the prevalence of TMDs in adolescents. A comprehensive literature search was conducted using PubMed, Web of Science, EMBASE, Google Scholar, and the Cochrane Library, yielding 886 records. After duplicate removal, 665 records were screened, and 8 studies were assessed for eligibility. Following quality assessment using the Joanna Briggs Institute checklist, 4 studies were included in the final analysis. Data were analyzed using a random-effects model in RevMan software. The meta-analysis revealed an overall odds ratio of 0.75 (95% CI: 0.37–1.51, p = 0.42), indicating no statistically significant association between fixed orthodontic treatment and the risk of developing TMDs. Substantial heterogeneity was observed (I² = 73%), attributed to variations in study designs, populations, and outcome measures. The risk of bias analysis highlighted concerns in several domains, particularly selection bias and measurement of outcomes. While confounding bias and missing data bias were generally well-controlled, deviations in intervention and inconsistent outcome measurements were noted across the studies. These findings suggest that fixed orthodontic treatment does not significantly alter the risk of developing TMDs in adolescents. However, the substantial heterogeneity and potential biases across the included studies emphasize the need for further high-quality, standardized research to confirm these results and provide clearer clinical guidance. Full article

Background/Objectives: A manual approach combined with therapeutic exercise versus therapeutic exercise alone is a debated issue in the literature. The American College of Rheumatology guidelines “conditionally recommended against” manual therapy for the management of hip osteoarthritis. Manual therapy followed by exercise, instead, appears to lead to a faster return to sport than exercise alone for adductor groin pain. There is a need to understand which is the most effective treatment in the management of hip nonspecific musculoskeletal diseases. The aim of this systematic review is to determine which is the most effective treatment between manual therapy combined with therapeutic exercise and therapeutic exercise alone in subjects with hip nonspecific musculoskeletal diseases. Methods: This systematic review complies with the guidelines of the 2020 Prisma Statement. The databases consulted were Pubmed, Cinahl, and Web Of Science. The search was conducted from October 2004 to November 2023. The search string was developed following the PICO model. Free terms or synonyms (e.g., manual therapy, exercise therapy, hip disease, effectiveness) and Medical Subject Headings terms were combined with Boolean operators (AND, OR, NOT). The risk-of-bias assessment was conducted using Version 2 of the Cochrane risk-of-bias tool for randomized controlled trials and the Newcastle Ottawa Scale for observational studies. A qualitative analysis of the results was conducted through narrative synthesis of key concepts. When possible, quantitative analysis was conducted through statistical parameters. Results: Ten articles were analyzed. Results show no differences between the interventions analyzed. Preliminary evidence seems to favor the combined intervention for the outcomes of pain, ROM, and patient satisfaction, with other studies claiming an absence of differences. Only one study claims that therapeutic exercise alone is more effective for quality of life. Preliminary evidence seems to show that manual therapy does not seem to bring any benefit in addition to therapeutic exercise in mid- and long-term functionality, especially for hip osteoarthritis. Conclusions: There seems to be no difference in effectiveness between manual therapy combined with therapeutic exercise and therapeutic exercise alone in individuals with hip nonspecific musculoskeletal diseases. Full article