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This study was undertaken to perform a dosimetric comparison of four distinct radiotherapy planning strategies for pituitary adenomas on the Varian Halcyon platform (Varian Medical Systems, Palo Alto, CA, USA): three-dimensional conformal radiotherapy (3DCRT) using electronically flattened beams, 3DCRT using true flattening filter-free (FFF) beams, intensity-modulated radiotherapy (IMRT), and volumetric modulated arc therapy (VMAT). The study additionally evaluated the feasibility and dosimetric implications of reproducing conventional forward-planned beam characteristics on an inherently FFF platform using dynamic multileaf collimator (MLC)-based electronic fluence shaping. Planning data from 15 patients were utilized. Four plans were generated per patient: 3DCRT with electronically flattened beams, 3DCRT with true FFF beams, IMRT, and VMAT. A prescription dose of 54 Gy in 30 fractions was applied with &#x2265;95% planning target volume (PTV) coverage. Plan evaluation included D2%, D50%, D98%, conformity index (CI), homogeneity index (HI), gradient index (GI), and doses to optic nerves, chiasm, lenses, cochleae, brain, and brainstem. All techniques achieved clinically acceptable coverage (V95% > 99%). IMRT and VMAT showed superior conformity compared with 3DCRT (p < 0.0001), with VMAT achieving the lowest HI. IMRT provided the lowest mean doses to lenses. VMAT achieved the lowest maximum doses to optic nerves, eyes, brain, and brainstem, and the lowest mean doses to the chiasm and brainstem. True 3DCRT FFF required fewer monitor units (MUs) and had sharper gradients, whereas electronically flattened plans were more uniform. Inverse-planned techniques provide superior organ-at-risk (OAR) sparing in pituitary adenomas. VMAT offers superior normal tissue dose constraints. Their complementary strengths suggest that technique selection should be guided by anatomical considerations and proximity of critical structures, emphasizing individualized planning rather than reliance on a single modality. Significant dosimetric differences exist between electronically flattened and true 3DCRT FFF delivery, underscoring the importance of beam model selection in forward-planned radiotherapy for pituitary adenomas.

Asthma rates are high in Chicago, but rescue inhaler access is more limited among Black and low-income populations, which impacts school attendance and academic achievement. Stock inhalers are undesignated asthma inhalers for respiratory distress at school, which may alleviate these needs. We assessed the pre-intervention asthma environment of pilot, ramp-up, and non-pilot Chicago Public Schools to retroactively ensure an equitable scale-up of a stock inhaler intervention across a large urban district. We also examined support plans for asthma by school and student characteristics. We used chi-squared tests, Kruskal Wallis tests, and generalized estimating equation models to analyze the association of asthma status with school and student characteristics within district-run schools. 517 district-run schools and over 266,000 students were included. High schools had a higher median asthma prevalence (6.39%) than elementary schools (4.49%). Students who identify as Non-Hispanic Black had higher odds of asthma than Hispanic students (OR:1.20[1.11, 1.30], p&#x2009;<&#x2009;0.001), but these students subsequently had lower odds of a 504 plan (OR:0.7[0.6, 0.7], p&#x2009;<&#x2009;0.001) and higher odds of an IEP (OR: 1.2[1.1, 1.3], p&#x2009;<&#x2009;0.001) compared to Hispanic students with asthma. Low-income (OR:1.53[1.45, 1.57], p&#x2009;<&#x2009;0.001) and unhoused students (OR:1.43[1.30, 1.57], p&#x2009;<&#x2009;0.001) had higher odds of asthma than those without these characteristics. While the scale-up itself was equitable,&#xa0;the analysis revealed gaps in asthma prevalence and support plans in Chicago Public Schools. Data-driven approaches like stock inhalers in schools are one solution to reducing disparities in access to asthma documentation and medication.

Returning home after international study can involve complex readjustment, especially when personal life plans, family expectations, workplace experiences, and broader social norms do not fully align. In contemporary China, never-married female returnees may encounter distinctive expectations concerning marriage timing, family responsibility, career development, and future life planning. Drawing on Bronfenbrenner's Ecological Systems Theory and Patriarchal Bargaining, this study adopts a qualitative design based on in-depth semi-structured interviews with 22 never-married Chinese female returnees who had studied in Western countries and returned to China. The findings suggest that participants' post-return experiences were shaped by multiple, interconnected layers of social life. At the family level, they encountered expectations related to marriage timing, filial responsibility, and socially approved life-course choices. At the workplace level, they described gendered assumptions, unequal professional opportunities, and concerns about career mobility. At the broader societal level, participants perceived public discussion around unmarried women and women with overseas experience as an additional source of pressure. These experiences shaped how participants evaluated marriage, with many approaching it cautiously while weighing family expectations, institutional conditions, reproductive concerns, and future quality of life. The study suggests that continued singlehood among female returnees should not be understood simply as individual preference or delayed transition. Rather, it can reflect an ongoing negotiation of gendered expectations during reacculturation. The study contributes to scholarship on return migration, singlehood, and gender by showing how family, workplace, and wider sociocultural contexts intersect in shaping women's post-return lives in contemporary China.

The study aims to develop and validate a multi-omics model based on preoperative ultrasound (US) imaging results, intraoperative H&E- stained slides, and clinical features to predict lymph node metastasis (LNM) before lymph node dissection (LND) in ovarian cancer (OC) patients. We analyzed 157 OC patients undergoing LND with definitive pathological confirmation of LNM status, comprising 91 patients in the training cohort, 38 in the internal validation cohort, and 28 in the external test cohort. US images were processed with PyRadiomics to extract radiomics features, while pathological WSIs were processed with deep learning (DL) algorithms and multi-instance learning(MIL) algorithms to extract pathomics features. Then, radiomics and pathomics models were developed using support vector machines (SVMs), logistic regression (LR), and extreme gradient boosting (XGBoost) after dimensionality reduction and feature selection. To create a powerful multi-omics model, clinical features were incorporated into the optimal radiomics and pathomics features. Performance of models was assessed by accuracy, AUC, 95% CI, sensitivity, specificity, PPV and NPV. A total of 11 features were used to build radiomics models out of a selection of 1561 radiomics features. The SVM_rad model demonstrated superior predictive performance (AUC: training=0.816, validation=0.760, test=0.775). In parallel, pathomics models were built using a refined set of 3 features selected from the original 206 pathomics features. Among these, the SVM_path model showed the highest predictive efficiency (AUC: training=0.983, validation=0.817, test=0.813). The multi-omics model showed the greatest discriminative power (AUC: training=0.988; validation=0.923; test cohort=0.862). The quality of the prediction model was demonstrated by the DeLong test, calibration curves, and decision curve analysis, which verified its high discrimination, calibration, and clinical usefulness. The study's findings indicate that the multi-omics model integrating the tumor-level radiological data, cellular-level pathological information, and patient-level clinical features can predict LNM before LND in OC and support rational treatment plans.

This study aimed to investigate the effects of a 14-week tempo-based strength periodization training program on muscle strength, power, and sport-specific performance in coastal rowers. A single-group pre-post study design was implemented. Twelve well-trained coastal rowers (age 20&#xa0;&#xb1;&#xa0;2.34 years; height 182.42&#xa0;&#xb1;&#xa0;4.83 cm; weight 79.25&#xa0;&#xb1;&#xa0;10.17 kg; training experience 6.33&#xa0;&#xb1;&#xa0;2.81 years) underwent a 14-week periodized training program, which consisted of four phases: hypertrophy, transition, maximal strength, and tapering. Three testing time points were set: baseline (T1), post-hypertrophy (T2), and post-intervention (T3). Assessments included maximal strength (1-repetition maximum squat, bench press, bench pull, deadlift), power (countermovement jump height and peak power), and sport-specific performance tests (50 m sprint, 500 m ergometer, and composite test: 50 m sprint + 750 m ergometer + 50 m sprint). Significant improvements were observed from T1 to T3 in maximal strength (squat: P&#xa0;<&#xa0;0.001, Effect Size (ES) = 1.01; bench press: P&#xa0;<&#xa0;0.001, ES = 0.86; bench pull: P&#xa0;<&#xa0;0.001, ES = 1.06; deadlift: P&#xa0;<&#xa0;0.001, ES = 0.93), countermovement jump (CMJ) height (P&#xa0;<&#xa0;0.001, ES = 0.37), 50-m sprint (P&#xa0;<&#xa0;0.001, ES = -0.42), 500-m ergometer performance (P&#xa0;<&#xa0;0.001, ES = -0.49), and the composite test (P&#xa0;<&#xa0;0.001, ES = -1.1). No significant change was found in CMJ peak power (P&#xa0;>&#xa0;0.05, ES = 0.16). A 14-week tempo-based strength periodization program was associated with significant improvements in muscle strength, countermovement jump (CMJ) height, and sport-specific performance in coastal rowers, suggesting potential utility in integrating structured tempo training into periodized strength plans for power-dependent water sports athletes.

Effective transition from pediatric to adult care is essential in Duchenne muscular dystrophy (DMD), but evidence on how transition is delivered in everyday practice remains limited. In Turkey, no clinical framework specifies how transition should occur, although national regulation requires completion of transfer by age 23. This study aimed to describe current practice, identify barriers and facilitators from physician and patient perspectives, and compare findings with international frameworks to inform a national guideline. As part of the AIM-DMD (National plan of action to raise Awareness and Improve Medical care of Duchenne Muscular Dystrophy) initiative, we conducted a national cross-sectional survey between June and December 2025, comprising parallel sub-studies of physicians and patients with DMD and their caregivers. Two structured online questionnaires were developed, guided by the Got Transition Six Core Elements framework and international Delphi consensus statements. The physician survey was distributed through professional networks; the patient and caregiver survey through the DMD Families Association and neuromuscular reference centers. Sixty-two physicians (43 pediatric and 19 adult neurologists) from 28 cities and 48 patients and caregivers from 24 of these cities responded. Only 17.7% of physicians reported a systematic institutional transition program, 38.7% prepared individualized transition plans, and 9.7% described true readiness assessment. Joint pretransition consultations were held regularly by only 6.5% of physicians. Among transitioned patients, 72.4% first heard about transition at age 17 or later, and 62.1% considered their preparation inadequate. All physicians reported transferring medical data at transition, most commonly through institutional electronic health records (80.6%); however, 41.4% of patients and caregivers were unaware that any information had been conveyed to the adult team. Physicians, patients, and caregivers all identified the lack of a formal transition protocol, joint pediatric and adult consultations, multidisciplinary integration, and a designated coordinator role as priority areas for improvement. DMD transition care across Turkey lacks consistent structure. Key gaps include limited readiness assessment, delayed discussions, poor patient and caregiver awareness of the transition process, and lack of coordinated multidisciplinary structures. Our study identified common priorities raised by physicians, patients, and caregivers that need to be improved and could inform the development of standardized protocols.

ObjectiveThis study evaluated the incidence, frequency, types, and risk factors of complications following staged autologous costal cartilage reconstruction for microtia at an academic hospital in Surabaya, Indonesia.DesignRetrospective descriptive study.SettingAcademic hospital in Surabaya, Indonesia, serving as a national referral center for microtia.ParticipantsMedical records of 122 unique patients with microtia who underwent autologous costal cartilage reconstruction between January 2014 and December 2024 were reviewed. Patients with incomplete records were excluded.InterventionsTwo-stage autologous microtia reconstruction using a costal cartilage framework. Stage-2 elevation was performed using either a temporoparietal fascia flap (TPF) or retroauricular fascial flap (RFF).Main Outcome MeasuresIncidence and type of postoperative complications involving the reconstructed ear, donor site, and neck.ResultsPostoperative complications occurred in 38 of 122 patients (31.1%), with 47 discrete complication events recorded. Complications were more frequent after stage 1 (27 events) than stage 2 (20 events). Stage-1 complications included skin necrosis (18.1%), cartilage exposure (9.0%), cartilage resorption (7.2%), and donor-site hypertrophic scar (5.4%). Stage-2 complications included skin necrosis (7.4%), synechiae (4.4%), auricular hypertrophic scar (4.4%), donor-site hypertrophic scar (7.4%), and wire exposure (1.4%). In stage 2, complications occurred in 25 of 57 TPF patients (43.8%), whereas no complications were observed in 10 RFF reconstructions.ConclusionsAutologous microtia reconstruction carries a notable complication risk, particularly after stage 1. Smoking, tissue quality, and flap selection may influence outcomes. Careful planning, counseling, flap selection, and postoperative care are essential to minimize complications and optimize results.

Intravascular hemolysis (IH) has emerged as a potential complication of pulsed-field ablation (PFA), yet reported incidence varies widely. This review synthesizes the clinical and preclinical literature, using an empirical framework to provide practical recommendations. We systematically evaluated all available human and translational PFA-IH studies from 2020 to 2025 according to 3 physiologic criteria: 1) biomarker kinetics; 2) determinants of energy delivery; and 3) clinical workflow. Each study was assigned an interpretability rating based on timing of sampling and biomarkers used to define IH (green, yellow, or red). Of the 53 studies reviewed, 34 were excluded, leaving 19 (16 in vivo, 3 in vitro) for assessment. Most (8) studies assessed received a yellow interpretability rating, 2 a red interpretability rating , and 6 a green interpretability rating. Although laboratory-defined severe IH (free plasma hemoglobin >100 mg/dL) was noted, the incidence of complications, namely, acute renal failure, remained low. IH following PFA is common but rarely clinically consequential, and its impact appears modifiable. Technology selection should align with ablation strategy, reserving large-footprint catheters for pulmonary vein isolation and favoring smaller footprint catheters for focal or linear ablation to minimize unintended energy delivery. A dose-dependent relationship underscores the need to limit applications to those required for acute success and ensure tissue contact with each delivery. Patient-specific vulnerability, particularly in those with renal dysfunction or hemodynamic compromise, should guide procedural planning and periprocedural optimization. Routine biomarker testing is not warranted, but selective screening in higher-risk scenarios may help identify clinically relevant IH.

To review the evolution of sleep medicine and surgical management of obstructive sleep apnea (OSA), focusing on anatomy-based and individualized treatment strategies. This narrative review was developed by an expert panel of otolaryngologists and sleep medicine specialists. Landmark studies, consensus statements, and clinically relevant investigations were analyzed. Surgical approaches were classified according to anatomical target and functional mechanism, with particular attention to drug-induced sleep endoscopy (DISE), patient phenotyping, and multimodal treatment strategies. Sleep surgery has progressed from highly invasive procedures to minimally invasive, function-preserving, and multilevel approaches. Advances in understanding upper airway anatomy and collapse mechanisms have enabled targeted interventions, including barbed pharyngoplasty, transoral robotic surgery, maxillomandibular advancement, and hypoglossal nerve stimulation. DISE has improved identification of obstruction patterns and individualized surgical planning. Current OSA management increasingly combines surgical, dental, behavioral, and medical therapies within personalized care pathways. Modern sleep surgery has evolved toward precision-based, multidisciplinary management. Individualized anatomical and functional assessment is central to treatment selection, while emerging diagnostic and therapeutic innovations may further improve outcomes.

Membrane-based direct air capture (m-DAC) offers an energy- efficient route to mitigate rising atmospheric CO2, but its practical deployment is hindered by low CO2 concentration and high humidity. Herein, we propose a "Sailing-with-Water" strategy that turns humidity from an obstacle into a mass-transfer driving force. The bifluorinated motifs are engineered by integrating fluorinated ionic liquid@UiO66 (IL@UiO) as porous fillers and a novel polymer, PIM-1DFBP, as the second fluorine source.&#xa0;The abundant fluorine sites within the membrane facilitate CO2 capture and enrichment from dilute streams via Lewis acid-base interactions. Notably, under high humidity conditions, the fluorine sites in the membrane form a hydrogen-bond network with water molecules, creating a polar microenvironment that further enhances CO2 affinity and builds ultrafast channels for CO2 permeation. The optimized membrane achieves a CO2 permeability of 12697.08 Barrer and CO2/N2 selectivity of 44.06 under 65% relative humidity, surpassing the 2019 Robeson upper bound.&#xa0;The membrane also exhibits 180-days stability, large-area defect-free fabrication, and process simulation shows that only 612.37&#xa0;m2 is needed to reach 40% CO2 outlet concentration. This work provides a humidity-resistant paradigm for high-performance m-DAC.

Co-production can be used to develop research, resources or interventions that are relevant for the groups they are co-produced with. We co-produced a training intervention to improve personal care assistance for people with dementia living in care homes. We aimed to reflect on the process to learn more about the co-production journeys of all group members and impacts. A co-production group comprised of five care home staff, two relatives of care home residents, two researchers and a public involvement relative/researcher met at the university for 2&#x2009;h a week, 10 times over an 11-week period. A care home resident and relative advised the process. We recorded co-production experiences by each contributing weekly reflections. We used the model of small group development to map out different co-production journeys. Care home staff, relatives and researchers had different journeys throughout the co-production process. Alongside the production of the training intervention, many positive and some negative impacts were identified. Relationships developed, members used and extended existing skills, and new learning, confidence and growth occurred. However, researchers found the process intense, care home staff had to catch up on missed work and one relative felt inhibited at times. Gaining multiperspective reflections from group members throughout co-production has produced new learning about how the process can impact people and groups differently. We share our processes, challenges and facilitators which can inform researchers planning co-production. When co-producing with care staff, consideration should be given to reduce potential negative impacts on social care settings. The wider study of which the co-production was part has a lived experience advisory group, hosted by a local care home, who advise 3-monthly on the design of the study, issues to be addressed, processes of research, documents and findings. The co-production presented in this article involved five care home staff, two relatives of care home residents and a relative/researcher who is the lived experience lead for the wider study. The co-production process had two advisors: a care home resident and a relative of a care home resident who met in one-to-one meetings with a researcher, their ideas and suggestions and those of a previous stakeholder consultation were fed into the main co-production group.

As the rate of induction of labor (IOL) is steadily increasing with the increasing rates of maternal age and obesity, having consequences on perinatal morbidity, health economics, and maternal childbirth experience, evidence for decision making should be available related to the indications. This study investigates the association of IOL indications with the delivery outcomes and provides clinicians with valuable information to weigh the benefits and potential risks associated with IOL. This retrospective five-year cohort study was conducted in Helsinki University Hospital between 2017 and 2021. A total of 16 377 pregnant women undergoing IOL&#x2009;&#x2265;&#x2009;37 gestational weeks with a live singleton fetus in cephalic presentation were included. The primary outcome measures were the rates of cesarean delivery (CD) and composite adverse neonatal outcome (including one or more of the following: perinatal death, neonatal intensive care admission, umbilical artery blood pH value&#x2009;&#x2264;&#x2009;7.05, base excess value <-12, and 5-minute Apgar score 0-6). The study population consisted of 16 377 women. The most common indications for IOL were post-term pregnancy (31.3%) and pre-labor rupture of membranes (PROM) (26.3%). Overall, the CD rate was 20.3%, and the incidence of composite adverse neonatal outcome was 12.7%. Delivery outcomes varied according to the indication for induction. The highest CD rate of 27.9% was observed among women induced for hypertensive disorders (adjusted OR 1.6, 95% CI 1.4-1.8), whereas inductions for maternal exhaustion were associated with the lowest CD rate. Composite adverse neonatal outcomes were most frequent (19.1%, n&#x2009;=&#x2009;179) following induction for fetal indications and least frequent (7.4%, n&#x2009;=&#x2009;42) among women induced because of fear of childbirth. In analyses, performed separately for each IOL indication, nulliparity, unfavorable cervix, maternal age&#x2009;&#x2265;&#x2009;35 years, maternal height&#x2009;<&#x2009;164&#xa0;cm, and pre-pregnancy BMI&#x2009;&#x2265;&#x2009;30 remained independent risk-factors for CD. The indication for IOL is associated with both CD and adverse neonatal outcomes. While indication-specific differences should be considered when counseling women and planning induction, maternal characteristics and parity remain important determinants of CD risk. These findings may support individualized clinical decision-making regarding IOL.

Epithelial ovarian cancer (EOC) can be broadly classified into type I and type II tumours, which exhibit distinct biological behaviours. Accurate preoperative differentiation between these subtypes is important for guiding treatment decisions and optimizing patient outcomes. To evaluate the diagnostic value of quantitative parameters derived from synthetic magnetic resonance imaging (SyMRI) alone and in combination with clinico-morphological features for differentiating type I from type II EOCs. This retrospective study included 92 patients with pathologically confirmed EOC, including 32 type I and 60 type II tumours, who underwent preoperative MRI. Quantitative parameters derived from SyMRI, including T1, T2, and proton density (PD), and DWI-derived apparent diffusion coefficient (ADC) values were measured from the solid components of the tumours. Clinico-morphological characteristics were also recorded. Differences between type I and type II EOCs were assessed using the independent Student's t, Mann-Whitney U test, or chi-squared tests. Multivariable logistic regression analysis was used to identify independent predictors and construct a combined model. The model's performance was evaluated using receiver operating characteristic (ROC) curve analysis. Type I EOCs exhibited significantly higher T1, T2, and ADC values than type II EOCs (all p&#x2009;<&#x2009;0.05), whereas PD values did not differ significantly between the two groups (p&#x2009;=&#x2009;0.746). Significant differences were also observed in patient age, serum CA125 levels, maximum tumour diameter, MRI enhancement characteristics, and texture (all p&#x2009;<&#x2009;0.05). A multivariable analysis identified T1 value, CA125 level, maximum tumour diameter, and enhancement characteristics served as independent predictors. The combined model incorporating these variables achieved an AUC of 0.936, which was significantly higher than that of any individual parameter (all p&#x2009;<&#x2009;0.05). SyMRI-derived quantitative parameters, particularly T1 values, may provide valuable biomarkers for differentiating EOC subtypes. A combined model integrating T1 values with clinico-morphological features showed high diagnostic performance and may support preoperative risk stratification and individualized treatment planning in patients with EOC.

Genetic Creutzfeldt-Jakob Disease (gCJD) is an autosomal dominant prion disease caused by heterozygous pathogenic variants in the PRNP gene. It is relatively prevalent in Israel due to a large cluster of individuals from Libyan Jewish origin harboring the p.Glu200Lys variant. In our experience, increasing awareness, expanded reproductive options, and the emergence of research initiatives have led more asymptomatic relatives to seek presymptomatic testing. Since gCJD is a highly penetrant and fatal condition, the decision to pursue testing involves complex medical, psychological, ethical, and familial considerations. An Israeli multidisciplinary expert panel, familiar with gCJD, collaborated to formulate a structured approach to the genetic testing process of at-risk individuals. We describe the core components of the recommended presymptomatic testing process, in a real-world setting. We focus on referral considerations, eligibility and timing of testing, psychological assessment, a stepwise approach for the testing process, results disclosure, post-result support, and implications for family planning. Based on the valuable experience of professionals who address these issues in clinical practice, the proposed framework aims to provide a comprehensive structured methodology for clinicians and care teams supporting individuals at risk for gCJD. It may serve as a model for the testing process of other late-onset monogenic neurodegenerative diseases, in Israel and worldwide.

Children with life-limiting conditions and their families face profound existential and spiritual challenges throughout the paediatric palliative care (PPC) trajectory. While spiritual care (SC) is a recognised component of PPC, its continuity and quality across care settings remain underexplored. This study examined how SC can be organised and safeguarded across the PPC continuum, from the perspectives of parents, healthcare professionals, and spiritual care providers. An exploratory qualitative study was conducted using multidisciplinary peer consultation groups. Two groups met online in 2022-2023, discussing six PPC cases over seven sessions. Participants included spiritual care professionals, clinicians from hospital and home settings, and parents. Data sources included audio-recorded transcripts, structured case descriptions, and field notes. A modified QUAGOL approach was used for narrative-informed thematic analysis. Coding was supported with team discussions. Continuity of care (relational, informational, and managerial) informed interpretation as a sensitising framework. Two themes were identified: (1) challenges in ensuring continuity of spiritual care, including fragmented referrals, lack of coordination, and cultural disconnects; and (2) defining and delivering quality SC, emphasising relational consistency, cultural and linguistic fit, and interprofessional collaboration. Parents valued providers who "knew their story", while professionals stressed clearer referral pathways and role alignment. Gaps in coordination and information transfer constrained support across transitions. &#xa0;Continuity of spiritual care in PPC is not merely a logistical task but a relational and interpretive process. Embedding SC into proactive care planning and interprofessional practice may improve coordination, enhance cultural responsiveness, and support families throughout the illness trajectory. &#x2022; Spiritual care is an essential dimension of paediatric palliative care but is often fragmented across settings. Traditionally, SC has been hospital-centred. &#x2022; Families frequently lack consistent support during transitions between hospital, home, and community care. &#x2022; This study suggests that continuity in spiritual care relies on sustained relationships, cultural attunement, and clear coordination. &#x2022; Embedding spiritual care in proactive planning may support consistency and family-centred support throughout the illness trajectory.

To systematically review patient activation interventions in adult populations with cancer, identify their key components, and synthesize evidence on the effectiveness of behavioral change-based strategies in enhancing patient activation. This systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines. A comprehensive systematic review was conducted across ten databases (PubMed, CINAHL, Embase, ISI Web of Science, Cochrane Library, Medline, CNKI, Wanfang, VIP, and CBM) to identify randomized controlled trials (RCTs) published between January 2005 and June 5, 2025. The Cochrane Risk of Bias tool was used to evaluate study quality. Meta-analyses were performed using Review Manager 5.3 and Stata 14.0, and sensitivity and subgroup analyses were conducted to examine heterogeneity and assess robustness.` RESULTS: Of 8329 records initially retrieved, 18 RCTs involving 2768 participants met the inclusion criteria. Behavior change interventions produced a statistically significant small-to-moderate effect on patient activation (SMD&#xa0;=&#xa0;0.32, 95% CI: 0.10-0.53), although with considerable heterogeneity (I2&#xa0;=&#xa0;86%). Subgroup analyses based on pre-specified variables did not identify the source of heterogeneity. Behavioral change-based interventions appear effective in enhancing patient activation among adults with cancer. Strategies emphasizing active patient engagement, such as knowledge shaping, goal setting and planning, and feedback and monitoring, were the most frequently employed and showed consistent benefits. Heterogeneity in intervention design limits generalizability. Further rigorous trials are needed to define the optimal components, duration, and intensity for sustained activation outcomes.

To describe a multidisciplinary protocol for the resection and reconstruction of complex lateral skull base pathology, based on over two decades of experience in a high-volume tertiary referral center in the United Kingdom. Retrospective descriptive analysis of institutional practice. A high-volume tertiary skull base unit in the United Kingdom. This study presents a summary of clinical experience in managing lateral skull base pathologies-both benign and malignant-over a 20-year period. It outlines a multidisciplinary approach involving ENT, neurosurgery, plastic surgery, anesthesia, radiology, oncology, and specialist nursing teams. The institutional protocol for resection and reconstruction is described, including surgical planning, intraoperative decision-making, perioperative care, and long-term rehabilitation strategies. The integrated multidisciplinary protocol enabled safe and effective management of a broad range of lateral skull base lesions. The team achieved high rates of complete resection and functional reconstruction, with acceptable levels of morbidity. Complex anatomy, tumor extent, and reconstructive requirements were successfully navigated through coordinated team-based planning. The approach has been refined through iterative experience and now serves as a reference pathway for similarly structured centers. Effective management of lateral skull base pathology requires a highly coordinated multidisciplinary strategy. The described protocol, developed and implemented over two decades, offers a structured and reproducible approach that may serve as a valuable reference for other high-volume centers involved in skull base surgery.

Remote sensing has rapidly advanced with the integration of deep learning, enabling more accurate and scalable detection of land use and land cover (LULC) changes, particularly with the increasing availability of Sentinel-1 and Sentinel-2 multispectral imagery. This review traces the evolution of classical machine learning approaches toward modern deep learning architectures, including Convolutional Neural Networks (CNNs), encoder-decoder models, Siamese and dual-stream networks, attention-based frameworks, and, more recently, Transformer-based models. Recent developments in Earth observation foundation models, trained on large-scale, multimodal datasets, have introduced new capabilities, including zero-shot inference, cross-sensor transferability, and improved generalization across diverse geographic regions. Despite these advances, significant challenges remain. The fusion of multimodal data, including optical, SAR, and ancillary sources, is complicated by differences in spatial, spectral, and temporal characteristics. Furthermore, domain adaptation, label noise, and limited geographic transferability continue to constrain the robustness of change detection pipelines. The quantification of uncertainty and model interpretability has also become increasingly important for operational applications in urban planning, agriculture, ecosystem monitoring, and disaster response. In addition, the growing computational and environmental costs of large-scale model pretraining underscore the need for more sustainable AI practices. Future research should therefore focus on advancing the Earth observation foundation and generative models, developing temporal AI methods for long-term sequence analysis, and promoting responsible, energy-efficient geospatial artificial intelligence. Integrating advances in remote sensing, machine learning, and environmental science will be essential for building practical, scalable, and reliable planetary monitoring systems.

Tethered cord syndrome (TCS) is an important consideration in pediatric scoliosis because it can present with curve progression, pain, and evolving neurologic or urologic dysfunction that may affect deformity evaluation and surgical planning. This state-of-the-art review summarizes the current literature on TCS in pediatric spinal deformity, with emphasis on diagnostic workup, scoliosis natural history, and surgical timing relative to deformity correction. A literature review was performed focusing on pediatric TCS in the setting of spinal deformity, including dysraphism-associated tethering, filum-based tethering, retethering, and occult tethered cord syndrome. Studies addressing diagnosis, neurologic and urologic evaluation, scoliosis progression, outcomes after detethering, and timing relative to deformity correction were synthesized narratively. Current evidence supports a clinically driven approach in which imaging findings alone are not sufficient to define clinically active tethering. Decision-making should focus on interval neurologic or urologic change and scoliosis behavior over time. Detethering may improve or stabilize cord-related symptoms, but it does not reliably prevent scoliosis progression, especially in larger curves and skeletally immature patients. Evidence supporting routine prophylactic detethering before deformity correction in asymptomatic patients remains limited. Variation in diagnostic criteria and outcome reporting continues to limit clear treatment recommendations. In pediatric deformity care, TCS management should be driven by objective clinical progression rather than imaging findings alone. Detethering should be viewed as treatment for active cord-related dysfunction, while scoliosis treatment should be guided by curve progression and skeletal maturity. Standardized definitions and prospective multicenter studies are needed to improve treatment algorithms and reduce practice variation.