Cause-effect Relationship Research Articles

A systematic review and meta-analysis of factors contributing to post-kidney transplant anemia and the effect of erythropoietin-stimulating agents.

The effects of various risk and associated factors on post-kidney transplant anemia (PTA) have not been fully compared and estimated. This meta-analysis aims to elucidate factors contributing to PTA and determine the influence of erythropoietin-stimulating agents (ESAs) on renal outcomes, thus offering potential pathways for enhanced management strategies post-transplant. A systematic review was conducted in electronical database. Studies reporting on risk factors (with cause-effect relationships) and associated factors (without definite cause-effect relationships) of PTA, and the effects of ESAs on post-kidney transplant outcomes, were included. Pooled odds ratios (ORs) and weighted mean differences (WMDs) were analyzed using random-effects models. This systematic review encompassed 38,233 patients from 85 studies. Factors increased PTA risk included African American, older donor age, human antigen leukocyte mismatches, and low pre-transplant hemoglobin levels. Poor allograft function, high interleukine-6, Cytomegalovirus, delayed graft function, allograft rejections, immunosuppressive medications, and renin-angiotensin system blockades were associated with PTA. Native autosomal dominant polycystic kidney disease was a protective factor against PTA. Administration of ESAs with the aim of normalizing hemoglobin levels in patients with chronic allograft dysfunction slowed the decline in eGFR and reduce the risk of death, with a pooled OR of 0.36 (95% CI: 0.14 to 0.89; p = 0.040). The risks and associated factors for PTA have been elucidated, underscoring the need for individualized treatment approaches. Late ESA therapy, aimed at hemoglobin normalization, suggests a renal-protective effect and reduced mortality, which should be considered in the management of PTA. PROSPERO CRD42024545330.

Prevalence and determinants of poor sleep quality among patients of diabetes mellitus: A tertiary hospital based cross sectional study

Background: The effects of diabetes on sleep quality are pronounced and have a cause-effect relationship. The major aim of this study was to check for the prevalence of poor sleep quality and associated factors among patients of diabetes mellitus in Pakistan as every 1 in 4th individual is suffering from diabetes in Pakistan. Materials and Methods: A hospital based cross-sectional study was conducted on diagnosed patients of diabetes mellitus from September 2023 to March 2024 using Pittsburgh Sleep Quality Index (PSQI). SPSS v.27 was used for data analysis. Frequencies, percentages for sample characteristics and means for PSQI were calculated. Chi-square and spearman were run for association and correlations respectively. Risk factors were predicted using binary logistic regression. Results: 384 responses were collected with 12 excluded. The prevalence of poor sleepers came out to be 82% and poor sleep was significantly associated and correlated with increasing age, poor glycemic control, and metformin as well as income, education and duration of diabetes respectively. Presence of comorbidities and uncontrolled diabetes were the only associated risk factors. Conclusions: Pakistani population with diabetes mellitus have an extremely high rate of poor sleep quality which should be addressed by adding sleep quality-oriented guidelines in the management of diabetes.

From the genome's perspective: Bearing somatic retrotransposition to leverage the regulatory potential of L1 RNAs.

Transposable elements (TEs) are mobile genomic elements constituting a big fraction of eukaryotic genomes. They ignite an evolutionary arms race with host genomes, which in turn evolve strategies to restrict their activity. Despite being tightly repressed, TEs display precisely regulated expression patterns during specific stages of mammalian development, suggesting potential benefits for the host. Among TEs, the long interspersed nuclear element (LINE-1 or L1) has been found to be active in neurons. This activity prompted extensive research into its possible role in cognition. So far, no specific cause-effect relationship between L1 retrotransposition and brain functions has been conclusively identified. Nevertheless, accumulating evidence suggests that interactions between L1 RNAs and RNA/DNA binding proteins encode specific messages that cells utilize to activate or repress entire transcriptional programs. We summarize recent findings highlighting the activity of L1 RNAs at the non-coding level during early embryonic and brain development. We propose a hypothesis suggesting a mutualistic relationship between L1 mRNAs and the host cell. In this scenario, cells tolerate a certain rate of retrotransposition to leverage the regulatory effects of L1s as non-coding RNAs on potentiating their mitotic potential. In turn, L1s benefit from the cell's proliferative state to increase their chance to mobilize.

Translating player monitoring into training prescriptions: Real world soccer scenario and practical proposals

Data-driven training prescription based on previous training or match data is thought to be associated with better training outcome, compared to prescription without considering any monitoring data. Understanding the complex relationship between training load, physical performance, fitness status, fatigue and injury risk represents a challenge for health and performance practitioners and researchers. Although studies have revealed a positive correlation between training load and injury risk, this cause-effect relation cannot be determined given the multifactorial nature of injuries. Additionally, conflicting findings have been published explaining the relationship between training load and injuries, underlining the importance of training load management, prescription, and communication within the multidisciplinary team to improve physical performance and reduce injury risk. In this sense, practitioners may benefit from practical examples based on training load data to make informed decisions for prescribing training. This narrative review provides real-world examples of training decisions based on training load data in soccer, including training prescription, drill design and multidisciplinary team communication. Finally, a framework was provided to make informed training prescription from a physiological standpoint and elucidate the relationship between training load and injury risk.

Assessment of barriers towards a sustainable and resilient poultry industry supply chain: A developing country viewpoint after COVID-19

The devastating COVID-19 epidemic has highlighted the weaknesses in supply chains (SCs) globally. To ensure smooth production in the current and post-COVID-19 era, the policymakers should focus on establishing a sustainable and resilient supply chain (SC) by reconfiguring their existing SC strategies. This study aims to investigate the difficulties poultry industry (PI) faces in coping with the effects of SC disruptions brought on by the COVID-19 pandemic from a developing country viewpoint: Bangladesh. Through literature review and expert opinion, 20 barriers were identified and categorized into five dimensions (i.e., social, environmental, economic, technical, and institutional) related to sustainability and resilience. Pareto analysis was conducted to screen out ‘Vital few’ barriers and later prominence vectors and cause-effect relationships of these barriers was examined through decision making trial and evaluation laboratory (DEMATEL) approach. Results indicate that natural and man- made disasters, quality of chicks, feed and vaccine, inaccurate forecasting, lack of access to technology, and environmental issues are the most significant barriers to achieve sustainability and resiliency. Also, the mitigation strategies to achieve simultaneous sustainability and resiliency in this sector are outlined for managers and practitioners.

Focus on residents’ mental health: the Public Health Residents’ Anonymous Survey in Italy (PHRASI)

Abstract The ‘Public Health Residents’ Anonymous Survey in Italy” (PHRASI) represented the first study to specifically investigate mental health and its determinants among Italian public health residents (PHRs). Using a voluntary, anonymous, electronic, 88-item questionnaire, the PHRASI study generated evidence on well-being, eating disorders, sleep disorders, alcohol abuse, depressive symptoms, and anxious symptoms among PHRs. This highlights the correlation with sociodemographic, lifestyle, and work-related characteristics during COVID-19 pandemic. The data was collected in a nationally representative sample of PHRs enrolled in any of the four course years of Italian Public Health schools. The recruitment took place through the communication channels of the Medical Residents’ Council of the Italian Society of Hygiene and Preventive Medicine in the summer 2022. The key findings reveal prevalence rates of mental health conditions comparable to those seen in other healthcare workers during the COVID-19 pandemic: 61% of residents report depressive symptoms and 36% report anxious symptoms. The study also highlights a negative correlation of these symptoms with characteristics of the training and working environment, such as the level of supervision and peer-to-peer support. A stronger social network and higher levels of physical activity emerged to be positively associated with well-being and depression. These and other findings will be available in the final report of the survey that will be presented during the congress. PHRASI led the way to the Residents’ Mental health Investigation, a Dynamic longitudinal study in Italy (ReMInDIt), that aims to explore potential cause-effect relationships between risk/protective factors and mental health outcomes. This evidence could guide the scientific community, school directors, universities, and policymakers in the continuous process of improving the educational quality and working conditions of PHRs. Key messages • Residency training and work environment impact the mental health of the PHR workforce. • It is important to deploy concrete efforts into building healthy work environments and guarantee adequate training for PHRs.

A system dynamics model based on ISM for risk perception in emergency by employees in chemical industrial parks

Risk perception is one of the factors that guide human behavior in the workplace. In accident prevention and emergency response, the risk perception of employees affects the safety behaviour and efficiency of emergency disposal. Besides, risk perception is a complicated process restricted by many influencing factors. The study aims to identify the most important factors affecting risk perception. This study had three phases. In the first, factors affecting the risk perception were extracted based on the questionnaire survey and the expert scoring. Then, the Interpretive Structure Model (ISM) was used to stratify the 14 influencing factors of risk perception and obtain a hierarchical structure chart. Finally, by analyzing the influence paths in the ISM, the system dynamics feedback loop diagram was constructed. The model took the state variable “risk perception→ risk response→ risk identification→ risk communication→ risk perception” as the main circular loop, and was supplemented and perfected by multiple feeder loop circuits. Research indicates risk experience is the most fundamental factor affecting risk perception. In the aspect of sensitivity analysis, the study shows that the risk perception of employees is related to the distance of the risk source. Its effectiveness in quantifying qualitative data, identifying influential factors, and establishing cause-effect relationships make it a valuable tool for enhancing risk perception in chemical industry park.

Cognitive Function and the Consumption of Probiotic Foods: A National Health and Nutrition Examination Survey Study.

Background/Objectives: Impaired cognition is a key trait of the diseases of aging and is an important quality of life factor for older adults and their families. Over the past decade, there has been an increasing appreciation for the role of the microbiome in cognition, as well as emerging evidence that probiotics, such as those in yogurt and other dairy products, can have a positive impact on cognitive function. However, it is unclear to what extent the consumption of yogurt is associated with improved cognitive function in older adults. Methods: Therefore, we compared the scores for the Wechsler Adult Intelligence Scale, Digit-Symbol Substitution Test between respondents who self-reported daily yogurt/dairy consumption with those who claimed they did not in an NHANES. Results: We found that cognitive scores were significantly higher (40.03 ± 0.64 vs. 36.28 ± 1.26, p = 0.017) in respondents reporting daily yogurt/dairy consumption, though only a trend remained after adjusting for sociodemographic covariates (p = 0.074). Conclusions: Further studies are required to confirm that this is a cause-effect relationship and whether changing diets is a low-cost means of protecting aging populations from cognitive decline and improving their quality of life.

Exploring the effect of energy transition on energy poverty in the european union: Empirical evidence

ABSTRACT During the past few years, the risk of energy poverty has become a reality for an increasing number of households in the European Union and worldwide. Institutions react to this problem basically by introducing new policy measures. However, their efforts collide with two significant issues: (1) the difficulty of objectively measuring energy poverty among countries and (2) the understanding of the cause-effect relationship among policy measures and their impact on energy poverty. In this study, we propose a composite measure of energy poverty alternative to the existing approaches in order to make more effective time comparisons across member states of European Union. Then, we verify whether the investments to support energy transition implemented so far has been able to affect energy poverty among European Union countries. Outcomes reveal that energy transition can be considered a means to alleviate energy poverty, supporting the efforts of policymakers who propose measures toward the energy transition.

Integrated Approach Using Intuitionistic Fuzzy Multicriteria Decision-Making to Support Classifier Selection for Technology Adoption in Patients with Parkinson Disease: Algorithm Development and Validation.

Parkinson disease (PD) is reported to be among the most prevalent neurodegenerative diseases globally, presenting ongoing challenges and increasing burden on health care systems. In an effort to support patients with PD, their carers, and the wider health care sector to manage this incurable condition, the focus has begun to shift away from traditional treatments. One of the most contemporary treatments includes prescribing assistive technologies (ATs), which are viewed as a way to promote independent living and deliver remote care. However, the uptake of these ATs is varied, with some users not ready or willing to accept all forms of AT and others only willing to adopt low-technology solutions. Consequently, to manage both the demands on resources and the efficiency with which ATs are deployed, new approaches are needed to automatically assess or predict a user's likelihood to accept and adopt a particular AT before it is prescribed. Classification algorithms can be used to automatically consider the range of factors impacting AT adoption likelihood, thereby potentially supporting more effective AT allocation. From a computational perspective, different classification algorithms and selection criteria offer various opportunities and challenges to address this need. This paper presents a novel hybrid multicriteria decision-making approach to support classifier selection in technology adoption processes involving patients with PD. First, the intuitionistic fuzzy analytic hierarchy process (IF-AHP) was implemented to calculate the relative priorities of criteria and subcriteria considering experts' knowledge and uncertainty. Second, the intuitionistic fuzzy decision-making trial and evaluation laboratory (IF-DEMATEL) was applied to evaluate the cause-effect relationships among criteria/subcriteria. Finally, the combined compromise solution (CoCoSo) was used to rank the candidate classifiers based on their capability to model the technology adoption. We conducted a study involving a mobile smartphone solution to validate the proposed methodology. Structure (F5) was identified as the factor with the highest relative priority (overall weight=0.214), while adaptability (F4) (D-R=1.234) was found to be the most influencing aspect when selecting classifiers for technology adoption in patients with PD. In this case, the most appropriate algorithm for supporting technology adoption in patients with PD was the A3 - J48 decision tree (M3=2.5592). The results obtained by comparing the CoCoSo method in the proposed approach with 2 alternative methods (simple additive weighting and technique for order of preference by similarity to ideal solution) support the accuracy and applicability of the proposed methodology. It was observed that the final scores of the algorithms in each method were highly correlated (Pearson correlation coefficient >0.8). The IF-AHP-IF-DEMATEL-CoCoSo approach helped to identify classification algorithms that do not just discriminate between good and bad adopters of assistive technologies within the Parkinson population but also consider technology-specific features like design, quality, and compatibility that make these classifiers easily implementable by clinicians in the health care system.

Action-based explanations as a basis for the analysis and design of the social world.

In sociology, the question of what it means to explain social phenomena and how this relates to the purpose of the social sciences is important but nowadays rarely asked. This article elaborates on this question and provides an answer by outlining the program of "explanatory sociology" as a branch of the modern social science approach. It is shown that, in this framework, to explain means to uncover cause-effect relationships based on models of individuals who are assumed the central force in social life. This idea is taken further to uncover specific challenges that individuals face in social life and how and why they establish and manage (or do not) social forms that help to organize the world from the viewpoint of their abilities and needs. Such action-oriented explanations have been presented and developed in sociology since its very beginning. Two main forms or logics to construct action-based explanations are outlined and developed due to the form and function of the used action theory or model. The article contributes to the discussion about the form and task of sociological theorizing by presenting action-based explanations as a form of sociological theorizing that defines a clear task in exploring challenges in social life and assessing possible forms of coping with them from the perspective of individuals. By doing so, two main ways of broadening explanations are considered and compared in light of what the purpose of sociology might be.

Some Yield and Growth Traits of Anatolian Buffaloes and the Effects of First Calving Age and Calving Interval on These Traits

Numerous in-depth studies have described the fertility traits, growth performance and milk yield traits of dairy animals, which are considered indicators of welfare, but there are limited studies examining these traits within the framework of cause-effect relationships, especially in buffaloes. The aim of this study was to determine the changes in some milk, growth and fertility traits of Anatolian buffaloes over the years in some dairy farms where the Buffalo Breeding Project in Public Conditions was implemented in Samsun province and, to investigate the effects of first calving age (FCA) and calving interval (CI) on milk and growth traits. The study was conducted in 27 buffalo farms (3295 buffalo cows and 3317 buffalo calves) located in Bafra district, the region with the highest buffalo population in Samsun province, Türkiye. The data was taken from records previously kept within the scope of the relevant project. The data such as growth characteristics [birth weight (BW), 6th and 12th-mo live weight (LW) values of calves born between 2013-2020] and lactation traits of cows [lactation milk yield (LMY) and lactation duration (LD)] and FCA and CI values were analyzed by analysis of variance. The effect of years on LMY of buffalo cows was found to be significant, and significant positive changes were determined from year to year. In addition, the BW, 6th-mo, and 12th-mo LW values of calves also varied from year to year. As the FCA value of buffaloes increased, the BW, 6th-mo, and 12th-mo LW values of calves and LMY of cows increased. Similarly, CI values affected the BW values of calves (P<0.01), and LMY and LD values increased in parallel with the increase in CI values. Consequently, determining the lactation and growth traits of buffaloes could benefit developing herd management practices that would optimize these performance indicators.

Prevalence of Internet Use among Adolescents of 15 to 18 Years of Age in A Village under RHTC of A Medical College: Cross-Sectional Study

Background: The environment in which today’s adolescents are growing has changed drastically and affected their access to internet as well. The study was conducted with the aim of estimating the prevalence of internet use and pattern of internet use among adolescents of a village area. Methods: About 114 adolescents of a village in Western Maharashtra belonging to age group 15-18 years participated in the study. They were selected based on the inclusion criteria of age group and willingness to participate in the study via universal sampling method and were interviewed with the help of semi-structured questionnaire, which included questions regarding socio-demography, internet use and its interrelationship with other variables. Chi-square test was used as a test of statistical significance to study the association between the predictor variable and the outcome with (p<0.05) as a level of significance. Results: The prevalence of internet use was 99.12%. Where 74% of adolescents used internet for an average of 1-2 hours in a day and 26% used internet for an about 2-4 hours in a day. Taking p < 0.05 as a level of significance we found gender was significantly associated with duration of internet use (p = 0.01) and Purpose of internet use (p = 0.004). Conclusion: Almost all adolescents have access to internet and are more inclined towards its use for non-educational purpose which can be detrimental for their educational progress and long-term career goals. Hence, monitoring of internet use by adolescents has to be done by guardians/teachers. Further studies should be conducted on cause-effect relationship to study the either way of association.

Underlying cerebrovascular pathology causing secondary psychosis

Case Background Psychosis can be classified as primary if it is caused by a psychiatric disorder or secondary if it is due to a specific medical condition. Despite there being multiple identified causes of secondary psychosis, making such a diagnosis can prove challenging. Case Details This case report presents a 57-year-old male who was brought by ambulance to the emergency department following an intentional jump from a first story window due to visual and auditory hallucinations and persecutory paranoid delusions. MRI findings on admission were consistent with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). The patient’s background included an ischaemic stroke with haemorrhagic transformation five years previously. He experienced psychotic symptoms during the immediate recovery period. Prior to this he had no psychiatric history. Discussion Post-stroke psychosis and the condition of CADASIL are both entities that are relatively rarely described in the literature. However, this may be due to missed diagnosis and therefore not reflective of true prevalence. Conclusion Identifying a cause-effect relationship and establishing a diagnosis of secondary psychosis can be confounded by many factors. Nevertheless, this patient’s case demonstrates the importance of considering an underlying cause, particularly when the presentation is atypical and there is a temporal relationship between the proposed medical condition and the symptoms of psychosis. Patient Consent Obtained: Yes

Sperm and leukocyte telomere length are related to sperm quality parameters in healthy men from the Led-Fertyl study.

Could sperm and leukocyte telomere length (TL) be associated with sperm quality parameters and reproductive health in men from the general population? A positive association between sperm and leukocyte TL with sperm concentration and total count has been demonstrated. Male factors account for almost half of cases of couple infertility, and shorter TLs have been observed in sperm from men with impaired sperm parameters. However, evidence in men from the general population is limited. A total of 200 volunteers of reproductive age were recruited between February 2021 and April 2023 to participate in the Lifestyle and Environmental Determinants of Seminogram and Other Male Fertility-Related Parameters (Led-Fertyl) cross-sectional study. TLs in sperm and leukocytes were measured using quantitative polymerase chain reaction (qPCR) in 168 and 194 participants, respectively. Sperm parameters, including concentration, total count, motility, vitality, and morphology, were analyzed using a computer-assisted sperm analysis (CASA) SCA® system according to the World Health Organization (WHO) 2010guidelines. Multivariable regression models were performed to assess the associations between sperm and leukocyte TL, either in tertiles or as continuous variables, and sperm quality parameters while adjusting for potential confounders. Participants in tertiles 2 (T2) and 3 (T3) of sperm TL showed a higher sperm concentration (β: 1.09; 95% CI: 0.09-2.09 and β: 2.06; 95% CI: 1.04-3.09 for T2 and T3, respectively; P-trend < 0.001), compared to those in the reference tertile (T1). Participants in the highest tertile of sperm TL showed higher total sperm count (β: 3.83; 95% CI: 2.08-5.58 for T3 vs T1; P-trend < 0.001). Participants in the top tertile of leukocyte TL showed higher sperm concentration (β: 1.49; 95% CI: 0.44-2.54 for T3 vs T1; P-trend = 0.004), and total count (β: 3.49; 95% CI: 1.62-5.35 for T3 vs T1; P-trend < 0.001) compared with participants in T1. These results remained consistent when sperm and leukocyte TL were modelled as continuous variables. One limitation is the impossibility of establishing a cause-effect relationship due to the cross-sectional study design. Additionally, the sample size of the study cannot be considered large. Sperm and leukocyte TLs are associated with sperm quality parameters in the general population. Additional determinations and further studies with larger sample sizes are needed to clarify the mechanisms underlying these associations and to investigate the further implications. The Led-Fertyl study was supported by the Spanish government's official funding agency for biomedical research, Instituto de Salud Carlos III (ISCIII), through the Fondo de Investigación para la Salud (FIS) and co-funded by the European Union ERDF/ESF, 'A way to make Europe'/'Investing in your future' (PI21/01447), and the Diputació de Tarragona (2021/11-No.Exp. 8004330008-2021-0022642). J.S.-S., senior author of the present study, is partially supported by ICREA under the ICREA Academia program. M.F.d.l.P. was supported by a predoctoral grant from the Rovira i Virgili University and Diputació de Tarragona (2020-PMF-PIPF-8). C.V.-H. received a predoctoral grant from the Generalitat de Catalunya (2022 FI_B100108). M.Á.M. was supported by the Sara Borrell postdoctoral fellowship (CD21/00045-Instituto de Salud Carlos III (ISCIII)). All authors declare that they have no conflicts of interest. N/A.

Longitudinal comparison of the relationship of energy intake with body composition and physical performance in elite female basketball and volleyball players

Abstract Purpose To maximise sporting success, disciplines such as basketball and volleyball need to improve their methods of analysing the sporting performance and fitness of their athletes. Although energy intake quantities have been established at a theoretical level for women to perform at a sporting level, it has been found that these energy intake levels are not met or followed and that, despite this, the performance of female players is not diminished. Thus, the purpose of this research study was to describe and compare the anthropometric characteristics of these two disciplines and to identify the differences in actual and theoretical energy intake, as well as to observe physical performance in both disciplines. Methods Anthropometric data, continuous quantitative data, training time and characteristics, and energy intake data were collected. Performance tests included upper and lower body strength, speed, agility, and endurance tests. Dietary monitoring showed lower intakes of total energy, carbohydrate and protein than theoretically recommended. However, the athletes experienced overall improvements in performance and body composition. Results The mean total energy intake was 20.2 ± 4.3 kcal·kg−1·day−1. The minimum individual mean intake was 9.8 kcal·kg−1·day−1 and the maximum was 25.95 kcal·kg−1·day−1. Carbohydrates accounted for 54.3% ± 8.8% of the energy intake; 20.3% ± 6.5% from fats; 25.4% ± 5.7% from proteins. Conclusions Current data suggest that, although a cause-effect relationship between dietary intake and BC performance cannot be determined, elite athletes in these sports disciplines may experience beneficial outcomes despite having lower total energy, CHO, protein, and fat intakes than previously recommended in the literature.

Semiparametric sensitivity analysis: unmeasured confounding in observational studies.

Establishing cause-effect relationships from observational data often relies on untestable assumptions. It is crucial to know whether, and to what extent, the conclusions drawn from non-experimental studies are robust to potential unmeasured confounding. In this paper, we focus on the average causal effect (ACE) as our target of inference. We generalize the sensitivity analysis approach developed by Robins etal., Franks etal., and Zhou and Yao. We use semiparametric theory to derive the non-parametric efficient influence function of the ACE, for fixed sensitivity parameters. We use this influence function to construct a one-step, split sample, truncated estimator of the ACE. Our estimator depends on semiparametric models for the distribution of the observed data; importantly, these models do not impose any restrictions on the values of sensitivity analysis parameters. We establish sufficient conditions ensuring that our estimator has $\sqrt{n}$ asymptotics. We use our methodology to evaluate the causal effect of smoking during pregnancy on birth weight. We also evaluate the performance of estimation procedure in a simulation study.

Differential response of multiple stream ecosystem processes to basin- and reach-scale drivers

Stream ecosystems are inherently dependent on their surroundings and, thus, highly vulnerable to anthropogenic impacts, which alter both their structure and functioning. Anchored in biologically-mediated processes, the response of stream ecosystem functioning to environmental conditions exhibits intricate patterns, reflecting both natural dynamics and human-induced changes. Our study aimed at determining the natural and anthropogenic drivers influencing multiple stream ecosystems processes (nutrient uptake, biomass accrual, decomposition, and ecosystem metabolism) at a regional scale. By examining 38 natural and anthropogenic variables across 63 stream reaches in Gipuzkoa (northern Iberian Peninsula), we used structural equation modeling to unravel the cascading effect of basin- and reach-scale drivers onto ecosystem process. The results reveal significant variability in ecosystem processes, with contrasting spatial patterns, suggesting that studied processes respond differently to environmental factors. Urban land-use emerged as a primary basin-scale driver, whereas reach-scale variables reflected both natural and anthropogenic influence. Nutrient uptake rates were primarily driven by nutrient concentrations in stream water, but models for biomass accrual, decomposition, and ecosystem metabolism exhibited more complex cause-effect relationships. Our findings highlight the impact of urban areas on multiple ecosystem processes and services, disproportionate when considering their small land cover. The present study emphasizes the convenience of measuring multiple ecosystem functions simultaneously to get a comprehensive diagnosis of the functional status of rivers.

Recommendations on bioacoustical metrics relevant for regulating exposure to anthropogenic underwater sounda).

Metrics to be used in noise impact assessment must integrate the physical acoustic characteristics of the sound field with relevant biology of animals. Several metrics have been established to determine and regulate underwater noise exposure to aquatic fauna. However, recent advances in understanding cause-effect relationships indicate that additional metrics are needed to fully describe and quantify the impact of sound fields on aquatic fauna. Existing regulations have primarily focused on marine mammals and are based on the dichotomy of sound types as being either impulsive or non-impulsive. This classification of sound types, however, is overly simplistic and insufficient for adequate impact assessments of sound on animals. It is recommended that the definition of impulsiveness be refined by incorporating kurtosis as an additional parameter and applying an appropriate conversion factor. Auditory frequency weighting functions, which scale the importance of particular sound frequencies to account for an animal's sensitivity to those frequencies, should be applied. Minimum phase filters are recommended for calculating weighted sound pressure. Temporal observation windows should be reported as signal duration influences its detectability by animals. Acknowledging that auditory integration time differs across species and is frequency dependent, standardized temporal integration windows are proposed for various signal types.

Organizational culture and leadership style in Spanish Hospitals: Effects on knowledge management and efficiency

Hospital culture and leadership style have attracted considerable attention in research, with compelling evidence indicating their potential competitive advantages, including their crucial role in ensuring the successful implementation of knowledge management and its impact on hospital efficiency. The aim of this paper is to identify the effects of organizational culture and leadership style on knowledge management and hospital efficiency. Fuzzy cognitive maps (FCMs) are relational models that can be used to represent the opinions and knowledge of expert to infer cause-effect relationships among different concepts. The use of FCMs as a simulation tool enables the evaluation of potential scenarios based on different organizational cultures and leadership styles in hospitals. Developing an FCM for this study involved several steps. Firstly, data were collected through interviews with 21 experts in hospital management. The interviews were conducted between May and September 2023 either face-to-face or via videoconference. Once individual cognitive maps had been created, consensus among them was achieved through a multicriteria decision-making process, wherein the expert opinions were averaged. The separate cognitive maps of each expert were then integrated to produce a single FCM using the augmented FCM approach. Reflecting expert insights from the FCM, hospitals with a hierarchy culture exhibit diminished levels of knowledge creation, management, and overall hospital efficiency, whereas those with an adhocracy culture show improvements in knowledge creation, knowledge exploitation, and overall hospital efficiency in comparison to alternative ones. From the experts' FCM perspective regarding leadership style, transformational leadership achieves the highest level of knowledge management and hospital efficiency in hospitals with an adhocracy culture. Finally, this paper offers a reference for practising knowledge management and improving hospital efficiency through adhocracy culture and transformational leadership.