The research team, led by Hsiu-Hua Shih and Tsai-Wei Huang of Taipei Medical University, searched five major biomedical databases—PubMed, MEDLINE, CINAHL, Embase, and the Cochrane Library—through March 2026. Their sweep identified 28 studies encompassing 3,232 participants and spanning nine categories of cancer. To be eligible, studies had to include adults with physician-confirmed malignancy and HRV measured either by electrocardiography or by photoplethysmography, the optical sensing technology embedded in most modern smartwatches and fitness bands. The breadth of the evidence base matters, because HRV research in oncology has long been fragmented across individual small trials, leaving clinicians without a clear quantitative picture of how large the autonomic differences between cancer patients and healthy controls actually are.

A key methodological decision shaped the entire analysis. Time-domain HRV indices such as SDNN, the standard deviation of normal-to-normal heartbeat intervals, scale directly with the length of the recording: a 24-hour ambulatory measurement yields systematically larger values than a five-minute resting snapshot. Pooling studies with different recording durations would therefore conflate measurement artifacts with genuine biology. The researchers restricted their primary quantitative pooling—designated Part A of the review—to short-term resting recordings of five to ten minutes obtained with age-matched non-cancer controls. Only five studies met these strict criteria. Long-term ambulatory recordings of twelve to thirty hours were reported separately, and the remaining studies were synthesized narratively or examined for longitudinal change over time. The team used the DerSimonian–Laird random-effects model and graded the certainty of all findings with the GRADE framework, registering the protocol in advance as PROSPERO CRD42026130103.

The pooled results were unambiguous in direction. Cancer patients showed lower SDNN than controls by a mean difference of 14.05 milliseconds, with a 95 percent confidence interval spanning 9.90 to 18.20 milliseconds. RMSSD, the root mean square of successive heartbeat-interval differences and a sensitive marker of vagal parasympathetic activity, was lower by 16.76 milliseconds. pNN50, the percentage of consecutive heartbeat intervals differing by more than 50 milliseconds, was reduced by 6.05 percentage points. All three differences were statistically significant at p less than 0.001, and heterogeneity across studies was modest, with I-squared values between 22.1 and 33.7 percent—remarkably low for a meta-analysis of clinical studies. Leave-one-out sensitivity analyses, in which each study is removed in turn to test whether any single dataset drives the result, confirmed the robustness of the pooled estimates.

Not every HRV metric told the same story. High-frequency power, a frequency-domain index that also reflects parasympathetic modulation, showed no statistically significant difference between cancer patients and controls, with a p-value of 0.118. The divergence between suppressed time-domain indices and an unchanged high-frequency component is scientifically intriguing, and it underscores a broader point the authors stress: HRV is not a single number but a family of indices, each capturing different aspects of autonomic regulation and each vulnerable to different technical and physiological confounders. Time-domain measures computed over short recordings are particularly sensitive to overall beat-to-beat variability, while spectral measures depend heavily on breathing patterns, recording conditions, and the mathematical assumptions of the underlying algorithms.

Beyond the between-group comparison, the review examined how HRV relates to one of the most common and debilitating symptoms in oncology: cancer-related fatigue. Within individual cancer cohorts, studies consistently reported inverse correlations between HRV and fatigue severity—lower variability, greater exhaustion. This pattern aligns with a physiological substrate proposed by earlier work, including studies of breast cancer survivors showing that low HRV tracks with persistent fatigue long after treatment ends. If reduced vagal tone is genuinely linked to the fatigue experienced by millions of cancer survivors, HRV could eventually help clinicians identify patients at risk and monitor responses to interventions such as exercise programs, which prior meta-analytic work has suggested may partially reverse autonomic dysfunction in this population.

The longitudinal strand of the review adds a dynamic dimension. Studies that followed patients over time documented HRV trajectories across the cancer journey, from preoperative measurements through surgery, chemotherapy, and radiation, into survivorship. Perioperative vagal withdrawal, the cardiotoxic effects of certain chemotherapeutic agents, and the physiological burden of the malignancy itself can each leave distinct imprints on autonomic regulation. Some studies even explored whether HRV patterns differ by tumor location or disease progression, and whether nonlinear HRV measures—fractal and entropy-based indices known to predict cardiovascular mortality in other populations—might carry prognostic information in patients with brain metastases, gastric cancer, or colorectal cancer. These exploratory findings remain preliminary, but they sketch a research agenda in which autonomic monitoring could complement existing clinical assessment.

Yet the authors are emphatic about what the pooled estimate cannot do. Because the aggregate combines mechanistically distinct sources of HRV suppression—the malignancy itself, treatment-related cardiotoxicity, perioperative vagal withdrawal, and long-term survivorship remodeling—the pooled figure cannot attribute the observed suppression to any single cause. Moreover, GRADE assessment rated all pooled outcomes as Very Low certainty, the weakest tier on the five-level scale, reflecting limitations in study design, risk of bias, and imprecision. On this basis, the team explicitly declines to recommend HRV as an established clinical biomarker for cancer care. The distinction between a consistent research signal and a validated clinical tool is one that the field has sometimes blurred, and this review draws the line carefully.

The path forward, according to the authors, requires studies stratified by treatment phase, standardized measurement protocols, and the incorporation of nonlinear HRV indices alongside conventional time-domain and frequency-domain metrics. Wearable devices, which have already been used to classify cancer-related fatigue from HRV signals in recent observational studies, could make large-scale, longitudinal autonomic monitoring feasible outside the clinic. If future research confirms that HRV suppression tracks with symptom burden, treatment toxicity, or survival, the humble millisecond-to-millisecond wobble of the heartbeat could evolve from a research curiosity into a practical, non-invasive vital sign for oncology. For now, the message of this meta-analysis is one of cautious confirmation: the autonomic nervous system is measurably altered in cancer, the alteration is real and reproducible in short-term recordings, and understanding what it means for patients is the next great challenge.

Subject of Research: Heart rate variability suppression in cancer patients versus non-cancer controls: a systematic review and meta-analysis

Article Title: Heart rate variability suppression in cancer patients versus non-cancer controls: a systematic review and meta-analysis

Article References: Heart rate variability suppression in cancer patients versus non-cancer controls: a systematic review and meta-analysis. (n.d.). https://doi.org/10.1007/s00520-026-11229-1

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11229-1

Keywords: Heart, rate, variability, suppression, cancer, patients, versus, non-cancer, controls, systematic, review, meta-analysis

The research team, working under PRISMA guidelines, searched MEDLINE, the Cochrane Library, and two Japanese databases, screening 299 articles down to eight eligible case series published between 2019 and 2022. Together, these studies covered 208 patients, nearly all treated in Japan, with one Dutch cohort. All participants had initially unresectable, locally advanced esophageal squamous cell carcinoma and received radiation doses between 50.4 and 60 Gy before undergoing salvage surgery. The authors assessed study quality with the Joanna Briggs Institute checklist and pooled outcomes using single-proportion meta-analysis with the Freeman–Tukey transformation. Because every included study was a case series, the overall evidence level was rated at four on the Oxford scale—weak by design, but for many of these patients it is the only evidence that exists.

The headline numbers are striking. Across the pooled cohort, 30 percent of patients experienced serious postoperative complications of Clavien–Dindo grade III or higher. Anastomotic leaks—the breakdown of the surgical connection between the remaining esophagus or stomach and the digestive tract—occurred in 18 percent of cases. Pulmonary complications, including pneumonia, pleural effusion, and acute respiratory distress syndrome, affected 31 percent of patients, making breathing problems the most common burden after these operations. Postoperative mortality, defined variously across studies as 30-day, 90-day, in-hospital, or surgery-related death, pooled at 7 percent. These figures place salvage esophagectomy firmly in the category of high-risk surgical oncology, comparable to the most demanding procedures performed today.

Yet the analysis also delivered a genuinely hopeful statistic: surgeons achieved an R0 resection—complete removal of the tumor with clear microscopic margins—in 72 percent of cases. This matters enormously because R0 status is the single strongest predictor of long-term survival in salvage surgery. In the included studies, five-year overall survival rates ranged widely, from as low as 5.7 percent to as high as 51.6 percent, depending on the institution and the completeness of resection. One study reported a five-year survival of 63.6 percent among patients who achieved R0 resection, compared with zero percent for those left with microscopic or gross residual disease. Another found that patients undergoing curative salvage surgery had a three-year survival of 58.7 percent, essentially matching the outcomes of patients whose tumors vanished completely with chemoradiotherapy alone.

The comparison with non-surgical outcomes is particularly sobering. In one Japanese series, patients who underwent salvage esophagectomy for T4 disease achieved a five-year overall survival of 51.6 percent, while those managed without surgery in the same cohort survived five years in only 1.3 percent of cases. This dramatic gap is the clinical argument for offering a procedure that carries a seven percent mortality risk: for a disease that is otherwise locally incurable, surgery may represent the only realistic path to long-term survival. The authors emphasize that when chemoradiotherapy fails locally—either leaving residual tumor or allowing relapse—salvage esophagectomy remains the only established strategy with the potential for cure.

Intriguingly, the pooled complication rates for these T4 patients were similar to those reported historically for salvage esophagectomy in earlier-stage disease, where morbidity rates of 50 to 79 percent and mortality rates of 6 to 22 percent have been documented. This suggests that pretreatment tumor depth may not dramatically alter surgical risk. Instead, the analysis revealed that institutional strategy—not the technology used—may be the decisive factor in pulmonary outcomes. One center that deliberately omitted prophylactic lymph node dissection and used open surgery reported a pneumonia rate of just 5.6 percent, while another performing standard two-field dissection with robotic assistance documented pulmonary complications in 54 percent of patients. The tension between oncological thoroughness and perioperative safety emerged as a central theme of the analysis.

Statistical heterogeneity was significant for both pulmonary complications and R0 resection rates, and sensitivity analyses pinpointed its sources. Excluding one study reduced the heterogeneity in pulmonary outcomes from 63 percent to 43 percent, implicating its unusual lymph node strategy. For R0 resection, heterogeneity fell when studies with a high proportion of relapsed tumors—rather than immediately residual disease—were removed. The authors note that surgery after relapse involves different pathological conditions and more treatment-induced fibrosis, which can obscure surgical planes and complicate complete resection. Even the definition of T4 disease varied: staging accuracy for CT and MRI has been reported at only 64 and 55 percent respectively, and diagnostic thresholds for declaring a tumor unresectable differed across centers, with some teams operating unless aortic or tracheal wall destruction was radiologically evident and others reserving surgery for tumors downstaged to T2 or below.

The authors are candid about the limitations of their work. All eight studies were case series vulnerable to selection bias, and publication bias may have inflated favorable outcomes—the Doi plots showed major asymmetry for pulmonary complications and R0 resection, indicated by LFK indices exceeding ±2. Survival meta-analysis was impossible due to inconsistent reporting, and mortality definitions were not standardized. Moreover, the results come largely from specialized esophageal centers in Japan, where surgeons may adopt more aggressive criteria for salvage candidacy than general institutions. These constraints mean the findings should be generalized with care, even as they affirm the procedure’s feasibility in expert hands.

What emerges from this synthesis is a nuanced picture of a discipline at its frontier. Salvage esophagectomy for T4 esophageal squamous cell carcinoma is a high-stakes intervention: roughly one in fourteen patients dies perioperatively, and nearly one in three suffers a major complication. But for the majority in whom a complete R0 resection can be achieved, the prospect of five-year survival exceeding 50 percent transforms a formerly fatal situation into a fight worth having. The authors call for standardized criteria for resectability and surgical extent, and they are conducting a nationwide survey through institutions accredited by the Japan Esophageal Society to gather more robust data. Given the rarity of eligible patients, randomized trials may never be practical—making carefully aggregated real-world evidence like this the compass that will guide surgeons and patients through one of cancer surgery’s most difficult decisions.

Subject of Research: Salvage esophagectomy for T4 esophageal squamous cell carcinoma after definitive chemoradiotherapy

Article Title: Systematic Review and Meta‐Analysis on the Efficacy and Safety of Salvage Esophagectomy for T4 Esophageal Squamous Cell Carcinoma

Article References: Sakai, M., Kuriyama, K., Nagai, K., Shirabe, K., & Saeki, H. (2026). Systematic Review and Meta‐Analysis on the Efficacy and Safety of Salvage Esophagectomy for T4 Esophageal Squamous Cell Carcinoma. Annals of Gastroenterological Surgery, 10(5), 1441-1449. https://doi.org/10.1002/ags3.70233

Image Credits: AI Generated

DOI: 10.1002/ags3.70233

Keywords: esophageal cancer, salvage esophagectomy, T4 esophageal squamous cell carcinoma, chemoradiotherapy, meta-analysis, R0 resection, anastomotic leak, postoperative complications, lymph node dissection, surgical oncology, Systematic, Review

At the heart of the field sits electrospinning, the workhorse technique that dominates nanofiber production. In this process, a high voltage is applied to a polymer solution or melt, overcoming surface tension at the needle tip to form a Taylor cone. A charged jet then streaks toward a grounded collector, elongating and thinning as solvent evaporates, until continuous ultrafine fibers accumulate as a nonwoven mat. The technique is exquisitely sensitive: polymer concentration, viscosity, surface tension, and conductivity shape fiber formation, while applied voltage, flow rate, needle-to-collector distance, temperature, and humidity govern fiber diameter, beading, and porosity. Higher conductivity and moderate flow rates yield finer, smoother fibers, and careful control of ambient humidity can even introduce useful surface pores. Typical operating windows include voltages of 10 to 30 kilovolts, flow rates of 0.5 to 3 milliliters per hour, and working distances of 10 to 20 centimeters.

Electrospinning itself has diversified dramatically. Coaxial arrangements using two concentric nozzles generate core-sheath fibers in which a drug-rich core is protected by a functional shell, while multi-needle and needleless designs, including roller, wire, bubble, and corona systems, draw dozens of jets simultaneously from free liquid surfaces to raise throughput. Centrifugal spinning replaces electrostatic forces with mechanical ones for higher output, and variants such as melt, wet, AC, and near-field electrospinning offer solvent-free processing or sub-micron patterning precision. Beyond electrospinning, the review catalogs alternative routes: molecular self-assembly, in which peptides or small molecules spontaneously organize through hydrogen bonding and hydrophobic interactions into fibers just a few nanometers wide; phase separation, which uses polymer gelation and freeze-drying to produce nanofibrous matrices with tunable porosity; template-assisted extrusion through nanoporous anodic aluminum oxide membranes; and nanofiber printing, exemplified by 3D printing of carbon nanotube-dispersed nanofibrillated cellulose into aligned, conductive microfibers. Each method carries trade-offs in scalability, cost, and control over fiber architecture.

Material selection proves equally decisive. Natural polymers such as collagen, gelatin, chitosan, alginate, silk fibroin, and hyaluronic acid closely mimic the extracellular matrix, offering biocompatibility, low immunogenicity, and built-in cell-binding motifs, though they often suffer from weak mechanical strength and batch-to-batch variability. Synthetic polymers including polycaprolactone, polylactic acid, polyglycolic acid, PLGA, polyvinyl alcohol, polyethylene oxide, and polyvinylpyrrolidone provide predictable degradation rates, robust mechanical performance, and easy processing, enabling precise tuning of release kinetics. Hybrid systems combine the best of both, while functionalization with inorganic nanoparticles such as silver, zinc oxide, hydroxyapatite, gold, or magnetic iron oxide confers antimicrobial, osteoconductive, or stimulus-responsive behavior. Crosslinkers like genipin and EDC/NHS chemistry, plasma treatment, and silanization stabilize the finished fibers and anchor bioactive ligands.

How a drug gets into the fiber determines how it comes out. The review identifies four principal loading strategies. Blending dissolves the drug directly into the spinning solution, a simple one-step approach that works for hydrophilic and hydrophobic compounds alike. Encapsulation via coaxial or emulsion electrospinning shepherds delicate molecules into protective cores, with emulsion systems notably reducing first-hour burst release and improving the oral delivery of poorly soluble anticancer agents such as paclitaxel. Physical adsorption, the simplest method, relies on electrostatic and van der Waals forces to immobilize drugs on fiber surfaces, though weak binding limits in vivo reliability. Chemical immobilization through covalent linkages offers stronger, quantifiable attachment at the cost of added synthetic complexity. Release then proceeds through diffusion, dissolution, degradation, or swelling of the carrier, or through targeted mechanisms in which ligand-receptor pairing triggers drug delivery specifically at diseased tissue.

Perhaps the most striking advance highlighted is the rise of smart, stimuli-responsive nanofibers that release their payload only when prompted. pH-sensitive polymers exploit the acidic microenvironment of tumors and inflamed tissue; redox-cleavable bonds disintegrate under oxidative stress; thermo-responsive materials like poly(N-isopropylacrylamide) contract with temperature shifts; gold nanorods enable near-infrared light-triggered release; and superparamagnetic iron oxide nanoparticles generate local heat under alternating magnetic fields. Dual- and multi-responsive platforms now combine these triggers for unprecedented spatiotemporal control. Biomimetic designs go further, replicating the architecture of the natural extracellular matrix to simultaneously deliver drugs and direct cell behavior, with fiber alignment shown to steer cell shape, mechanotransduction signaling, and even metabolic phenotype, promoting myogenic differentiation and neurite outgrowth along aligned fibers.

Safety remains a central concern as these materials advance. Because of their nanoscale dimensions and enormous surface area, nanofibers can provoke cytotoxicity, genotoxicity, or inflammation depending on polymer chemistry, fiber dimensions, surface features, and degradation byproducts. Airborne fibers pose inhalation hazards during manufacture. The review stresses that standard metabolic assays such as MTT can be misleading on porous, high-surface-area scaffolds, where formazan crystals adsorb onto fiber surfaces, and recommends corroborating results with live/dead confocal staining, lactate dehydrogenase leakage assays, hemolysis testing, and flow cytometry. Long-term stability also demands attention: electrospinning can render crystalline drugs amorphous, improving solubility but risking recrystallization, while sterilization by ethylene oxide or gamma irradiation can fuse, degrade, or embrittle polymer fibers.

The clinical picture is brightening rapidly. In vivo studies demonstrate nanofiber matrices loaded with Exendin-4 improving rat tendon healing, propolis-infused silk fibroin gels closing full-thickness wounds by day 17, honey-based fibers achieving 94.3 percent healing in diabetic wounds, and radially oriented PLGA fibers releasing metformin for over 30 days in burn models. Nanofibers now serve as platforms for non-viral CRISPR activation, sustaining VEGF gene expression for three weeks and accelerating wound repair, and for localized AAV vector delivery enabling cardiac genome editing in mice. Commercially, products have already crossed the regulatory finish line: the nanofibrillar cellulose dressing FibDex, the self-assembling peptide hemostat PuraStat, and FDA-cleared orthopedic scaffolds such as Rotium wick and TAPESTRY are in clinical use, with trials also underway in dentistry, ophthalmology, and diabetic foot ulcer care.

Looking forward, the authors argue that artificial intelligence and 3D bioprinting will unlock truly personalized nanofiber medicine. Machine learning models, including support vector machines, artificial neural networks, and Gaussian process regression, are already predicting optimal electrospinning parameters, fiber diameter, encapsulation efficiency, and drug release profiles from existing datasets, slashing experimental iteration. Bioprinting enables patient-specific dosage forms, from self-dissolving vascular devices implanted in rat veins to polypill configurations for complex medication regimens. Major hurdles persist, chiefly scalable manufacturing, solvent residues, regulatory standardization, and the scarcity of human in vivo data, but the trajectory is unmistakable: nanofiber drug delivery systems, once a laboratory curiosity, are consolidating into a versatile, clinically validated platform poised to make treatment safer, smarter, and tailored to the individual patient.

Subject of Research: Nanofiber-based drug delivery systems for controlled and targeted therapeutic release

Article Title: A review of nanofiber-based drug delivery systems: fabrication, characterization, advances, and future prospects

Article References: Saleh, A. M., Selim, R. N., El-Morsy, M. T., Mansour, S. A., Elhady, R., Ismail, S. F. K., Gamal, M., & Kenawy, E.-R. S. (2026). A review of nanofiber-based drug delivery systems: fabrication, characterization, advances, and future prospects. Journal of Materials Science: Polymers, 1(1), Article 10. https://doi.org/10.1007/s44493-026-00009-2

Image Credits: AI Generated

DOI: 10.1007/s44493-026-00009-2

Keywords: nanofibers, drug delivery, electrospinning, controlled release, biomimetic materials, stimuli-responsive polymers, biocompatibility, 3D bioprinting, artificial intelligence, clinical translation, review, nanofiber-based

Patient navigation, a concept that originated in the United States in the 1990s, aims to reduce barriers to care by guiding patients through screening, diagnosis, treatment, rehabilitation, survivorship and end-of-life care. Navigators may be nurses, social workers or trained lay people, and their work spans education, barrier assessment, care coordination, psychosocial support and referrals. Yet while navigation has become a fixture of American cancer care, the European evidence base remains fragmented, inconsistently evaluated and rarely tailored to the ageing patient.

The review, conducted as part of the EU-funded EU-NAVIGATE project (2022–2027), followed PRISMA-ScR guidelines and searched PubMed, CINAHL and Web of Science for studies published between 1993 and 2025, supplemented by grey literature and manual reference screening. Of 4,249 records identified, 215 studies met the inclusion criteria. Only 28 of these reported patient navigation interventions conducted in Europe, spanning 11 countries, with Denmark contributing the most studies (six), followed by France (five) and the United Kingdom (four). The United States accounted for 153 studies, reflecting its far longer tradition of navigation research and implementation.

The numbers for older adults are stark. Across the 28 European studies, only one exclusively targeted adults aged 65 and over, and just one focused on adults aged 75 and over — the latter being the EU-NAVIGATE project itself, which is testing a navigation intervention for older people with cancer and their family caregivers across six European countries. Six further studies targeted pre-elderly populations aged 50 and above, while the remaining 20 involved general adult populations that included older participants. Only eight studies worldwide specifically investigated navigation programs for adults aged 65 and over.

The content of European programs varied with the age group served. Among interventions for adults aged 50 and over, education and barrier assessment dominated, with six of the eight programs operating at the cancer screening stage, one in treatment and one in supportive, palliative and end-of-life care. In contrast, programs for broader adult populations most often operated during treatment and placed greater emphasis on education, emotional support, barrier assessment and care coordination, with additional activities including skills building, symptom management, appointment assistance and referrals.

Navigator profiles differed sharply by age group. In European studies involving adults aged 50 and over, lay navigators (50 percent) and social workers (38 percent) predominated, with nurses accounting for just 13 percent. The pattern reversed in studies of general adult populations, where nurses delivered navigation in 16 of the studies and lay navigators were almost absent. In the United States, lay navigators were also the most frequently reported group among programs for people 50 and over, whereas nurses dominated in studies from other regions. The authors suggest that lay and social-work navigators may be particularly suited to addressing the social, practical and community needs of older patients, while professional navigators contribute clinical expertise and familiarity with treatment pathways.

Training practices revealed both promise and inconsistency. Nearly all European studies targeting adults 50 and over reported navigator training, typically lasting from two hours to one week, and European studies in this age group more frequently documented training in psychosocial skills, medical knowledge and the navigation process than did studies from the United States or elsewhere. Training content ranged from communication skills, motivational interviewing and coaching to healthcare system knowledge, nutrition, exercise and disease-specific topics. By contrast, in studies of broader adult populations, training was reported in only half of cases, and competencies were usually inferred from professional qualifications rather than defined by explicit frameworks.

Perhaps the most troubling finding concerns evaluation. Fewer than half of the European studies — 12 of 28 — described any form of evaluation, and only a handful used structured methodological approaches. Where assessment occurred, it often relied on participants’ subjective satisfaction rather than objective outcomes. Systematic evaluation was reported in 38 percent of European studies involving adults 50 and over, compared with just 2 percent in the United States and none elsewhere. Only two European studies assessed cost-effectiveness, and standardized outcome measures, such as quality-of-life instruments and the Work Ability Score, appeared only rarely.

The authors argue that the scarcity of age-tailored navigation may amount to a form of elder neglect in cancer care research, echoing broader concerns about ageism and the underrepresentation of older adults in clinical studies. Older people account for the majority of cancer diagnoses, yet recent ASCO guidelines recommending routine geriatric assessment for patients aged 65 and over have rarely been reflected in the design of navigation programs. Navigation during palliative and end-of-life care — where coordination needs are most acute — was almost entirely absent from the literature, with only one identified program specifically serving adults aged 70 and over.

The review concludes that patient navigation holds genuine promise across the cancer care continuum but must be adapted to the complex, individual needs of older patients, including frailty, cognitive and functional impairment and caregiver burden. The authors call for age-sensitive navigation models with clearly defined competencies, standardized evaluation using outcomes such as quality of life, functioning and independence, and well-structured training for lay navigators as a promising route to expanding navigation within European cancer care systems. Until such models are built and rigorously tested, they warn, Europe’s fastest-growing group of cancer patients will continue to navigate a fragmented system largely on their own.

Subject of Research: Patient navigation interventions for older adults with cancer in Europe

Article Title: Scoping review on navigation interventions for older adults with cancer in Europe and beyond

Article References: Stodolska, A., Wójcik, G., Reigada, C., Ashford, K., Miranda, R., Van den Block, L., Malmur, E., Drapała, N., & Szczerbińska, K. (2026). Scoping review on navigation interventions for older adults with cancer in Europe and beyond. European Geriatric Medicine. https://doi.org/10.1007/s41999-026-01609-5

Image Credits: AI Generated

DOI: 10.1007/s41999-026-01609-5

Keywords: patient navigation, older adults, cancer care, geriatric oncology, care coordination, navigator training, psychosocial support, scoping review, Europe, frailty, Scoping, review

The headline figure concerns recharge efficiency. Across the compiled literature, drywells achieved an average recharge efficiency of 83.4 percent, a figure 2.22 times higher than the 37.5 percent average recorded for surface-based recharge methods such as percolation ponds, spreading basins and infiltration reservoirs. The difference stems from fundamental physics. Surface systems lose substantial volumes of applied water to evaporation before it can percolate downward, and they depend on the slow, often limiting vertical hydraulic conductivity of surface soils. Drywells bypass the most restrictive near-surface layers entirely, injecting water through a borehole into permeable vadose zone materials where infiltration occurs along the well’s entire wetted depth. The result is a structure that converts a far greater fraction of captured stormwater or treated wastewater into actual aquifer storage.

Speed of operation tells an equally dramatic story. The review found that drywells required between 1 and 20 days to initiate measurable recharge after water was introduced, whereas surface reservoirs needed anywhere from 81 to 450 days before recharge began in earnest. For water managers confronting intense but brief storm events, monsoon pulses or episodic snowmelt, that temporal gap can determine whether a capture opportunity is exploited or lost entirely. Evaporative losses compound the contrast: drywells lost less than 2 percent of applied water to evaporation, since water is stored and infiltrated below ground, while surface methods routinely surrendered 10 to 40 percent of their inflow to the atmosphere. In arid and semi-arid regions where every cubic meter counts, the review’s authors argue that such losses represent a systemic inefficiency that buried infiltration structures can largely eliminate.

Longevity and land use further favor the subsurface approach. Drywells in the reviewed studies exhibited service lives of 25 to 35 years, between 60 and 250 percent longer than comparable surface systems, which are prone to sediment accumulation, vegetation encroachment and structural degradation. Their footprint advantage is even more dramatic. Because a drywell concentrates infiltration into a vertical column rather than spreading it across a horizontal plane, the technology required 40 to 4,000 times less land area than surface basins delivering equivalent recharge. In densely built urban environments where open land is scarce and expensive, this compactness transforms managed aquifer recharge from a land-intensive rural strategy into a viable component of city-scale stormwater and water supply infrastructure. The vadose zone itself adds a bonus: as water migrates from the well through unsaturated soil and rock, natural filtration and attenuation processes improve water quality before it reaches the aquifer.

These performance advantages come with engineering caveats, and the review dedicates considerable attention to design specifications distilled from the literature. The authors recommend drywell depths of 15 to 30 meters, diameters of 0.9 to 1.5 meters, and a separation of more than 10 meters between the base of the structure and the water table. That vertical buffer is not arbitrary. It preserves an unsaturated treatment zone through which recharged water must pass, providing residence time for pathogen die-off, filtration of suspended solids and attenuation of chemical contaminants. It also maintains a hydraulic gradient that sustains infiltration capacity. Site-specific hydrogeology remains decisive: the thickness and heterogeneity of the vadose zone, the hydraulic conductivity of the receiving layers and the quality of the source water all shape how a given drywell will perform, and the review emphasizes that careful site characterization should precede any installation.

Clogging emerges as the technology’s principal operational enemy, and the review identifies pretreatment systems and intermittent operation as the most effective countermeasures documented across the 71 studies. Suspended sediments, organic matter, microbial growth and chemical precipitates can progressively seal the walls and base of an infiltration well, throttling recharge rates over time. Settling basins, sand filters and other pretreatment units intercept the worst offenders before water enters the drywell, while alternating wet and dry operational cycles allow the infiltration surface to aerate and partially regenerate between recharge events. The literature also documents more active interventions, including backflushing concepts tested in laboratory settings to restore lost infiltration capacity. The review’s synthesis suggests that with disciplined maintenance regimes, the long service lives reported for well-managed drywells are achievable rather than exceptional.

Contamination risk is the question that most often shadows drywell deployment, particularly when the injected water is urban stormwater carrying hydrocarbons, metals, nutrients, PFAS or pathogens. The reviewed studies confront this concern directly, noting that the vadose zone provides meaningful but not unlimited protection, and that virus transport modeling and field assessments of stormwater drywells have informed guidelines on setback distances and acceptable source water quality. The authors stress that the same 10-meter minimum separation from the water table that safeguards recharge performance also functions as a water quality safeguard, and that pairing drywells with robust pretreatment substantially reduces the mass of pollutants reaching the aquifer. Nevertheless, the review is candid that unclear regulatory frameworks remain one of the chief barriers to wider adoption, with many jurisdictions lacking explicit permitting pathways, monitoring requirements or technical guidance for vadose zone injection structures.

That regulatory ambiguity helps explain a geographic paradox the authors highlight: despite superior measured performance, drywell technology remains confined to specific regions, notably parts of the United States, India, Israel and a handful of other countries with active managed aquifer recharge programs. Where surface spreading dominates, the choice often reflects institutional familiarity and established permitting rather than hydrogeological superiority. The review argues that the evidence base now assembled, quantifying efficiency, longevity, land savings and treatment benefits across six decades of research, provides regulators and engineers with the technical foundation needed to write the standards and design manuals that have been missing. Standardized design specifications, coupled with documented pretreatment and maintenance protocols, could allow drywells to move from a niche solution to a mainstream instrument of groundwater management.

The implications arrive at a moment of acute global water stress. Previous assessments have estimated that roughly four billion people experience severe water scarcity for at least one month each year, and declining aquifers underpin agriculture and drinking water supplies on every inhabited continent. Managed aquifer recharge, in which surplus surface water, stormwater or treated wastewater is deliberately stored underground, has been recognized for decades as a proven technology for water supply resilience. What this review adds is a rigorous, quantitative case that the subsurface branch of that family, the humble drywell, deserves far more prominent placement in the toolkit. With recharge efficiencies more than double those of surface basins, startup times measured in days rather than seasons, evaporative losses nearly eliminated and land requirements slashed by orders of magnitude, drywells offer a rare alignment of hydrogeological performance and urban practicality. The challenge, the authors conclude, is no longer proving that the technology works, but building the regulatory and technical frameworks that will let it work everywhere it is needed.

Subject of Research: Performance, design and implementation strategies of artificial recharge drywell technologies for managed groundwater recharge.

Article Title: Review: Performance, design and implementation strategies for artificial recharge drywell technologies

Article References: Devappa, Veerabadran, R., Selvaraj, S., Kaliaperumal, R., Kannan, B., Alagirisamy, B., & Balasubramaniam, S. (2026). Review: Performance, design and implementation strategies for artificial recharge drywell technologies. Hydrogeology Journal. https://doi.org/10.1007/s10040-026-03165-5

Image Credits: AI Generated

DOI: 10.1007/s10040-026-03165-5

Keywords: artificial recharge, drywell technology, vadose zone infiltration, groundwater management, managed aquifer recharge, recharge efficiency, clogging prevention, stormwater infiltration, hydrogeology, water scarcity, groundwater quality, Review

The construct at the center of the review is subtle but powerful. Psychological mattering, first articulated by Morris Rosenberg and B.C. McCullough in 1981, describes a person’s need to feel significant to other people—not merely to belong to a group, but to know that specific others notice, rely on, appreciate, and would miss them. Contemporary theory breaks the construct into seven components: importance, attention, dependence, ego extension, noted absence, appreciation, and individualization. The distinction from belonging matters, the authors emphasize. A teenager can feel embedded in a peer group yet still privately doubt that anyone would notice their absence. Mattering is person-focused, anchored to particular figures such as parents, teachers, coaches, or friends, and this anchoring appears to give it unique predictive power over engagement, self-esteem, and emotional regulation.

Developmental science offers a reason to expect mattering to be especially consequential during adolescence. As young people acquire formal operational thinking and abstract reasoning, they also become acutely self-conscious and sensitive to how others evaluate them—phenomena classic theorists described as the imaginary audience and heightened egocentrism. Because adolescents are constantly scanning their social worlds for cues of significance, the authors argue that perceived mattering may function differently, and perhaps more intensely, in this age band than in adulthood. The stakes are considerable. Roughly 15 percent of adolescents experience clinically significant mental health difficulties, and rates of depressive symptoms, anxiety, and loneliness rose after the COVID-19 pandemic disrupted schooling and social connection. Meanwhile, estimates cited in the review suggest that 40 to 60 percent of adolescents feel they do not matter in their communities—an experience strongly associated with negative mental health outcomes.

Methodologically, the review was registered with PROSPERO before data collection began and followed PRISMA reporting guidelines. Eligible studies had to sample adolescents aged ten to nineteen, quantify mattering or antimattering, measure at least one mental health indicator such as depression, anxiety, self-esteem, or stress, recruit from a single social context, and use a cross-sectional or longitudinal design. Grey literature was deliberately excluded to preserve methodological rigor and comparability. Study quality was appraised with the National Institutes of Health tool for observational and cross-sectional research and the Joanna Briggs Institute checklist for analytical cross-sectional studies, with two reviewers rating each study and discrepancies resolved by consensus. Interrater agreement at the screening stage was substantial, with an initial agreement rate of 87 percent and a kappa of .74.

What the nineteen studies revealed was strikingly consistent in direction. Thirteen studies that reported correlations between mattering and mental health found statistically significant associations, with p values ranging from less than 0.001 to less than 0.05. Higher mattering traveled with lower depression in five studies, with correlation coefficients spanning weak to moderate negative relationships, from r = -0.02 to r = -0.42. Combined depression and anxiety composites in three studies showed negative associations between r = -0.16 and r = -0.42. Self-esteem moved the opposite way: five studies documented weak-to-moderate positive correlations between mattering and self-esteem, ranging from 0.19 to 0.52, with the strongest positive relationship, r = 0.54, emerging between mattering and self-esteem in a study using the Antimattering Scale. Wellness and well-being correlations were likewise positive in most analyses, including a strong r = 0.55 between mattering and psychological well-being on Ryff’s scale.

The review also surfaced a curious outlier. One study of at-risk high school students reported moderate-to-strong negative associations between mattering and wellness, with coefficients between -0.28 and -0.55, contradicting the broader literature in which mattering predicts wellness. The original authors did not address the anomaly in their results or discussion, and the review’s authors flag the finding as unexplained and possibly a reporting problem—a cautionary illustration of why methodological transparency matters in this field.

Indeed, measurement emerged as the review’s central technical concern. Mattering was most often assessed with the General Mattering Scale, used in ten studies, followed by Marshall’s Mattering to Others Questionnaire in five. But the provenance of the General Mattering Scale is surprisingly murky: its canonical source is an unpublished 1987 conference presentation by Rosenberg and Marcus that has proved difficult to locate, and several studies adapted the scale for their own purposes without reporting how items were changed or whether validity survived the modification. Similar problems afflicted mental health measures. One research team selected eight of twenty-seven items from the Child Depression Inventory without specifying which items were retained or dropped. Another used only three questions from the Mattering to Others Questionnaire plus a single item from a romantic-relationship subscale, offering no rationale for the deviation. Two studies relied on a single school-mattering item pulled from the CDC’s Youth Risk Behavior Surveillance System, whose psychometric properties for that purpose remain unevaluated.

Depression dominated the outcome landscape, appearing in ten studies, with self-esteem second at seven, followed by anxiety, wellness, life meaning, stress, and suicide ideation. Across the board, higher mattering was associated with reduced stress, anxiety, and suicidal thinking, and with greater wellness and sense of purpose. One study found that depression mediated some of the relationship between mattering and suicide ideation, hinting at a pathway by which feeling insignificant may translate into risk. Still, the review’s authors judged meta-analytic pooling inappropriate: the studies varied in design, relied on underpowered convenience samples of 69 to 1,794 participants without sample-size justification in most cases, modified validated instruments without revalidation, and rarely controlled for confounders. Fifteen of nineteen studies were rated high risk of bias on the NIH sample-size justification criterion alone.

The geographic and contextual reach of the evidence was equally narrow. Fifteen studies were conducted in the United States, three in Canada, and one in China, with sixteen of nineteen using cross-sectional designs and only three following participants over time. Data came overwhelmingly from schools, with a handful of online samples and one youth camp. Family, school, and general contexts received attention, but the settings where adolescents actually spend much of their lives—sports teams, extracurricular clubs, after-school programs—remain essentially unexplored, leaving influential adults such as coaches unstudied as sources of mattering.

The authors conclude that psychological mattering deserves recognition as a promising protective factor, with practical implications for mentorship programs, peer-support initiatives, and inclusive classroom practices that emphasize recognition and social validation. But the path forward, they argue, runs through better science: age-appropriate, psychometrically validated measures of mattering for adolescents; longitudinal and mixed-method designs capable of establishing causal pathways; attention to developmental phenomena like self-consciousness that may inflate or distort mattering reports; and samples diverse enough in culture, socioeconomic status, and gender to support broad generalization. Until that work is done, the safest summary of four decades of evidence is this—when adolescents believe someone would miss them, their minds appear measurably healthier for it, and helping more young people feel that way may be one of the most accessible mental health interventions available.

Subject of Research: Psychological Mattering and Well-being in Adolescents: A Systematic Review

Article Title: Psychological Mattering and Well-being in Adolescents: A Systematic Review

Article References: Williams, R. E., & Blanton, J. E. (2026). Psychological Mattering and Well-being in Adolescents: A Systematic Review. Journal of Child and Family Studies. https://doi.org/10.1007/s10826-026-03372-4

Image Credits: AI Generated

DOI: 10.1007/s10826-026-03372-4

Keywords: Psychological, Mattering, Well-being, Adolescents, Systematic, Review, scientific research

The review, conducted by Louis Bourgaux and André Tricot of Université de Montpellier Paul Valéry and Fred Paas of Erasmus University Rotterdam and the University of New South Wales, is one of the most comprehensive syntheses of worked-example research ever assembled. The team screened 2,644 unique records across peer-reviewed literature and grey literature, including a targeted search of dissertations and theses, and ultimately included 85 empirical reports: 82 peer-reviewed articles and 3 doctoral dissertations representing 127 distinct studies and experiments. That scale matters because transfer is a notoriously slippery outcome. Studies vary enormously in how far the “new” problem differs from the training example, in how transfer is measured, and in the populations tested. By cataloguing the evidence systematically, the authors were able to identify which design features of worked examples have been experimentally linked to improved transfer, and under what conditions those features succeed or fail.

The theoretical backbone of the review is the interplay between the architecture of human memory and the demands of novel problems. Cognitive load theory holds that working memory can juggle only a small number of interacting elements at once, so instruction for novices must manage that capacity carefully. Worked examples reduce extraneous load by eliminating blind search through the problem space, freeing cognitive resources to build schemas, the organized knowledge structures that allow experts to recognize problem types and select appropriate solution strategies almost automatically. Transfer, however, demands more than a single polished schema for one familiar problem format. It requires flexible schemas that capture the deep, relational structure of a problem class rather than its surface features. The central design question the review addresses is therefore how worked examples can be engineered so that learners extract those abstract structures instead of memorizing surface routines.

A key organizing move in the review is to sort the design strategies by the type of knowledge they target: factual, conceptual, procedural, and metacognitive. Each type supports transfer differently, and the evidence for each differs in strength and boundary conditions. Strategies aimed at conceptual knowledge, for example, include prompting learners to self-explain why each step works, embedding conceptually oriented explanations within the example, and presenting multiple representations of the same underlying principle. Self-explanation prompts are among the most robustly supported interventions in the entire example-based learning literature: asking students to articulate the principle behind a step forces deeper processing than passive reading, and meta-analytic work has repeatedly confirmed its benefits. The review shows that when such prompts are built into worked examples, learners are more likely to map the solution onto novel problems that share structure but not surface appearance.

Procedural knowledge, by contrast, is addressed through techniques that gradually hand responsibility back to the learner. Completion problems and faded examples, in which some steps of a solution are progressively blanked out until the learner solves entire problems independently, occupy a central place here. The logic is a controlled transition: early full guidance builds a schema, then fading demands retrieval and reconstruction, which strengthens the schema and makes it more accessible in unfamiliar situations. Subgoal labeling, the practice of marking the meaningful phases of a solution rather than presenting it as an undifferentiated stream of algebra, has produced some of the most striking transfer effects in the literature, particularly in statistics and programming. Studies by Richard Catrambone and colleagues demonstrated that learners who studied examples organized around labeled subgoals were substantially better at solving novel problems because they could reason about which subgoal applied rather than matching steps one to one.

The review also highlights strategies that exploit comparison and variability. Presenting multiple worked examples that share deep structure but differ in surface story encourages learners to abstract the common principle, a mechanism well documented in analogical learning research since the classic experiments of Mary Gick and Keith Holyoak. Comparing alternative solution methods for the same problem, a line of work developed by Bethany Rittle-Johnson and Jon Star, fosters procedural flexibility, so students can choose among strategies rather than executing a single memorized one. Meanwhile, varying the surface characteristics of practice examples protects learners from overfitting their knowledge to one context. Importantly, the review stresses boundary conditions: variability and comparison can impose heavy working-memory demands on novices, and the expertise reversal effect means that designs helping beginners can actually impede more advanced learners, who no longer need and may be actively distracted by the same scaffolds.

Erroneous examples, worked solutions containing deliberate mistakes that learners must find and fix, emerge as another promising family of designs. Studying an incorrect solution and diagnosing the error can sharpen conceptual understanding, expose common misconceptions, and train the metacognitive skill of monitoring one’s own work for flaws. Several included studies showed transfer gains when erroneous examples were paired with explanatory feedback or when learners compared correct and incorrect versions side by side. The authors note, however, that error-based designs must be handled carefully: poorly integrated errors can confuse low-prior-knowledge students or be mis-encoded, and the balance between the benefits of error analysis and the risk of encoding wrong procedures depends on learner expertise and the quality of accompanying support.

Metacognitive knowledge receives dedicated attention, reflecting a growing recognition that transfer ultimately depends on learners recognizing, on their own, when a known strategy applies to a new situation. Designs here include prompts that ask students to monitor their understanding, reflect on which principles the example illustrates, and plan how they would approach a related but different problem. The review’s synthesis suggests that worked examples alone tend to build competence within the trained format, but that transfer across formats is amplified when the examples explicitly invite learners to think about their own thinking, whether through embedded reflection questions, strategy comparisons, or faded sequences that require self-assessment before support is reintroduced. Collaboration adds another layer: several studies found that pairs discussing worked examples, particularly when knowledge is unevenly distributed between partners, elaborated more deeply and transferred more than individuals working alone.

For practitioners, the payoff of the review is a practical checklist for designing worked examples that promote transfer rather than mere step-following. The checklist distills the evidence into concrete design decisions: clarify which knowledge type the example should target; add subgoal labels to reveal solution structure; insert self-explanation prompts at meaningful points; use faded steps to taper guidance as competence grows; include varied surface features and, where expertise allows, comparison of multiple solutions; consider erroneous examples with adequate support; and calibrate all of this to the learner’s prior knowledge, reducing guidance as expertise develops. The authors emphasize that no single feature is a silver bullet; the strategies interact, and the appropriate combination shifts across the learning trajectory. Still, the checklist gives textbook authors, learning-platform developers, and classroom teachers an evidence-based starting point far more specific than the generic advice to “provide examples.”

The broader significance of the work lies in reframing the debate between guided and minimally guided instruction. Critics of worked examples have argued that heavily guided learning produces brittle knowledge that dies at the classroom door. The 127 studies synthesized here tell a more nuanced story: guidance is not the enemy of transfer, but poorly designed guidance is. When worked examples are engineered to highlight deep structure, demand active processing, and fade strategically, they can produce knowledge flexible enough to survive the trip into unfamiliar territory. In an era when adaptive tutoring systems and AI-assisted learning platforms must decide moment by moment how much help to give, an integrative map of when and how worked examples foster transfer is precisely the tool the field has lacked. The review, published as Volume 38, article 118 of Educational Psychology Review, consolidates that map and hands it to both researchers and practitioners.

Subject of Research: Worked Examples and Transfer: An Integrative Review, Design Framework, and Practitioner Checklist

Article Title: Worked Examples and Transfer: An Integrative Review, Design Framework, and Practitioner Checklist

Article References: Bourgaux, L., Tricot, A., & Paas, F. (2026). Worked Examples and Transfer: An Integrative Review, Design Framework, and Practitioner Checklist. Educational Psychology Review, 38(1), Article 118. https://doi.org/10.1007/s10648-026-10206-8

Image Credits: AI Generated

DOI: 10.1007/s10648-026-10206-8

Keywords: Worked, Examples, Transfer, Integrative, Review, Design, Framework, Practitioner, Checklist, scientific research

The study arrives at the intersection of two defining challenges of the twenty-first century: climate change and population ageing. Their convergence is particularly acute in China, which faces both a rapidly ageing population and an escalating frequency of devastating floods that cause annual economic losses exceeding ten billion US dollars. For older adults, floods carry risks well beyond immediate physical danger, including heightened rates of injuries, post-traumatic stress disorder, depression, and the exacerbation of diabetes and cardiovascular and respiratory conditions. These outcomes directly undermine healthy ageing, defined by the United Nations Decade of Healthy Ageing as the process of developing and maintaining the functional ability that enables well-being in older age.

To capture how nature-based solutions might counteract these harms, a research team led by Binhua Fu and Joseph Kimuli Balikuddembe of Sichuan University’s Institute for Disaster Management and Reconstruction conducted a scoping review following the Arksey and O’Malley framework and the PRISMA-ScR reporting guidelines. The team searched PubMed, Scopus, and Google Scholar for qualitative studies published between 2000 and early 2025, focusing on research that examined nature-based solutions for flood risk reduction—such as Sponge City infrastructure, green infrastructure, wetland restoration, and ecosystem-based adaptation—in settings across mainland China. Of 622 retrieved records, only 13 studies met the eligibility criteria, a finding that itself underscores how nascent and fragmented this evidence base remains.

The analytical machinery behind the review is worth noting for its technical sophistication. The researchers extracted data into six healthy ageing outcome domains aligned with the World Health Organization’s conceptual framework: physical activity and mobility, mental health, cognitive functioning, well-being and social support, environmental quality, and economic security. They then employed narrative synthesis alongside a Sankey diagram analysis, generated in R using the networkD3 package, to visualize weighted flows connecting geographical context, flood type, intervention type, and health co-benefit. This multi-level edge-list approach, in which each conceptual connection was weighted by its frequency across eligible studies, provided a quantitative representation of the dominant pathways within the qualitative literature.

Geographically, the evidence base spans at least nine provinces and provincial-level municipalities, with case studies concentrated in major urban centers such as Wuhan, Shanghai, and Guangzhou, and in designated pilot Sponge Cities including Guiyang and Ningbo. Temporally, the field is moving fast: ten of the thirteen included studies were published from 2020 onwards, coinciding with the scaling of China’s Sponge City Program amid mounting climate risks. Urban or pluvial flooding dominated the literature, addressed in ten of the thirteen studies, with fluvial, riverine, and general flooding covered by single investigations. Permeable pavements, rain gardens, bioswales, green roofs, and wetland restoration were consistently perceived as effective at reducing surface runoff and easing pressure on drainage networks.

The synthesis’s central revelation is the breadth of co-benefits these interventions deliver. The most prominently documented domain was psychosocial well-being and social support: aesthetically pleasing, accessible green spaces became hubs for conversation, leisure, and recreation, directly strengthening social and peer support networks and mitigating loneliness among older residents. Mental health benefits followed closely, with one study in Guangzhou linking the use of urban green infrastructure to measurable decreases in anxiety, dysphoria, and emotional exhaustion, and other studies reporting stress relief, relaxation, and high perceived aesthetic and health value. Physical activity and mobility improved as Sponge City features provided convenient, walkable spaces after rain, while urban parks encouraged walking and cycling.

Environmental improvements formed a cross-cutting co-benefit with direct implications for independent living. Studies reported enhanced air quality, noise mitigation, and cooling effects that reduce urban heat islands, creating safer and more comfortable outdoor environments for older adults. Cognitive functioning evidence was thinner but tantalizing: a single study associated urban green infrastructure use with memory enhancement, suggesting a possible pathway for NbS to support cognitive health in later life. Economic and community participation benefits emerged from multifunctional designs that integrated productive landscapes, including community engagement in risk-adaptive agriculture within flood detention zones and the use of green infrastructure spaces for vegetable and flower gardens—activities representing livelihood diversification, economic savings, and meaningful occupation for retired residents.

The review’s authors are equally candid about what the evidence lacks. Their analysis identified five principal gaps: an exclusively urban focus that neglects rural elderly populations; a methodological reliance on perceived rather than objectively or clinically measured benefits; a conceptual gap in which older adults appear only as incidental subsets of broader studies rather than central subjects of gerontological research; a thematic gap with cognitive function and nutrition severely underexplored; and an economic gap in the absence of quantified financial impacts on older persons. Sample sizes for older adult subgroups varied enormously, from as few as three retired persons to 95 participants aged 56 and above, and several key studies failed to report age-disaggregated data at all.

The policy implications are nonetheless substantial. The authors argue that the co-benefits provide a tangible pathway to operationalize China’s parallel national commitments to its “ecological civilization” vision and the Healthy China 2030 strategy, framing Sponge City rain gardens and urban wetlands not as drainage projects but as practical manifestations of a dual mandate: managing floodwater while creating the green, accessible environments that promote physical activity, mental restoration, and social connection. The economic case is compelling, the authors contend, because fostering environments that support activity, well-being, and cohesion can function as primary prevention, potentially reducing the incidence and severity of age-related chronic conditions and easing the mounting financial burden on China’s social and healthcare system—a perspective consistent with the One Health paradigm that treats investments in ecosystem health as direct investments in human health.

The rural blind spot carries particular equity weight. Rural communities in China are often on the front lines of riverine and pluvial flooding, yet they remain conspicuously absent from research on nature-based co-benefits, a disparity the authors warn risks exacerbating health inequalities among the elderly. They point to low-cost, replicable approaches such as flood-adaptive farming, grassland management, and riparian ecosystem restoration as candidates for scaling in rural settings, where older residents may be even more dependent on their immediate environment for both income and social connection.

The study’s limitations also shape its recommendations. The review was restricted to English-language publications, potentially excluding relevant Chinese-language studies, and, as is standard for scoping reviews, no formal critical appraisal of individual study quality was conducted. The predominance of qualitative and mixed-methods designs, while essential for understanding lived experiences and contextual factors, means the magnitude of health impacts remains unmeasured. The authors urge researchers to adopt longitudinal and mixed-methods designs employing validated health metrics, and call on policymakers and urban planners to intentionally design and evaluate nature-based solutions with geriatric outcomes as a primary objective, ensuring equitable distribution between urban and rural settings.

For a country that simultaneously confronts an “aging tsunami” and intensifying floods, the message of this review is that flood control and healthy ageing are not separate policy problems but two faces of the same infrastructure investment. If future research can move beyond perceived benefits to establish causal pathways and quantify costs, nature-based flood risk reduction may prove to be one of the most cost-effective preventive health strategies available to ageing societies in China and far beyond its borders.

Subject of Research: Beyond Flood Control: A Scoping Review Deciphering the Co-benefits of Nature-Based Flood Risk Reduction for Healthy Ageing in China

Article Title: Beyond Flood Control: A Scoping Review Deciphering the Co-benefits of Nature-Based Flood Risk Reduction for Healthy Ageing in China

Article References: Fu, B., Balikuddembe, J. K., Lu, Y., Yang, A., Di, B., Tian, B., & Reinhardt, J. D. (2026). Beyond Flood Control: A Scoping Review Deciphering the Co-benefits of Nature-Based Flood Risk Reduction for Healthy Ageing in China. International Journal of Disaster Risk Science. https://doi.org/10.1007/s13753-026-00741-x

Image Credits: AI Generated

DOI: 10.1007/s13753-026-00741-x

Keywords: Beyond, Flood, Control, Scoping, Review, Deciphering, Co-benefits, Nature-Based, Risk, Reduction, Healthy, Ageing

The core difficulty is deceptively simple to state and brutally hard to solve. Ceramic-metal composite components are indispensable across electronic packaging, thermal management, aerospace structures, micro-electromechanical systems sensors and photovoltaic modules, because they integrate the high-temperature resistance, corrosion resistance and mechanical strength of ceramics with the toughness, conductivity and machinability of metals. But their coefficients of thermal expansion differ dramatically. Heat a joined ceramic-metal part and the two sides expand at different rates, generating residual stresses during thermal cycling that crack the joint. On top of that, molten metals barely wet ceramic surfaces, inhibiting intimate contact and sufficient bonding, and uncontrolled interfacial reactions can spawn brittle intermetallic phases or oxide layers that act as built-in fracture sites. Conventional brazing and diffusion bonding struggle to fully tame these problems, frequently leaving behind pores, cracks and incomplete fusion that impair long-term reliability. The promise of energy-field-assisted joining is that precisely delivered external energy — light, current, sound, microwaves or magnetic force — can attack each failure mode at its physical root, either by localizing heat, activating the interface chemically, or mechanically disrupting the oxide films that block bonding, thereby reconciling the trade-off between joining efficiency and joint quality.

Laser-assisted joining emerges in the review as the most technologically mature of the single-field approaches, and the details are striking. Femtosecond and picosecond pulses deliver such intense, transient energy that they drive atomic-scale interdiffusion and the formation of entirely new phases at the interface. In one study cited by the authors, molecular dynamics simulation of femtosecond laser irradiation at an aluminum–fused silica interface showed local transient temperatures of roughly 10,000 K and pressures near 20 gigapascals, driving large numbers of aluminum atoms into the quartz matrix, expanding the mixing zone and forming atomic bonds. That degree of mixing was quantified directly: the intermixing length of aluminum and fused silica in the weld reached about 75 micrometers, while in quartz glass-aluminum welding with a pre-deposited chromium oxide film the fusion zone narrowed to just 3 micrometers, supported by key interface phases such as (Si, Al)2Cr. When femtosecond lasers created a mechanical pinning structure connecting Al6082 aluminum alloy to SiO2, the resulting hybrid of mechanical interlocking and chemical adhesion produced joints with shear strengths exceeding 100 megapascals. In MgAl2O4-to-Ti6Al4V bonding, the ultra-high peak power of the femtosecond laser promoted interfacial mixing and revealed a newly discovered Ti6O phase that directly improved joint integrity.

Yet the laser story is one of trade-offs as much as triumphs. The review documents how parameter tuning — laser power, scanning speed, defocus and pulse characteristics — sits on a knife’s edge: sufficient energy promotes the interfacial reaction, but excessively high power causes cracks or excessive spatter. In welding high-borosilicate glass to TC4 titanium alloy, a carefully chosen combination of 180 W power, 3 mm/s welding speed and zero defocus produced joints reaching 60.67 MPa thanks to the formation of Ti5Si3, which bound the interface well. Nanosecond lasers, meanwhile, trade the extreme peak intensities of ultrafast systems for gentler, diffusion-driven chemistry. A chromium interlayer introduced during nanosecond welding of silica glass to stainless steel boosted shear strength by more than 40 percent to 41.4 MPa, thanks to newly formed Fe-O-Si and Cr-Si bonds. The review also flags the persistent villain of silicon carbide-aluminum systems: brittle aluminum carbide, Al4C3, which seeds cracks but can be suppressed by high-power, high-speed parameters or by alloying additions of zirconium that convert the harmful phase into fine, benign carbides.

If lasers represent the high-energy extreme, electric-field-assisted joining occupies the opposite, elegant end of the spectrum. The technique descends from anodic bonding, in which a DC voltage of around 500 volts applied at moderate temperature drives sodium and potassium ions out of glass, leaving a charge-depleted zone that electrostatically presses the surfaces together and enables chemical bonding. Extending the principle to ceramics, the review shows that field-induced ion migration, polarization and electrostatic attraction can raise the shear strength of alumina-titanium diffusion joints by 50.2 percent compared with joints made without a field. Even more remarkable is flash joining, where an electric field above a critical threshold bonds ceramics to metals within seconds. In the Cu–5YSZ system, oxygen vacancies created by electrochemical reactions allow copper and zirconium atoms to interdiffuse, producing a sound joint at 753 °C in just three minutes. Crucially, the bonding is directional — it only works when the field points from ceramic to metal — and reversing the field can deliberately debond the joint, opening the door to reversible, on-demand assembly of zirconia-nickel superalloy structures completed in a single second at 800 °C.

Ultrasonic energy fields attack the wettability problem with pure mechanics. High-frequency vibration first fractures the oxide layer through micro-cracking, then grinds and expels the fragments outward in a self-cleaning process that eliminates the need for any surface pretreatment. Studies cited in the review show that removing a 50-nanometer oxide film can raise aluminum-glass joint strength by two to three times. Once clean atomic contact is established, ultrasonic energy drives element diffusion and genuine chemical bonding — Auger electron spectroscopy confirmed that a mere 1.5 seconds of excitation forms Al-O bonds at an aluminum-alumina interface, and in highly compatible aluminum-glass systems the room-temperature bond completes in just 0.4 seconds. Ultrasonic-assisted brazing adds acoustic cavitation in the molten filler, whose micro-jets break oxides on both base metal and solder, dramatically accelerating wetting. In electromagnetic ultrasonic brazing, capillary filling of Al-12Si solder reached an impressive 12.21 millimeters, while tin-zinc solder on silicon carbide — normally a wettability nightmare — achieved spreading radii of 12.4 to 14.1 millimeters under the combined action of Lorentz forces and acoustic streaming.

Microwave and magnetic fields bring their own distinctive physics to the table. Microwaves heat volumetrically from within rather than conducting heat inward from the surface, allowing ceramics to reach joining temperatures within minutes at power levels as low as 100 watts, and enabling selective heating and microstructural control. In microwave hybrid joining with nickel-coated tin solder paste, joint shear strength climbed to 43.11 MPa — a 45.49 percent improvement over conventional reflow soldering — by exploiting interface polarization to redistribute electromagnetic energy precisely where it is needed. Magnetic fields, acting through Lorentz forces on molten metal, suppress the keyhole instabilities and porosity that plague laser welding: a modest 15-millitesla field concentrated energy at the pool bottom, reduced plasma plume intensity and evened out the temperature gradient during cooling. Pulsed magnetic fields even strengthen solid joints directly — a magnetoplastic effect in alumina-aluminum composites raised tensile strength by 20.7 percent to 532 MPa through dislocation accumulation triggered by electron spin-state transitions.

Perhaps the most forward-looking section of the review concerns hybrid fields, where two or more energy sources are coupled to cover each other’s weaknesses. The ultrasonic-electric combination is the most mature: Joule heating and plasma discharge lower the cavitation threshold of the ultrasound while ultrasonic vibration homogenizes the current distribution. When Sn-0.7Cu solder was clad onto ADC12 aluminum alloy under coupled fields, a single second of treatment produced a 98.72 percent cladding rate and 16.57 MPa shear strength — gains of 43.11 percent and 279.17 percent over ultrasonic processing alone. Laser-magnetic coupling tames the melt pool during precision welding, while magneto-ultrasonic brazing pushes capillary filling to record lengths through alternating Lorentz forces and acoustic pressure. The authors are candid that many of these synergies remain incompletely understood at the quantitative level, and they call for high-fidelity multiphysics simulation frameworks validated by in situ techniques such as synchrotron diffraction and high-speed imaging.

Looking ahead, the Harbin team sketches a roadmap that reads like a blueprint for the next decade of smart manufacturing: data-driven optimization of interlayer and filler design using machine learning, adaptive closed-loop control of multi-field parameters, modular and affordable equipment, and functionalized interfaces engineered for self-healing, enhanced conductivity or corrosion resistance. The applications stretch from third-generation semiconductor packaging — where pulsed laser welding already achieves leak rates as low as 5.2 × 10⁻¹⁰ Pa·m³/s with 278 MPa shear strength — to diamond saw blades with 1200 MPa tooth strength, fusion reactor divertor components requiring copper-tungsten gradient joints, and biomedical implants built from piezoelectric ceramic-titanium scaffolds. Tool manufacturing and electronic packaging, the review notes, are already benefiting from laser-assisted processes that minimize heat-affected zones while promoting atomic diffusion and phase formation. What was once a catalogue of disconnected laboratory tricks is now, thanks to this synthesis, a coherent engineering discipline with identifiable mechanisms, quantified performance benchmarks and a clear trajectory toward reliable ceramic-metal components in the most demanding environments humans can construct.

The review, published open access as volume 1, article 14 of Advanced Materials Joining, ultimately delivers more than a summary of techniques. By establishing a comprehensive framework linking bonding mechanisms, process optimization strategies, filler and interlayer designs, and engineering applications across diverse material systems, it highlights how energy-field-assisted technologies effectively mitigate residual stresses, improve wettability and suppress detrimental interfacial reactions. For engineers selecting among laser, electric, ultrasonic, microwave, magnetic or hybrid approaches, the message is that the choice of energy field should be dictated by the dominant failure mode of the joint — thermal mismatch, poor wetting, or brittle phase formation — and that combining fields, rather than intensifying a single one, is increasingly the path to joints that survive thermal cycling, corrosion and mechanical shock in aerospace, electronics and energy systems.

Subject of Research: Energy field-assisted technology for ceramic/metal joining: a review

Article Title: Energy field-assisted technology for ceramic/metal joining: a review

Article References: Fu, M., Lin, P., Fu, W., Li, Y., Dong, G., Liu, H., Zhao, Y., Yang, B., He, P., & Lin, T. (2026). Energy field-assisted technology for ceramic/metal joining: a review. Advanced Materials Joining, 1(1), Article 14. https://doi.org/10.1007/s44500-026-00014-z

Image Credits: AI Generated

DOI: 10.1007/s44500-026-00014-z

Keywords: Energy, field-assisted, technology, ceramic, metal, joining, review, scientific research

The dominance of China, with 85 publications, and Italy, with 25, reflects complementary strengths rather than simple redundancy. Chinese groups have historically driven much of the fundamental materials chemistry of layered hydroxides, including refinements in co-precipitation, hydrothermal, and reconstruction methods that control layer charge density, interlayer spacing, and particle size, all of which govern how much antibiotic can be hosted and how quickly it escapes. Italian contributions, by contrast, have been closely associated with the biomedical translation of anionic clays, particularly in antitumoral and anti-inflammatory delivery, and that translational orientation naturally extends to antimicrobial applications where controlled release can reduce dosing frequency and limit the emergence of resistance at infection sites. The concentration of output in journals such as Applied Clay Science, the International Journal of Nanomedicine, and the International Journal of Biological Macromolecules illustrates the interdisciplinary position of the field: it sits at the intersection of clay mineralogy, nanomedicine, and macromolecular therapeutics, and authors must choose venues according to whether the novelty lies in the material synthesis or in the biological outcome.

The keyword co-occurrence findings, in which LDH, sustained release, and drug delivery emerge as central nodes, confirm that the community defines itself around the release kinetics problem rather than around any single antibiotic class. This is consistent with the underlying chemistry. The general formula of these materials, in which divalent and trivalent metal cations form positively charged hydroxide sheets balanced by interlayer anions and water, allows antibiotics bearing carboxylate, phosphate, or other anionic groups to be intercalated electrostatically. Once intercalated, release is governed by a combination of anion exchange with physiological counter-ions, partial dissolution of the layers, and diffusion through the particle periphery. Because the layers dissolve more readily in acidic media, the resulting carriers exhibit pronounced pH sensitivity, a property that is valuable at infected sites and in intracellular compartments such as phagolysosomes, where pH falls below that of blood and can be used to trigger preferential drug liberation. This same alkaline degradation behavior in gastric media, noted in the source literature, is a double-edged characteristic: it complicates oral delivery of acid-labile payloads yet can be exploited for gastric-responsive formulations.

The comparative framing against other carrier families provides useful context for interpreting why LDHs attract sustained attention despite their younger bibliography. Polyvinyl alcohol hydrogels are appreciated for biocompatibility and water processing but suffer from mechanical weakness and excessive hydrophilicity that accelerate burst release. Metal-organic frameworks offer exceptional internal surface area and tunable pore chemistry, yet concerns over long-term structural stability in aqueous biological environments, biodegradation products, and scalable cost remain active research questions. Mesoporous silica materials are the most clinically mature of the three comparators, but their typical pore dimensions constrain the size of molecules that can be loaded efficiently, and pore architecture influences release in ways that are difficult to tune independently. LDHs occupy a distinctive niche among these alternatives because their loading capacity is not limited by rigid pore windows; instead, the interlayer gallery can expand to accommodate bulky anionic species, and the layer charge can be adjusted through the divalent to trivalent cation ratio, giving formulators a direct handle on loading density and exchange kinetics. Their documented high anion exchange capacity, colloidal stability, and low toxicity in the reviewed literature further support this positioning.

The bibliometric emphasis on citation trends and thematic evolution also illuminates how the field has responded to the clinical backdrop of antimicrobial resistance. The 2022 GLASS report cited in the source article documents high resistance rates among common bacterial pathogens, and the parallel slowdown in the discovery of genuinely new antibiotic scaffolds has shifted attention toward maximizing the performance of existing drugs. Sustained-release delivery is one of the few strategies that improves the pharmacodynamic profile of an established antibiotic without requiring new chemistry at the molecular level. By flattening the sharp plasma spikes and troughs characteristic of immediate-release formulations, steady delivery maintains concentrations within the therapeutic window for longer periods, reduces the frequency of subinhibitory exposure that selects for resistant subpopulations, and improves patient adherence through fewer doses. In this sense, the bibliometric growth of LDH antibiotic delivery research can be read as a materials-science response to a pharmacological and epidemiological problem.

The methodological apparatus of the review itself deserves comment, because bibliometric analysis is increasingly used to map emerging biomedical materials fields and its limitations should be understood when interpreting the results. Restricting the corpus to English-language publications indexed in SCI-Expanded and ESCI introduces a selection bias toward established journals and anglophone or internationally publishing groups, which may undercount contributions from regions with strong domestic journals. The exclusion terms applied to remove degradation and adsorption studies, while scientifically justified, may also have removed hybrid papers that examined both adsorption and release. Nevertheless, the use of two complementary tools, VOSviewer for network visualization and the Bibliometrix package in R for descriptive and thematic statistics, strengthens the reliability of the mapping, since agreement between independent platforms on core findings such as country productivity and keyword clusters reduces the likelihood of software-specific artifacts. The reporting of total link strength as a measure of interaction intensity between nodes follows standard practice in science-mapping studies and allows readers to gauge not just the presence of a collaboration or co-occurrence but its relative weight within the network.

The identification of prominent authors, highly cited works, and funding sources within the 217-document corpus serves a practical function for newcomers to the field. Highly cited papers typically cluster around foundational demonstrations of antibiotic intercalation and release profiling, and tracing the citation flow from these works toward more recent publications reveals a thematic migration: early studies emphasized proof of concept for loading and release, while later work increasingly incorporates biological evaluation, including minimum inhibitory concentration assays, biofilm models, and cytocompatibility testing. The three-field plot analysis, which links countries, institutions, and keywords, exposes where interdisciplinary gaps persist, and the review’s framing of these gaps as opportunities for collaboration is consistent with the observation that no single discipline currently owns the problem. Materials chemists can optimize synthesis and interlayer architecture, microbiologists can define clinically relevant resistance and biofilm challenges, pharmacologists can model release and dosing, and toxicologists can establish biocompatibility thresholds, yet the bibliometric evidence suggests these communities have not fully converged.

The connection drawn between LDH drug delivery research and the Sustainable Development Goals reflects a broader trend in which bibliometric studies situate technical fields within global health priorities. Antimicrobial resistance is explicitly recognized in international frameworks as a threat to sustainable development, and delivery technologies that extend the useful life of existing antibiotics contribute to that agenda without demanding new molecular discovery. The emphasis on relevance to Sustainable Development Goals in the keyword and funding analysis indicates that funding agencies and journals increasingly reward work framed in these terms, which may in turn shape the direction of future publications toward applications with clear health-system relevance, such as wound dressings, implant coatings, and oral formulations for persistent infections.

Looking forward, the bibliometric evidence points toward several strategic directions that follow logically from the identified themes. First, the prominence of sustained release as a keyword suggests that quantitative release modeling, rather than qualitative demonstration, will be the differentiating contribution in coming years, since regulatory translation requires reproducible kinetics under physiologically relevant conditions. Second, the presence of gene therapy, biosensing, and ocular applications in the broader LDH literature signals that antimicrobial researchers may borrow formulation strategies from these adjacent domains, for example exploiting the positive surface charge that prolongs corneal residence to design mucoadhesive antimicrobial films. Third, the geographic concentration of output in two countries implies substantial untapped collaborative capacity, particularly in regions with high antimicrobial resistance burden but lower publication visibility in the indexed corpus, and international partnerships could align material development with the clinical epidemiology of resistance. Finally, the absence of prior bibliometric treatment of this field, which the review establishes as its central novelty, means that the 2025 dataset will serve as a baseline against which future updates can measure whether the field grows in volume, diversifies in geography, or shifts thematically from synthesis-oriented to clinically validated studies, and such longitudinal comparison is precisely the kind of insight that systematic bibliometric monitoring is designed to provide.

Subject of Research: Layered double hydroxides in sustained antibiotic delivery: a bibliometric review

Article Title: Layered double hydroxides in sustained antibiotic delivery: a bibliometric review

Article References: Verma, S. S., Varadavenkatesan, T., Selvaraj, R., & Vinayagam, R. (2026). Layered double hydroxides in sustained antibiotic delivery: a bibliometric review. Journal of Saudi Chemical Society, 30(5), Article 65. https://doi.org/10.1007/s44442-026-00120-7

Image Credits: AI Generated

DOI: 10.1007/s44442-026-00120-7

Keywords: Layered, double, hydroxides, sustained, antibiotic, delivery, bibliometric, review, scientific research