Search Results (361)

Background: Cataracts are a major cause of reversible visual impairment worldwide, particularly among older adults. Visual deterioration associated with cataracts may compromise spatial perception, postural control, and balance, thereby increasing the risk of falls. In this context, cataract surgery has emerged not only as an effective intervention for visual rehabilitation but also as a potential strategy to improve mobility and functional performance in aging populations. Objective: The objective of this study was to systematically evaluate the impact of cataract surgery on postural control, balance, and fall risk in adults and older individuals by comparing preoperative and postoperative outcomes. Methods: A systematic review was conducted following a protocol registered in PROSPERO. Searches were initially conducted in PubMed, Web of Science, Cochrane Library, and Scopus on 20 October 2025, and rerun on 10 March 2026, which was considered the final search date. Twelve studies were included, encompassing prospective cohorts, retrospective population-based analyses, and comparative studies. The certainty of evidence was assessed using the GRADE framework, and the methodological quality of individual studies was evaluated using JBI critical checklists. Results: The included studies generally reported improvements in visual function following cataract surgery, while several studies also reported favorable changes in postural stability, functional balance, and fall-related outcomes. However, findings varied according to study design, outcome definition, surgical timing, and follow-up period. Some studies reported more favorable fall-related and postural outcomes after second-eye surgery; however, the observational nature of the evidence and heterogeneity across studies preclude determining whether bilateral surgery itself caused these improvements. Conclusions: Cataract surgery appears to be associated with improved visual and postural function and, in several studies, with reduced fall incidence, particularly after bilateral correction. However, due to substantial heterogeneity, the predominance of observational evidence, and discordant findings on severe injurious outcomes, the certainty of this effect remains limited. The procedure should be regarded as a component of visual rehabilitation that may coincide with reduced fall risk in selected contexts, rather than a universal prevention strategy. Further prospective studies with standardized outcomes are needed to clarify the relationship between cataract surgery, visual function, postural control, and fall-related outcomes. Full article

The equitable allocation of mental health rehabilitation support spaces provides an important foundation for community living and social participation among persons with mental disabilities. Existing accessibility studies tend to focus on a single facility type or travel mode, with limited consideration of the relationships among rehabilitation needs, travel conditions, and spatial opportunities. Using the central urban area of Tianjin as a case study, we aggregated records of persons with mental disabilities at the residential community level and classified rehabilitation support spaces into four types: professional rehabilitation spaces, natural restorative spaces, social interaction spaces, and occupational participation spaces. The Gaussian-enhanced two-step floating catchment area (Gaussian E2SFCA) method was used to estimate accessibility by space type and comprehensive accessibility under public transport, walking, and car passenger travel scenarios. Moran’s I, bivariate LISA, Lorenz curves, the Gini coefficient, and screening for communities with high needs and low accessibility were combined to assess spatial clustering, overall distribution, and needs-based spatial equity. The results show that travel modes substantially reshape the spatial distribution of rehabilitation support opportunities. Public transport accessibility was higher in central areas and lower on the periphery, whereas high walking accessibility was confined to scattered patches around facilities. Car passenger travel reduced spatial disparities but access remained constrained by family caregiving capacity and financial resources. Sensitivity to travel constraints varied across space types, with the largest gaps in access observed for occupational participation and professional rehabilitation spaces, indicating that comprehensive accessibility cannot replace assessment by space type. Screening at the residential community level identified multiple units with high needs and low accessibility, revealing that overall equity assessments can obscure local mismatches between supply and demand. These findings indicate that transport improvements can reduce distance-related barriers but do not automatically achieve needs-based equity. The study provides spatial evidence to inform the allocation of mental health rehabilitation resources, the identification of priority areas, and the development of compensatory transport support policies. Full article

To address ecological degradation in estuarine coastal wetlands caused by the combined pressures of land–sea interactions and anthropogenic activities, we developed an improved Coastal Wetland Ecological Status Index (CWESI). Using Landsat time-series observations from 1994 to 2024, together with the coefficient of variation (CV), Theil–Sen slope estimator, Mann–Kendall significance test, and Hurst exponent, we quantified the spatiotemporal dynamics and persistence characteristics of ecological quality in the Liaohe Estuary coastal wetland. Furthermore, an optimal parameter-based geographical detector (OPGD) model was employed to investigate the relative contributions and interactive effects of natural and anthropogenic factors on ecological quality heterogeneity. The results revealed the following: (1) Ecological quality exhibited an overall fluctuating improvement trend during 1994–2024, with the mean CWESI value increasing from 0.45 to 0.52. Spatially, ecological quality displayed a decreasing gradient from inland areas towards coastal zones, with high-quality ecological patches primarily concentrated in reed wetlands and core conservation areas. (2) During the study period, the area of low-quality ecological spaces decreased by 75.23 km², whereas areas classified as Moderate or higher expanded by 74.96 km². Approximately 78.66% of the study area exhibited stable or improving ecological conditions, while only 5.23% experienced ecological degradation. (3) Driver analysis indicated that fractional vegetation cover and net primary productivity were the dominant natural factors influencing ecological quality. Their interactions with soil moisture and climatic variables exhibited significant bivariate enhancement effects. These results show that wetland ecological quality is regulated by the synergistic interactions among multiple environmental factors. Long-term ecological restoration measures, including aquaculture withdrawal and wetland rehabilitation as well as ecological water replenishment projects, acted as critical anthropogenic drivers promoting sustained ecological improvement. The proposed CWESI framework provides a robust methodological basis for dynamic monitoring, conservation planning, and adaptive ecological management of coastal wetlands facing similar environmental pressures. Full article

Rapid urbanization has intensified the urban heat island (UHI) effect in Southeast Asian megacities, necessitating effective nature-based solutions. This study evaluates the cooling capacity of diverse green spaces in Khung Bang Kachao (KBK), Thailand, by integrating Google Earth Engine (GEE), field vegetation inventories, and temperature monitoring across 20 plots representing three types: rehabilitation forest, agroforestry, and urban areas. Results demonstrate that mean LST varied significantly across green space types: rehabilitation forests achieved the lowest mean LST (33.86 °C), followed by agroforestry (35.19 °C) and urban areas (40.77 °C). Structural parameters (tree density, crown cover, height, species composition, and NDVI) correlated negatively with LST, with NDVI exhibiting the strongest correlation (r = −0.74). Multivariable modeling revealed NDVI as the sole significant predictor of LST reduction at 10 m and 30 m resolutions, highlighting NDVI as a stronger driver of LST reduction than other structural parameters. In temporal analysis (2020–2024), rehabilitation forest cover contracted sharply from 31.94% to 12.02% due to agricultural conversion, corresponding to lower NDVI and higher LST, potentially exacerbating the localized UHI effect. Furthermore, a weak correlation between LST and air temperature underscores the influence of built environment heat factors. The final model included only Month and Light Intensity. While NDVI indicates LST, satellite-derived LST alone cannot reflect air temperature, requiring both environmental and physical factors in urban heat management. Full article

Hemispheric strokes impair motor control in contralateral body parts, necessitating effective rehabilitation strategies. Motor imagery-based brain–computer interfaces (MI-BCIs) promote neuroplasticity, aiding the recovery of motor functions. While deep learning has shown promise in decoding MI actions for stroke rehabilitation, existing studies largely focus on bilateral MI actions and are limited to offline evaluations. Decoding directional information from unilateral MI, however, offers a more natural control interface with greater degrees of freedom but remains challenging due to spatially overlapping neural activity. This work proposes a novel deep learning framework for online decoding of binary directional MI signals from the dominant hand of 20 healthy subjects. The proposed method employs EEGNet-based convolutional filters to extract temporal and spatial features. The EEGNet model is enhanced by squeeze-and-excitation (SE) layers that rank the electrode importance and feature maps. A subject-independent model is initially trained using calibration data from multiple subjects and fine-tuned for subject-specific adaptation. The performance of the proposed method is evaluated using subject-specific online session data. The proposed method achieved an average right vs. left binary direction-decoding accuracy of $58.7\pm 8\%$ for unilateral MI tasks, outperforming the existing deep learning models. Additionally, the SE-layer ranking offers insights into electrode contribution, enabling potential subject-specific BCI optimization. The findings highlight the efficacy of the proposed method in advancing MI-BCI applications for a more natural and effective control of BCI systems. Full article

Current Spanish road specifications, in accordance with circular economy strategies, allow reclaimed asphalt pavement (RAP) to be used in hot-mix asphalt production. RAP is produced by milling asphalt layers during pavement rehabilitation activities. The percentage of permitted RAP depends on the pavement layer and expected traffic conditions. However, current regulations do not authorize its use in the base or sub-base layers of flexible pavements with unbound materials or in semi-rigid pavements, such as soil–cement or gravel–cement layers. This research evaluates the influence of replacing natural aggregates with RAP obtained from a BBTM surface mixture (gap-graded asphalt mixture) in the manufacture of soil–cement for semi-rigid pavements. This study focuses on the effects of RAP incorporation on the maximum dry density and optimum moisture content determined through the modified Proctor test, as well as on the unconfined compressive strength (UCS). Four mixtures were analyzed: a reference mixture containing only natural aggregates and three additional mixtures in which 25%, 50%, and 75% of the aggregate was substituted with BBTM-RAP. In total, 3.5% of cement was used in each mixture. Modified Proctor and 7-day UCS tests were subsequently performed to assess the mechanical behavior of the mixtures. The results showed that increasing the RAP content reduced the maximum dry density while increasing the water demand required for compaction. Higher RAP percentages also led to lower compressive strength values. Nevertheless, the average unconfined compressive strength (UCS) at 7 days for all mixture formulations exceeded 2.5 MPa. These findings support the ongoing investigation into the potential application of BBTM-RAP as a more sustainable alternative material for semi-rigid pavement base layers. Full article

Background: Despite the increasing use of vibration therapy (VT) in neurorehabilitation, its efficacy on post-stroke gait recovery remains controversial due to substantial heterogeneity in study protocols and outcome assessments. Previous systematic reviews have often aggregated disparate gait metrics and stroke stages, potentially obscuring domain-specific therapeutic effects and limiting clinical applicability. Furthermore, the specific influence of vibration parameters, such as frequency and amplitude, on gait outcomes has not been sufficiently quantified. Objective: This protocol outlines a systematic review and meta-regression analysis designed to rigorously evaluate the clinical efficacy of VT on the multidimensional recovery of gait function in stroke survivors. Unlike prior reviews, this study aims to decipher the heterogeneity of treatment effects by analyzing outcome variations based on specific gait domains and exploring associations between individual vibration parameters and treatment effect estimates. Methods: In adherence to PRISMA-P guidelines, a comprehensive search will be conducted across PubMed, Embase, Cochrane Library, Web of Science, and Scopus for randomized and non-randomized controlled trials involving adult stroke survivors. Interventions will include whole-body vibration (WBV) and focal muscle vibration (FMV) compared to sham or standard care. To address the multidimensional nature of gait, outcomes will be strictly categorized into four domains: (1) gait speed, (2) gait endurance, (3) functional mobility, and (4) spatiotemporal parameters. Methodological quality will be assessed using the Cochrane Risk of Bias 2 (RoB 2) and Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) tools. Data synthesis will utilize random-effects models, and prespecified meta-regression analyses will be employed to investigate the influence of key moderators, including vibration frequency, amplitude, and session duration. Discussion: This review aims to move beyond simple efficacy verification by exploring potential moderators of treatment effects and generating hypotheses regarding vibration parameters that may be associated with more favorable gait outcomes. By providing granular evidence across distinct gait domains and analyzing parameter-specific effects, this study is expected to resolve existing conflicting evidence and offer precise guidance for the clinical application of VT in post-stroke gait rehabilitation. Full article

Pectin, a natural biopolymer, is a cost-effective, biocompatible, non-toxic, abundant, and flexible material, making it suitable for recording high-quality bioelectric signals from the dynamic surface of the human body. In this work, pectin-based flexible bioelectrodes were developed for the non-invasive monitoring of biopotentials. The bioelectrodes are composed of pectin, polyaniline emeraldine salt (PANI-ES), glycerol, and polydimethylsiloxane (PDMS) and therefore abbreviated as PPGP. The PPGP electrodes demonstrated a bulk electrical conductivity of (7.54 ± 0.81) × 10⁻³ S/cm, a very low impedance of 34 Ω, and a high charge storage capacity of 4.63 ± 2.70 mC/cm². The surface morphology of the PPGP electrode plays a crucial role in enhancing biopotential signal detection by improving adhesion to skin contours. PPGP electrodes have been successfully used for high-fidelity electromyographic (EMG) bioelectric signal measurements. The developed PPGP bioelectrodes have the potential to advance next-generation human–machine interface (HMI) technologies and wearable healthcare systems, including prosthetic control, rehabilitation monitoring, and assistive communication devices. Full article

The leaching behavior of bisphenol A (BPA) remains a significant environmental concern. Despite EU regulatory restrictions and the World Health Organization (WHO) establishing precautionary values for human exposure to this monomer, BPA is still widely used in polymer-based products, including materials for sewer rehabilitation. Standard leaching assessments typically employ deionized water, although natural waters represent actual field conditions. This study investigates the release of BPA and its substitute, bisphenol F (BPF), from an epoxy resin system and a vinyl ester resin system. Sample discs (0.5 cm in height and 11 cm in diameter) were subjected to dynamic surface leaching tests using groundwater and tap water as leaching media. Eluate replacement intervals followed the standardized Dynamic Surface Leaching Test (DSLT; EN 16637-2), marking the first application of natural waters within this standardized test procedure. The detection limit for the gas chromatography analyses was 0.001 µg/L. Compared with the deionized water prescribed by the standard, natural waters resulted in significantly higher cumulative releases of BPA and BPF, with cumulative BPA release increasing by factors of 5.2–9.2 to a maximum of 0.412 mg/m². These findings indicate that the standardized 64-day DSLT may underestimate environmentally relevant emissions and that permissible cumulative release values, derived from modeling and regulatory thresholds, may not be maintained under environmentally relevant conditions. GC–MS screening and the Umu test showed no evidence of genotoxic effects in the leachates. Exploratory analysis suggested a positive relationship between BPA release and pH (R² = 0.79). Overall, the results demonstrate that the choice of leaching medium strongly influences measured emissions and should therefore be reconsidered in assessment frameworks for polymer-based construction materials to better reflect environmentally relevant conditions. Full article

Desertification represents a critical environmental challenge in arid and semi-arid regions, driven by the combined impacts of climate change and unsustainable land-use practices. This review provides a comparative assessment of desertification dynamics, mitigation strategies, and ecological restoration approaches in the Ningxia Hui Autonomous Region (China) and Egypt. Both regions are characterized by severe water scarcity, increasing climatic variability, and fragile ecosystems; however, they differ in ecological conditions, institutional frameworks, and dominant land degradation processes. The study synthesizes major drivers of desertification, including rising temperatures, precipitation variability, recurrent droughts, soil salinization, overgrazing, wind erosion, and unsustainable agricultural expansion. It further evaluates key control measures implemented in both regions, such as afforestation and ecological engineering, sand dune stabilization, water-efficient irrigation systems, soil rehabilitation practices, and the integration of remote sensing and GIS-based monitoring technologies. The analysis highlights China’s large-scale, long-term ecological restoration programs, which have significantly improved vegetation cover and reduced land degradation, compared to Egypt’s emphasis on irrigation efficiency, land reclamation, and salinity management under extreme aridity constraints. Importantly, the comparison underscores institutional differences, with China’s state-led ecological engineering contrasting against Egypt’s multi-actor reclamation initiatives, offering novel insights into governance pathways for combating desertification. The comparative synthesis demonstrates that effective desertification control requires integrated strategies combining ecological restoration, sustainable water resource management, technological innovation, and strong policy support. Despite contextual differences, both regions offer complementary lessons for dryland management. The study emphasizes the potential for enhanced China–Egypt cooperation in climate-smart agriculture, digital environmental monitoring, and nature-based solutions, thereby advancing sustainable land restoration and contributing to global efforts toward land degradation neutrality under future climate change scenarios. Full article

Purpose: Upper extremity motor impairments following stroke substantially limit independence in daily living. Hand-tracking virtual reality (VR) rehabilitation systems may support intensive task-oriented practice while enhancing motivation; however, evidence integrating objective kinematic indicators with usability and patient-reported outcomes for controller-free consumer-grade VR remains limited. The primary aim of this single-arm pilot study was to evaluate the feasibility, safety (tolerability), and usability of a hand-tracking VR rehabilitation system delivered as an adjunct to conventional physiotherapy in individuals with stroke; describing its preliminary in-game kinematic profile and exploring participants’ experiences through open-ended feedback were secondary aims. The study was explicitly not designed or powered to test clinical efficacy. Materials and Methods: Ten individuals with stroke completed a 20-session (8-week) single-arm pilot intervention; all participants concurrently received standard hospital-based physiotherapy (median 3 sessions/week, ∼45 min/session). Early-phase (sessions 1–5) and late-phase (sessions 16–20) within-subject performance were compared using the Wilcoxon signed-rank test with Holm–Bonferroni correction across four pre-specified primary outcomes. Movement smoothness was assessed using the Spectral Arc Length (SPARC), usability was evaluated using the System Usability Scale (SUS), and cybersickness was monitored with the Simulator Sickness Questionnaire (SSQ). Results: Sixteen patients were screened, of whom fourteen started the intervention and ten completed the 8-week per-protocol program (intervention completion rate, 10/14 = 71.4%; per-protocol session adherence among the ten completers, 200/200 = 100%; no SSQ-defined adverse events). Within-subject comparisons showed a $+10.6$-point increase in success rate (adjusted $p=0.020$), a $+0.10$ m/s increase in mean movement speed (adjusted $p=0.020$), a $-341$ ms reduction in pause duration (adjusted $p=0.022$), and a $+27.0$-point Hodges–Lehmann median-difference increase in SS-QOL (95% CI $14.0$–$41.0$; participant-level median $\mathsf{\Delta }$$+18.5$; adjusted $p=0.020$). The mean SUS score was $78.5\pm 5.4$, indicating “good” usability. Thematic analysis of post-intervention open-ended feedback identified three themes—motivation and engagement, the value of feedback, and design and comfort suggestions—that converged with the high adherence and good usability ratings. Correlations between VR-derived kinematic change and clinical change were non-significant trends ($p\ge 0.12$). Conclusions: A controller-free hand-tracking VR system was found to be feasible, well tolerated, and rated as having good usability when delivered as an adjunct to conventional therapy. Because the study used a single-arm design, included only ten participants, and did not control for the confounding effect of concurrent conventional physiotherapy or natural recovery, the observed within-subject changes cannot be causally attributed to the VR intervention and should be interpreted as exploratory feasibility signals. Adequately powered randomized controlled trials with stroke-specific clinical scales (e.g., FMA-UE, ARAT) are required before clinical efficacy can be claimed. Full article

In recent years, the potential of exoskeletons to enhance human capabilities has attracted significant research interest. Nevertheless, the control of Rehabilitation Lower-Limb Exoskeletons (RLLEs) is challenging because of their strong nonlinear behaviour. In the paper, a Grey Fuzzy Sliding-Mode (GFSM) controller, which is designed based on the optimization accuracy and estimation capability of the fuzzy logic system, was used for trajectory tracking of a RLLE’s joints. This paper presents the tuning of the controller parameters optimally using Grey Wolf Optimization (GWO) integrated with an Interval Type-2 Fuzzy Logic System (IT2FLS) in real-time. The GFSM was selected as the controller law, in which initially, GWO was used to tune the parameters based on the estimated RLLE’s mathematical model. The optimal tuned parameters were employed to determine the defuzzification range of the fuzzy logic system. IT2FLS was provided to tune the real-time controller parameters. The performance of the GFSM was validated by human-RLLE experiments which showed superior performance compared to other conventional controllers. The experimental results show that the controller achieved reductions in the average error of 81.8%, 82.9%, 84.1%, and 80.6%, respectively, compared with conventional adaptive control methods. These findings indicate that the GFSM can be used to improve motor function recovery in individuals with hemiplegia. By integrating biomechanically inspired motion assistance with IT2FLS, our proposed GFSM controller contributes to the development of biomimetic rehabilitation exoskeletons capable of reproducing natural human gait. Full article

Ecological restoration of abandoned mountainous mines remains challenging because of complex geological conditions, severe substrate degradation, and long-term environmental impacts. Conventional restoration strategies primarily emphasize vegetation establishment and slope stabilization, while the potential contribution of carbon sequestration is often insufficiently considered. Enhanced Rock Weathering (ERW) has recently emerged as a promising negative-emission technology that accelerates the natural weathering of silicate minerals to remove atmospheric CO₂ while improving soil quality. This paper synthesizes current knowledge on ERW and proposes a conceptual framework for integrating this technology into the ecological restoration of abandoned mountainous mines. The framework comprises four complementary dimensions: (1) Physical Restoration, utilizing fragmented rock materials to improve slope stability and substrate structure; (2) Acid–Base Neutralization, exploiting alkaline silicate minerals to alleviate acid mine drainage (AMD) and regulate geochemical conditions; (3) Pedogenic Optimization, promoting soil formation, improving soil physicochemical properties, and facilitating CO₂ infiltration and mineral carbonation; and (4) Biological Synergy, enhancing plant–microbe–mineral interactions to accelerate weathering processes and support long-term ecosystem development. Drawing on existing evidence, we discuss how the use of on-site waste rock as reactive substrates may simultaneously reduce restoration-related carbon emissions, provide essential mineral nutrients (e.g., Ca, Mg, and K), and enhance carbon sequestration potential. Overall, this synthesis suggests that integrating ERW into abandoned mine restoration has the potential to simultaneously advance ecological rehabilitation and climate-change mitigation. The proposed framework provides a theoretical basis for future experimental validation, field-scale implementation, and the development of low-carbon strategies for sustainable mine restoration. Full article

Hearing-functioning problems contribute substantially to disability and rehabilitation needs globally; however, evidence describing the range and interconnected nature of these problems across African populations remains fragmented. This study aimed to describe hearing-functioning problems associated with high-burden adult health conditions across African populations using data from the Rehab4All database. A secondary exploratory analysis was conducted using data extracted from a large Africa-wide scoping review of functioning problems associated with conditions contributing substantially to years lived with disability (YLD). The parent review systematically searched PubMed, Scopus, Web of Science, EBSCOhost, and SABINET and included English-language studies conducted in African adults. Hearing-functioning problems were classified according to the International Classification of Functioning, Disability and Health (ICF). Descriptive analyses, visual mapping techniques, and exploratory random-effects prevalence meta-analyses were performed. Ninety-seven articles published between 2007 and 2022 were included. Most studies originated from Southern Africa, particularly South Africa. Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), tuberculosis (TB), diabetes mellitus (DM), hearing-loss cohorts, and headache-related conditions contributed most frequently to reported hearing-functioning problems. Hearing loss, tinnitus, and vestibular dysfunction were the most commonly reported problems; however, multidimensional co-occurring auditory and vestibular profiles were frequently identified. Distinct functional patterns emerged across conditions, with TB demonstrating predominantly auditory dysfunction, while HIV/AIDS and DM demonstrated broader auditory–vestibular involvement. Hearing-functioning problems within the African evidence base appear multidimensional, interconnected, and unevenly distributed geographically. Full article

Background/Objectives: Young adults living with advanced cancer often experience substantial psychological and existential health challenges, while frequently being underserved by existing rehabilitative and palliative services. This mixed-methods study evaluated the effects and experiences of a nature-based intervention designed to ease the burden of distress and support coping in the context of an incurable illness. Methods: Four consecutive intervention groups participated in a six-week program consisting of one overnight nature camp and three outdoor sessions. Quantitative data on quality of life (FACT-G) were collected before and after each intervention cycle. At the session level, pre–post measures assessed distress, vitality, resilience, and perceived connectedness. Qualitative data consisted of post-intervention semi-structured group interviews. Results: Twenty-four participants completed the intervention. No significant change was observed in overall quality of life which is in line with expectations for palliative interventions for individuals with incurable illness. In contrast, session-level analyses showed consistent reductions in distress and increases in vitality, resilience, and connectedness across multiple domains. The qualitative findings indicated that the intervention provided a supportive context for emotional regulation, coping, social belonging and existential orientation. Conclusions: Together, the findings support that nature-based rehabilitative palliation may offer meaningful support for young adults living with advanced cancer. The study underscores the importance of multi-level mixed-methods evaluation for capturing the value of palliative interventions where temporality and situational benefit constitute central outcomes. Full article