Search Results (210)

Background: Virtual reality (VR), often used with motion sensors, provides interactive tools for physiotherapy aimed at enhancing motor functions. This systematic review examined the effects of VR-based interventions, alone or combined with conventional physiotherapy (PT), on balance and gait in individuals with Parkinson’s disease (PD). Methods: Following PRISMA guidelines, eight randomized controlled trials (RCTs) published between January 2019 and April 2025 were included. Interventions lasted between 5 and 12 weeks and were grouped as VR alone or VR combined with PT. Methodological quality was assessed using the PEDro Scale. Results: Of the 31 comparisons for balance and gait, 30 were favored by the experimental group, with 12 reaching statistical significance. Secondary outcomes (function, cognition, and quality of life) showed mixed results, with 6 comparisons favoring the experimental group (3 statistically significant) and 4 favoring the control group (1 statistically significant). Overall, the studies showed fair to good quality and a moderate risk of bias. Conclusions: VR-based interventions, particularly when combined with PT, show promise for improving balance and gait in PD. However, the evidence is limited by the small number of studies, heterogeneity of protocols, and methodological constraints. More rigorous, long-term trials are needed to clarify their therapeutic potential. Full article

Palliative care aims to alleviate suffering and prioritize the quality of life of patients facing serious and fatal diseases, such as cancer. Cancer patients, especially in advanced stages, often have many difficult-to-control symptoms, such as pain, fatigue, dyspnea, anxiety, and depression, requiring the attention of a multidisciplinary team highly trained in palliative care and end-of-life management. Pain, dyspnea, nausea, and vomiting are the focus of symptomatic assessment in palliative care, but patients experience other equally important symptoms that do not receive as much attention and are often overlooked, which negatively impacts the quality of life of these patients. One of the main aims of palliative care is to provide patients with the best possible quality of life through adequate symptom control, teamwork, and psychosocial support based on the principles, values, and wishes of the patient and family. In this review, the authors summarize the management of common symptoms in patients in oncology and palliative care, as well as present a brief reflection on quality of life in this context. Full article

The emission and presence of volatile organic compounds (VOCs) in the indoor air of houses and factories has been a growing topic of debate in the industry and related research fields. Given the extended times people in modern society spend indoors, monitoring VOCs is crucial due to the associated potential health hazards, with formaldehyde being particularly noteworthy. Wood and wood-based panels (WBPs) (the latter constituting a significant segment of the wood-transforming industry, being widely used in furniture, construction, and other applications) are known sources for the emission of VOCs to indoor air. In the case of the WBPs, the emission of VOCs depends on the type and species of wood, together with industrial processing and addition of additives. This review integrates perspectives on the production processes associated with WBPs, together with the evolving global regulations, and thoroughly examines VOC sources associated with WBPs, health risks from exposure, and current analytical methods utilized for VOC detection. It comprises an overview of the WBP industry, providing relevant definitions, descriptions of manufacturing processes and adhesive use, analysis of legal constraints, and explanations of VOC source identification and describing analysis techniques utilized for VOCs in WBPs. Full article

Background/Objectives: Knee osteoarthritis is one of the most significant diseases globally and in Portugal. Despite the availability of international guidelines, there is a lack of tailored, evidence-based recommendations specifically for Portuguese physiotherapists to manage their knee osteoarthritis patients with non-pharmacological and non-surgical interventions. This study aimed to develop a clinical practice guideline that integrates the latest international evidence with local clinical practice data to enhance patient outcomes. Methods: To achieve the objective, a comprehensive search was conducted in November 2024 across major health-related databases, to identify robust and recent evidence regarding the efficacy of non-pharmacological and non-surgical interventions, as well as their usage in the national context. Two key sources were identified: An umbrella and a mixed-methods study. Data from both sources were independently reviewed and integrated through a comparative analysis to identify interventions with robust scientific support and high local acceptability. Recommendations were then formulated and categorized into gold (strong), silver (moderate), and bronze (weak) levels based on evidence quality and clinical relevance. A decision-making flowchart was developed to support guideline implementation and clinical usage. Results: The integrated analysis identified three gold-level interventions, namely Nutrition/Weight Loss, Resistance Exercise, and Self-care/Education. Five silver-level recommendations were Aerobic Exercise, Balneology/Spa, Extracorporeal Shockwave Therapy, Electrical Stimulation, and Manual Therapy. Similarly, five bronze-level recommendations comprised Kinesio Taping, Stretching, Ultrasound Therapy, Thermal Agents, and Walking Aids. Conclusions: This clinical practice guideline provides a context-specific, evidence-based framework for Portuguese physiotherapists managing knee osteoarthritis. By bridging international evidence with local clinical practice, the guideline aims to facilitate optimal patient care and inform future research and guideline updates. Full article

The singular biodiversity of the Brazilian Caatinga inspires innovative solutions in food science. In this study, we evaluated the prebiotic potential of honeys produced by Apis mellifera in the Pajeú hinterland, Pernambuco, Brazil (Caatinga Biome), with different floral origins: Mastic (Aroeira), Mesquite (Algaroba), and mixed flowers. These were used to formulate synbiotic and alcoholic beverages fermented by Saccharomyces boulardii CNCM I-745. Static and dynamic simulations of the human gastrointestinal tract (GIT) were used, as well as physicochemical, rheological, and microbiological analyses. The results revealed that honey positively influences the viability and resilience of probiotic yeast, especially honey with a predominance of Algaroba, which promoted the highest survival rate (>89%) even after 28 days of refrigeration and in dynamic in vitro simulation of the GIT (more realistic to human physio-anatomical conditions). The phenolic composition of the honeys showed a correlation with this tolerance. The use of complementary methodologies, such as flow cytometry, validated the findings and highlighted the functional value of these natural matrices, revealing an even greater longevity potential compared to conventional microbiological methodology. The data reinforces the potential of the Caatinga as a source of bioactive and sustainable compounds, proposing honey as a promising non-dairy synbiotic vehicle. This work contributes to the appreciation of the biome and the development of functional food products with a positive social, economic, and ecological impact. Full article

Technological advancement has radically transformed higher education, requiring faculty members to continually adapt to new tools and teaching methods. In this context, the phenomenon of fear of missing out (FoMO) has gained relevance, often manifesting through a range of negative emotional states, including technostress—stress associated with the use of technology. Objectives: This study aimed to map the available scientific evidence on technostress among nursing faculty in higher education, through a scoping review conducted according to the methodology proposed by the Joanna Briggs Institute (JBI). Methods: The literature search was performed across eight databases, including Medline (via PubMed), CINAHL Complete, Scopus, and the Teacher Reference Center. Results: Of the 266 studies identified, only 3 met the inclusion criteria. Conclusions: Findings reveal varying levels of technostress among nursing educators, with higher levels observed among older faculty members, frequently associated with limited technical and administrative support. Although the direct impact on job satisfaction was not significant, the anxiety induced by intensive technology use and the perceived necessity for constant professional updating—often driven by FoMO—was shown to affect daily academic life, highlighting the need for effective coping strategies. Understanding technostress within the context of nursing education is essential for addressing the challenges of pedagogical modernization. This review supports the need for future institutional interventions aimed at preventing technostress and fostering a more balanced, reflective, and sustainable relationship with technology in academic settings. Full article

Nearshore bathymetry is key to most oceanographic studies and coastal engineering works. This work proposes a new methodology to assess nearshore wave celerity and infer bathymetry from video images. Shoaling and breaking wave patterns were detected on the Timestacks distinctly, and wave celerity was estimated from wave trajectories. The wave type separation enabled the implementation of specific domain formulations for depth inversion: linear for shoaling and non-linear for breaking waves. The technique was validated over a rocky bottom using video acquisition of an online streaming webcam for a period of two days, with significant wave heights varying between 1.7 m and 3.5 m. The results were corroborated in comparison to ground-truth data available up to a depth of 10 m, yielding a mean bias of 0.05 m and a mean root mean square error (RMSE) of 0.43 m. In particular, RMSE was lower than 15% in the outer surf zone, where breaking processes occur. Overall, the depth-normalized RMSE was always lower than 20%, with the major inaccuracy due to some local depressions, which were not resolved. The developed technique can be readily applied to images collected by coastal monitoring stations worldwide and is applicable to drone video acquisitions. Full article

Background: As e-commerce expands and delivery services diversifies, understanding the factors that shape consumer preferences becomes critical to designing efficient and sustainable urban logistics. This study examines how perceived walkability influences consumers’ preferences for shopping channels (in-store or online) and delivery methods (home delivery versus pickup points). Method: The analysis is based on structural equation modeling and utilizes survey data collected from 444 residents of Belo Horizonte, Brazil. Results: The findings emphasize the importance of walkability in supporting weekday store visits, encouraging pickup for online purchases and fostering complementarity between different modes of purchase and delivery services. Perceived walkability positively affects the preference to buy in physical stores and increases the likelihood of using pickup points. Educated men, particularly those living in walkable areas, are the most likely to adopt pickup services. In contrast, affluent individuals and women are less likely to forgo home delivery in favor of pickup points. Conclusions: The results highlight the role of perceived walkability in encouraging in-person pickup as a sustainable alternative to home delivery, providing practical guidance for retailers, urban planners, and logistics firms seeking to align consumer convenience with sustainable delivery strategies. Full article

Background/Objectives: This study aimed to explore the functional implications of occlusal changes during clear aligner treatment (CAT) to (a) analyze occlusal changes throughout CAT and the extent of post-treatment occlusal recovery; (b) assess the relationship between post-treatment occlusion and masticatory performance; (c) investigate whether case complexity, facial biotype, and type of malocclusion influence occlusal adaptation and functional outcomes; and (d) evaluate the presence and progression of signs or symptoms of TMDs in patients undergoing CAT. Methods: This longitudinal cohort pilot study included 42 individuals who underwent CAT. Occlusion was evaluated at three timepoints: before treatment (T0), at treatment completion (T1), and three months after with night-only aligner use (T2). Masticatory performance was assessed using a two-colored chewing gum test analyzed through colorimetric software. TMD signs/symptoms were assessed using the Diagnostic Criteria for TMD [DC/TMD]. Statistical analysis used non-parametric tests. Results: A significant decrease in occlusal contact area was observed during active CAT [p = 0.016], which partially recovered at follow-up. Individuals with normal facial proportions (normodivergent) showed more anterior contacts at T1 compared to hyperdivergent individuals [p = 0.013]. Masticatory performance remained stable between T1 and T2 [p = 0.528]. A weak negative correlation was found between posterior contact number and performance score at T1 [r = −0.378, p < 0.05], suggesting that more contacts may be linked to better chewing. No TMD signs or symptoms were detected at any timepoint. Conclusions: Although CAT temporarily reduces occlusal contact area, it does not negatively impact chewing efficiency or trigger TMD symptoms. These findings support the functional safety of CAT when treatment is properly planned and monitored. Full article

Background/Objectives: Immune checkpoint inhibitors (ICIs) have revolutionized advanced melanoma treatment, yet many patients fail to achieve sustained clinical benefit. Several biomarkers, including tumor microenvironment (TME) signature, PD-1/PD-L1 expression, and IFN-γ signaling, have been proposed. However, robust predictive markers remain elusive. This study aimed to identify molecular markers of response by analyzing tumor and peripheral immune signatures. Methods: This study analyzed 21 advanced melanoma patients treated with ICIs. Formalin-fixed, paraffin-embedded tumors underwent RNA-sequencing targeting 1392 immuno-oncology probes. Genes significantly associated with progression-free survival (PFS) by log-rank test underwent hierarchical clustering analysis (HCA). Differential expression and xCell analyses were then performed on the resulting clusters. Cox multivariate analysis was applied to identify independent PFS predictors. Pre-treatment peripheral blood mononuclear cells were analyzed by mass cytometry, followed by FlowSOM and UMAP clustering. Results: Fifty-five genes significantly associated with PFS identified two molecular clusters via HCA. Cluster A demonstrated prolonged PFS (59.4 vs. 2.4 months, p = 0.0004), while Cluster B was characterized by downregulated IFN-γ signaling, antigen presentation pathways, and reduced immune score. Multivariate Cox analysis confirmed molecular cluster as an independent PFS predictor (p < 0.001). Mass cytometry revealed higher frequencies of circulating PD-1+ CD4+ effector memory (EM) T subpopulations among responders. Conclusions: This study highlights the potential role of molecular and immune profiling in predicting ICI response in advanced melanoma. The identification of distinct molecular clusters underscores significant TME heterogeneity, with immune-cold tumor clusters associated with poorer outcomes. Furthermore, circulating PD-1+ T subpopulations emerged as potential markers of ICI response, suggesting their value in improving patient stratification. Full article

The adoption of healthcare technologies has grown significantly, with real-time location systems (RTLSs) gaining particular attention. Despite decades of research, gaps persist in understanding the current state of the field and its future directions. This scoping review, conducted by PRISMA guidelines, identified 1718 articles retrieved from six databases, from which 83 were included. The findings reveal a dominance of U.S.-based case studies and a lack of systematic literature reviews. While RFID is the most commonly used technology, alternative solutions are emerging, though few studies explore their combined use. The emergency department is the most studied setting, focusing on patient flow. However, case study quality varies, which affects replicability, and literature reviews often fail to justify technological choices adequately. RTLS benefits include improved efficiency, enhanced patient safety, and cost reduction, but challenges such as precision issues and signal interference persist. RTLS also serves as a foundation for digital twins, integrating AI and Industry 4.0 technologies for more sustainable healthcare operations. Technological advancements may shift perceptions of RTLS challenges and benefits, highlighting the need for analysis by technology type and release date. Additionally, current MeSH terms fail to adequately cover healthcare technologies, resulting in the exclusion of relevant studies. Full article

CO₂ emissions, a significant contributor to climate change, have spurred the exploration of sustainable solutions. One putative solution involves using recycled aggregates (RAs) from construction and demolition waste (CDW) to substitute natural sand in construction materials. This not only extends the life cycle of the waste but also reduces the use of natural resources. The potential to capture CO₂ in RAs presents a promising route to mitigate the environmental impact of the construction industry and contribute to its much anticipated decarbonization. This research takes a unique approach by investigating the incorporation of an amine-based additive—specifically 2-amino-2-methyl-1,3-propanediol (AMPD)—to enhance CO₂ capture into a real-case RA from recycling plants, transforming CDW with low carbon-capture potential into a highly reactive CO₂ capture material. Through TG analysis, FTIR-ATR and the combination of both (TG-FTIR), we were able to validate the use of RA materials as a support medium and quantify the CO₂ capture potential (12%) of the AMPD amine; a dual valorization was achieved: new value was added to low-quality CDW and we enhanced CO₂ sequestration, offering hope for a more sustainable future. Full article

We investigate the convergence properties of policy iteration and value iteration algorithms in reinforcement learning by leveraging fixed-point theory, with a focus on mappings that exhibit weak contractive behavior. Unlike traditional studies that rely on strong contraction properties, such as those defined by the Banach contraction principle, we consider a more general class of mappings that includes weak contractions. Employing Zamfirscu’s fixed-point theorem, we establish sufficient conditions for norm convergence in infinite-dimensional policy spaces under broad assumptions. Our approach extends the applicability of these algorithms to feedback control problems in reinforcement learning, where standard contraction conditions may not hold. Through illustrative examples, we demonstrate that this framework encompasses a wider range of operators, offering new insights into the robustness and flexibility of iterative methods in dynamic programming. Full article

Urban regeneration projects have been part of urban planning in different cities to recover strategic areas and combat new land consumption. Often, Public-Private Partnerships (PPPs) agreements are signed to meet the demands of these projects. In the Brazilian context, the general PPP law classifies concessions into two types: sponsored concessions or administrative concessions. Urban regeneration projects in the Brazilian context can be carried out through different policies and instruments, such as those in the City Statute. Despite this, there are several obstacles in how these practices are developed, which require greater attention to the enabling environment and the Critical Success Factors (CSFs) that can improve the performance of these public procurement practices. Based on this, this study aims to analyze the Brazilian context of PPP arrangements in urban regeneration projects and the specific case of the “Porto Maravilha” in Rio de Janeiro. To this scope, the study adopts a previously established CSF framework. The data analyzed are derived from secondary sources obtained through documentation collection and primary sources obtained through interviews. Regarding the PPP process, the results indicate financial and execution problems. Concerning the project, which remains unfinished, the results point to a transformation of the port area, but with significant social impacts. Full article

This study presents a remote sensing (RS) approach for monitoring invasive aquatic species and assessing their impact on water quality in the Lis Valley Irrigation District (LVID), Portugal. Using high-resolution PlanetScope imagery (3.7 m resolution), this method overcomes spatial limitations in narrow irrigation canals. Representative sub-zones were selected to analyze spatial and temporal trends, and vegetation indices (Normalized Difference Vegetation Index—NDVI, Enhanced Vegetation Index—EVI, Green Chlorophyll Index—GCI) were calculated to map the spread of Eichhornia crassipes (water hyacinth—WH) and Myriophyllum aquaticum (parrot’s feather—PF). All three vegetation indices exhibited significant linear regressions with pH, with the EVI showing the highest coefficient of determination (R² = 0.761), followed by the NDVI (R² = 0.726) and GCI (R² = 0.663), with p-values and ANOVA p-values below 0.05. Dissolved Oxygen (DO) also showed strong correlations, particularly with the GCI (R² = 0.886 for both DO concentration and saturation). The NDVI and EVI demonstrated significant regressions for these parameters, with R² values between 0.661 and 0.862. The results demonstrate the potential of RS to detect invasive species and assess their ecological impact, providing a cost-effective tool for management strategies in irrigation systems. Future research should integrate more field data and extend the study period to enhance classification accuracy. Full article