Search Results (1,718)

Background: Riedel’s thyroiditis is a rare fibrosing thyroid disorder that remains one of the most difficult to diagnose, often being initially interpreted as malignant due to its clinical, radiological, and histopathological similarities with anaplastic carcinoma or other infiltrative thyroid diseases. Preoperative investigations, including fine-needle aspiration cytology (FNAC), may be misleading and contribute to an erroneous diagnosis of cancer. Methods: We report the case of a 44-year-old woman presenting with a rapidly enlarging, hard goiter associated with compressive symptoms and cytological findings suspicious for papillary thyroid carcinoma (Bethesda V). Based on these findings and the multidisciplinary team’s assessment, surgical intervention was undertaken. Intraoperatively, the thyroid gland was densely fibrotic and adherent to adjacent structures, prompting frozen-section analysis that revealed a benign fibroinflammatory process consistent with Riedel’s thyroiditis. This intraoperative finding guided the surgical team toward a near-total thyroidectomy, preventing unnecessary radical excision. Results: The paraffin-embedded section confirmed the diagnosis. Postoperative recovery was favorable, with complete resolution of compressive symptoms. Conclusions: This case highlights the persistent diagnostic challenges of Riedel’s thyroiditis and illustrates how intraoperative frozen-section examination can contribute to differentiating it from malignancy when preoperative findings remain inconclusive. A multidisciplinary approach and surgical expertise are essential in tailoring the extent of resection, preventing complications, and achieving both diagnostic confirmation and symptom relief. Full article

Background: Joubert syndrome (JS) is a rare ciliopathy characterized by cerebellar and brainstem malformations and the molar tooth sign on magnetic resonance imaging. Motor impairment is primarily driven by axial hypotonia, impaired postural control, and disrupted respiratory-postural integration. Longitudinal reports describing structured neurorehabilitation with standardized functional outcomes remain limited. Case presentation: We report a female child with prenatally suspected vermian hypoplasia and postnatally MRI-confirmed Joubert syndrome. Subsequent molecular testing performed at the age of 3 years and 11 months identified heterozygous variants in the B9D2 gene associated with Joubert syndrome. Early development was marked by axial hypotonia, global motor delay, impaired trunk stabilization, sleep-disordered breathing, and early hip migration. At 2.5 years of age, following motor plateau under conventional therapy, a structured 12-month rehabilitation programme was introduced, combining Vojta-based reflex locomotion, respiratory therapy targeting thoraco-diaphragmatic synchronization, daily home-based practice, and supported standing. Results: After 12 months, gross motor function improved substantially, with GMFM-88 increasing from 12% to 52% (+40 percentage points). PEDI scaled scores improved across all domains, with mobility increasing from 8 to 40, self-care from 15 to 45, and social function from 25 to 50. Ataxia severity decreased from 22 to 15 on the modified Brief Ataxia Rating Scale, consistent with improved trunk stability and coordination. Postural and respiratory organization improved, reflected by a reduction in the subcostal angle from 137° to 90°, an increase in sacral slope from 5° to 10°, and increased expiratory pressure from 10 to 25 mmHg. Caregiver-reported assessment combined with structured clinical observation indicated improved functional visual performance, including enhanced visual attention, visuomotor coordination, and environmental visual interaction. Conclusions: Structured neurorehabilitation was associated with substantial functional improvement across motor, postural, and respiratory domains. These findings support the clinical relevance of mechanism-oriented neurorehabilitation and standardized longitudinal outcome assessment in Joubert syndrome. Full article

Background: Mild traumatic brain injury (mTBI) is frequently associated with persistent cognitive and psychosocial symptoms, yet biological correlates of recovery remain poorly understood, particularly among Asian and Pacific Islander (API) populations. Pre-injury psychosocial adversity may further shape post-injury recovery trajectories. This pilot study examined associations between participation in a 2-week, home-based, dual-task cognitive–walking intervention (Daily Brain Exercise; DBE) and changes in cognitive, psychological, and salivary microRNA (miRNAs) measures among APIs with and without a self-reported history of mTBI. Methods: API participants completed remote cognitive testing (CNS Vital Signs), psychosocial assessments (Neuro-QoL), and saliva collection before and after DBE participation. Salivary RNA was purified, and miRNA expression was profiled using nCounter^® Human v3 miRNA Expression Panels (NanoString). Differential expression analyses were conducted using ROSALIND^® platform (OnRamp Bioinformatics, San Diego, CA, USA), a cloud-based bioinformatics analysis system, to calculate fold changes and p-values. Pre-injury psychosocial adversity was assessed via the Trauma History Screen and examined descriptively as a contextual modifier of functional outcomes. Results: Twenty-one APIs (mean age 22.9 years; 76.7% female) were enrolled, including 14 individuals with a self-reported history of mTBI (mean 4.64 years post-injury; 50% with multiple injuries). Following DBE participation, increases in cognitive flexibility and executive function scores were observed in both mTBI and control groups. Additional increases in psychomotor speed, processing speed, sleep disturbance, and depressive symptoms were observed descriptively within the mTBI group. Subgroup analyses suggested variability in pre–post patterns across combinations of mTBI history and pre-injury psychosocial adversity. Exploratory miRNA analyses identified seven miRNAs that were differentially expressed in the mTBI group following DBE (unadjusted p < 0.005), including hsa-miR-7-5p, previously reported in association with neurodevelopmental and neurological pathways. Conclusions: In this pilot, feasibility-focused study, participation in a brief, home-based, dual-task intervention was associated with descriptive changes in selected cognitive and psychosocial measures among APIs, particularly those with a history of mTBI and pre-injury adversity. The observed subgroup patterns warrant confirmation in adequately powered, controlled studies. Exploratory changes in salivary miRNAs co-occurred with functional improvements, thus generating a hypothesis for a future investigation. Full article

Large language models (LLMs) and diffusion-based image generators can rapidly produce architectural ideas and imagery, yet translating conceptual narratives into massing composition is often implicit and difficult to reproduce. In this paper, we present a knowledge-augmented two-stage workflow for architectural concept-to-massing generation and evaluation. The outputs are represented as axonometric massing proxy images, which serve as 2D visual proxies for early-stage massing refinement rather than editable 3D models. The workflow integrates a prototype library and Knowledge Graph (KG) routing to map narrative cues into executable strategy and operation tokens and compile stage-specific prompts. Stage 1 produces structural concept sketches emphasizing legible composition, while Stage 2 generates axonometric massing proxy images conditioned on Stage 1 sketches to stabilize composition across candidates. Under a fixed sampling budget, candidates are ranked using a rubric-based scoring protocol with Top-K selection, and evaluation signals can be written back to update prompt compilation iteratively. Across diverse project briefs, ablation studies demonstrate that knowledge augmentation improves constraint compliance and composition readability while maintaining controlled diversity for early exploration. We report expert ratings together with paired statistical tests to support reproducible comparisons. Full article

Lesser hedgehog tenrecs (Echinops telfairi) are small, nocturnal insectivores from Madagascar that exhibit hibernation and brief torpor bouts. While multiple studies have investigated torpor physiology, no studies have focused on torpor in tenrecs maintained under human care or their recommended husbandry. We surveyed 96 institutions (71.9% response rate) housing 172 tenrecs to assess husbandry, torpor, handling, and associated weight changes. Most institutions reported that torpor occurred annually, typically between October and April, and lasted approximately 5–6 months. Weight distributions differed significantly pre- versus post-torpor, with females and males losing 34.4 g and 20.9 g on average, respectively. Females were heavier than males before and after torpor, the first report of a sex-based weight difference in this species. Most institutions used tenrecs as ambassador animals, and approximately half continued educational programming during torpor. Tenrecs handled more frequently during torpor tended to gain more weight, likely due to increased energy expenditure and compensatory feeding. Tenrecs entered torpor regardless of daylight, temperature, or humidity, with no significant husbandry differences between torpor- and non-torpor-reporting institutions. Torpor is a critical physiological adaptation supporting energy conservation and species survival. Its expression should be supported through appropriate environmental conditions, diet, minimal disturbance, and monitoring. Full article

The role of body position during sleep, particularly the supine position, is now recognized as an important factor in the development of sleep-disordered breathing such as snoring, apnea, and hypopnea. This pilot study aimed to evaluate the efficacy of a new wearable vibrotactile device (SoftSleep) in reducing sleep time in the supine position without negatively affecting total sleep duration or perceived sleep quality. This pilot study included 20 healthy volunteers. Sleep was monitored over two consecutive nights: the first night without positional therapy (PT) and the second night using a PT device. The primary outcome measures were total sleep time, sleep duration in the supine position, number of position changes, and subjective sleep quality (using the modified Pittsburgh Sleep Quality Index). Use of SoftSleep showed a significant reduction in the mean proportion of sleep in the supine position from 56.01% to 7.84% (p < 0.001). Total sleep time did not change significantly (7:39 ± 1:33 vs. 7:42 ± 1:19; p > 0.05). A moderate increase in the number of position changes was not accompanied by a deterioration in subjective sleep quality: 90% of participants rated their sleep with the device as very good or fairly good. Only three participants reported brief awakenings, which did not affect their overall perception of nighttime rest. These results indicate that the SoftSleep device effectively promotes sleep in a non-supine position without altering sleep quality or subjective perception of sleep. The high tolerability of the device confirms its potential for further clinical evaluation in patients with positional sleep apnea. Full article

Sudden disruptions can destabilize everyday routines and open the door to pro-environmental behavioral change. This paper examines whether exogenous Moments of Change (MoC) with different temporal profiles—an acute nationwide power outage in Spain and the prolonged COVID-19 disruption—reshape employees’ workplace pro-environmental behavior (PEB) by weakening the relationship between habits and PEB. Study 1 surveyed 226 Spanish office workers 38 days after a brief blackout, while Study 2 followed 135 employees in Spain and the Netherlands longitudinally across the COVID-19 period. We found that, while reported PEB increased after both disruptions, the short-term blackout was insufficient to weaken the relationship between habits and behavior significantly, or to strengthen individual and organizational drivers of behavior. In contrast, the more prolonged COVID-19 disruption significantly weakened the influence of habits on PEB and strengthened the relationship between perceived corporate environmental responsibility and behavior. These findings suggest that the duration of a disruption is a critical factor. Specifically, brief shocks may elicit specific new behaviors; only prolonged disruptions appear sufficient to break established habits and enhance the influence of organizational factors on employees’ pro-environmental actions. Full article

Background/Objectives: Sport-related concussion (SRC) elicits multi-systemic symptoms, including nausea, fatigue, and cognitive changes. Gastrointestinal (GI) symptoms are not well captured in current concussion assessments and may be under-recognised in clinical follow-up. GI disturbances may influence intake tolerance and day-to-day fuelling during post-SRC recovery. This study investigated the prevalence and severity of self-reported GI symptoms in Irish athletes after their most recent SRC, examined sex-based patterns, and evaluated the rationale for integrating GI symptom checks into standard concussion tools (e.g., SCAT6) and post-injury monitoring. Methods: An online survey was completed by recreational, competitive, and elite athletes who retrospectively self-reported concussion history, GI symptoms, and bowel function post-SRC and at the time of survey completion (ToSC; 0.03–216 months post-injury). The survey used the Bristol Stool Chart, Rivermead Post-Concussion Symptoms Questionnaire, and validated GI symptom measures. Descriptive statistics and chi-square tests examined timepoint- and sex-based differences. Results: A total of 106 athletes participated (55.7% female; mean age 26.4 ± 7.7 years), of whom 90.6% reported ≥1 GI symptom post-SRC, with greater severity observed for appetite loss, bloating, and abdominal discomfort. Bowel habits shifted bidirectionally for 42.5%, and 26.4% were experiencing ongoing symptoms at ToSC. Conclusions: Self-reported GI symptoms were common and appear under-recognised post-SRC. These findings support greater attention to GI symptom assessment and suggest that brief GI checks and facilitated access to nutrition advice where symptoms persist may be feasible within multidisciplinary, athlete-centred care. Prospective studies are needed to determine clinical relevance and to evaluate nutrition-related strategies. Full article

Point-of-care ultrasound (POCUS) is portable and radiation-free, but its clinical reliability is constrained by operator-dependent image acquisition and the limited scalability of expert quality assurance (QA) review. As handheld devices proliferate faster than mentorship capacity, trainees increasingly rely on heterogeneous free open access medical education (FOAMed) resources that rarely provide real-time psychomotor feedback. We conducted a structured narrative review (MEDLINE, Embase, Scopus, and Web of Science; last searched on 23 February 2026), with searches performed by H.H. and independently checked by J.J.P. (both POCUS-trained clinicians). After screening, 31 studies were included. We synthesized evidence on artificial intelligence (AI) systems that support bedside image acquisition and automate QA. The primary synthesis centered on key prospective or comparative clinical evaluations of AI-guided acquisition across echocardiography, focused assessment with sonography in trauma, abdominal aortic aneurysm screening, and lung ultrasound, complemented by peer-reviewed studies of FOAMed appraisal tools and online resource quality. These evaluations suggest that real-time probe guidance, view recognition, anatomy labeling, and automated capture may enable novices, after brief training, to acquire diagnostically adequate images for narrowly defined tasks. Early reports of automated QA scoring and program-level triage for expert review suggest potential to reduce expert workload and shorten feedback cycles, but external validation, generalizability across devices and patient habitus, and patient-centered outcomes remain limited. Acquisition-focused AI may therefore serve as an upstream “digital mentor” to improve novice image acquisition. We propose a practical pathway that integrates curated FOAMed resources and simulation with AI-guided bedside acquisition and continuous QA governance for safe deployment. Full article

Mild cognitive impairment (MCI), also known as mild neurocognitive disorder, represents a transitional stage between normal cognitive aging and dementia and often signals early neurodegenerative change. Despite its clinical importance, MCI remains poorly understood by the public and family care partners, leading to uncertainty and distress following diagnosis. This study evaluated UnderstandingMCI.ca, a brief multimedia e-learning lesson designed to improve MCI literacy among the public and care partners. The lesson was disseminated through the McMaster Optimal Aging Portal, with web analytics tracking uptake, progress, and completion, and a post-lesson survey incorporating the Net Promoter Score (NPS), the Information Assessment Method for all (IAM4all) questionnaire, and open-text feedback assessing perceived impact. Between 15 January and 7 February 2025, over 5000 users initiated the lesson, 1537 completed it, and 984 responded to the survey. Respondents were predominantly women aged 65 years or older. The NPS was 72 (“excellent”); 942 respondents (96%) found the lesson relevant, 937 (95%) anticipated benefits from using the information, and nearly all (982 respondents) reported understanding the material. Thematic analysis of 296 comments identified greater understanding of MCI versus normal aging and dementia, emotional reassurance, and motivation for proactive brain-health behaviors. UnderstandingMCI.ca was well-received, with respondents reporting that the lesson was understandable and relevant, and that they intended to use the information, suggesting it may be a feasible and scalable approach to public and care partner education about MCI. Full article

Background/Objective: Helping Early Adolescents Live Their Healthiest Youth (HEALTHY) is a four-session, smoothie-based nutrition education program grounded in Social Cognitive Theory (SCT) and Choice Architecture, designed to promote nutrition security among rural adolescents. This study examined students’ experiences with the program, including perceptions of likeability and perceived learning, as well as the theoretical mechanisms shaping engagement. Methods: A mixed-methods evaluation was conducted in two rural middle schools where the programming was delivered. Process indicators were assessed using brief paper-based surveys administered after each program session. Quantitative items captured likability and willingness to consume smoothies again (at home or school lunch), and qualitative open-ended responses were analyzed inductively. Post-program focus groups were conducted with a subsample of participants (N = 18) and analyzed deductively using a coding framework aligned with SCT constructs. Results: Across sessions, students (N = 360) reported high smoothie likeability, with fewer than 15% indicating dislike of any recipe. Willingness to consume smoothies again remained high, with affirmative responses ranging from 72% to 94% at home and 79% to 97% at school lunch. Inductive thematic analysis indicated that 53% of survey responses reflected session-aligned nutrition knowledge, along with themes related to acceptability and suggestions for improvement. Focus group findings reflected multiple SCT constructs, including knowledge awareness, self-efficacy, and goal-setting, as well as environmental influences regarding engagement, consistent with Choice Architecture. Conclusions: Findings indicate that the HEALTHY program was well received by rural adolescents and reflected key theoretical mechanisms underlying its design. Student feedback guides future program refinement. Full article

This paper reports initial experimental results related to the preparation of colored anodic titania thin layers using various deep eutectic solvent (DES)-based formulations. Electrolytes based on choline dihydrogen citrate–oxalic acid–ethylene glycol (1:1:1 molar ratio), choline chloride–oxalic acid (1:1 molar ratio) and choline chloride–lactic acid (1:2 molar ratio) eutectic mixtures were investigated. The anodization has been performed at constant voltage in a range of 10–100 V for various periods of time between 1 and 5 min at room temperature under mild stirring. A brief description of anodization procedures, as well as of some characteristics, from appearance and morphological viewpoints, is presented. A quantitative analysis of color characteristics in relation to the DES-based electrolyte and applied voltage using the CIELAB system is also discussed. The achieved chromatic scale follows this order of colors: golden—blue—light blue—light blue/green—pink—violet. This depends on the applied potential and the DES-based electrolyte. The films present a relatively high brightness and color saturation. The hue vs. anodization voltage diagrams suggest an almost linear dependence of the oxide growth measured against the applied voltage. The corrosion performance has been assessed through continuous immersion tests in (i) 0.5 M NaCl for 240 h and (ii) Hank’s biological solution for 96 h with intermediate visual examinations and recording corrosion potential, as well as potentiodynamic polarization curves and impedance spectra at open circuit potential. Different corrosion performances are discussed considering the aggressive medium involved and the used DES-based systems. Full article

In recent years, imaginative techniques have effectively addressed the growing demand for brief, evidence-based treatments applicable in various contexts. Among these, Imagery with Rescripting (ImRs) was developed within the Schema Therapy model. ImRs can be applied individually or in combination with other protocols, demonstrating significant outcomes even after just one session. This narrative review aims to provide an overview of the applications of ImRs, with a specific focus on its effectiveness in trauma-related disorders. The search string used was “(‘imagery with Rescripting’) AND ((‘Trauma’ OR ‘PTSD’ OR ‘dissociation’))”. The following databases were utilized: PubMed, Scopus, Web of Science, Medline, Embase, and PsychInfo. The research included English-language and Italian-language studies, encompassing experimental and observational designs, case reports, and case series. Samples consisted of healthy participants or clinical populations aged 18 years and older, with no temporal limitations. A total of 56 articles were selected. The results highlight the efficacy of this intervention, whether administered individually or as part of combined protocols, across a wide range of diagnostic categories, including healthy samples, post-traumatic stress disorder (PTSD), borderline personality disorder (BDP), sleep disorders, psychotic spectrum disorders, chronic pain, anxiety disorders, depression, and eating disorders. The studies also support hypotheses about the mechanisms underlying the technique: ImRs facilitates the reprocessing of the meaning associated with mental representations and reduces the occurrence of negative intrusive images related to past events. This process alters and rewrites the individual’s negative memories and images. The narrative review supports the effectiveness of ImRs in treating various psychopathological disorders, both trauma-related and non-trauma-related. In addition to highlighting the effectiveness of ImRs when appropriately integrated with other techniques, the review emphasizes the importance of conducting efficacy studies on larger samples to evaluate ImRs as a standalone intervention model. Full article

Background: Standard accelerometer summaries obscure meaningful differences in how people move while upright. We introduce an operational two-class Ambulatory Behaviour Framework that separates Ambulatory Tasks—periods of standing and short continuous stepping bouts (<1 min) that are indicative of activity in a single locus—from Ambulatory Journeys—long continuous stepping bouts (≥1 min) that are indicative of movement between locations. Methods: We analysed thigh-worn activPAL3 data from 3545 participants in the age-46 sweep of the 1970 British Cohort Study (24,815 valid monitor-days). Event-based algorithms grouped upright events and classified them as an Ambulatory Task or Journey; linear models examined associations with sitting time and differences by sex and BMI. Results: Mean upright time averaged 6.50 h day⁻¹; Ambulatory Tasks dominated (5.91 h; 90.6% of upright exposure), whereas Ambulatory Journeys contributed 0.61 h (9.4%). Each additional hour of Ambulatory Tasks corresponded to 0.61 h less sitting (β = −0.61 h; 95% CI: −0.63 to −0.61), while an extra hour of Ambulatory Journeys displaced only 0.04 h of sitting (β = −0.04 h; 95% CI: −0.044 to −0.039). Women accumulated significantly more time in Ambulatory Tasks and less sitting time than men. Both upright behaviours declined with increasing BMI. Conclusions: Ambulatory Tasks substantially replace sitting time, whereas Ambulatory Journeys leave sitting essentially unchanged. Interventions to displace sitting should concentrate on fostering frequent, brief, context-embedded tasks throughout the day. This novel framework yields interpretable, sensor-agnostic metrics to target behaviour change and standardise reporting of free-living mobility. Full article

Background and Objectives: Emergency physicians practice in high-pressure environments and face occupational stressors that may affect their mental health. This study was designed to evaluate the prevalence of depression among emergency physicians in South Korea and examined environmental, sociolegal, and individual factors associated with depressive symptoms in the post-pandemic period. Materials and Methods: This nationwide cross-sectional study analyzed data from the 2025 Korean Emergency Physician Survey. Screening positive for depressive symptoms was defined as a Patient Health Questionnaire-9 (PHQ-9) score ≥ 10, indicating moderate-to-severe depressive symptom severity. Measures included the PHQ-9, the Korean Epworth Sleepiness Scale (KESS), and the Adult APGAR, a brief self-administered instrument assessing overall wellness. Multivariable logistic regression was performed to identify factors associated with depression after adjusting for demographic, clinical, and work-related variables. Results: Of the 1050 physicians who responded (response rate: 37.5%), 743 emergency physicians completed the PHQ-9 section (completion rate: 70.8%; mean age, 43.2 ± 7.78 years; 86.5% male), and 111 (14.9%) screened positive for depressive symptoms. Objective workload indicators, including total work hours and number of night shifts, did not differ between physicians with and without depression. However, emergency physicians screening positive for depression reported higher perceived burdens related to staffing shortages and patient-related stressors. Protective factors included being married (adjusted odds ratio [AOR], 0.22; 95% confidence interval [CI], 0.08–0.58), longer sleep duration (AOR, 0.65; 95% CI, 0.50–0.86), better sleep quality (AOR, 0.45; 95% CI, 0.27–0.74), fixed mealtimes (AOR, 0.60; 95% CI, 0.39–0.93), and higher Adult APGAR scores (AOR, 0.72; 95% CI, 0.60–0.86). Factors associated with increased odds of depression included a history of cancer (AOR, 14.63, 95% CI, 2.53–84.61), current alcohol consumption (AOR, 2.54, 95% CI, 1.14–5.68), daytime sleepiness (AOR, 1.17; 95% CI, 1.04–1.31), and more frequent verbal abuse during the previous 12 months (AOR, 1.25; 95% CI, 1.08–1.44). Conclusions: Depression was prevalent and was associated with perceived work burden, sleep health, lifestyle regularity, and psychosocial factors. Interventions should address sleep quality, workplace safety, and social support. Full article