Search Results (803)

Background: Inborn errors of immunity (IEI) are mainly genetically driven disorders that affect immune function and present with highly heterogeneous clinical manifestations, ranging from severe combined immunodeficiency (SCID) to adult-onset immune dysregulatory diseases. This clinical heterogeneity, coupled with limited awareness and the absence of a universal diagnostic test, makes early and accurate diagnosis challenging. Although genetic testing methods such as whole-exome and genome sequencing have improved detection, they are often expensive, complex, and require functional validation. Recently, artificial intelligence (AI) tools have emerged as promising for enhancing diagnostic accuracy and clinical decision-making for IEI. Methods: We conducted a systematic review of four major databases (PubMed, Scopus, Web of Science, and Embase) to identify peer-reviewed English-published studies focusing on the application of AI techniques in the diagnosis and treatment of IEI across pediatric and adult populations. Twenty-three retrospective/prospective studies and clinical trials were included. Results: AI methodologies demonstrated high diagnostic accuracy, improved detection of pathogenic mutations, and enhanced prediction of clinical outcomes. AI tools effectively integrated and analyzed electronic health records (EHRs), clinical, immunological, and genetic data, thereby accelerating the diagnostic process and supporting personalized treatment strategies. Conclusions: AI technologies show significant promise in the early detection and management of IEI by reducing diagnostic delays and healthcare costs. While offering substantial benefits, limitations such as data bias and methodological inconsistencies among studies must be addressed to ensure broader clinical applicability. Full article

Streptococcus pneumoniae remains a leading cause of invasive diseases, particularly affecting young children and the elderly. Currently, two main types of pneumococcal vaccines are commercially available: polysaccharide vaccine (PPSV23) and conjugate vaccines (e.g., PCV20). Of over 100 identified pneumococcal serotypes, vaccines targeting 24 serotypes covered by PPSV23 and PCV20 (19 serotypes overlap between the two vaccines) have been developed, with serotype distribution varying by geography, age, and time. The immune response to pneumococcal vaccines differs across serotypes, vaccine types (polysaccharide vs. conjugate), and host factors. Quantitative methods for antibody assessment—particularly newer high-throughput assays—have emerged since 2000 to address limitations in conventional approaches. However, these methods have not been comprehensively reviewed. This scoping review aimed to systematically map the existing literature on quantitative methods used to assess antibody responses to pneumococcal vaccines. Specific objectives included the following: 1. summarizing conventional and novel quantitative immunoassays; 2. evaluating the current state of validation and application of these methods; 3. identifying knowledge gaps and methodological challenges. We followed the PRISMA-ScR guidelines. We included the following: 1. peer-reviewed, open-access papers related to immunoassays used for pneumococcal antibody assessment; 2. articles written in English; 3. Studies published between 2000 and 2023. We excluded the following: 4. studies focusing on other pathogens, employing different analytical methods, or using animal models. Articles meeting the eligibility criteria were primarily retrieved from PubMed and Scopus. If free full-text versions were unavailable there, Google Scholar or the original journal databases were consulted. All references were exported to EndNote 20 for further management. At the beginning of the review, a data-charting form was developed based on prior studies and commonly addressed themes. Additional charts were created to accommodate newly identified variables during the review. All charting tools were reviewed and finalized through discussion among all research team members. The included studies were classified into five thematic groups: 1. general descriptions of quantitative assessment methods, 2. assay development and validation, 3. comparative studies, 4. technical details of assay development, 5. interpretation of assay application findings. Of 1469 articles from PubMed and 2946 articles from Scopus initially identified, 55 articles met the inclusion criteria. The earliest methods included radioimmunoassays, later replaced by WHO-standardized ELISA. While ELISA remains the gold standard, it is limited by labor, cost, and throughput. Multiplex immunoassays (MIAs), including Luminex-based platforms, have demonstrated advantages in efficiency and scalability. However, many MIAs did not initially meet WHO validation criteria. More recent assays show an improved performance, yet interlaboratory variability and lack of standardized protective thresholds remain major limitations. This review provides the first comprehensive mapping of quantitative antibody assessment methods for pneumococcal vaccines. Although ELISA continues to serve as the benchmark, MIAs represent a promising next-generation approach. Continued efforts are needed to harmonize assay validation protocols and establish global standards for protective thresholds, which will enhance the reliability of vaccine efficacy monitoring across diverse populations. Full article

The integration of gamification into digital learning environments is reshaping educational models, advancing towards more adaptive and personalized teaching evolution. However, within large Chinese corpora, the transition mechanism from passive participation to adaptive gamified learning remains underexplored in a systematic manner. This study fills this gap by utilizing LDA topic modeling and sentiment analysis techniques to delve into user comment data on the Bilibili platform. The results extract five major themes, which include multilingual task-driven learning, early-age programming thinking cultivation, modular English competency certification, cross-domain cognitive integration and psychological safety, as well as ubiquitous intelligent educational environments. The analysis reveals that most themes exhibit highly positive emotions, particularly in applications for early childhood education, while learning models that involve certification mechanisms and technological dependencies tend to provoke emotional fluctuations. Nevertheless, learners still experience certain challenges and pressures when faced with frequent cognitive tasks. In an innovative manner, this study proposes a theoretical framework based on Self-Determination Theory and Connectivism to analyze how motivation satisfaction drives cognitive restructuring, thereby facilitating the process of adaptive learning. This model demonstrates the evolutionary logic of learners’ cross-disciplinary knowledge integration and metacognitive strategy optimization, providing empirical support for the gamification learning transformation mechanism in China’s digital education sector and extending the research framework for personalized teaching and self-regulation in educational technology. Full article

Background: The ageing population demands effective health solutions for the elderly. Wearable devices offer real-time monitoring and early alerts, but a comprehensive review of research in this field is lacking. This study uses bibliometric methods to analyse trends and advances in wearable devices for the elderly. Methods: Literature from 2014 to 2024 was retrieved from the Web of Science Core Collection using keywords related to the elderly and wearable devices. A total of 1015 English-language papers were analysed using tools including CiteSpace, VOSviewer, and R-Bibliometrix. Results: The annual growth rate of publications was 7.65%, with research increasing from 4 in 2014 to 1015 in 2024. Major contributors were the United States and China, with key authors including Bijan Najafi and Lynn Rochester. Research shifted from fall detection and activity monitoring to heart rate variability, balance, and AI integration. Key themes included “digital health”, “wearable technology”, and “cardiac health monitoring”. Conclusions: Research on wearable devices for the elderly is growing rapidly. Future studies should focus on multimodal sensor fusion, AI-enhanced analytics and personalised health interventions, and long-term, real-world validation of wearable solutions to improve elderly health management. Full article

Objectives: Obesity has become a major health issue, with multifactorial etiologies involving lifestyle, genetic, and neuroendocrine mechanisms. Despite public health campaigns and lifestyle interventions, long-term weight loss is often difficult to achieve or sustain. This literature review aims to summarize current knowledge on the main molecular mechanisms that hinder weight loss and to summarize the newest therapeutic strategies targeting obesity. Methods: The literature review was conducted using PubMed, Scopus, and Web of Science databases, with a preference for peer-reviewed original articles, systematic reviews, and meta-analyses. Eligible studies were required to be published in the English language and within the last ten years (2015–2025), with the exception of historically significant publications. A total of 112 articles were included in our review. Results: Obesity is a complex, chronic, recurrent metabolic condition that requires personalized, multidisciplinary treatment approaches. In this review, we summarize the major molecular mechanisms underlying weight gain and weight maintenance in obesity. In this literature review, we address the metabolic memory and epigenetics that act through DNA and histone modifications and micro interfering RNAs, resulting in an energy imbalance that can be passed on to further generations. The dysfunction of adipose tissue contributes to chronic low-grade inflammation and insulin resistance, leading to more severe obesity. The ratio of white, beige, and brown adipocytes also plays an important role in regulating energy balance. Novel medical interventions offer promising results in attenuating these mechanisms against successful weight loss. Conclusions: Current interventions, including calorie restriction, physical activity, and pharmacological treatment together, may show great promise in combating obesity, but long-term efficacy and safety remain to be established. Full article

Background and Objectives: Over the past few years, there has been a significant shift in focus from developing better diagnostic tools to detecting Alzheimer’s disease (AD) earlier and initiating treatment interventions. This review will explore four main objectives: (a) the role of biomarkers in enhancing the diagnostic accuracy of AD, highlighting the major strides that have been made in recent years; (b) the role of neuropsychological testing in identifying biomarkers of AD, including the relationship between cognitive performance and neuroimaging biomarkers; (c) the amyloid hypothesis and possible molecular mechanisms of AD; and (d) the innovative AD therapeutics and the challenges and limitations of AD research. Materials and Methods: We have searched PubMed and Scopus databases for peer-reviewed research articles published in English (preclinical and clinical studies as well as relevant reviews and meta-analyses) investigating the molecular mechanisms, biomarkers, and treatments of AD. Results: Genome-wide association studies (GWASs) discovered 37 loci associated with AD risk. Core 1 biomarkers (α-amyloid Aβ42, phosphorylated tau, and amyloid PET) detect early AD phases, identifying both symptomatic and asymptomatic individuals, while core 2 biomarkers inform the short-term progression risk in individuals without symptoms. The recurrent failures of Aβ-targeted clinical studies undermine the amyloid cascade hypothesis and the objectives of AD medication development. The molecular mechanisms of AD include the accumulation of amyloid plaques and tau protein, vascular dysfunction, neuroinflammation, oxidative stress, and lipid metabolism dysregulation. Significant advancements in drug delivery technologies, such as focused Low-Ultrasound Stem, T cells, exosomes, nanoparticles, transferin, nicotinic and acetylcholine receptors, and glutathione transporters, are aimed at overcoming the BBB to enhance treatment efficacy for AD. Aducanumab and Lecanemab are IgG1 monoclonal antibodies that retard the progression of AD. BACE inhibitors have been explored as a therapeutic strategy for AD. Gene therapies targeting APOE using the CRISPR/Cas9 genome-editing system are another therapeutic avenue. Conclusions: Classic neurodegenerative biomarkers have emerged as powerful tools for enhancing the diagnostic accuracy of AD. Despite the supporting evidence, the amyloid hypothesis has several unresolved issues. Novel monoclonal antibodies may halt the AD course. Advances in delivery systems across the BBB are promising for the efficacy of AD treatments. Full article

Lord Byron’s life and poetic works have inspired musical compositions across genres even during his lifetime. The English author’s fictional characters and themes impressed nineteenth-century European composers, especially since his Byronic heroes were often conflated with their creators’ own melancholy and revolutionary personas. In contrast to Byron-inspired songs and operas, instrumental programme music has raised doubts towards a direct correlation with its poetic sources. While epigraphs help direct listeners to specific ideas, their absence has prompted dismissals of intermedial relationships, even those proposed by the composers themselves. This essay explores major connections between Hector Berlioz’s Harold in Italy, a Symphony in Four Parts with Viola Obbligato (premiered 1834), and Byron’s semi-autobiographical narrative poem Childe Harold’s Pilgrimage: A Romaunt (published 1812–1818). Although Berlioz’s titles and memoirs partially identify Byron’s Childe Harold as his inspiration, other references, including his visits to the Abruzzi mountains, his fascination with Italian folk music, his reuse of earlier material, and his reflections on brigands and solitude, have fuelled ongoing debates about the work’s programmatic content. Combining historical-biographical research, melopoetics, and musical semiotics, this essay clarifies how indefinite elements were transmitted from poetic source to musical target. Particular focus is placed on the “Harold theme”, which functions as a Byronic microcosm: a structural, thematic, and gestural condensation of Byron’s poem into music. Observing the interactions between microcosmic motifs and macrocosmic forms in Berlioz’s symphony and their poetic analogues, this study offers a new reading of how Byron’s legacy is encoded in musical terms. Full article

Background: Emotional abuse is both prevalent and underrecognized particularly in culturally complex settings like India. Adolescents, being in a critical developmental phase, are especially vulnerable to the long-lasting psychological effects of emotional abuse. This qualitative literature review aims to synthesize findings from primary studies that explore the lived experiences of emotional abuse among Indian adolescents and identify emerging patterns across sociocultural contexts. Method: Electronic databases, including DOAJ, Google Scholar, ProQuest, JSTOR, Pubmed, PsycNet, and SCOPUS, were searched for peer-reviewed articles published in English up to March 2025. Inclusion criteria comprised qualitative or mixed-methods research focusing on emotional abuse among adolescents aged 12–20 in Indian contexts. The Critical Appraisal Skills Programme (CASP) was used for quality assessment. Results: Five major thematic domains were identified across the included studies: (1) Family as a primary site of emotional abuse; (2) Gendered experiences of abuse; (3) Cultural normalization and silence; (4) Psychological and emotional consequences; and (5) Coping and resilience among adolescents. These themes reflect shared experiences of emotional abuse shaped by cultural, familial, and gender-based expectations. Conclusions: This review highlights the urgent need for increased awareness and culturally sensitive interventions addressing emotional abuse in Indian adolescents. The findings suggest that parents, educators, and policymakers must recognize emotionally harmful behaviors and implement prevention-oriented strategies, particularly through non-violent communication and adolescent mental health support frameworks. Full article

This study synthesizes the rapidly expanding evidence on how digital technologies reshape international trade, with a particular focus on small and medium-sized enterprises (SMEs). Guided by two research questions—(RQ1) How do digital tools influence the volume and composition of cross-border trade? and (RQ2) How do these effects vary by countries’ development level and firm size?—we conducted a PRISMA-compliant systematic literature review covering 2010–2024. Searches across eight major databases yielded 1857 records; after duplicate removal, title/abstract screening, full-text assessment, and Mixed Methods Appraisal Tool (MMAT 2018) quality checks, 86 peer-reviewed English-language studies were retained. Findings reveal three dominant technology clusters: (1) e-commerce platforms and cloud services, (2) IoT-enabled supply chain solutions, and (3) emerging AI analytics. E-commerce and cloud adoption consistently raise export intensity—doubling it for digitally mature SMEs—while AI applications are the fastest-growing research strand, particularly in East Asia and Northern Europe. However, benefits are uneven: firms in low-infrastructure settings face higher fixed digital costs, and cybersecurity and regulatory fragmentation remain pervasive obstacles. By integrating trade economics with development and SME internationalization studies, this review offers the first holistic framework that links national digital infrastructure and policy support to firm-level export performance. It shows that the trade-enhancing effects of digitalization are contingent on robust broadband penetration, affordable cloud access, and harmonized data-governance regimes. Policymakers should, therefore, prioritize inclusive digital-readiness programs, while business leaders should invest in complementary capabilities—data analytics, cyber-risk management, and cross-border e-logistics—to fully capture digital trade gains. This balanced perspective advances theory and practice on building resilient, equitable digital trade ecosystems. Full article

Background: Mesenchymal stem cells (MSCs), multipotent and immune-regulatory cells derived from tissues such as bone marrow, dental pulp, and periodontal ligament, emerged as promising agents in regenerative dentistry. Their clinical applications include endodontic tissue regeneration, periodontal healing, and alveolar bone repair, addressing critical challenges in dental tissue restoration. Methods: A systematic review was conducted following PRISMA guidelines and registered in PROSPERO. We searched PubMed, Scopus, and Web of Science databases for open-access, English-language clinical trials and observational studies published from 2015 to 2025. Studies focusing on the application of MSCs in dental tissue regeneration were included based on predefined eligibility criteria. Results: Out of 2400 initial records, 13 studies met the inclusion criteria after screening and eligibility assessment. Most studies investigated MSCs derived from dental pulp and periodontal ligament for regenerating periodontal tissues and alveolar bone defects. The majority reported improved clinical outcomes; however, variations in MSC sources, delivery methods, sample sizes, and follow-up periods introduced methodological heterogeneity. Conclusions: MSCs show significant potential in enhancing bone and periodontal regeneration in dental practice. Nonetheless, the current evidence is limited by small sample sizes, short follow-up, and inconsistent methodologies. Future large-scale, standardized clinical trials are required to validate MSC-based regenerative therapies and optimize treatment protocols. Full article

Introduction: Burnout syndrome, long described as an “occupational phenomenon”, now affects 15–20% of the general workforce and more than 50% of clinicians, teachers, social-care staff and first responders. Its precise nosological standing remains disputed. We conducted a mechanistic review of electroencephalography (EEG) studies to determine whether burnout is accompanied by reproducible brain-function alterations that justify disease-level classification. Methods: Following PRISMA-adapted guidelines, two independent reviewers searched PubMed/MEDLINE, Scopus, Google Scholar, Cochrane Library and reference lists (January 1980–May 2025) using combinations of “burnout,” “EEG”, “electroencephalography” and “event-related potential.” Only English-language clinical investigations were eligible. Eighteen studies (n = 2194 participants) met the inclusion criteria. Data were synthesised across three domains: resting-state spectra/connectivity, event-related potentials (ERPs) and longitudinal change. Results: Resting EEG consistently showed (i) a 0.4–0.6 Hz slowing of individual-alpha frequency, (ii) 20–35% global alpha-power reduction and (iii) fragmentation of high-alpha (11–13 Hz) fronto-parietal coherence, with stage- and sex-dependent modulation. ERP paradigms revealed a distinctive “alarm-heavy/evaluation-poor” profile; enlarged N2 and ERN components signalled hyper-reactive conflict and error detection, whereas P3b, Pe, reward-P3 and late CNV amplitudes were attenuated by 25–50%, indicating depleted evaluative and preparatory resources. Feedback processing showed intact or heightened FRN but blunted FRP, and affective tasks demonstrated threat-biassed P3a latency shifts alongside dampened VPP/EPN to positive cues. These alterations persisted in longitudinal cohorts yet normalised after recovery, supporting trait-plus-state dynamics. The electrophysiological fingerprint differed from major depression (no frontal-alpha asymmetry, opposite connectivity pattern). Conclusions: Across paradigms, burnout exhibits a coherent neurophysiological signature comparable in magnitude to established psychiatric disorders, refuting its current classification as a non-disease. Objective EEG markers can complement symptom scales for earlier diagnosis, treatment monitoring and public-health surveillance. Recognising burnout as a clinical disorder—and funding prevention and care accordingly—is medically justified and economically imperative. Full article

In recent studies, public health has been considered a key stakeholder in climate mitigation and adaptation in cities since they are more exposed to the impact of climate change. Nurses represent a vast majority of public health professionals, playing a key role in health promotion that allows them to influence individuals, families, and communities in adopting healthier behaviours and decarbonized lifestyles. Therefore, the purpose of this study is to map the existing evidence on nursing interventions, which are being led or implemented to reduce the health risks related to climate change in urban areas. The present review follows the JBI methodological framework, including a search on PubMed, MEDLINE complete, CINAHL Complete, Scopus, Web of Science, SciELO (Scientific Electronic Library Online), BASE (Bielefeld Academic Search Engine), and RCAAP. Hand searched references were also considered, including quantitative, qualitative, and mixed-methods studies between January 2014 and October 2024, for a more contemporary perspective. A three-step search strategy and data extraction tool were used by two independent reviewers. Twenty-seven studies in English and Portuguese were eligible for inclusion, all targeting a population of professionals with nursing-related roles: two case studies, one Delphi panel, one descriptive study, one historical research paper, two using a methodological design format, four narrative reviews, one observational study, nine review articles, three scoping reviews, and three systematic reviews. Eight categories of nursing interventions that contribute to decarbonized lifestyles, reducing health risks in relation to climate change, were acknowledged. Nurses play a key role in empowering individuals, families, and communities, promoting climate awareness and literacy, supporting health policy change, advocating for the most vulnerable and engaging in environmental activism, using evidence-based research, and taking advantage of marketing strategies and social media. Full article

Background: University academics are often the first points of contact for students experiencing mental health problems (MHPs) because of the pre-existing relationship between academics and students. Aim: The aim of this review is to explore the experience of university academics who have supported students with MHPs. Methods: This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidance. Searches were conducted using six databases and were limited to peer-reviewed studies published in the English language between 2013 and 2023. Results: Thematic analyses identified three major themes: academics’ perceptions of mental health problems among students, the role of academics in supporting students and the academics’ perceived barriers to supporting students. Conclusions: Universities need to acknowledge the vulnerability of students’ mental health and prepare to respond appropriately. Improving the mental health literacy of university academics, and providing clarity about roles and mechanisms to support the mental health of university students will be crucial to achieve this. Full article

Background: Anxiety and depression are among the most common mental health disorders affecting adolescents worldwide. Skipping breakfast is a prevalent dietary behaviour linked to inadequate nutrient intake, which may contribute to the development or exacerbation of mental health issues in this age group. Despite growing interest, a comprehensive synthesis of evidence on the association between breakfast omission and adolescent anxiety or depression remains limited. Objectives: This scoping review aimed to synthesise existing research on the association between skipping breakfast and the risk of anxiety and/or depression in adolescents. Methods: A systematic scoping review was conducted using the Joanna Briggs Institute (JBI) methodological framework. A comprehensive search of PubMed, ProQuest, and EBSCOhost databases was performed, focusing on studies published in English between 2014 and 2024. Keywords included “skipping breakfast,” “risk,” “anxiety,” “depression,” and “adolescen*.” Studies were screened and selected based on predefined inclusion and exclusion criteria. Results: Out of 1671 initially identified studies, 12 met the inclusion criteria. The majority were cross-sectional (n = 9), with one prospective cohort study, one secondary data analysis, and one systematic review with meta-analysis. Most studies reported a significant association between breakfast skipping and increased risk of anxiety and depression in adolescents. Only one study reported no significant relationship between the two variables. Conclusions: This review underscores a consistent association between skipping breakfast and elevated risk of anxiety and depression among adolescents. While causality remains to be established, breakfast omission emerges as a modifiable lifestyle factor with potential public health implications. These findings highlight the need for prospective research, as well as the importance of community- and school-based health promotion strategies that advocate for regular and nutritious breakfast consumption as part of broader mental health support efforts. Full article

Background: Gestational diabetes mellitus (GDM) affects 7–9% of pregnancies worldwide and is associated with adverse maternal and neonatal outcomes. Nutritional therapy is a key component of GDM management. However, inconsistencies exist across international and national guidelines regarding macronutrient distribution, glycemic targets, and micronutrient supplementation. This systematic review aims to compare updated nutritional recommendations for GDM across major health organizations and identify areas of consensus, divergence, and evidence gaps. Methods: This systematic review was conducted following PRISMA guidelines and registered in PROSPERO (CRD420251026194). A comprehensive literature search was performed in PubMed, Scopus, and Google Scholar (concluding March 2025), along with manual searches of official websites of professional health organizations (e.g., ADA, WHO, NICE, IDF). Guidelines published within the last 10 years (or the most relevant national guideline if slightly older), available in English or with access to translation, and including explicit nutritional recommendations for GDM were included. Data were extracted on macronutrient composition, glycemic targets, and micronutrient supplementation, with evaluation of the supporting evidence and regional context, incorporating findings from recent key guideline updates. Results: In total, 12 guidelines met the inclusion criteria. While all guidelines emphasized carbohydrate moderation and adequate fiber intake, significant discrepancies were found in carbohydrate quality recommendations (e.g., low-glycemic index focus vs. total carbohydrate restriction), postprandial glucose targets (e.g., 1-h vs. 2-h measurements and varying thresholds like <120 vs. <140 mg/dL), and the use of non-routine micronutrients such as chromium, selenium, and omega-3 fatty acids (generally lacking endorsement). Recent updates from key bodies like ADA, Diabetes Canada, and KDA largely maintain these core stances but show increasing emphasis on dietary patterns and acknowledgement of CGM technology, without resolving key discrepancies. Cultural adaptability and behavioral counselling strategies were minimally addressed across most guidelines. Conclusions: Despite general agreement on the principal recommendations of nutritional management in GDM, substantial variation persists in specific recommendations, even considering recent updates. Consistent, evidence-based, and culturally adaptable guidelines incorporating implementation strategies are needed to optimize care and reduce disparities in GDM management across regions. Full article