Search Results (85)

Background. Paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) are widely used treatments for mild to moderate pain and fever in pediatric patients. Notwithstanding, greater caution and awareness of their distinct safety profiles is warranted, especially in children with comorbidities. Expert opinion. Herein, expert opinion is presented on the use of these drugs in this setting. Paracetamol is suggested as first-line treatment for managing fever in pediatric patients. For pain, paracetamol is suggested for acute mild-to-moderate pain, whereas NSAIDs are preferred for pain associated with inflammatory conditions. A fixed-dose combination of paracetamol and ibuprofen may be considered for moderate pain, which allows effective analgesia while potentially reducing the risk of adverse events associated with monotherapy. Based on opinion and clinical experience, suggestions were made for pediatric patients considering a large variety of comorbidities. For example, in patients with infection/influenza, the panel concluded that paracetamol should be preferred over NSAIDs. In pediatric patients with inflammatory bowel disease, it was suggested to avoid long-term or high-dose NSAID treatment, particularly in those with active disease. In the presence of skin and soft tissue infections, it was suggested to limit the use of NSAIDs and prioritize paracetamol as first-line therapy. It was also recommended to exercise caution when using NSAIDs in pediatric patients with diabetes. Lastly, shared therapeutic flowcharts were developed that facilitate the patient journey of pediatric patients with comorbidity and fever or pain, which may help promote therapeutic appropriateness and reduce the risk of adverse events, providing practical guidance for general practitioners and pediatricians. Full article

Background/Objectives: Migraine is a common, disabling neurological disorder disproportionately affecting women during hormonally sensitive phases like menarche, pregnancy, and menopause. Despite awareness of sex-specific risk factors, management remains fragmented and predominantly neurologist-led, with limited coordination. To address these gaps, this project aimed to develop a national expert consensus, endorsed by scientific societies, on multidisciplinary migraine management in women across the lifespan, integrating perspectives from neurology, gynecology, endocrinology, cardiology, and general medicine. Methods: A two-round Delphi survey was conducted among 145 Italian clinicians representing the five specialties. The Scientific Board formulated 50 questions, each consisting of a variable number of statements, covering diagnostic approaches, hormonal therapies, comorbidities, and organizational care pathways. Statements were rated on a nine-point Likert scale, and consensus was defined using pre-specified criteria based on median scores and agreement. Results: Overall, 79 of 145 statements (54%) achieved consensus. High-level agreement emerged on sex-informed diagnostic strategies, including systematic gynecological and endocrinological evaluation and hormonal profiling in women with migraine. Round 2 facilitated consensus on contentious issues, such as avoiding estrogen-containing contraceptives in migraine with aura, individualized thrombotic risk assessment during menopause, and structured interdisciplinary coordination—particularly among neurologists, gynecologists, and general practitioners—during fertility planning and assisted reproduction. Qualitative feedback emphasized the need to update clinical pathways, implement standardized referral models, and strengthen interprofessional communication. However, persistent divergence remained on selected topics, particularly the role of hormonal contraceptives as a first-line approach to migraine management in women of reproductive age, reflecting different priorities between gynecologists and neurologists. Conclusions: This Delphi initiative provides the first national multidisciplinary consensus on migraine management in women in Italy. The findings support the development of sex- and life-stage-specific clinical guidance and integrated care models tailored to the complex needs of women with migraine. Full article

Background/Objectives: Contemporary periodontal therapy is increasingly guided by evidence-based clinical protocols, particularly the European Federation of Periodontology (EFP) S3 Clinical Practice Guidelines. The present study aimed to assess dentists’ perceptions regarding modern periodontal therapy and to perform a preliminary psychometric evaluation of a newly developed questionnaire. Methods: A cross-sectional questionnaire-based study was conducted among 109 dental practitioners. The questionnaire evaluated perceptions regarding non-surgical periodontal therapy, surgical periodontal therapy, and the comparative role of both therapeutic approaches. Descriptive statistical analysis, internal consistency analysis using Cronbach’s Alpha, Intraclass Correlation Coefficient (ICC), repeated measures ANOVA, and exploratory factor analysis (Principal Component Analysis—PCA) with Varimax rotation were performed to evaluate the psychometric properties of the instrument. Results: The questionnaire demonstrated good internal consistency, with Cronbach’s Alpha values ranging from 0.77 to 0.86. ICC analysis confirmed satisfactory reliability. Respondents showed favorable attitudes toward evidence-based periodontal management, supporting non-surgical therapy as first-line treatment and the staged integration of surgical approaches in complex cases. Exploratory factor analysis identified a coherent factorial structure, with four components explaining 73.94% of the total variance. Conclusions: The questionnaire showed good psychometric properties, supporting its potential utility as a reliable and useful instrument for evaluating professional attitudes and clinical decision-making in periodontology. Full article

IoT devices operate as integrated systems spanning hardware, firmware/software layers, and communication layers. In operational settings, many faults and performance degradations are emergent: they arise from cross-layer interactions, workload changes, and telemetry artifacts, rather than a single physics-of-failure mechanism. These realities make traditional supervised fault classification difficult because labeled fault data are rarely available during deployment, and the fault surface is unknown and a priori. This paper presents a practitioner-oriented, label-free fault detection and diagnosis (FDD) pattern based on Dynamic Time Warping (DTW) for rapid implementation in production IoT telemetry. The method represents a device as a sequence of overlapping episodes and organizes telemetry into interpretable layers (hardware sensors, communication health proxies, and software/firmware-derived KPIs). A reference library of regular episodes is built from an assumed-healthy training window; new episodes are scored using constrained DTW distances against this library, while retaining per-layer and per-channel contributions for attribution. We show that production performance depends strongly on operational parameterization, including episode length, DTW constraints, robust threshold learning, and temporal validation. Within a verified-healthy evaluation window, the tuned configuration achieves an AUROC of 0.97 for the temporally structured faults DTW is suited to (bias, drift, and interaction faults, with spikes detected at an AUROC of 0.93), detecting 100% of injected faults, with a mean delay under 25 min. We further show that constant-value (stuck-at) and missing-data (dropout) faults fall outside DTW’s shape-matching scope (AUROC about 0.66) and are better served by complementary variance- and missingness-based detectors, a consequence of DTW’s shape-matching scope rather than a parameter choice. This work contributes a system-level methodological framework for deploying DTW as an IoT fault-detection-and-diagnosis capability: an episode-and-layer architecture aligned with hardware, communication, and software/firmware ownership; a label-free reference library requiring only assumed-healthy data; per-layer and per-channel attribution for cross-domain triage; and a reproducible operational tuning procedure. Together, these deliver a fast-to-deploy, scalable, and accurate first-line detector for label-scarce IoT systems. Full article

Background: Pulpitis is a common cause of dental pain in children and is primarily an inflammatory condition that can be effectively managed with local operative treatment. Although antibiotics are indicated only in cases of systemic involvement or infection spread, they are frequently overprescribed in dental practice. This misuse contributes to antimicrobial resistance and adverse health outcomes. This systematic review aimed to evaluate antibiotic prescribing practices for pulpitis in pediatric patients and to assess adherence to current clinical guidelines. Methods: A systematic review was conducted in accordance with the PRISMA 2020 statement and registered in PROSPERO (CRD420261342269). A comprehensive search was performed in PubMed/MEDLINE, Scopus, and Embase up to March 2026. Observational studies assessing antibiotic prescribing practices among pediatric dentists were included. A meta-analysis of proportions was conducted using a random-effects model. Risk of bias was assessed using the Joanna Briggs Institute Checklist, and certainty of evidence was evaluated using the GRADE approach. Results: Five cross-sectional studies were included. Antibiotic prescribing rates for pulpitis ranged from 0.6% to 50.0%. The pooled prevalence of antibiotic prescribing was 14.0% (95% CI: 5.0–33.5%), with high heterogeneity across studies (I² = 95%). Amoxicillin and amoxicillin–clavulanic acid were the most commonly prescribed first-line antibiotics, while clindamycin was the most frequently reported alternative in patients with penicillin allergy. Treatment duration was generally consistent, ranging from 5 to 7 days. Conclusions: Although pediatric dentists tend to prescribe antibiotics more conservatively than general practitioners, inappropriate use remains prevalent, particularly in conditions such as pulpitis where antibiotic therapy is not indicated. These findings highlight a persistent gap between evidence-based recommendations and clinical practice and underscore the need for targeted antimicrobial stewardship strategies to optimize antibiotic use in pediatric dentistry. Full article

Background: In pediatric dental care, antibiotics are routinely prescribed for both therapeutic and preventive purposes. Their use is primarily indicated for the management of widespread dental or oral infections, in conjunction with appropriate clinical treatment. Additionally, antibiotics are administered to prevent infective endocarditis (IE) in patients identified as being at increased risk. The present study aimed to evaluate the knowledge and prescribing practices of Italian dentists regarding antibiotic use in pediatric patients through an anonymous online questionnaire. Methods: A specifically designed questionnaire was electronically distributed to a group of Italian dentists. The questionnaire included three sections: demographic data, general knowledge on antibiotic prescribing, and IE prophylaxis in pediatric dentistry. Data were analyzed using appropriate statistical methods. Results: The study included 242 Italian dentists. Only a limited number of statistically significant differences were observed between specialists in pediatric dentistry and general dentists or those with other specializations, as well as between practitioners who mainly treat pediatric patients and those who predominantly treat adults. Regarding antibiotic prophylaxis for IE, most respondents identified amoxicillin as the first-line antibiotic for pediatric patients without penicillin allergy, whereas nearly 30% indicated clindamycin for patients with penicillin allergy. The knowledge about the dosage of assumption of the antibiotic of choice and the timing of administration of the antibiotic prophylaxis were considered as not sufficient. Conclusions: Important gaps remain in dentists’ knowledge of current guidelines for IE prophylaxis, particularly regarding drug dosage and administration. Increased awareness of updated recommendations and potential adverse effects of alternative antibiotics, such as clindamycin, is needed. Full article

Background and Objectives: Visceral artery aneurysms (VAAs) are rare but potentially catastrophic vascular abnormalities, particularly in pregnant patients or women of childbearing age. Rupture is often fatal for both mother and fetus, with mortality rates exceeding 70% in some series. While most VAAs are found incidentally, a subset may present acutely with nonspecific abdominal or flank pain, making early recognition and appropriate referral essential. This review article aims to provide General Practitioners (GPs) and emergency department (ED) clinicians with a practical approach to the recognition, investigation, initial management, and escalation pathways for VAAs. Results: Physiological and hormonal adaptations in pregnancy heighten aneurysm rupture risk. Despite this, imaging is frequently delayed. Computed tomography angiography (CTA) remains the gold standard for diagnosis and is safe in pregnancy when clinically justified, with fetal radiation exposure well below teratogenic thresholds. Guidelines from major vascular societies uniformly recommend repairing VAAs in pregnancy or women planning pregnancy irrespective of aneurysm size, and treating pseudoaneurysms urgently in all patients. Endovascular intervention is first-line where anatomy permits, while open or hybrid approaches remain essential in unstable presentations. The manuscript outlines practical steps for ED and GP settings, including haemodynamic stabilization, early obstetric involvement, transfer considerations for rural environments, reproductive counselling, and post-repair surveillance. Conclusions: With an increasing number of abdominal scans being performed in primary and tertiary settings, there is an associated increased volume of incidental findings that require work-up. This article outlines a practical investigation and management strategy for clinicians presented with VAAs, including in high-risk cohorts, emphasizing early imaging, inter-specialty coordination, and guideline-supported thresholds for intervention. Full article

Chronic constipation (CC) is one of the most common disorders of gut–brain interaction, affecting more than 11% of adults in Western countries, with higher prevalence in women and in the elderly. Despite its significant impact on quality of life, most patients self-manage their symptoms, while only a minority seek medical attention from general practitioners (GPs) or specialists. Proper assessment not only often requires a multidimensional approach but also accurate diagnostic and therapeutic pathways that define the exact role of GPs and specialists. This paper describes a comprehensive Diagnostic–Therapeutic Care Pathway (DTCP) for CC, focusing on the full spectrum of diagnostic and therapeutic methodologies required for accurate patient assessment and management. The pathway involves a primary care physician intervention phase, responsible for first-line diagnostic and therapeutic management and evaluation using objective parameters, as well as reassessment at appropriate time points to identify patients requiring further specialist evaluation. Advanced diagnostic methodologies are described as being performed in specialized gastroenterology or neurogastroenterology settings. These include colonic transit studies with radiopaque markers, high-resolution anorectal manometry, balloon expulsion testing, magnetic resonance imaging or conventional defecography, ultrasonography, and neurophysiological assessments such as anal sphincter EMG and pudendal nerve latency testing. Full article

Background: Self-myofascial release (SMFR) is a treatment whose main benefits are enhanced recovery and increased flexibility without impairing athletic performance. Previous research has often targeted the posterior myofascial chain (superficial back line, SBL), which runs from the plantar fascia to the posterior cranium and is commonly linked to hamstring-related outcomes. However, its potential influence on knee extensor force production remains unclear and would likely be indirect. Many SMFR tools have entered the market in recent years, with Auramat^® being one of them, yet it has not been investigated to date. Therefore, this study aimed to determine the effects of Auramat^® (AUR) on posterior-chain flexibility and knee extensor (KE) function and to compare them with those of a traditional warm-up (TW). Methods: This study was a randomised, counterbalanced, cross-over design where 20 recreationally active participants (12 males, 8 females; age = 27.20 ± 4.98 years) attended the laboratory 3 times over a 2-week period. The first week consisted of a familiarisation session during which participants performed several tests. In the second week, the groups that were randomly assigned at AUR or TW conditions performed the two intervention protocols separated by 48 h. The pre-post ratings of perceived exertion (RPE), maximal voluntary isometric contraction (MVIC), straight leg raise test (SLRT) and rate of force development (RFD) were measured. All tests were performed on the dominant limb. Results: There was no significant difference in RFD and MVIC for conditions (p = 0.91), time (p = 0.24), or condition × time (p = 0.41). Both conditions improved posterior chain flexibility (p ≤ 0.01) with a larger effect in TW (d = 2.03; ↑ 7.81%) compared to the AUR condition (d = 0.89; ↑ 3.69%). RPE for TW showed significant higher RPE values compared to the AUR condition (p ≤ 0.01; ES = 2.32; TW = 4.3 ± 1.45 vs. AUR = 1.55 ± 0.82). Conclusions: Both SMFR with AUR and TW increased flexibility without any significant reduction in KE force production. Practitioners may use TW in a session where the aim is an increase in flexibility and AUR when the time is limited and the increase in fatigue can be relevant, due to the lower RPE reported. In any case, these results should be taken with caution since even the AUR was more time-efficient; the findings are preliminary owing to the small sample and absence of a control condition. Full article

The purpose of this study was to quantify the between-session reliability of time, velocity, and distance measures over 54.7 m straight-line and home-to-second base sprints (curvilinear), using global positioning satellite (GPS) technology. Twelve trained male high school baseball position players attended four sessions: one familiarization session and three identical testing sessions, separated by at least two days, each consisting of two linear and two curvilinear trials. There was no statistically significant evidence (p < 0.05) of systematic change in any of the variables between sessions, with the majority of the mean percent changes ranging from −2.7 to 2.5%, and only four between-session comparisons greater than 2% (−6.2 to 3.4%). In terms of absolute consistency, no measure exceeded a coefficient of variation (CV) of 10%, with the majority (93%) of the CVs under 5%. With regard to relative consistency, 66% of the measures had intraclass correlation coefficients (ICCs) greater than 0.74, ranging from 0.76 to 0.98. Comparison of smallest worthwhile change (SWC) values with CV-derived typical error indicated that several key time- and speed-based metrics were sensitive to meaningful performance changes, with error estimates that were comparable to or smaller than SWC. In contrast, event-timed typical errors (e.g., time to peak speed) were substantially greater than the SWC, indicating limited sensitivity for detecting small performance changes. The non-significant changes in the mean, low CVs, and high ICCs, for the most part, over repeated testing occasions, indicate acceptable between-session reliability for many of the procedures and GPS-derived variables examined in this study. Practitioners should prioritize linear time at 41.1 m and 54.7 m and velocity at 27.4 m and 41.1 m for return-to-play and short-term performance tracking. For curvilinear running, peak speed before first base, peak speed before second base and after first base, and speed at 41.1 m are the most suitable monitoring metrics based on the results. Specifically, speed at 41.1 m should be considered for return-to-play and short-term performance tracking, while peak speed before first base and peak speed before second base and after first base may be used cautiously when larger performance changes are expected. Full article

Background/Objectives: Child vulnerability is a predictor for potentially adverse challenges for the child and family, but the term is used inconsistently across settings. Danish general practitioners (GPs) are centrally positioned as the front line of the health care system. Thus, the aim of this study is to explore Danish GPs’ perspectives and assessment of child vulnerability, using an exploratory, sequential mixed-methods approach. Methods: Eleven GPs were interviewed, focusing on perceptions and management of child vulnerability in the context of preventive child health examinations (PCHEs). Interviews were analyzed in two stages. From the first deductive analysis, a quantitative data recording chart was developed. This was distributed to 10 general practices, to collect GPs’ perceptions and management of child vulnerability, and 197 recordings were completed. Secondly, to develop themes independently of the deductive coding, data was analyzed inductively, creating an in-depth understanding of GPs’ perspectives. This resulted in four themes. Results: GPs associated the concept of child vulnerability with a multitude of social, somatic, and psychological factors. To recognize child vulnerability, GPs found time and scope during PCHEs limited and knowledge of the family essential. Collaboration with social services was perceived as insufficient. The most frequent finding during PCHEs was related to somatic challenges (60%) and follow-up consultation was the most frequent response (64%). Conclusions: GPs considered child vulnerability a complex term. Assessment of child vulnerability was strongly related to knowledge of the family, and usually based on several consultations, which underscores that PCHEs represent only one of several contexts where concerns are assessed and addressed. Full article

Prostate cancer survivors require coordinated long-term care after treatment. We examined patterns of follow-up care and identified characteristics associated with the frequency of radiation oncology (RO) visits during survivorship. We conducted a population-based cohort study of men diagnosed with prostate cancer between April 2010 and March 2019 in Ontario, Canada, who underwent first-line radiotherapy. Survivorship began three years following radiation. Using a recurrent event framework, we identified demographic and clinical characteristics associated with the rate of RO follow-up. Survivors seeking RO follow-up declined by 46.2% over five years of survivorship. Higher-risk characteristics, such as higher ISUP grade, higher stage, detectable prostate-specific antigen (PSA) score, and receipt of brachytherapy and/or hormones, were associated with more frequent RO visits. For instance, relative to International Society of Urological Pathology (ISUP) Grade 1, those with Grades 3 through 5 experienced follow-up rates that were 20%, 25%, and 34% higher, respectively. Despite concordance between patient risk and rate of RO follow-up, 23.6% of survivors continued to visit their RO providers into their fifth year of survivorship, more than half of whom were ISUP grades 1–2. Primary care follow-up remained stable. While frequency of RO follow-up appropriately reflected patient risk profile, many low-risk survivors still sought long-term RO-led care. This suggests an opportunity to encourage lower-risk prostate cancer survivors to seek follow-up care with their general practitioner. Full article

The aim of this study was to analyze the effects of different competition formats on the plyometric performance of under-13 basketball players, considering the influence of maturational age and monitored through GPS devices. Thirty-seven under-13 male basketball players (age = 12.91 ± 0.57 years) from four southeast Spanish teams participated in two different tournaments. On the first day, the tournament was played according to the official Spanish Basketball Federation (FEB) rules for under-14 players. On the second day, the competition was held with modified rules (Modified Tournament), in which the basket height was lowered to 2.90 m and the three-point line was replaced by a rectangle located 4 m from the basket. Plyometric variables, such as number of impacts (total and in zones), number of horizontal impacts (total and in zones), number of steps, number of jumps (total and in zones) and g-force of jumps during takeoff and landing, were assessed using GPS monitoring. In addition, the moderating effect of maturational age on the intervention in each of the variables under study will be evaluated. The results showed that the modified tournament (MT) showed significant differences compared to the standard format (FEB) in playing time, steps, landings 5–8 G, and takeoffs >8 G during positional attacks, as well as in horizontal impact variables during counterattacks and effective playing time. Bayesian analysis provided moderate-to-strong evidence for several of these variables, and extreme evidence for playing time and impacts during effective time. Moreover, maturational age (%PAH) consistently moderated the intervention effects, particularly in impact loads and locomotor demands. These findings can provide useful insights for coaches and practitioners in youth basketball. Adjusting competition rules and considering maturational status may optimize player development by creating contexts that enhance plyometric performance while adapting to the physical and biological characteristics of young athletes. Full article

Construction firms struggle to implement sustainable practices, delivering triple bottom line benefits despite growing environmental pressures. While research examines isolated sustainability drivers, the understanding of how organizational factors integrate to enable successful implementation remains fragmented. This systematic literature review synthesizes 249 articles (2010–2025) to develop an integrated framework explaining how internal capabilities drive sustainable innovation and performance in construction. This thematic synthesis reveals three critical insights. First, successful sustainability requires integrated configuration across green innovation capabilities, organizational learning, environmental governance responses, and performance measurement, not isolated initiatives. Second, construction’s project-based discontinuity, fragmented supply chains, and regulatory heterogeneity require capability configurations absent from manufacturing-focused sustainability theories. Third, cross-domain synergies create reinforcing feedback loops where capabilities enable compliance, measurement accelerates innovation, and governance catalyses development. This research provides practitioners an actionable framework identifying critical capability investments and interdependencies for sustainability implementation. Theoretically, we extend the Natural Resource-Based View and the Dynamic Capability View through three construction-specific mechanisms: temporal knowledge discontinuity paradox, distributed capability configuration, and regulatory complexity multipliers. These extensions advance sustainability theory beyond manufacturing, providing a foundation for understanding sustainable competitive advantage in project-based, fragmented industries. Full article

Inequities for Indigenous people in child protection systems are well established. One avenue for addressing these inequities is at the ‘front door’ of child protection, when reports are first made to statutory child protection services. This article reports on a formative evaluation of a shared decision-making forum in a small city in Aotearoa New Zealand, where a community Māori organisation meets to make initial decisions about reports together with the statutory agency. The aim is to improve information quality by bringing local, relational knowledge to the decision and provide a service response to those cases that are ‘closed’. The findings are that initial enablers were the policy context that emphasized community devolution, consensus on problems and aims, relationships between leaders in both organisations, and high community investment. Early challenges were a reluctance from some workers to engage in the process, lack of agreed processes, and fears of simply replicating the statutory agency in the community. Current enablers following a period of establishment were relationships of trust, the development of practice processes, commitment to review, increased information sharing, community location and leadership, and an alignment with practitioners’ values. Challenges were conflicts about moderate risk situations, lack of other key services, inconsistent attendance, and authority conflicts over legal mandates and information sharing practices, especially relating to high-acuity situations. The implications are that organisational, policy, and resourcing level changes and relationships from front-line workers to leaders are essential for moving institutional logics. Full article