Search Results (819)

Background/Objectives: Iron deficiency without anaemia (IDNA) is common in non-dialysis-dependent chronic kidney disease (CKD) and contributes to fatigue, reduced exercise tolerance, and impaired quality of life (QoL). While intravenous (IV) iron replacement is known to benefit anaemic patients, its role in IDNA remains uncertain. This study aimed to evaluate the impact of ferric derisomaltose (FDI) on patient-reported QoL outcomes in CKD patients with IDNA. Methods: This was a post hoc analysis of the double-blind, multicentre Iron and the Heart randomised controlled trial. Fifty-four participants with IDNA (ferritin < 100 µg/L or transferrin saturation < 20% and haemoglobin 110–150 g/L) and CKD stages G3b–G5 were randomised 1:1 to receive either 1000 mg FDI (n = 26) or placebo (n = 28). An additional 10 iron-replete CKD patients served as controls. SF-36v2 QoL surveys were collected at baseline, 1 month, and 3 months. Results: SF-36v2 scores declined across all domains, but deterioration was consistently milder in the FDI group. Role physical declined by 3% in the FDI group versus 12% with placebo and 4% in controls. Bodily pain improved by 2.8% with FDI but worsened by 1.5% in the placebo group. Mental health improved by 3.4 points with FDI and declined by 2.7 points in the placebo group, creating a 6.1-point separation. While differences did not reach statistical significance, likely due to small sample size, the consistent trends favour FDI. Conclusions: IV iron may attenuate QoL decline in non-dialysis-dependent CKD patients with IDNA. These findings support the need for larger, adequately powered trials to assess patient-centred outcomes in this population. Full article

Background/Objectives: Delayed gastric emptying (DGE) is a well-known complication of laparoscopic pylorus-preserving gastrectomy (LPPG). Patients who underwent LPPG in the KLASS-04 trial, which was a multicenter prospective randomized control trial comparing LPPG and laparoscopic distal gastrectomy (LDG), showed an unneglectable incidence of long-term DGE compared to patients who underwent LDG. This study aimed to identify the multifactorial risk factors associated with DGE and to analyze the quality of life (QoL) of patients with DGE following LPPG. Methods: DGE was defined as “nearly normal diet residue” at least once in the endoscopic follow-up at 1, 2, and 3 years after the surgery. Clinicopathological features, surgical outcomes, and QoL were compared between the DGE and non-DGE groups. Results: DGE was observed in 21/124 patients (16.3%) who underwent LPPG. Patients without previous abdominal surgery had a higher incidence of DGE in the univariate (32% vs. 4.8%, p = 0.011) and logistic regression analyses (odds ratio: 0.106, 95% confidence interval: 0.014–0.824, p = 0.032). Patients with DGE reported more symptoms of nausea and vomiting (p = 0.004), constipation (p = 0.04), and a dry mouth (p = 0.005). Conclusions: Despite the strict protocol used to avoid well-known risk factors for DGE, such as damage to the hepatic branch of the vagus nerve, infrapyloric artery and vein, and short antral cuff, the LPPG group of the KLASS-04 trial exhibited a considerable incidence of DGE. No clinicopathological or surgical factors, other than the absence of a previous surgical history, were identified as multifactorial risk factors for DGE. However, DGE had a negative impact on the QoL of patients. Full article

Network Music Performance (NMP) refers to network-based remote collaboration when applied to music performances, such as musical education, music production and live music concerts. In NMP, the most important parameter for the Quality of Experience (QoE) of the participants is low end-to-end audio delay. Increasing delays prevent musicians’ synchronization and lead to a suboptimal musical experience. Visual contact between the participants is also crucial for their experience but highly demanding in terms of bandwidth. Since audio compression induces additional coding and decoding delays on the signal path, most NMP systems rely on audio quality reduction when bandwidth is limited to avoid violating the stringent delay limitations of NMP. To assess the delay and quality tolerance limits for NMP and see if they can be satisfied by emerging 5G networks, we asked eleven pairs of musicians to perform musical pieces of their choice in a carefully controlled laboratory environment, which allowed us to set different end-to-end delays or audio sampling rates. To assess the QoE of these NMP sessions, each musician responded to a set of questions after each performance. The analysis of the musicians’ responses revealed that actual musicians in delay-controlled NMP scenarios can synchronize at delays of up to 40 ms, compared to the 25–30 ms reported in rhythmic hand-clapping experiments. Our analysis also shows that audio quality can be considerably reduced by sub-sampling, so as to save bandwidth without significant QoE loss. Finally, we find that musicians rely more on audio and less on video to synchronize during an NMP session. These results indicate that NMP can become feasible in advanced 5G networks. Full article

Private 5G networks offer exclusive, secure wireless communication with full control deployments for many clients, such as enterprises and campuses. In these networks, edge computing plays a critical role by hosting both application services and the User Plane Functions (UPFs) as containerized workloads close to end devices, reducing latency and ensuring stringent Quality of Service (QoS). However, edge environments often face resource constraints and unpredictable failures such as network disruptions or hardware malfunctions, which can severely affect the reliability of the network. In addition, existing redundancy-based UPF resilience strategies, which maintain standby instances, incur substantial overheads and degrade resource efficiency and scalability for the applications. To address this issue, this study introduces a novel design that enables quick detection of UPF failures and two failover mechanisms to restore failed UPF instances either within the cluster hosting the failed UPF or across multiple clusters, depending on that cluster’s resource availability and health. We implemented and evaluated our proposed approach on a Kubernetes-based testbed, and the results demonstrate that our approach reduces UPF redeployment time by up to 37% compared to baseline methods and lowers system cost by up to 50% under high-reliability requirements compared to traditional redundancy-based failover methods. These findings demonstrate that our design can serve as a complementary solution alongside traditional resilience strategies, offering a particularly cost-effective and resource-efficient alternative for edge computing and other constrained environments. Full article

Background: Sarcopenic obesity, characterized by reduced skeletal muscle mass and excess adiposity, is strongly associated with chronic pain and functional decline in older adults. Objective: This prospective controlled trial without randomization investigated the effects of a structured, three-phase rehabilitation program on physical performance, pain, and sarcopenia-specific quality of life in elderly patients with sarcopenic obesity and chronic pain. Methods: In this study, 82 participants were enrolled and allocated to a study group (SG, n = 40), receiving supervised rehabilitation, nutritional counseling, and supplementation, or to a control group (CG, n = 42), which did not receive rehabilitation. The final analysis included 35 patients in SG and 36 in CG. Outcomes were assessed at baseline and six months using the Sarcopenia Quality of Life Questionnaire (SarQoL), Short Physical Performance Battery (SPPB), Numeric Rating Scale (NRS), and Pressure Pain Threshold (PPT). Results: The SG showed significant improvements in all outcomes: SarQoL increased from 57.02 to 63.98, SPPB increased from 7.14 to 8.4, PPT increased from 69.31 to 78.05, and NRS decreased from 6.94 to 4.65 (all p < 0.001). The CG showed no significant changes. Conclusions: The implementation of a structured, three-phase rehabilitation program resulted in clinically and statistically significant improvements in physical performance, pain perception, and sarcopenia-related quality of life in older adults with sarcopenic obesity and chronic pain. Full article

Background/Objectives: Cochlear implants (CIs) and hearing aids (HAs) have enhanced auditory rehabilitation in elderly individuals, yet limitations in musical perception and psychosocial integration persist. This systematic review aimed to evaluate the effects of music therapy (MT) on the quality of life (QoL), self-esteem, auditory perception, and cognition in older CI and HA users. Methods: A comprehensive search of PubMed was conducted up to March 2022 following PRISMA guidelines. Studies involving participants aged ≥ 60 years with CIs and/or HAs were included. Ten studies (n = 21,632) met eligibility criteria. Data were extracted and assessed using the Newcastle–Ottawa Scale. Results: MT led to improved sound quality, with HISQUI19 scores rising from 60.0 ± 21.8 to 74.2 ± 27.5. Early MT exposure was associated with significantly better MUMU outcomes (p = 0.02). Bilateral CI users showed enhanced stereo detection (52% to 86%), and CI + HA users achieved CNC scores exceeding 95%. Postlingual CI users outperformed prelingual peers in musical discrimination (9.81 vs. 3.48; p < 0.001). Long-term HA use was linked to better a QoL and reduced loneliness. Conclusions: While music therapy appears to support auditory and psychosocial functioning in hearing-impaired older adults, the absence of randomized controlled trials limits causal inference regarding its effects. These results support its integration into hearing rehabilitation strategies for older adults. Full article

Efficient and intelligent spectrum access is crucial for meeting the diverse Quality of Service (QoS) demands of Vehicular Internet of Things (V-IoT) systems in next-generation cellular networks. This work proposes a novel reinforcement learning (RL)-based priority-aware spectrum management (RL-PASM) framework, a centralized self-learning priority-aware spectrum management framework operating through Roadside Units (RSUs). RL-PASM dynamically allocates spectrum resources across three traffic classes: high-priority (HP), low-priority (LP), and best-effort (BE), utilizing reinforcement learning (RL). This work compares four RL algorithms: Q-Learning, Double Q-Learning, Deep Q-Network (DQN), and Actor-Critic (AC) methods. The environment is modeled as a discrete-time Markov Decision Process (MDP), and a context-sensitive reward function guides fairness-preserving decisions for access, preemption, coexistence, and hand-off. Extensive simulations conducted under realistic vehicular load conditions evaluate the performance across key metrics, including throughput, delay, energy efficiency, fairness, blocking, and interruption probability. Unlike prior approaches, RL-PASM introduces a unified multi-objective reward formulation and centralized RSU-based control to support adaptive priority-aware access for dynamic vehicular environments. Simulation results confirm that RL-PASM balances throughput, latency, fairness, and energy efficiency, demonstrating its suitability for scalable and resource-constrained deployments. The results also demonstrate that DQN achieves the highest average throughput, followed by vanilla QL. DQL and AC maintain fairness at high levels and low average interruption probability. QL demonstrates the lowest average delay and the highest energy efficiency, making it a suitable candidate for edge-constrained vehicular deployments. Selecting the appropriate RL method, RL-PASM offers a robust and adaptable solution for scalable, intelligent, and priority-aware spectrum access in vehicular communication infrastructures. Full article

Digital Twins (DTs) are transforming manufacturing by bridging the physical and digital worlds, enabling real-time insights, predictive analytics, and enhanced decision making. In Industry 4.0, DTs facilitate automation and data integration, while Industry 5.0 emphasizes human-centric, resilient, and sustainable production. However, implementing DTs in robotic metal additive manufacturing (AM) remains challenging because of the complexity of the wire-based laser metal deposition (LMD) process, the need for real-time monitoring, and the demand for advanced defect detection to ensure high-quality prints. This work proposes a structured DT architecture for a robotic wire-based LMD cell, following a standard framework. Three DT implementations were developed. First, a real-time 3D simulation in RoboDK, integrated with a 2D Node-RED dashboard, enabled motion validation and live process monitoring via MQTT (message queuing telemetry transport) telemetry, minimizing toolpath errors and collisions. Second, an Industrial IoT-based system using KUKA iiQoT (Industrial Internet of Things Quality of Things) facilitated predictive maintenance by analyzing motor loads, joint temperatures, and energy consumption, allowing early anomaly detection and reducing unplanned downtime. Third, the Meltio dashboard provided real-time insights into the laser temperature, wire tension, and deposition accuracy, ensuring adaptive control based on live telemetry. Additionally, a prescriptive analytics layer leveraging historical data in FireStore was integrated to optimize the process performance, enabling data-driven decision making. Full article

Achieving global coverage and performance goals for 6G requires seamless integration of satellite and terrestrial networks, yet current operational frameworks lack common standards for managing these heterogeneous infrastructures. This paper addresses the critical need for unified satellite-terrestrial network operations by proposing the CMS framework, a novel task-scheduling-based approach that bridges the operational gap between satellite operations (SatOps) and network operations (NetOps). The framework integrates satellite-specific constraints with network service requirements and QoS metrics through constraint satisfaction programming and multi-objective optimization. Three novel architectures are introduced: integrated operations (embedding NetOps within SatOps), coordinated operations (unified control with separate execution channels), and adaptive operations (mutual adaptation through intelligent interfaces). Each architecture addresses different connectivity scenarios and integration requirements for both sporadic and persistent satellite constellations. The proposed architectures are evaluated against challenges spanning infrastructure and architecture, interoperability and standardization, integrated management, operational dynamics, and technology maturation and deployment. Validation through simulation demonstrates significant performance improvements, with task completion rates improving by 17.87% to 44.02% and data throughput gains of 25.09% to 93.62% compared to traditional approaches. The CMS framework establishes a resilient operational standard for future 6G networks, offering practical solutions to bridge the current divide between satellite and terrestrial network operations. Full article

Introduction: Unruptured intracranial aneurysms (UIAs) can induce psychological stress, leading to anxiety, depression, and impaired quality of life (QoL). Most studies on this topic are limited by small sample sizes, cross-sectional designs, and a focus on treated rather than untreated cases, leaving a gap in the literature. We aimed to conduct a systematic review and meta-analysis to evaluate mental health and QoL outcomes in patients with untreated UIAs. Methods: A systematic search was conducted up to 30 November 2024 using PubMed, Scopus, and Cochrane Central for studies comparing patients with untreated UIAs to a control group. The outcomes of interest included anxiety, depression, and QoL. Statistical analysis was performed using RevMan 5.1.7 and R 4.3.1. Heterogeneity was assessed using I² statistics and the Cochrane Q test. Risk ratios (RR) and standardized mean differences (SMD) were computed using a frequentist random-effects model. Results: We included five studies with 417,152 patients, of whom 85,668 (20.53%) had untreated UIAs. In the pooled analysis, patients with untreated UIAs had significantly higher anxiety levels (SMD 0.66; 95% CI [0.16; 1.17]; p = 0.01; I² = 76%) and lower QoL (SMD −0.82; 95% CI [−1.12; −0.53]; p = 0.01; I² = 56%) compared to the control group However, no statistically significant differences were found in depression (RR 0.94; 95% CI [0.52; 1.72]; p = 0.84; I² = 88%) between groups. Conclusions: This meta-analysis indicates a potential association between untreated UIAs and increased anxiety levels and reduced QoL. Regarding depression, no significant differences were observed between groups. Full article

Background and Objectives: This study explored the lived experiences of individuals with post-COVID condition (PCC) who participated in a 12-week exercise rehabilitation and recovery programme (PCCRRP) delivered by a professional football club community trust (FCCT). The aim was to understand the effects of the programme on physical function and quality of life (QoL). This study aims to address the gap in the literature of a lack of qualitative research exploring the experiences and perspectives of individuals engaging in exercise and physical activity as part of their recovery from PCC. Furthermore, it seeks to provide in-depth participant accounts to better understand outcome-level data. Methods: A qualitative approach was employed, involving semi-structured interviews with seven participants (mean age of 52 ± 8.54 years, with ages ranging from 45 to 60 years) following the 12-week PCCRRP to explore perceived changes in physical function and QoL. Thematic analysis was used to analyse the interview data, including participants’ narratives on their QoL experiences. Results: Participants reported improvements in exercise capacity, fatigue, and breathlessness, leading to enhanced physical function and QoL. They also experienced improvements in emotional well-being, including increased confidence and reduced anxiety. The programme’s focus on tailored exercise plans empowered participants to manage their symptoms and regain control over their lives. Conclusions: The PCCRRP delivered by an FCCT had positive effects on the physical function and QoL of individuals with PCC. This highlights the potential of FCCTs in providing effective rehabilitation and support for individuals with PCC. Full article

Background and Objectives: Heart failure (HF) represents a major public health challenge worldwide, with rising prevalence, high morbidity and mortality rates, and substantial healthcare costs. Non-invasive telemonitoring has emerged as a promising adjunct in HF management, yet its clinical effectiveness remains unclear. Materials and Methods: In this systematic review, we summarize randomized controlled trials (RCTs) between 2004 and 2024 examining the efficacy of non-invasive telemonitoring on mortality, readmission, and quality of life (QoL) in HF. In addition, we characterize the heterogeneity of features of different telemonitoring interventions. Results: In total, 32 RCTs were included, comprising 13,294 participants. While some individual studies reported benefits, non-invasive telemonitoring demonstrated mixed effects on mortality, readmission rates, and QoL. The most common modality for interfacing with patients was by mobile application (53%), followed by web portals (22%), and stand-alone devices (19%). Periodic feedback (63%) was more common than continuous feedback (31%) or on-demand feedback (6%). Clinician reviews of patient telemonitoring data was event-triggered (44%) more commonly than based on a prespecified timeline (38%). In most designs (90%), patients played a passive role in telemonitoring. Conclusions: Non-invasive telemonitoring interventions for HF exhibited considerable variation in duration and system design and had a low rate of patient engagement. Future work should focus on identifying telemonitoring-responsive subgroups and refining telemonitoring strategies to complement traditional HF care. Full article

Background/Objectives This systematic review and network meta-analysis aimed to determine the most effective therapeutic exercise modality for improving quality of life (QoL) in patients with advanced-stage cancer. Specifically, the study compared the effects of aerobic training, strength training, and combined aerobic and strength training on QoL outcomes. Methods A systematic literature search was conducted in PubMed, Embase, Cochrane Reviews, and the Cochrane Central Register of Controlled Trials up to 24 February 2023. The review adhered to PRISMA guidelines. Included studies were randomized controlled trials (RCTs) involving adult patients with advanced-stage cancers (e.g., pancreatic, colorectal, lung, breast, prostate, gastrointestinal, gynecological, hematological, head and neck, melanoma, or cancers with bone metastases). The primary outcome was post-intervention QoL, while the secondary outcome assessed was the dropout rate across exercise modalities. Results Aerobic training demonstrated the greatest improvement in QoL with a standardized mean difference (SMD) of 0.30 (95% CI: 0.00 to 0.61), followed by strength training (SMD = 0.13; 95% CI: −0.41 to 0.66) and combined training (SMD = 0.07; 95% CI: −0.11 to 0.24). However, none of the interventions showed statistically significant superiority. Dropout rates were comparable across all exercise modalities and control groups, suggesting strong adherence and feasibility of these interventions in advanced cancer populations. Conclusions While all exercise modalities were associated with improved QoL in patients with advanced-stage cancer, no single intervention emerged as significantly superior. Aerobic exercise may offer a slight advantage, although this effect was not statistically significant. These results highlight the importance of individualized exercise prescriptions based on patient preference, functional status, and treatment context. Further research is warranted to identify patient subgroups that may benefit most from specific exercise interventions and to explore QoL subdomains such as fatigue, emotional well-being, and physical functioning. Full article

Objective: A self-management telehealth program to improve hand strength and function in systemic sclerosis (SSc) patients may improve their quality of life, so we investigated its efficacy. Methods: A 6-week prospective randomized controlled study was conducted in adults with SSc with a hand mobility in scleroderma (HAMIS) score > 1 or a limited range of motion in at least one hand joint. Participants were randomly allocated into three groups for six weeks of health education: (a) typical education, (b) watching video guides as needed, in addition to typical education, and (c) watching video guides and receiving weekly telephone notifications, in addition to typical education. The endpoints were the differences in self-management behavior, HAMIS scores, hand grip strength (HGS), and quality of life (QoL) using the European Quality of Life-5 Dimensions between groups, as well as the changes in these parameters compared to baseline. Results: A total of 24 patients per group were enrolled, with the majority diagnosed with diffuse cutaneous SSc (79.2%). Six weeks post-intervention, HGS improved significantly in both the video guide and telephone notification groups compared to typical education in both hands (p = 0.028, p = 0.044). Pincer grip differed between the groups in the non-dominant hand. Household modifications were more frequent in the video guide and telephone notification groups than in the typical education group (p = 0.023). All groups showed significant improvements in HGS and HAMIS scores in both hands, as well as in self-management behaviors, compared to baseline. QoL, as measured using a visual analog scale, improved significantly after the intervention in both the video guide and telephone notification groups, but not in the typical education group. Conclusions: Self-management telehealth programs effectively enhance hand strength, function, and self-management behaviors in patients with SSc with limited hand function. Weekly telephone notifications further reinforced continuity and engagement in these patients. Full article

(1) Background: Quality of life (QoL) assessment is a crucial aspect for patients diagnosed with cancer. Over the years, different tools have been developed to measure QoL, both generic and pathology specific, but the inclusion of quality of life among other indicators of efficacy in randomized controlled trials (RCTs) remains a controversial issue. In this review, we aim to review the frequency and modality of QoL assessment in RCTs, enrolling patients diagnosed with mesenchymal tumors. (2) Methods: An electronic literature search of bone and soft tissue sarcoma and GIST-related RCTs published between January 2000 and December 2023 was performed by two independent reviewers using PubMed. English-language phase II and III clinical trials enrolling at least more than 15 patients were included, regardless of the disease stage. Studies involving patients under the age of 18 years or for which the full text was not available were excluded. For each study, data regarding the journal and year of publication, the study design, the primary objective, and the evaluation of quality of life as an endpoint with any type of patient-reported outcomes used were extracted. (3) Results: Among the 742 publications screened, 171 resulted eligible. QoL assessment was listed among the endpoints in 35 trials and QoL results were reported in 29 primary publications. In these trials, 16 included patients with soft tissue sarcomas, 8 Kaposi sarcomas, 6 GIST, and 3 desmoid tumors. Among all the trials included, 10.4% on an adjuvant/neoadjuvant setting and 24.4% on a metastatic setting included QoL as an endpoint. The proportion of trials, including QoL, was variable over time, as follows: 16.9% of trials in 2000–2014 vs. 23.4% in 2015–2023. In 35 trials, including QoL endpoints, 27 had a superiority design and 25 reported a positive result. In the majority of trials (80%), the tools for QoL assessment were generic and those mostly used were the EORTC QLQ-C30, the EQ-5D questionnaire, and the modified Brief Pain Inventory–Short Form. (4) Conclusions: Quality of life has not been assessed or published in many phase II and III trials, despite an improvement over time. QoL evaluation in RCTs should be considered even more carefully in patients with rare tumors, where the low number of patients who can be enrolled makes it difficult to draw statistically significant conclusions on the effectiveness of treatments. Full article