Search Results (1,335)

Opioid use disorder (OUD) is a chronic disease that remains difficult to treat, even with significant improvements in available medications. While current treatments work well for some, they often do not account for the unique needs of individual patients, leading to less-than-ideal results. Precision medicine offers a new path forward by tailoring treatments to fit each person’s genetic, psychological, and social needs. This review takes a close look at medications for OUD, including methadone, buprenorphine, and naltrexone, as well as long-acting options that may improve adherence and convenience. Beyond medications, the review highlights the importance of addressing mental health co-morbidities, trauma histories, and social factors like housing or support systems to create personalized care plans. The review also explores how emerging technologies, including artificial intelligence and digital health tools, can enhance how care is delivered. By identifying research gaps and challenges in implementing precision medicine into practice, this review emphasizes the potential to transform OUD treatment. A more individualized approach could improve outcomes, reduce relapse, and establish a new standard of care focused on recovery and patient well-being. Full article

Amid global environmental changes, urbanisation erodes nature connectedness, an important driver of pro-environmental behaviours and human well-being, exacerbating human-made risks like biodiversity loss and climate change. This study introduces a novel hybrid agent-based model (ABM), calibrated with historical urbanisation data, to explore how urbanisation, opportunity and orientation to engage with nature, and intergenerational transmission have shaped nature connectedness over time. The model simulates historical trends (1800–2020) against target data, with projections extending to 2125. The ABM revealed a significant nature connectedness decline with excellent fit to the target data, derived from nature word use in cultural products. Although a lifetime ‘extinction of experience’ mechanism refined the fit, intergenerational transmission emerged as the dominant driver—supporting a socio-ecological tipping point in human–nature disconnection. Even with transformative interventions like dramatic urban greening and enhanced nature engagement, projections suggest a persistent disconnection from nature through to 2050, highlighting locked-in risks to environmental stewardship. After 2050, the most transformative interventions trigger a self-sustaining recovery, highlighting the need for sustained, systemic policies that embed nature connectedness into urban planning and education. Full article

Background/Objectives: Despite advancements in surgery, esophagectomy remains one of the most challenging and complex gastrointestinal surgical procedures, burdened by significant perioperative morbidity and mortality rates, as well as high financial costs. Recognizing the need for standardized care provided by a multidisciplinary healthcare team, the EUropean PErioperative MEdical Networking (EUPEMEN) initiative developed a dedicated protocol for perioperative care of patients undergoing esophagectomy, aiming to enhance recovery, reduce morbidity, and homogenize care delivery across European healthcare systems. Methods: Developed through a multidisciplinary European collaboration of five partners, the protocol incorporates expert consensus and the latest scientific evidence. It addresses the entire perioperative pathway, from preoperative preparation to hospital discharge and postoperative recovery, emphasizing patient-centered care, risk mitigation, and early functional restoration. Results: The implementation of the EUPEMEN esophagectomy protocol is expected to improve patient outcomes through a day-by-day structured prehabilitation plan, meticulous intraoperative management, and proactive postoperative rehabilitation. The approach promotes reduced postoperative complications, earlier return to oral intake, and shorter hospital stays, while supporting multidisciplinary coordination. Conclusions: The EUPEMEN protocol for esophagectomy provides a comprehensive guideline framework for optimizing perioperative care in esophageal surgery. In addition, it serves as a practical guide for healthcare professionals committed to advancing surgical recovery and standardizing clinical practice across diverse care environments across Europe. Full article

The increased occurrence and severity of cyber-attacks on critical infrastructure have underscored the need to embrace systematic and prospective approaches to resilience. The current research takes as its hypothesis that the InfraGuard Cybersecurity Framework—a capability model that measures the maturity of cyber resilience through three functional pillars, Cyber as a Shield, Cyber as a Space, and Cyber as a Sword—is an implementable and understandable means to proceed with. The model treats the significant aspects of situational awareness, active defense, risk management, and recovery from incidents and is measured using globally standardized maturity models like ISO/IEC 15504, NIST CSF, and COBIT. The contributions include multidimensional measurements of resilience, a scored scale of capability (0–5), and domain-based classification enabling organizations to assess and enhance their cybersecurity situation in a formalized manner. The framework’s applicability is illustrated in three exploratory settings of power grids, healthcare systems, and airports, each constituting various levels of maturity in resilience. This study provides down-to-earth recommendations to policymakers through the translation of the attributes of resilience into concrete assessment indicators, promoting policymaking, investment planning, and global cyber defense collaboration. Full article

With the continuous development of the Internet, people have put forward higher requirements for the stability and availability of the network. Although we constantly strive to take measures to avoid network failures, it is undeniable that network failures are unavoidable. Therefore, in this situation, enhancing the stability and reliability of the network to cope with possible network failures has become particularly crucial. Therefore, researching and developing high fault protection rate intra-domain routing protection schemes has become an important topic and is the subject of this study. This study aims to enhance the resilience and service continuity of networks in the event of failures by proposing innovative routing protection strategies. The existing methods, such as Loop Free Alternative (LFA) and Equal Cost Multiple Paths (ECMP), have some shortcomings in terms of fast fault detection, fault response, and fault recovery processes, such as long fault recovery time, limitations of routing protection strategies, and requirements for network topology. In response to these issues, this article proposes a new routing protection scheme, which is an intra-domain routing protection scheme based on the minimum cross-degree backup path. The core idea of this plan is to find the backup path with the minimum degree of intersection with the optimal path, in order to avoid potential fault areas and minimize the impact of faults on other parts of the network. Through comparative analysis and performance evaluation, this scheme can provide a higher fault protection rate and more reliable routing protection in the network. Especially in complex networks, this scheme has more performance and protection advantages than traditional routing protection methods. The proposed scheme in this paper exhibits a high rate of fault protection across multiple topologies, demonstrating a fault protection rate of 1 in the context of real topology. It performs commendably in terms of path stretch, evidenced by a figure of 1.06 in the case of real topology Ans, suggesting robust path length control capabilities. The mean intersection value is 0 in the majority of the topologies, implying virtually no common edge between the backup and optimal paths. This effectively mitigates the risk of single-point failure. Full article

As part of the post-conflict reconstruction and recovery, the development of Kabul New City aims to bring relief to the existing capital city, Kabul, which has experienced exponential population growth, putting heavy pressure on its existing resources. Kabul New City is divided into four subsectors, and each of them is being developed and is expected to reach a target population by 2025, as defined by the master plan. The study’s objective is to determine which of the four zones are in demand and need to be prioritized for development, as per the model results. The data collection involves an online questionnaire, and the responses are collected from residents of Kabul and Herat. Agent-based modeling (ABM) is an emerging method of simulating urban dynamics. Cities are evolving continuously and are forming unique spatial patterns that result from the movement of residents in search of new locations that accommodate their needs and preferences. An agent-based model is developed using the weighted random selection process based on household size and income levels. The agents are the residents of Kabul and Herat, and the environment is the land use classification image using the Sentinel 2 image of Kabul New City. The barren class is treated as the developable area and is divided into four sub-sectors. The model simulates three alternative growth rate scenarios, i.e., ambitious, moderate, and steady. The results of the simulation reveal that the sub-sector Dehsabz South, being closer to Kabul city, is in higher demand. Barikab is another sub-sector high in demand, which has connectivity through the highway and is an upcoming industrial hub. Full article

Background/Objectives: Nerve injuries cause functional loss and psychosocial issues due to prolonged rehabilitation. Recently, 3D-modeled nerve conduits have been used to aid in surgical planning. This study investigated the impact of 3D-bioprinted PLA, chitosan, alginate, and collagen conduits on nerve regeneration in a rat sciatic nerve crush injury model. Methods: This study, conducted at Kütahya University of Health Sciences, involves 50 rats were divided into four groups: (1) sham-operated controls, (2) sciatic nerve injury without treatment, (3) injury treated with a PLA conduit, and (4) injury treated with 3D-printed tubes composed of chitosan and alginate. The procedures were performed, blood was collected, and the rats were sacrificed after two months. Weekly checks for infection, scar healing, and motor responses were performed. Results: Rats with nerve conduits showed less macroscopic scarring. Weekly assessments of motor nerve recovery showed no movement restrictions in limbs treated with PLA conduits, graft conduits, or conduits bridging retracted nerve stumps, based on responses to stimulus checks. An infection developed in the sciatic nerve and surrounding muscle tissue of one rat with a bio-graft conduit, prompting histopathological examination to investigate its cause. Conclusions: This proof-of-principle study demonstrates the feasibility of using 3D-printed biocompatible nerve conduits for peripheral nerve repair, providing a basis for future, more comprehensive investigations. Full article

Background/Objectives: Successful discourse relies not only on linguistic but also on prosodic information. Difficulty recognizing emotion conveyed through prosody (receptive affective aprosodia) following right hemisphere stroke (RHS) significantly disrupts communication participation and personal relationships. Growing evidence suggests that damage to white matter in addition to gray matter structures impairs affective prosody recognition. The current study investigates lesion–symptom associations in receptive affective aprosodia during RHS recovery by assessing whether disruptions in distinct white matter structures impact different underlying affective prosody recognition skills. Methods: Twenty-eight adults with RHS underwent neuroimaging and behavioral testing at acute, subacute, and chronic timepoints. Fifty-seven healthy matched controls completed the same behavioral testing, which comprised tasks targeting affective prosody recognition and underlying perceptual, cognitive, and linguistic skills. Linear mixed-effects models and multivariable linear regression were used to assess behavioral performance recovery and lesion–symptom associations. Results: Controls outperformed RHS participants on behavioral tasks earlier in recovery, and RHS participants’ affective prosody recognition significantly improved from acute to chronic testing. Affective prosody and emotional facial expression recognition were affected by external capsule and inferior fronto-occipital fasciculus lesions while sagittal stratum lesions impacted prosodic feature recognition. Accessing semantic representations of emotions implicated the superior longitudinal fasciculus. Conclusions: These findings replicate previously observed associations between right white matter tracts and affective prosody recognition and further identify lesion–symptom associations of underlying prosodic recognition skills throughout recovery. Investigation into prosody’s behavioral components and how they are affected by injury can help further intervention development and planning. Full article

Background: Measuring frequencies of antigen-specific memory B cells (B_mem), their immunoglobulin (Ig) class and subclass usage, cross-reactivity, and affinity can provide insights into the efficacy of future antibody responses in case of antigen re-encounter. B cell ImmunoSpot^® assays can provide such information; however, like most cell-based tests, they require considerable amounts of blood to be drawn from the donor and this has hindered their inclusion in clinical trials and routine immune diagnostics. Methods: We introduce strategies for reducing the cell numbers required to 2–3 million peripheral blood mononuclear cells (PBMCs) per antigen, obtainable from 2–3 mL of blood from healthy adult donors. Results: Except when B_mem frequencies were very low, we found that testing PBMCs in singlet wells, but in serial dilution, enables as reliable B_mem frequency assessments as when testing replicate wells at a single fixed cell number. Additionally, B cell ImmunoSpot^® assays can be multiplexed for detecting four Ig classes, or IgG subclasses, simultaneously and without loss of sensitivity. The requirement for low cell numbers and the retention of B cell functionality by cryopreserved PBMCs equivalent to freshly isolated material implies that fewer than the standard 10 million PBMCs per vial can be frozen. This would reduce the number of individuals who could not be tested for B_mem due to insufficient availability of PBMCs, a common problem with such assays. Conclusions: The predictable need for and recovery of cryopreserved PBMCs facilitates planning of and optimal cell utilization in B cell ImmunoSpot^® assays and increases the practical feasibility of extensive B_mem characterization in larger cohorts. Full article

Background/Objectives: Cerebral hemorrhage (CH) has physical, cognitive, and emotional consequences. Recovery requires a complex rehabilitation process in which coping strategies play a fundamental role in supporting psychological adaptation. The aim of this study is to investigate and understand the extent and manner in which coping strategies have been assessed in the CH population within the scientific literature. Methods: Studies were identified through searches in the PubMed, Scopus, and Embase databases. Eight studies published between 2014 and 2024 were selected. Results: The most frequently adopted coping strategies include task-oriented coping, avoidance, emotion-focused coping, acceptance, planning, and emotional support. Task-oriented strategies and acceptance are associated with better psychological outcomes. Conversely, avoidant and emotion-focused strategies correlate with higher levels of anxiety, depression, and poorer adaptation. Resilience and social participation emerge as protective factors. Finally, Action/Distraction is associated with a better quality of life, while Trivialization/Resignation is linked to lower levels. Conclusions: Coping seems to represent a modifiable, patient-centered lever that can mitigate the psychosocial sequelae of intracranial hemorrhage when assessed systematically and addressed through tailored rehabilitation programs. Our findings lay the groundwork for evidence-based, coping-focused interventions and highlight critical avenues for future longitudinal and mechanistic research. Full article

Background: Stroke recovery is influenced not only by clinical but also sociodemographic factors (SDFs). However, data on how variables such as age, sex, marital status, education, and employment status affect rehabilitation outcomes remain limited, particularly in structured inpatient settings. This study aimed to analyze the impact of key SDFs on functional recovery after stroke. Methods: A retrospective cohort of 289 stroke patients undergoing structured inpatient rehabilitation was analyzed. Functional status was assessed at admission, after three weeks, and at discharge using five standardized outcomes: gait speed (primary outcome), Barthel Index, Berg Balance Scale, Action Research Arm Test, and Ashworth scale. Repeated measures ANOVA and multivariable logistic regression were used to evaluate within-subject changes and associations with SDFs. Results: The cohort consisted predominantly of middle-aged to older adults (58% female, 62% married, 60% retired, 60% with primary education or less). Most patients (88%) had ischemic strokes of moderate severity. Significant improvements were observed across all functional measures. Employed, married, younger, and male patients achieved better outcomes. Interaction models indicated that older and female patients with moderate stroke severity demonstrated greater improvement than younger and male counterparts with milder strokes. Mean gait speed increased by +0.32 m/s, exceeding the minimal clinically important difference (MCID) of 0.16 m/s. Conclusions: Age, sex, marital status, education, and employment status are relevant predictors of stroke rehabilitation outcomes. These findings emphasize the importance of incorporating sociodemographic profiles into individualized rehabilitation planning to optimize functional recovery and reduce disparities among stroke survivors. 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

Using innovative and sustainable materials has become crucial for developed countries. Reusing waste as a secondary raw material in industrial processes central to the circular economy could enhance environmental sustainability and support local economies. Building materials such as Portland cement have a significant environmental impact due to greenhouse gas emissions and construction and demolition waste (CDW), which is challenging to recycle. Research into sustainable alternatives is, therefore, essential. The European Union has set ambitious targets to reduce greenhouse gas emissions by 55% by 2030 and achieve climate neutrality by 2050. The National Recovery and Resilience Plan (PNRR) supports the green transition in Italy by promoting sustainable materials like geopolymers. These ceramic-like materials are based on aluminosilicates obtained through the chemical activation of waste rich in silica and aluminosilicate compounds. Though promising, these materials require further research to address challenges like long-term durability and chemical variability. Collaboration between scientific research and industry is essential to develop specific protocols and suitable infrastructures. This article provides a critical review of the advancements and challenges in using alkali-activated waste as construction binders, focusing on Italy, and encourages the exploration of alternative sustainable materials beyond conventional Portland cement. Full article

This survey provides a comprehensive review of the integration of large language models (LLMs) into autonomous robotic systems, organized around four key pillars: locomotion, navigation, manipulation, and voice-based interaction. We examine how LLMs enhance robotic autonomy by translating high-level natural language commands into low-level control signals, supporting semantic planning and enabling adaptive execution. Systems like SayTap improve gait stability through LLM-generated contact patterns, while TrustNavGPT achieves a 5.7% word error rate (WER) under noisy voice-guided conditions by modeling user uncertainty. Frameworks such as MapGPT, LLM-Planner, and 3D-LOTUS++ integrate multi-modal data—including vision, speech, and proprioception—for robust planning and real-time recovery. We also highlight the use of physics-informed neural networks (PINNs) to model object deformation and support precision in contact-rich manipulation tasks. To bridge the gap between simulation and real-world deployment, we synthesize best practices from benchmark datasets (e.g., RH20T, Open X-Embodiment) and training pipelines designed for one-shot imitation learning and cross-embodiment generalization. Additionally, we analyze deployment trade-offs across cloud, edge, and hybrid architectures, emphasizing latency, scalability, and privacy. The survey concludes with a multi-dimensional taxonomy and cross-domain synthesis, offering design insights and future directions for building intelligent, human-aligned robotic systems powered by LLMs. Full article

Background: Nutritional disorders may affect short-term recovery after major orthopaedic surgery, but evidence is lacking. This study assessed whether and how different nutritional disorders diagnosed at admission could influence early recovery after hip replacement. Methods: A prospective analytical study was designed to include 60 patients scheduled for elective primary hip replacement and assess their nutritional status to diagnose 5 malnutrition phenotypes: undernutrition, sarcopenia, obesity, sarcopenic obesity, and sarcopenic undernutrition. Outcome measures were 24 h change in neutrophils, 72 h change in haemoglobin, and 10-day gait speed regain. Results: Haemoglobin reached the nadir at day 2–3 and partially recovered by day 10 in all patients, with sarcopenia and undernutrition being the strongest predictors of the postoperative drop (−2.37 g∙dL⁻¹ and −0.80 g∙dL⁻¹, p < 0.05). Neutrophils peaked immediately after surgery and returned to baseline levels at discharge, with sarcopenic undernutrition displaying a blunted response after surgery (−16.20%, p < 0.01). Undernutrition was found to be the most influential preoperative variable on gait speed recovery, but with a marginal effect. None of the patients covered the reference energy and protein needs through diet in the 10 postoperative days. Conclusions: In this cohort, nutritional disorders with reduced body function and reserves (sarcopenia and undernutrition) grounded a greater vulnerability to surgery in terms of early stress response and short-term recovery. This calls for both advanced planning of nutritional prehabilitation strategies for these conditions and adequate postoperative nutritional support. Full article