Search Results (5,081)

Anxiety and depression are common comorbidities in patients with chronic obstructive pulmonary disease (COPD), which can contribute to increased morbidity, reduced quality of life, and worse clinical outcomes. Nevertheless, these psychological conditions remain largely overlooked. This narrative review includes studies published between 1983 and 2025 to synthesise the current evidence on the risk factors, clinical impacts, and therapeutic strategies for these comorbidities. While the exact mechanisms leading to their increased prevalence are not fully understood, growing evidence implicates a combination of biological (e.g., systemic inflammation), social (e.g., isolation and stigma), and behavioural (e.g., smoking and inactivity) factors. Despite current guidelines recommending the identification and management of these comorbidities in COPD, they are not currently included in COPD assessments. Undetected and unmanaged anxiety and depression have serious consequences, including poor self-management, non-adherence to medications, increased risk of exacerbation and hospitalisations, and even mortality; thus, there is a need to incorporate screening as part of COPD assessments. There is robust evidence showing that pulmonary rehabilitation, a core non-pharmacological intervention, can improve mood symptoms, enhance functional capacity, and foster psychosocial resilience. Psychological therapies such as cognitive behavioural therapy (CBT), mindfulness-based approaches, and supportive counselling have also demonstrated value in reducing emotional distress and improving coping mechanisms. Pharmacological therapies, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs), are commonly prescribed in moderate to severe cases or when non-pharmacological approaches prove inadequate. However, the evidence for their efficacy in COPD populations is mixed, with concerns about adverse respiratory outcomes and high discontinuation rates due to side effects. There are also barriers to optimal care, including underdiagnosis, a lack of screening protocols, limited provider training, stigma, and fragmented multidisciplinary coordination. A multidisciplinary, biopsychosocial approach is essential to ensure early identification, integrated care, and improved outcomes for patients with COPD. Full article

Concrete cracks and sulfate degradation severely compromise structural durability, highlighting the need for sustainable solutions to enhance longevity and minimize environmental impact. This study assesses the efficacy of bacterial self-healing technology utilizing Bacillus megaterium (BM) and Bacillus sphaericus (BS) in enhancing the resistance of concrete to sulfate attacks and improving its mechanical properties. Bacterial suspensions (1% and 2.5% of cement weight) were mixed with concrete containing silica fume or fly ash (10% of cement weight) and cured in freshwater or sulfate solutions (2%, 5%, and 10% concentrations). Specimens were tested for compressive strength, flexural strength, and microstructure using a Scanning Electron Microscope (SEM), Energy-Dispersive X-ray Spectroscopy (EDS), and X-ray diffraction (XRD) at various ages. The results indicate that a 2.5% bacterial content yielded the best performance, with BM surpassing BS, enhancing compressive strength by up to 41.3% and flexural strength by 52.3% in freshwater-cured samples. Although sulfate exposure initially improved early-age strength by 1.97% at 7 days, it led to an 8.5% loss at 120 days. Bacterial inclusion mitigated sulfate damage through microbially induced calcium carbonate precipitation (MICP), sealing cracks, and bolstering durability. Cracked specimens treated with BM recovered up to 93.1% of their original compressive strength, promoting sustainable, sulfate-resistant, self-healing concrete for more resilient infrastructure. Full article

DIALOGUE (DIagnostic AI Learning through Objective Guided User Experience) is a generative artificial intelligence (GenAI)-based training program designed to enhance diagnostic communication skills in medical students. In this single-arm pre–post study, we evaluated whether DIALOGUE could improve students’ ability to disclose a type 2 diabetes mellitus (T2DM) diagnosis with clarity, structure, and empathy. Thirty clinical-phase students completed two pre-test virtual encounters with an AI-simulated patient (ChatGPT, GPT-4o), scored by blinded raters using an eight-domain rubric. Participants then engaged in ten asynchronous GenAI scenarios with automated natural-language feedback. Seven days later, they completed two post-test consultations with human standardized patients, again evaluated with the same rubric. Mean total performance increased by 36.7 points (95% CI: 31.4–42.1; p < 0.001), and the proportion of high-performing students rose from 0% to 70%. Gains were significant across all domains, most notably in opening the encounter, closure, and diabetes specific explanation. Multiple regression showed that lower baseline empathy (β = −0.41, p = 0.005) and higher digital self-efficacy (β = 0.35, p = 0.016) independently predicted greater improvement; gender had only a marginal effect. Cluster analysis revealed three learner profiles, with the highest-gain group characterized by low empathy and high digital self-efficacy. Inter-rater reliability was excellent (ICC ≈ 0.90). These findings provide empirical evidence that GenAI-mediated training can meaningfully enhance diagnostic communication and may serve as a scalable, individualized adjunct to conventional medical education. Full article

Serious games that integrate educational content with engaging gameplay mechanics hold promise for reducing cognitive load and increasing student motivation in STEM and health science education. This preliminary study presents the development and evaluation of the Medimon NASA Demo, a game-based learning prototype designed to teach undergraduate students about the musculoskeletal and visual systems—two critical domains in space medicine. Participants (n = 23) engaged with the game over a two-week self-regulated learning period. The game employed mnemonic-based characters, visual storytelling, and turn-based battle mechanics to reinforce medical concepts. Quantitative results demonstrated significant learning gains, with posttest scores increasing by an average of 23% and a normalized change of c = 0.4. Engagement levels were high across multiple dimensions of situational interest, and 74% of participants preferred the game over traditional formats. Qualitative analysis of open-ended responses revealed themes related to intrinsic appeal, perceived learning efficacy, interaction design, and cognitive resource management. While the game had minimal impact on short-term STEM career interest, its educational potential was clearly supported. These findings suggest that mnemonic-driven serious games like Medimon can effectively enhance engagement and learning in health science education, especially when aligned with real-world contexts such as space medicine. Full article

Background: Exposure-based cognitive behavioral therapy (Ex-CBT) is widely seen as the gold-standard treatment for anxiety and obsessive-compulsive disorder (OCD). Yet, minoritized youth are underrepresented in efficacy studies, raising questions about the applicability of Ex-CBT to minoritized youth. Effectiveness data suggest systematic adaptation of Ex-CBT to address youth culture and context is likely needed, and many clinicians make adaptations and augmentations in practice. However, research on the specific strategies clinicians use to address their youth clients’ culture and context within anxiety and OCD treatment is lacking. In the current study, we assess practice-based adaptations, augmentations, and process-based approaches utilized when delivering treatment to youth for OCD and anxiety in public mental health clinics. Methods: We conducted qualitative interviews with 16 clinicians from both specialty anxiety and general mental health clinics serving youth with anxiety or OCD in the public mental health system. Participating clinicians had a mean age of 32.19 (SD = 5.87) and 69% of therapists identified as female; 69% identified as White, 25% identified as Asian, and 6% as Black or African American. In qualitative interviews, clinicians shared how they addressed clients’ culture and context (e.g., social identities, stressors and strengths related to social identities and lived environment). Thematic analysis identified the strategies clinicians employed to address culture and context. Results: Clinicians reported incorporating culture and context through process-based approaches (e.g., building trust gradually, considering clients’ social identity stressors, engaging in self-awareness to facilitate cultural responsiveness) and through culturally adapting and augmenting treatment to promote person-centered care. Core strategies included proactive and ongoing assessment of clients’ cultural and contextual factors, adapting exposures and augmenting Ex-CBT with strategies such as case management and discussion of cultural context, and taking a systems-informed approach to care. Conclusions: Examining practice-based adaptations, augmentations, and process-based approaches to treatment for minoritized youth with OCD or anxiety can inform efforts to understand what comprises person-centered culturally responsive Ex-CBT. Empirical testing of identified strategies is a needed area of future research. Full article

Armed conflict poses a significant threat to the mental health of youth worldwide. This study focused on the role of teachers as protective agents fostering resilience among their students. The study examined the moderating effects of teachers’ personal well-being and their efficacy in the school on relations between their students’ armed conflict exposure and student psychiatric symptoms. Participants included 1260 students and their homeroom teachers from 62 8–11th grade classes. Using self-report standardized measures, teachers reported their life satisfaction and sense of efficacy while students reported their armed conflict exposure and psychiatric symptoms. Data were analyzed using a multilevel modeling (MLM) approach. Findings revealed positive correlations between student armed conflict exposure and psychiatric symptoms. In the between-class level of analysis, teacher personal life satisfaction and efficacy in participation in the school system emerged as protective factors for the students, significantly moderating relations between student exposure and their psychiatric symptoms. However, teacher efficacy in class management showed no significant moderating effect on student mental-health difficulties. Results highlight the importance of supporting teachers in conflict-affected environments and emphasize the need for preventive and therapeutic initiatives that prioritize teacher well-being and organizational resources to enhance teachers’ capacity to foster student resilience. Full article

Background/Objective: Nursing and non-nursing students experience high stress levels, making them susceptible to mental health issues. This study compared stress, anxiety, and depression between these two groups after 2 years of the COVID-19 pandemic. Additionally, it explored the relationship between perceived helplessness, self-efficacy, and symptoms of mental stress and strain resulting from challenging internship conditions for nursing students. Methods: This cross-sectional study included 154 nursing students (mean age = 22.43 years) and 291 non-nursing students (mean age = 27.7 years). Data were collected using the Depression Anxiety Stress Scales (DASS-21), Perceived Stress Scale-10 (PSS-10), and a questionnaire on mental stress and strain. Results: Nursing students reported significantly higher scores in the DASS-21 subscales depression (ηp² = 0.016) and anxiety (ηp² = 0.037), and global stress (PSS-10; ηp² = 0.029) compared to non-nursing students, but no significant difference on the DASS-21 Stress subscale. The observed group differences in the present study may be partially attributed to group differences in demographic factors. Helplessness correlated strongly with nearly all scales of mental stress and strain during internships (all p’s < 0.001), while self-efficacy showed a strong negative correlation with non-occupational difficulties, health impairment, and emotional problems (all p’s < 0.001). Conclusions: Nursing students experience elevated depression, anxiety, and perceived stress levels compared to non-nursing students. Stronger feelings of helplessness and lower confidence in their ability to overcome challenges were strongly correlated with mental stress and strain during clinical training. Targeted interventions such as cognitive behavioral training and stress management should be integrated into nursing curricula to enhance resilience and coping strategies. Full article

Background/Objective: Staphylococcus aureus (S. aureus) is a clinically significant pathogenic bacterium. Daptomycin (DAP) is a cyclic lipopeptide antibiotic used to treat infections caused by multidrug-resistant Gram-positive bacteria, including S. aureus. However, DAP currently faces clinical limitations due to its short half-life, toxic side effects, and increasingly severe drug resistance issues. This study aimed to develop a biomimetic nano-drug delivery system to enhance targeting ability, prolong blood circulation, and mitigate resistance of DAP. Methods: DAP-loaded chitosan nanocomposite particles (DAP-CS) were prepared by electrostatic self-assembly. Macrophage membrane vesicles (MM) were prepared by fusion of M1-type macrophage membranes with 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC). A biomimetic nano-drug delivery system (DAP-CS@MM) was constructed by the coextrusion process of DAP-CS and MM. Key physicochemical parameters, including particle diameter, zeta potential, encapsulation efficiency, and membrane protein retention, were systematically characterized. In vitro immune escape studies and in vivo zebrafish infection models were employed to assess the ability of immune escape and antibacterial performance, respectively. Results: The particle size of DAP-CS@MM was 110.9 ± 13.72 nm, with zeta potential +11.90 ± 1.90 mV, and encapsulation efficiency 70.43 ± 1.29%. DAP-CS@MM retained macrophage membrane proteins, including functional TLR2 receptors. In vitro immune escape assays, DAP-CS@MM demonstrated significantly enhanced immune escape compared with DAP-CS (p < 0.05). In the zebrafish infection model, DAP-CS@MM showed superior antibacterial efficacy over both DAP and DAP-CS (p < 0.05). Conclusions: The DAP-CS@MM biomimetic nano-drug delivery system exhibits excellent immune evasion and antibacterial performance, offering a novel strategy to overcome the clinical limitations of DAP. Full article

Ternary chalcogenide-based sulfide materials with distorted morphologies such as BaZrS₃, CaZrS₃, and SrZrS₃, have recently gained much attention in optoelectronics and photovoltaics due to their high structural and thermal stability and compatibility with low-cost, earth-abundant synthesis routes. However, their relatively large bandgaps often limit their suitability for near-infrared (NIR) photodetectors. Here, we conducted a comprehensive investigation of SrHfSe₃, a ternary chalcogenide with an orthorhombic crystal structure and distinctive needle-like morphology, as a promising candidate for NIR photodetection. SrHfSe₃ exhibits a direct bandgap of 1.02 eV, placing it well within the NIR range. Its robust structure, high temperature stability, phase stability and natural abundance make it a compelling material for next-generation, self-powered NIR photodetectors. An in-depth analysis of the SrHfSe₃-based photodetector was performed using SCAPS-1D simulations, focusing on key performance metrics such as J–V behavior, photoresponsivity, and specific detectivity. Device optimization was achieved by thoroughly altering each layer thickness, doping concentrations, and defect densities. Additionally, the influence of interface defects, absorber bandgap, and operating temperature was assessed to enhance the photoresponse. Under optimal conditions, the device achieved a short-circuit current density (Jsc) of 45.88 mA/cm², an open-circuit voltage (Voc) of 0.7152 V, a peak photoresponsivity of 0.85 AW⁻¹, and a detectivity of 2.26 × 10¹⁴ Jones at 1100 nm. A broad spectral response spanning 700–1200 nm confirms its efficacy in the NIR region. These results position SrHfSe₃ as a strong contender for future NIR photodetectors and provide a foundation for experimental validation in advanced optoelectronic applications. Full article

Addressing global challenges such as climate change and inequality requires convergence competencies that enable learners to devise sustainable solutions. Such competencies have been emphasized in Science, Technology, Engineering, Mathematics (STEM) fields, but empirical research and assessment tools tailored to Humanities, Arts, and Social Sciences (HASS) remain scarce. This study aimed to develop and validate a self-assessment tool to measure convergence competencies among HASS learners. A three-round Delphi survey with domain experts was conducted to evaluate and refine an initial pool of items. Items with insufficient content validity were revised or deleted, and all retained items achieved a Content Validity Ratio (CVR) of ≥0.800, with most scoring 1.000. The validated instrument was administered to 455 undergraduates participating in a convergence education program. Exploratory factor analysis identified five key dimensions: Convergent Commitment, Future Problem Awareness, Future Efficacy, Convergent Learning, and Multidisciplinary Inclusiveness, explaining 69.72% of the variance. Confirmatory factor analysis supported the model’s goodness-of-fit (χ² (160) = 378.786, RMSEA = 0.054, CFI = 0.952), and the instrument demonstrated high internal consistency (Cronbach’s α = 0.919). The results confirm that the tool is both reliable and valid for diagnosing convergence competencies in HASS contexts, providing a practical framework for interdisciplinary learning and reflective engagement toward sustainable futures. Full article

The Statistics Anxiety Rating Scale (STARS) is a 51-item scale commonly used to measure college students’ anxiety regarding statistics. To date, however, limited empirical research exists that examines statistics anxiety among ethnically diverse or first-generation graduate students. We examined the factor structure and reliability of STARS scores in a diverse sample of students enrolled in graduate courses at a Minority-Serving Institution (n = 194). To provide guidance on assessing dimensionality in small college samples, we compared the performance of best-practice factor analysis techniques: confirmatory factor analysis (CFA), exploratory structural equation modeling (ESEM), and Bayesian structural equation modeling (BSEM). We found modest support for the original six-factor structure using CFA, but ESEM and BSEM analyses suggested that a four-factor model best captures the dimensions of the STARS instrument within the context of graduate-level statistics courses. To enhance scale efficiency and reduce respondent fatigue, we also tested and found support for a reduced 25-item version of the four-factor STARS scale. The four-factor STARS scale produced constructs representing task and process anxiety, social support avoidance, perceived lack of utility, and mathematical self-efficacy. These findings extend the validity and reliability evidence of the STARS inventory to include diverse graduate student populations. Accordingly, our findings contribute to the advancement of data science education and provide recommendations for measuring statistics anxiety at the graduate level and for assessing construct validity of psychometric instruments in small or hard-to-survey populations. Full article

Background and Objectives: Transcatheter heart valve (THV) selection is challenging as self-expanding valves (SEVs) are associated with lower post-procedural mean aortic gradients, while balloon-expandable valves (BEVs) have lower rates of paravalvular leak (PVL) and permanent pacemaker implantation (PPI). We aimed to compare the 30-day and 1-year outcomes following Myval BEV (Meril Life Sciences, Vapi, Gujarat, India) and intra-annular Portico SEV (Abbott, St. Paul, MN, USA) implantation. Materials and Methods: We retrospectively analyzed the data from the all-comer TAVI registry of the University Medical Centre Ljubljana, Slovenia, from October 2017 to August 2023. Safety and efficacy outcomes following Myval BEV and Portico SEV implantation were compared overall and after propensity score matching. Results: Of the total 1152 THVs implanted, 97 patients (8%) received a Myval BEV and 47 (4%) a Portico SEV. After propensity score matching, there were no significant differences between the two patient cohorts regarding 30-day (Myval 0.0% vs. Portico 2.9%, p = 1.000) and 1-year mortality (Myval 0.0% vs. Portico 5.9%, p = 0.492). Likewise, the rates of new PPI, device failure (mean aortic gradient and more than mild PVL), and periprocedural in-hospital complications were comparable between the two groups. Conclusions: In this retrospective analysis of two intra-annular THVs, the Myval BEV was associated with comparable short- and mid-term outcomes as the Portico SEV. Full article

Low uptake of pre-exposure prophylaxis (PrEP) for HIV prevention among Black women has been partly attributed to barriers related to patient-provider communication. The goal of this paper was to investigate the association between exposure to the #ShesWell campaign and Black women’s communication about PrEP with a healthcare provider (HCP). We conducted a cross-sectional survey of 403 sexually active, Black women after the initial phase of #ShesWell and used multivariable regression models to analyze whether exposure to #ShesWell was associated with talking to an HCP about PrEP or intention to discuss PrEP with an HCP in the future. Approximately 33% of women surveyed reported exposure to #ShesWell. Campaign exposure was significantly associated with talking to an HCP in the past year about PrEP (OR = 4.96, p = 0.001) and intention to discuss PrEP with an HCP in the next six months (B = 0.29, p = 0.038). Stronger beliefs that doctors should initiate sexual health conversations were positively associated with past PrEP conversations (OR = 2.32, p < 0.001) and future intention (B = 0.11, p = 0.029). Greater comfort discussing prevention (B = 0.35, p < 0.001), self-efficacy discussing PrEP (B = 0.29, p = 0.001), and concern about getting HIV (B = 0.51, p < 0.001) were also associated with intention to discuss PrEP with an HCP. Findings highlight the potential for communication campaigns to motivate patient-provider communication about PrEP, addressing a reported barrier to PrEP uptake among Black women. Full article

CareCoach seeks to enhance self-efficacy in family caregivers of people living with dementia and has been feasibility tested in a multicentre randomised controlled trial. The intervention offers two face-to-face sessions with a trained coach and access to an online platform with nine modules. This paper reports findings from an embedded qualitative process evaluation assessing implementation from the implementer’s (‘coach’s’) (n = 8) perspective using individual interviews and implementer group discussions. Qualitative data were transcribed verbatim, inductively coded and analysed using Normalisation Process Theory. Implementers demonstrated (1) ‘Coherence’ by seeking to understand how CareCoach compared to current practice, highlighting the importance of supporting coaches to differentiate and identify boundaries between their new ‘coach role’ and usual practice; (2) ‘Cognitive Participation’ by reviewing training and resources to understand their role own responsibilities and facilitate delivery of coaching sessions; group supervision and peer support were also emphasised; (3) ‘Collective Action’ through interactions with carers to deliver key behavioural aspects such as goal setting, problem solving, and providing feedback; and (4) ‘Reflexive Monitoring’ by appraising the intervention to gain useful insights that could facilitate refinement of CareCoach training and delivery. This study provides a theoretically informed understanding of the implementation of CareCoach for caregivers of people living with dementia and provides recommendations to enhance training for coaches, intervention delivery and carer engagement. Full article

The application of extended reality (XR) in design education has grown substantially; however, empirical evidence on its educational benefits remains limited. This two-year study examines the impact of incorporating a virtual reality (VR) learning module into undergraduate landscape architecture (LA) construction courses, focusing on brick masonry instruction. A conventional learning sequence—lecture, sketching, CAD, and 3D modeling—was supplemented with an immersive VR experience developed using Unreal Engine 5 and deployed on Meta Quest devices. In Year 1, we piloted a preliminary version of the module with landscape architecture students (n = 15), and data on implementation feasibility and student perception were collected. In Year 2, we refined the learning module and implemented it with a new cohort (n = 16) using standardized VR evaluation metrics, knowledge retention tests, and self-efficacy surveys. The findings suggest that when sequenced after a theoretical introduction, VR serves as a pedagogical bridge between abstract construction principles and physical implementation. Moreover, the VR module enhanced student engagement and self-efficacy by offering experiential learning with immediate feedback. The findings highlight the need for intentional design, institutional support, and the continued development of tactile, collaborative simulations. Full article