Search Results (8,135)

Given the overlap of epidemiological and clinical presentations of both rickettsioses and malaria infections, diagnostic testing where malaria is confirmed or excluded, without subsequent rickettsial testing, specifically in the case of Plasmodium vivax or P. ovale infection, may mask the possibility of relapse. A lack of clinical suspicion of co-infections, absence of knowledge on the geographic distribution of diseases, and lack of availability of point-of-care diagnostic testing for other tropical diseases can often lead to missed diagnosis or misdiagnosis of common tropical infections, including rickettsioses. We herein describe a case of confirmed intercurrent rickettsial and P. vivax infection, with the former potentially triggering a relapse of the latter in a febrile traveler returning to Canada from South America, and review the literature on tropical coinfections in returning travelers. Full article

As an example of pedagogical approaches that blend online and face-to-face instruction, the flipped classroom model has seen exponential growth in business schools. To explore its effectiveness, expectancy-value theory and cognitive load theory were employed to develop a framework linking students’ perceived usefulness of the online and in-person content to their pre-class preparation, class participation, perceived learning, and skills development. A preliminary test of this framework was conducted using a flipped Organizational Behavior course within a business diploma program at a publicly funded Canadian college. The perceived usefulness of the online component was positively associated with students’ pre-class preparation, which, in turn, was positively related to both their perceived learning and skills development. Implications for practice and directions for future research are discussed. Full article

Surface and sub-surface atomic configurations are critical for catalysis as they host the active sites governing electrochemical processes. This study employs density functional theory (DFT) calculations and Monte Carlo simulations combined with the cluster-expansion approach to investigate atom distribution and Pt segregation in Pt-Fe alloys across varying Pt/Fe ratios. Our simulations reveal a strong tendency for Pt atoms to segregate to the surface layer while Fe atoms enrich the sub-surface region. Crucially, the calculations predict the stability of a periodic Pt₂Fe alloy surface model, characterized by specific defect structures, at low platinum content and low annealing temperatures. Electronic structure analysis indicates that forming this Pt₂Fe surface alloy lowers the d-band center of Pt atoms, weakening CO adsorption and thereby enhancing resistance to CO poisoning. Although defect-induced strains can modulate the d-band center, crystal orbital Hamilton population (COHP) analysis confirms that such strains generally strengthen Pt-CO interactions. Therefore, the theoretical design of Pt₂Fe alloy surfaces and controlling defect density are predicted to be effective strategies for enhancing catalyst resistance to CO poisoning. This work highlights the advantages of periodic Pt₂Fe surface models for anti-CO poisoning and provides computational guidance for designing efficient Pt-based electrocatalysts. Full article

This article examines two Caribbean texts which use 20th-century journeys on passenger ships as opportunities to investigate ways in which colonial anxieties of race and gender are worked out through nautical desires. Mayra Montero’s erotic novel La última noche que pasé contigo (1991) and Claude McKay’s Romance in Marseille (2020) both wrestle with the imagined and material consequences of pervasive anti-blackness. They also raise crucial questions about embodied practices of struggle for survival. My analysis seeks to answer the following questions. What happens when anti-blackness masquerades as desire? How do we read and represent an anti-blackness that seeks to consume parts of the Caribbean and then dispense as refuse with what it sees as superfluous? What reading practices might we adopt in order to make sense of Caribbean bodies dehumanized on their own shores, and what narrative solutions might Caribbean fiction propose that might begin to restore humanity and value to these bodies? Full article

Background/Objectives: Neurodegenerative proteinopathies, such as Alzheimer’s disease (AD), Parkinson’s disease (PD), and dementia with Lewy bodies (DLB), are increasingly prevalent worldwide mainly due to population aging. These conditions are marked by complex etiologies, overlapping pathologies, and progressive clinical decline, with significant consequences for patients, caregivers, and healthcare systems. This review aims to synthesize evidence on the healthcare complexities of major neurodegenerative proteinopathies to highlight current knowledge gaps, and to inform future care models, policies, and research directions. Methods: We conducted a comprehensive literature search in PubMed/MEDLINE using combinations of MeSH terms and keywords related to neurodegenerative diseases, proteinopathies, diagnosis, sex, management, treatment, caregiver burden, and healthcare delivery. Studies were included if they addressed the clinical, pathophysiological, economic, or care-related complexities of aging-related neurodegenerative proteinopathies. Results: Key themes identified include the following: (1) multifactorial and unclear etiologies with frequent co-pathologies; (2) long prodromal phases with emerging biomarkers; (3) lack of effective disease-modifying therapies; (4) progressive nature requiring ongoing and individualized care; (5) high caregiver burden; (6) escalating healthcare and societal costs; and (7) the critical role of multidisciplinary and multi-domain care models involving specialists, primary care, and allied health professionals. Conclusions: The complexity and cost of neurodegenerative proteinopathies highlight the urgent need for prevention-focused strategies, innovative care models, early interventions, and integrated policies that support patients and caregivers. Prevention through the early identification of risk factors and prodromal signs is critical. Investing in research to develop effective disease-modifying therapies and improve early detection will be essential to reducing the long-term burden of these disorders. Full article

There is limited published guidance available to help less experienced practitioners assess and manage shoulder conditions, including spasticity, after acquired central nervous system (CNS) lesions. To address this gap, 11 spasticity and dystonia experts convened in a 2023 meeting to build on existing guidance, provide consensus on best treatment practice, and develop expert recommendations to guide the diagnosis and treatment of complications of shoulder conditions following CNS lesions. Presentations by each expert on diagnosis and management were followed by discussion; consensus on assessment and treatment practices was identified and recommendations developed. The expert panel recommended an assessment approach structured using the following components: patient history, including interpretation of reported symptoms; observation of postures and pain responses; clinical examination with targeted tests for specific signs; diagnostic tests; and assessment of upper limb impairment, activity limitations, and participation restrictions. This assessment process and the recommended measures recognize the importance of identifying shoulder involvement in upper limb spasticity as part of the diagnostic process in shoulder conditions following CNS lesions. These recommendations provide a practical approach to diagnosis and treatment for clinicians who are less experienced in evaluating and treating such conditions, simplifying otherwise complicated clinical scenarios. Full article

African, Caribbean, and Black (ACB) communities face increased COVID-19 morbidity and mortality, coupled with significant barriers to vaccine acceptance and uptake. Addressing these challenges requires innovative, multifaceted strategies. Peer-led interventions, grounded in critical health literacy (CHL) and critical racial literacy (CRL), and integrating collaborative equity learning processes, can enhance community capacity, empowerment, and health outcomes, contributing to long-term health equity. This paper describes and presents the evaluative outcomes of a peer-led intervention aimed at enhancing COVID-19 vaccine confidence and acceptance. The Peer-Equity Navigator (PEN) intervention consisted of a specialized training curriculum grounded in CHL and CRL. Following training, PENs undertook a 5-month practicum in community or health settings, engaging in diverse outreach and educational activities to promote vaccine literacy in ACB communities. The evaluation utilized a modified Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework, using quantitative and qualitative methods to collect data. Sources of data included tracking records with community feedback, and a PEN focus group, to assess program feasibility, outreach, and effectiveness. From 16 September 2022, to 28 January 2023, eight trained PENs conducted 56+ community events, reaching over 1500 community members. Both PENs and community members reported high engagement, endorsing peer-led, community-based approaches and increased vaccine literacy. The PEN approach proves feasible, acceptable, and effective in promoting positive health behaviors among ACB communities. This intervention has clear implications for health promotion practice, policy, and research in equity-deserving communities, including immigrants and refugees, who also face multiple and intersecting barriers to health information and care. Full article

Survivors of pediatric cancer are at risk for late effects and require risk-adapted long-term follow-up (LTFU) care. Yet less than 50% of survivors attend LTFU care. This study aimed to identify barriers and enablers of engaging with LTFU care as perceived by Canadian survivors of pediatric cancer and healthcare providers (HCPs). Survivors (n = 108) and HCPs (n = 20) completed surveys assessing barriers and enablers to attending LTFU care, summarized using descriptive statistics. Participants were invited to participate in survivor focus groups (n = 22) or HCP semi-structured interviews (n = 7). These were analyzed using reflexive thematic analysis and the Capability, Opportunity, and Motivation for Behaviour Change (COM-B) model, which explores how an individual’s capability, opportunity, and motivation influence a target behaviour. Structural barriers, transitioning from pediatric to adult care, and time constraints were highlighted as barriers that affect survivors’ physical opportunity to engage in LTFU care. Accessibility, financial support, HCPs and family support, and community resources were highlighted as enablers that better survivors’ physical and social opportunity to engage in LTFU care. In conclusion, Canadian survivors of pediatric cancer highlighted barriers that limited their physical opportunity to attend LTFU care, while factors that enhanced their physical and social opportunities facilitated greater engagement with LTFU care. Full article

This paper proposes a strategic framework to enhance nuclear energy governance by advancing the Qudrat-Ullah Nuclear Peace and Trust (Q-NPT) framework. Designed to complement existing treaties such as the Nuclear Non-Proliferation Treaty (NPT) and International Atomic Energy Agency (IAEA) safeguards, Q-NPT integrates principles of equity, transparency, and trust to address persistent governance challenges. The framework emphasizes sustainable nuclear technology access, multilateral cooperation, and integration with global energy transition goals. Through an analysis of institutional, economic, technological, and geopolitical barriers, the study outlines actionable pathways for adoption, including legal harmonization, differentiated financial instruments, and deployment of advanced verification technologies such as blockchain, artificial intelligence (AI), and remote monitoring. A phased implementation timeline is presented, enabling adaptive learning and stakeholder engagement over short-, medium-, and long-term horizons. Regional case studies, including Serbia and Latin America, demonstrate the framework’s applicability in diverse contexts. By linking nuclear policy to broader climate, energy equity, and global security objectives, Q-NPT offers an operational and inclusive roadmap for future-ready governance. This approach contributes to the literature on energy systems transformation by situating nuclear governance within a sustainability-oriented, trust-centered paradigm. Full article

As global populations age, there is increasing demand for effective, person-centered healthcare solutions that support older adults to age in place. Home healthcare has emerged as a crucial strategy to address the complex health and social needs of older adults while reducing reliance on institutional care. This umbrella review aimed to synthesize evidence from existing systematic reviews and meta-analyses on home healthcare services and interventions targeting older adults. A comprehensive search was conducted across five databases and gray literature sources, including Google Scholar, for reviews published between 2000 and 2025. The review followed the Joanna Briggs Institute methodology and PRISMA statement. Twenty reviews met the inclusion criteria, encompassing a total of over 3.1 million participants. Interventions were grouped into four categories: integrated and multidisciplinary care, preventive and supportive home visits, technological and digital interventions, and physical, transitional, and environmental support. Results indicated that many interventions led to improved health outcomes, including enhanced functional ability, reduced hospital readmissions, and increased satisfaction. However, effectiveness varies depending on the intervention type, delivery model, and population. Challenges such as caregiver burden, digital exclusion, and implementation in diverse settings were noted. This review highlights the promise of home healthcare interventions and underscores the need for context-sensitive, equitable, and scalable models to support aging populations. Full article

Background/Objectives: Frailty is a multifactorial clinical syndrome characterized by diminished physiological reserves and increased vulnerability to stressors. It is increasingly recognized as a predictor of poor outcomes in cardiac rehabilitation (CR). However, how frailty is defined, assessed, and addressed across outpatient CR programmes remains unclear. This scoping review aimed to map the extent, range, and nature of research examining frailty in the context of outpatient CR, including how frailty is measured, its impact on CR participation and outcomes, and whether sex and gender considerations or participation barriers are reported. Methods: Following the PRISMA-ScR guidelines, we conducted a comprehensive search across six electronic databases (from inception to 15 May 2025). Eligible peer-reviewed studies included adult participants assessed for frailty using validated tools and enrolled in outpatient CR programmes. Two reviewers independently screened citations and extracted data. Results were synthesized descriptively and narratively across three domains: frailty assessment, sex and gender considerations, and barriers to CR participation. The protocol was registered with the Open Science Framework. Results: Thirty-nine studies met inclusion criteria, all conducted in the Americas, Western Pacific, or Europe. Frailty was assessed using 26 distinct tools, most commonly the Kihon Checklist, Fried’s Frailty Criteria, and Frailty Index. The median pre-CR frailty prevalence was 33.5%. Few studies (n = 15; 38.5%) re-assessed frailty post-CR. Sixteen studies reported sex or gender data, but none applied sex- or gender-based analysis (SGBA) frameworks. Only eight studies examined barriers to CR participation, identifying physical limitations, emotional distress, cognitive concerns, healthcare system-related factors, personal and social factors, and transportation as key barriers. Conclusions: The literature on frailty in CR remains fragmented, with heterogeneous assessment methods, limited global representation, and inconsistent attention to sex, gender, and participation barriers. Standardized frailty assessments and individualized CR programme adaptations are urgently needed to improve accessibility, adherence, and outcomes for frail individuals. Full article

Robotic search of people in human-centered environments, including healthcare settings, is challenging, as autonomous robots need to locate people without complete or any prior knowledge of their schedules, plans, or locations. Furthermore, robots need to be able to adapt to real-time events that can influence a person’s plan in an environment. In this paper, we present MLLM-Search, a novel zero-shot person search architecture that leverages multimodal large language models (MLLM) to address the mobile robot problem of searching for a person under event-driven scenarios with varying user schedules. Our approach introduces a novel visual prompting method to provide robots with spatial understanding of the environment by generating a spatially grounded waypoint map, representing navigable waypoints using a topological graph and regions by semantic labels. This is incorporated into an MLLM with a region planner that selects the next search region based on the semantic relevance to the search scenario and a waypoint planner that generates a search path by considering the semantically relevant objects and the local spatial context through our unique spatial chain-of-thought prompting approach. Extensive 3D photorealistic experiments were conducted to validate the performance of MLLM-Search in searching for a person with a changing schedule in different environments. An ablation study was also conducted to validate the main design choices of MLLM-Search. Furthermore, a comparison study with state-of-the-art search methods demonstrated that MLLM-Search outperforms existing methods with respect to search efficiency. Real-world experiments with a mobile robot in a multi-room floor of a building showed that MLLM-Search was able to generalize to new and unseen environments. Full article

The primary objective of any conservation breeding program is to preserve the genetic diversity of populations. This objective is a persistent challenge, especially in small populations which are prone to loss of heterozygosity. In this study, we proposed a novel parent-selection strategy aimed at the long-term maintenance of high levels of genetic diversity. Our approach is based on estimating the Probability of Offspring Heterozygosity (POH)—the likelihood that a mating will produce heterozygous offspring—using SNP genotype data. This strategy was evaluated through computer simulations, where parental pairs with the highest POH values were preferentially selected to produce the next generation. Simulations explored the effects of varying the number of breeding pairs, and the number of unlinked SNP markers. Selection based on POH resulted in observed heterozygosity (H_OBS) consistently exceeding expected heterozygosity (H_EXP), a trend that was sustained for up to 1000 generations. While further evaluation is needed within more complex population genetic frameworks—accounting for linkage disequilibrium, recombination, optimal contribution, and phenotypic selection—our findings highlight the potential of POH as a valuable tool for enhancing genetic diversity in conservation breeding programs. Full article

The agents of prion diseases have the capacity to efficiently infect susceptible hosts by peripheral routes and to project to clinical target areas of the central nervous system (CNS) via peripheral nerves. Understanding the process of prion spread from the site of infection to the CNS may allow us to identify novel therapeutic strategies. To investigate the mechanism involved in the intranerval transit of 263K scrapie prions in golden Syrian hamsters (GSHs), we transected the sciatic nerve at increasing times post-footpad injection and recorded the incubation periods as estimates of the efficiency of infection. We calculated that intranerval transit of this strain of scrapie is at least 10 times faster than previously reported and may reach 50 mm/day, similar to other neurotropic viruses. By in vivo exposure/injection of sciatic nerves to 263K infectivity, we have also shown that prion entry likely occurs via nerve terminals rather than by direct contact with the sciatic nerve. Application of this experimental approach in other forms of prion diseases could allow verification of the timing of neuroinvasion, a relevant parameter for the definition of therapeutic interventions. Full article

Despite being highly prevalent among women of reproductive age, the psychological dimensions of iron deficiency anemia (IDA) often go unrecognized. While the hematological consequences of IDA are well established, emerging evidence suggests that it may also adversely affect emotional processing, mental health, and overall quality of life. This study aimed to systematically assess levels of alexithymia, anxiety, depressive symptoms, and quality of life in women diagnosed with IDA compared to age-matched healthy controls. A total of 151 women with confirmed IDA and 150 healthy controls were recruited. Participants underwent laboratory testing and completed validated questionnaires, including the Beck Depression Scale (BDS), State-Trait Anxiety Inventory (STAI), WHOQOL-BREF-TR, and the Toronto Alexithymia Scale (TAS-20). Women with IDA demonstrated significantly higher alexithymia and anxiety scores and lower quality of life compared to controls. Within the IDA group, probable alexithymia was associated with more severe anemia parameters and poorer psychological outcomes. These findings indicate that IDA is not only a hematological disorder but also one with a substantial psychological burden. Recognizing and addressing these psychological dimensions in clinical practice is critical. A multidisciplinary management approach that integrates both hematological treatment and mental health interventions may be essential to improve overall patient outcomes among women with IDA. Full article