Search Results (1,476)

Background and Objectives: Depression is a leading cause of disability globally, with treatment challenges including limited access, stigma, and poor adherence. Gamification, which applies game elements such as points, levels, and storytelling into non-game contexts, offers a promising strategy to enhance engagement and augment traditional treatments. Our research is the first study designed to explore the implementation of gamification within the Malaysian context. The objective was to explore the feasibility of implementation of gamification as an adjunctive treatment for adults with depression. Materials and Methods: Focus group discussions were held with five mental health professionals and ten patients diagnosed with moderate depression. The qualitative component assessed perceptions of gamified interventions, while quantitative measures evaluated participants’ depressive and anxiety symptomatology. Results: Three key themes were identified: (1) understanding of gamification as a treatment option, (2) factors influencing its acceptance, and (3) characteristics of a practical and feasible intervention. Clinicians saw potential in gamification to boost motivation, support psychoeducation, and encourage self-paced learning, but they expressed concerns about possible addiction, stigma, and the complexity of gameplay for some patients. Patients spoke of gaming as a source of comfort, escapism, and social connection. Acceptance was shaped by engaging storylines, intuitive design, balanced difficulty, therapist guidance, and clear safety measures. Both groups agreed that gamification should be used in conjunction with standard treatments, be culturally sensitive, and be presented as a meaningful therapeutic approach rather than merely as entertainment. Conclusions: Gamification emerges as an acceptable and feasible supplementary approach for managing depression in Malaysia. Its success depends on culturally sensitive design, robust clinical oversight, and seamless integration with existing care pathways. Future studies should investigate long-term outcomes and establish guidelines for the safe and effective implementation of this approach. We recommend targeted investment into culturally adapted gamified tools, including training, policy development, and collaboration with key stakeholders to realistically implement gamification as a mental health intervention in Malaysia. Full article

The 2025 avian influenza A(H5N1) outbreak has highlighted the urgent need for rapidly generated health communication materials during public health emergencies. Artificial intelligence (AI) systems offer transformative potential to accelerate content development pipelines while maintaining scientific accuracy and impact. We evaluated an AI-generated health communication material on bird flu precautions among 100 U.S. adults. The material was developed using ChatGPT for text generation based on CDC guidelines and Leonardo.AI for illustrations. Participants rated perceived message effectiveness, quality, realism, relevance, attractiveness, and visual informativeness. The AI-generated health communication material received favorable ratings across all dimensions: perceived message effectiveness (3.83/5, 77%), perceived message quality (3.84/5, 77%), realism (3.72/5, 74%), relevance (3.68/5, 74%), attractiveness (3.62/5, 74%), and visual informativeness (3.35/5 67%). Linear regression analysis revealed that all features significantly predicted perceived message effectiveness in unadjusted and adjusted models (p < 0.0001), e.g., multivariate analysis of outcome on perceived visual informativeness showed β = 0.51, 95% CI: 0.37–0.66, p < 0.0001. Also, mediation analysis revealed that visual informativeness accounted for 23.8% of the relationship between material attractiveness and perceived effectiveness. AI tools can enable real-time adaptation of prevention guidance during epidemiological emergencies while maintaining effective risk communication. Full article

Systematic reviews are a cornerstone of evidence-based research, providing comprehensive summaries of existing studies to answer specific research questions. This article offers a detailed guide to conducting high-quality systematic reviews in biology, health and social sciences. It outlines key steps, including developing and registering a protocol, designing comprehensive search strategies, and selecting studies through a screening process. The article emphasizes the importance of accurate data extraction and the use of validated tools to assess the risk of bias across different study designs. Both meta-analysis (quantitative approach) and narrative synthesis (qualitative approach) are discussed in detail. The guide also highlights the use of frameworks, such as GRADE, to assess the certainty of evidence and provides recommendations for clear and transparent reporting in line with the PRISMA 2020 guidelines. This paper aims to adapt and translate evidence-based review principles, commonly applied in clinical research, into the context of biological sciences. By highlighting domain-specific methodologies, challenges, and resources, we provide tailored guidance for researchers in ecology, molecular biology, evolutionary biology, and related fields in order to conduct transparent and reproducible evidence syntheses. Full article

Through a systematic review of sustainable rural dwelling recovery, this study offers a broader reflection on retrofitting practices, viewing eco-efficiency as a means to enhance both cultural heritage and agricultural landscapes. The work is based on the assumption that vernacular architecture in rural contexts embodies historical, cultural, and typological values worthy of preservation, while remaining adaptable to reuse through eco-efficient solutions and technological innovation. Using the PRISMA protocol, 115 scientific contributions were selected from 1711 initial records and classified into four macro-groups: landscape relationships; seismic and energy retrofitting; construction techniques and innovative materials; and morphological–typological analysis. Results show a predominance (over 50%) of passive design strategies, compatible materials, and low-impact techniques, while active systems are applied more selectively to protect cultural integrity. The study identifies replicable methodological models combining sustainability, cultural continuity, and functional adaptation, offering recommendations for future operational guidelines. Conscious eco-efficient retrofitting thus emerges as a strategic tool for the integrated valorization of rural landscapes and heritage. Full article

The integration of renewable energy into power grids is imperative for reducing carbon emissions and mitigating reliance on depleting fossil fuels. In this paper, we develop symmetric and asymmetric evolutionary game-theoretic models to analyze how user–grid cooperation in peak shaving can be enhanced by incorporating whole-process democracy (deliberative governance) into decision-making. Our framework captures excess returns, cooperation-driven profits, energy pricing, participation costs, and benefit-sharing coefficients to identify equilibrium conditions under varied subsidy, cost, and market scenarios. Furthermore, this study integrates the theory, path, and mechanism of deliberative procedures under the perspective of whole-process democracy, exploring how inclusive and participatory decision-making processes can enhance cooperation in renewable energy systems. We simulate seven scenarios that systematically adjust subsidy rates, cost–benefit structures, dynamic pricing, and renewable-versus-conventional competitiveness, revealing that robust cooperation emerges only under well-aligned incentives, equitable profit sharing, and targeted financial policies. These scenarios systematically vary these key parameters to assess the robustness of cooperative equilibria under diverse economic and policy conditions. Our findings indicate that policy efficacy hinges on deliberative stakeholder engagement, fair profit allocation, and adaptive subsidy mechanisms. These results furnish actionable guidelines for regulators and grid operators to foster sustainable, low-carbon energy systems and inform future research on demand response and multi-source integration. Full article

Technological roadmaps are essential tools for managing and planning complex projects, especially in the rapidly evolving field of space exploration. Defined as dynamic schedules, they support strategic and long-term planning while coordinating current and future objectives with particular technology solutions. Currently, the available methodologies are mostly built on experts’ opinions and in just few cases, methodologies and tools have been developed to support the decision makers with a rational approach. In any case, all the available approaches are meant to draw “ideal” maturation plans. Therefore, it is deemed essential to develop an integrate new algorithms able to decision guidelines on “non-nominal” scenarios. In this context, Politecnico di Torino, in collaboration with the European Space Agency (ESA) and Thales Alenia Space–Italia, developed the Technology Roadmapping Strategy (TRIS), a multi-step process designed to create robust and data-driven roadmaps. However, one of the main concerns with its initial implementation was that TRIS did not account for time and budget estimates specific to the space exploration environment, nor was it capable of generating alternative development paths under constrained conditions. This paper discloses two main significant updates to TRIS methodology: (1) improved time and budget estimation to better reflect the specific challenges of space exploration scenarios and (2) the capability of generating alternative roadmaps, i.e., alternative technological maturation paths in resource-constrained scenarios, balancing financial and temporal limitations. The application of the developed routines to available case studies confirms the tool’s ability to provide consistent planning outputs across multiple scenarios without exceeding 20% deviation from expert-based judgements available as reference. The results demonstrate the potential of the enhanced methodology in supporting strategic decision making in early-phase mission planning, ensuring adaptability to changing conditions, optimized use of time and financial resources, as well as guaranteeing an improved flexibility of the tool. By integrating data-driven prioritization, uncertainty modeling, and resource-constrained planning, TRIS equips mission planners with reliable tools to navigate the complexities of space exploration projects. This methodology ensures that roadmaps remain adaptable to changing conditions and optimized for real-world challenges, supporting the sustainable advancement of space exploration initiatives. Full article

To address the wear life prediction challenge of Guide Cones in passive compliant connectors under dynamic loads within specialized equipment, this study proposes a dynamic wear modeling and life assessment method based on the improved Archard model. Through integrated theoretical modeling, finite element simulation, and experimental validation, we establish a bidirectional coupling framework analyzing dynamic contact mechanics and wear evolution. By developing phased contact state identification criteria and geometric constraints, a transient load calculation model is established, revealing dynamic load characteristics with peak contact forces reaching 206.34 N. A dynamic contact stress integration algorithm is proposed by combining Archard’s theory with ABAQUS finite element simulation and ALE adaptive meshing technology, enabling real-time iterative updates of wear morphology and contact stress. This approach constructs an exponential model correlating cumulative wear depth with docking cycles (R² = 0.997). Prototype experiments demonstrate a mean absolute percentage error (MAPE) of 14.6% between simulated and measured wear depths, confirming model validity. With a critical wear threshold of 0.8 mm, the predicted service life reaches 45,270 cycles, meeting 50-year operational requirements (safety margin: 50.9%). This research provides theoretical frameworks and engineering guidelines for wear-resistant design, material selection, and life evaluation in high-reliability automatic docking systems. Full article

Background/Objectives: Early experiences can significantly influence brain development, particularly when they occur during specific time windows known as sensitive or critical periods. Therefore, the early promotion of neurodevelopmental functions is crucial in children at risk for neurodevelopmental disabilities, such as those with cerebral palsy. This article introduces AMIRA (A Multidimensional and Integrated Rehabilitation Approach), a rehabilitative framework designed for infants at risk of neurodevelopmental disabilities. Methods: AMIRA is intended to guide clinical–rehabilitation reasoning rather than prescribe a rigid sequence of predetermined activities for the child. The theoretical foundation and structure of AMIRA are presented by formalizing its criteria, objectives, tools, and intervention procedures. The framework comprises four distinct sections, each supported by adaptive strategies to facilitate access to materials and to promote play-based interactions among the child, their environment, and communication partners. Particular attention is given to optimizing both micro- and macro-environments for children with, or at risk of, co-occurring visual impairment. Each rehabilitative section includes three progressive phases: an initial observation phase, a facilitation phase to support the child’s engagement, and an active experimentation phase that gradually introduces more challenging tasks. Results: The intervention pathways in AMIRA are organized according to six core developmental domains: behavioral–emotional self-regulation, visual function, postural–motor skills, praxis, interaction and communication, and cognitive function. These are outlined in structured charts that serve as flexible guidelines rather than prescriptive protocols. Each chart presents activities of increasing complexity aligned with typical developmental milestones up to 24 months of age. For each specific ability, the corresponding habilitation goals, contextual recommendations (including environmental setup, objects, and tools), and suggested activities are provided. Conclusions: This study presents a detailed intervention approach, offering both a practical framework and a structured set of activities for use in rehabilitative settings. Further studies will explore the efficacy of the proposed standardized approach. Full article

Background/Objectives: Infants with high-output enterostomies often require prolonged parenteral nutrition (PN), increasing risks of infections, liver dysfunction, and impaired growth. Mucous fistula refeeding (MFR) is proposed to enhance intestinal adaptation, weight gain, and distal bowel maturation. This systematic review and meta-analysis assessed its effectiveness, safety, and technical aspects. Methods: Following PRISMA guidelines, studies reporting MFR-related outcomes were included without data or language restrictions. Data sources included PubMed, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Library, and UpToDate. Bias risk was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Meta-analysis employed random- and fixed-effects models, with outcomes reported as odds ratios (ORs) and 95% confidence interval (CI). Primary outcomes assessed were weight gain, PN duration, and complications and statistical comparisons were made between MFR and non-MFR groups. Results: Seventeen studies involving 631 infants were included; 482 received MFR and 149 did not. MFR started at 31 postoperative days and lasted for 50 days on average, using varied reinfusion methods, catheter types, and fixation strategies. MFR significantly improved weight gain (4.7 vs. 24.2 g/day, p < 0.05) and reduced PN duration (60.3 vs. 95 days, p < 0.05). Hospital and NICU stays were also shorter (160 vs. 263 days, p < 0.05; 122 vs. 200 days, p < 0.05). Cholestasis risk was lower (OR 0.151, 95% CI 0.071–0.319, p < 0.0001), while effects on bilirubin levels were inconsistent. Complications included sepsis (3.5%), intestinal perforation (0.83%), hemorrhage (0.62%), with one MFR-related death (0.22%). Conclusions: Despite MFR benefits neonatal care, its practices remain heterogeneous. Standardized protocols are required to ensure MFR safety and efficacy. Full article

Background/Objectives: Heart transplantation is a life-saving procedure for patients with end-stage heart failure, yet it involves significant psychological and emotional challenges throughout its various stages. International guidelines recommend a multi-professional approach to the care of these patients and a psycho-social assessment for listing. The recommendations focus on content aspects, but not on the psychometric measure to be administered to patients as part of the assessment. Therefore, the purpose of this study is to provide the preliminary results of administering the protocol used by our center, measuring coping strategies, cognitive functioning, quality of life, and psychological distress in a sample of patients who are candidates for and undergo cardiac transplantation, and to observe any variations after the procedure. Methods: We conducted a comprehensive psychological-clinical assessment involving 40 patients, focusing on psychosocial functioning, cognitive reserves, mental health, and coping strategies. Tools such as the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), Beck Depression Inventory-II (BDI-II), Montreal Cognitive Assessment (MoCA), General Anxiety Disorder 7 (GAD-7), and Medical Outcomes Survey Short Form 36 (SF-36) were employed to evaluate readiness for transplantation and post-transplant adaptation. Results: Results showed high levels of clinical anxiety (52.5%) and low perceived physical health (98%) before the transplant, while post-operative evaluations indicated reduced anxiety (13.51%) and depressive symptoms (10.81%), along with improved psychological well-being and reintegration into daily life. Conclusions: These results show improvement in physical and cognitive levels, accompanied by a state of enhanced psychological well-being after transplantation. A longitudinal psychological approach, from pre-transplant screening to post-discharge follow-up, is needed to address distress, improve coping mechanisms, and promote treatment adherence. This integrative strategy is critical to improving the quality of life and long-term outcomes for heart transplant recipients. Full article

Glucose-6-phosphate dehydrogenase (G6PD) deficiency, the most common enzymatic disorder, affects over 500 million people worldwide and is often linked to exercise intolerance due to oxidative stress, but its true impact on physical performance remains unclear. This study aimed to evaluate the physiological and metabolic effects of G6PD deficiency on endurance capacity. Using humanized mice carrying the African G6PD variant [V68M; N126D] (hG6PD_A−), we show that despite reduced pentose phosphate pathway activity, these mice exhibit a 10.8% increase in treadmill critical speed (CS)—suggesting enhanced endurance capacity. Multi-omics profiling across red blood cells, plasma, skeletal muscle, spleen, kidney, and liver reveals metabolic adaptations, including elevated glycolysis, fatty acid oxidation, and increased mitochondrial activity, alongside heightened oxidative phosphorylation in muscle and accelerated red blood cell turnover in the spleen and liver. These findings indicate that systemic metabolic reprogramming may offset antioxidant deficiencies, potentially conferring a performance advantage. Given that G6PD deficiency affects up to 13% of African Americans and is associated with cardiovascular health disparities, our results challenge conventional exercise restrictions and highlight the need for personalized exercise guidelines for affected individuals. Full article

Introduction: Burnout syndrome, long described as an “occupational phenomenon”, now affects 15–20% of the general workforce and more than 50% of clinicians, teachers, social-care staff and first responders. Its precise nosological standing remains disputed. We conducted a mechanistic review of electroencephalography (EEG) studies to determine whether burnout is accompanied by reproducible brain-function alterations that justify disease-level classification. Methods: Following PRISMA-adapted guidelines, two independent reviewers searched PubMed/MEDLINE, Scopus, Google Scholar, Cochrane Library and reference lists (January 1980–May 2025) using combinations of “burnout,” “EEG”, “electroencephalography” and “event-related potential.” Only English-language clinical investigations were eligible. Eighteen studies (n = 2194 participants) met the inclusion criteria. Data were synthesised across three domains: resting-state spectra/connectivity, event-related potentials (ERPs) and longitudinal change. Results: Resting EEG consistently showed (i) a 0.4–0.6 Hz slowing of individual-alpha frequency, (ii) 20–35% global alpha-power reduction and (iii) fragmentation of high-alpha (11–13 Hz) fronto-parietal coherence, with stage- and sex-dependent modulation. ERP paradigms revealed a distinctive “alarm-heavy/evaluation-poor” profile; enlarged N2 and ERN components signalled hyper-reactive conflict and error detection, whereas P3b, Pe, reward-P3 and late CNV amplitudes were attenuated by 25–50%, indicating depleted evaluative and preparatory resources. Feedback processing showed intact or heightened FRN but blunted FRP, and affective tasks demonstrated threat-biassed P3a latency shifts alongside dampened VPP/EPN to positive cues. These alterations persisted in longitudinal cohorts yet normalised after recovery, supporting trait-plus-state dynamics. The electrophysiological fingerprint differed from major depression (no frontal-alpha asymmetry, opposite connectivity pattern). Conclusions: Across paradigms, burnout exhibits a coherent neurophysiological signature comparable in magnitude to established psychiatric disorders, refuting its current classification as a non-disease. Objective EEG markers can complement symptom scales for earlier diagnosis, treatment monitoring and public-health surveillance. Recognising burnout as a clinical disorder—and funding prevention and care accordingly—is medically justified and economically imperative. Full article

Industrial robots are undergoing a transformative shift as Artificial Intelligence (AI)-driven and bio-inspired control strategies unlock new levels of precision, adaptability, and multi-dimensional sustainability aligned with Industry 5.0 (energy efficiency, material circularity, and life-cycle emissions). This systematic review analyzes 160 peer-reviewed industrial robotics control studies (2023–2025), including an expanded bio-inspired/human-centric subset, to evaluate: (1) the dominant and emerging control methodologies; (2) the transformative role of digital twins and 5G-enabled connectivity; and (3) the persistent technical, ethical, and environmental challenges. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, the study employs a rigorous methodology, focusing on adaptive control, deep reinforcement learning (DRL), human–robot collaboration (HRC), and quantum-inspired algorithms. The key findings highlight up to 30% latency reductions in real-time optimization, up to 22% efficiency gains through digital twins, and up to 25% energy savings from bio-inspired designs (all percentage ranges are reported relative to the comparator baselines specified in the cited sources). However, critical barriers remain, including scalability limitations (with up to 40% higher computational demands) and cybersecurity vulnerabilities (with up to 20% exposure rates). The convergence of AI, bio-inspired systems, and quantum computing is poised to enable sustainable, autonomous, and human-centric robotics, yet requires standardized safety frameworks and hybrid architectures to fully support the transition from Industry 4.0 to Industry 5.0. This review offers a strategic roadmap for future research and industrial adoption, emphasizing human-centric design, ethical frameworks, and circular-economy principles to address global manufacturing challenges. 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

Background/Objectives: The demand for accessible and reliable digital health services has increased significantly in recent years, particularly in regions facing physician shortages. HomeDOCtor, a conversational AI platform developed in Slovenia, addresses this need with a nationally adapted architecture that combines retrieval-augmented generation (RAG) and a Redis-based vector database of curated medical guidelines. The objective of this study was to assess the performance and impact of HomeDOCtor in providing AI-powered healthcare assistance. Methods: HomeDOCtor is designed for human-centered communication and clinical relevance, supporting multilingual and multimedia citizen inputs while being available 24/7. It was tested using a set of 100 international clinical vignettes and 150 internal medicine exam questions from the University of Ljubljana to validate its clinical performance. Results: During its six-month nationwide deployment, HomeDOCtor received overwhelmingly positive user feedback with minimal criticism, and exceeded initial expectations, especially in light of widespread media narratives warning about the risks of AI. HomeDOCtor autonomously delivered localized, evidence-based guidance, including self-care instructions and referral suggestions, with average response times under three seconds. On international benchmarks, the system achieved ≥95% Top-1 diagnostic accuracy, comparable to leading medical AI platforms, and significantly outperformed stand-alone ChatGPT-4o in the national context (90.7% vs. 80.7%, p = 0.0135). Conclusions: Practically, HomeDOCtor eases the burden on healthcare professionals by providing citizens with 24/7 autonomous, personalized triage and self-care guidance for less complex medical issues, ensuring that these cases are self-managed efficiently. The system also identifies more serious cases that might otherwise be neglected, directing them to professionals for appropriate care. Theoretically, HomeDOCtor demonstrates that domain-specific, nationally adapted large language models can outperform general-purpose models. Methodologically, it offers a framework for integrating GDPR-compliant AI solutions in healthcare. These findings emphasize the value of localization in conversational AI and telemedicine solutions across diverse national contexts. Full article