Search Results (2,971)

Background: Healthcare workers (HCWs) have experienced sustained occupational exposure to SARS-CoV-2 throughout the COVID-19 pandemic. While infection prevention and control (IPC) practices have been widely implemented, limited prospective data exist on how occupational exposure risk and adherence to protective practices evolve over time, particularly beyond the acute phases of the pandemic. This study aimed to prospectively assess occupational and community exposure risk to COVID-19 among HCWs and to evaluate temporal changes in adherence to IPC practices during routine care and aerosol-generating procedures. Methods: A prospective observational study was conducted among HCWs from four public hospitals in the region of Thessaly, Greece. Eligible participants were HCWs who reported contact with suspected or confirmed COVID-19 cases. The data were collected at baseline (January–March 2022) and at a six-month follow-up using the World Health Organization’s “Risk Assessment and Management of Exposure of Health Care Workers in the Context of COVID-19” questionnaire. The instrument captured demographic characteristics, professional roles, occupational and community exposure, and adherence to IPC practices. Results: A total of 203 HCWs participated in the study. The overall proportion of HCWs reporting occupational exposure was 72.9% in both assessments. Among HCWs with occupational exposure (n = 148), the proportion classified as high-risk showed a statistically significant increase from 76% (95% CI: 0.6951–0.8320) at baseline to 88% (95% CI: 0.8258–0.9310) at follow-up (p = 0.010). This shift reflects a substantial effect size, with the odds of high-risk classification being more than double at follow-up (OR = 2.24). Nurses consistently demonstrated higher risk compared with physicians. The overall use of personal protective equipment remained high. However, adherence to several IPC practices declined over time, including removal and replacement of PPE according to protocol and frequent decontamination of high-touch surfaces. Conclusions: Occupational exposure risk among HCWs remained substantial and increased over time despite stable occupational exposure estimates. The observed decline in adherence to key IPC measures highlights the need for continuous monitoring and reinforcement of protective practices in healthcare settings. Full article

Background/Objectives: The study primarily examined whether an IoT-based medication assistance system enhances ART adherence relative to standard care, and secondarily evaluated device feasibility and error patterns over time. Methods: This prospective study was conducted between June 2022 and October 2023 at a tertiary hospital in South Korea. Adults (≥19 years) living with HIV and prescribed ART were included; those with comorbid hepatitis B or C were excluded. People living with HIV who agreed to use the IoT-based InPHRPILL system (Sofnet Inc., Seoul, Republic of Korea) were assigned to the intervention group, whereas those who declined were assigned to the control group. Viral suppression, CD4⁺ cell counts, and adherence rates were measured. Additional analyses evaluated 12-month longitudinal adherence using pill-count data in both groups, and device-measured adherence and device-associated error rates in the intervention group. Results: Thirty-five participants (12 in the intervention group and 23 in the control group) were included. The intervention group demonstrated marginally shorter durations since HIV diagnosis and ART initiation at study enrollment, as well as slightly higher baseline HIV-RNA levels; however, these differences did not reach statistical significance. The median pill-counting and IoT device adherence rates were 100% and 87.4%, respectively (median deviation error rate = 4.4%). Poisson regression revealed significantly reduced error rates over time (β = −0.06493, p < 0.01), suggesting improved device use proficiency. Conclusions: IoT-based medication assistance systems may provide objective, real-time monitoring of ART adherence and facilitate identification of discrepancies between clinical evaluations and actual adherence patterns. Larger studies targeting individuals with suboptimal adherence are warranted to determine whether such systems can enhance adherence outcomes. Full article

In digital-measurement-assisted assembly of large aircraft components, the spatial layout of Enhanced Reference System (ERS) points determines coordinate transformation accuracy and stability. To address manual layout limitations—specifically low efficiency, occlusion susceptibility, and physical deployment limitations—this paper proposes an adaptive planning method under engineering constraints. First, based on the Guide to the Expression of Uncertainty in Measurement (GUM) and weighted least squares, an analytical transformation sensitivity model is constructed. Subsequently, a multi-scale sample library generated via Monte Carlo sampling trains a high-precision BP neural network surrogate model, enabling millisecond-level sensitivity prediction. Combining this with ray-tracing occlusion detection, a weighted genetic algorithm optimizes transformation sensitivity, spatial uniformity, and station distance within feasible ground and tooling regions. Experimental results indicate that the method effectively avoids occlusion. Specifically, the Registration-Induced Error (RIE) is controlled at approximately 0.002 mm, and the Registration-Induced Loss Ratio (RILR) is maintained at about 10%. Crucially, comparative verification reveals an RIE reduction of approximately 40% compared to a feasible uniform baseline, proving that physics-based data-driven optimization yields superior accuracy over intuitive geometric distribution. By ensuring strict adherence to engineering constraints, this method offers a reliable solution that significantly enhances measurement reliability, providing solid theoretical support for automated digital twin construction. Full article

Fabry disease (FD) is an X-linked systemic lysosomal storage disease caused by mutations in the galactosidase-α (GLA) gene, which encodes the α-galactosidase A (α-AGAL) enzyme. FD can lead to serious complications, including early death, if left untreated. For over 20 years, enzyme replacement therapy (ERT) based on the use of agalsidase-α and agalsidase-β has been the standard treatment for FD, alongside new molecules that have enriched the therapeutic armamentarium and others that are being tested to expand it further. Unfortunately, ERT can be associated with the formation of inhibiting antidrug antibodies (ADAs), which impact ERT clinical efficacy and have consequences affecting safety and therapeutic adherence. A group of FD specialists discussed the problem of immunogenicity in FD, analyzing the most recent literature and the strategies that are currently being used to address it. Once formed, fluctuating levels of ADAs persist and have an impact on the clinical picture and prognosis of the disease that is still the subject of lively scientific debate. The critical nature of ADAs is demonstrated by their ability to bind to the enzyme, increasing drug clearance while forming immune complexes that can build up in the tissues causing chronic inflammation that aggravates the progression of the disease and affects the onset of acute reactions after the infusion, impacting therapeutic adherence. Although similar in their therapeutic mechanism, agalsidase-α and agalsidase-β differ in their production process, with resulting differences from a pharmacokinetic and pharmacodynamic point of view and diverse immunological implications: despite showing rather overlapping efficacy outcomes, agalsidase-α demonstrates a better tolerability profile, with a lower frequency of ADAs, than agalsidase-β. Given the extreme variability of the clinical picture, it is crucial for optimal FD management that the most appropriate molecule is chosen by taking into account the unique immunological risk profile of each single patient, and particular attention should be paid to naïve subjects by periodic measurement of ADAs during therapy and cross-referencing data to correlate serological and clinical patterns. Full article

Background/Objectives: This descriptive cross-sectional study examined adherence to the Mediterranean diet (MD) among primary school students and its associations with out-of-school physical activity, bicycle availability and use, and satisfaction with physical education (PE). The MD is regarded as an ideal dietary pattern for promoting health during childhood and adolescence. Its well-established benefits support its integration into nutrition and health education within the PE curriculum. However, the connection between adherence to the MD and factors such as satisfaction with PE, bicycle availability and use, and out-of-school physical activity during primary education remains insufficiently explored. Methods: The study included 347 primary school students (53.6% girls; M_age = 10.55, SD = 0.97). Data were collected using an ad hoc questionnaire including sociodemographic information, out-of-school physical activity, and bicycle availability and use. MD adherence was evaluated using the KIDMED index, while satisfaction with PE was measured with the Spanish version of the Physical Activity Class Satisfaction Questionnaire (PACSQ). Results: No significant associations were found between MD adherence and out-of-school physical activity (χ² = 0.882; p = 0.663) or bicycle use (χ² = 4.767; p = 0.092). In contrast, a significant association was observed between MD adherence and satisfaction with PE (p < 0.002), including most of its dimensions. Conclusions: Overall, the findings indicate an association between satisfaction with PE and MD adherence, which should be interpreted as exploratory and non-causal in nature. Full article

Objectives: This study aimed to assess whether low-iodine diet (LID) adherence is associated with therapeutic response in papillary thyroid carcinoma (PTC), specifically in relation to post-therapeutic thyroglobulin (Tg) release as a surrogate marker for the acute radiation-induced response following radioactive iodine (RAI) therapy. Methods: This retrospective study included 895 patients with PTC treated with RAI. LID adherence was assessed using the urine iodine-to-creatinine (I/Cr) ratio, with <66.2 μg/g Cr defined as good adherence. The Tg ratio (ratioTg), calculated by dividing post-RAI Tg (measured 7 days after RAI) by pre-RAI Tg, was used to reflect the magnitude of the radiation-induced Tg release. Patients were stratified by ratioTg (≤1 vs. >1), and associations between LID adherence and therapeutic response were analyzed within each group. Results: Well-adherent patients exhibited significantly higher ratioTg compared to poorly adherent patients (15.7 ± 2.2 vs. 8.9 ± 1.3, p = 0.007). Among patients with ratioTg > 1 (n = 630), LID adherence was independently associated with improved therapeutic response (OR, 2.004; 95% CI, 1.270–3.162; p = 0.003). No such association was observed in patients with ratioTg ≤ 1 (n = 265; p = 0.546). Conclusions: The clinical benefit of LID appears to depend on the presence of a certain magnitude of radiation-induced Tg release. RatioTg may serve as a useful marker for identifying patients likely to benefit from LID. Full article

Introduction: Vitamin D deficiency [25(OH)D < 30 ng/mL] is widely prevalent globally and the efforts to tackle it have been rather unsuccessful to date. Despite different cutoffs used to define it, many clinicians adhere to the 2011 Endocrine Society definition. We present a special treat-to-target protocol aiming to restore and maintain vitamin D sufficiency. Methods: We reviewed the efficacy and safety of our vitamin D supplementation protocol over 5 years, and compared it to a group of patients who self-reported never taking vitamin D supplements. We recorded the baseline, 2-month, and annual 25(OH)D (D) measurements, along with subjects’ age, sex, BMI, history of osteoporosis, nephrolithiasis, nephrocalcinosis, and renal colics. According to our supplementation protocol, replenishment of vitamin D involves cholecalciferol dosing in two steps: a loading dose (LD) for 2 months and a maintenance dose (MD) thereafter. Please refer to the main text for loading and maintenance dose titration. Results: Of 8329 cases with vitamin D measurements, 2248 had adequate follow up data of 3524.5 patient-years and were included in the study: a total of 1575 intervention subjects and 673 controls, with an average follow-up of 18.8 months. Baseline vitamin D concentrations of 22.6 ng/mL (controls) did not change significantly (2 months: 22.2; 1 year: 21.7; 2 years: 22.0; 3 years: 23.8; 4 years: 21.8; and 5 years: 22.1 ng/mL), while concentrations of 21.9 ng/mL (intervention group) reached and remained 40 ng/mL (2 months: 41.0; 1 year: 39.4; 2 years: 39.0; 3 years: 39.3; 4 years: 40.4; and 5 years: 39.4 ng/mL). Vitamin D adequacy was achieved in 91.6% of patients in the intervention arm compared to only 16.9% in controls (p < 0.0001). Mean D and rates of adequacy were significantly higher over time in the intervention arm (p < 0.0001). The incidence of renal adverse events or hypervitaminosis did not differ between groups (p > 0.05). Conclusions: Our intervention protocol appears highly efficient in achieving and maintaining vitamin D adequacy over 5 years, with no increase in adverse events compared with controls, presenting it as an effective long-term strategy. Full article

Grounded in Self-Determination Theory (SDT), this study tested the hypothesis that body image perception delineates distinct motivational pathways, linking the perceived interpersonal style of exercise professionals to basic psychological needs, motivation quality, and long-term exercise persistence intentions. A sample of 821 regular exercisers was divided into two groups based on body image: “Satisfied” (n = 276) and “Dissatisfied due to Overweight” (n = 545). Participants completed validated measures of perceived interpersonal behaviors (supportive/thwarting), basic psychological need satisfaction/frustration, motivational regulation, and exercise persistence intention. A clear divergent pattern emerged, strongly supporting the main hypothesis. The “Satisfied” group reported a positive pathway: perceiving more need-supportive behaviors from instructors was associated with greater satisfaction of autonomy, competence, and relatedness, which in turn correlated with more self-determined motivation and stronger persistence intentions. Conversely, the “Dissatisfied” group reported a negative pathway: perceiving more need-thwarting behaviors was associated with greater need frustration, which correlated with more non-self-determined motivation and weaker persistence intentions. Measurement invariance confirmed these pathways are comparable across groups. The findings highlight that body image perception is a key correlate of distinct motivational experiences in exercise settings. Crucially, they underscore the significant association between the professional’s perceived interpersonal style and these pathways. Fostering need-supportive environments that enhance autonomy, competence, and relatedness is associated with more adaptive motivation and adherence, offering a valuable framework for practitioners aiming to support clients, particularly those with body image concerns. Full article

Background/Objective: Hand hygiene is a cornerstone of infection prevention; however, compliance is inconsistent in intensive care units (ICUs), particularly in resource-constrained settings. This study evaluated whether a low-cost, multimodal quality improvement intervention could improve process-level hand hygiene compliance using routine, episode-based audits embedded in the ICU practice. Methods: We conducted a single-cycle Plan-Do-Study-Act quality improvement project in a 12-bed mixed medical–surgical ICU in Pakistan (December 2023–January 2024). Hand hygiene performance was assessed using the unit’s routine weekly episode-based audit protocol, aligned with the WHO Five Moments framework. A targeted multimodal intervention comprising education, point-of-care visual reminders, audit feedback, and leadership engagement was implemented between the pre- and post-intervention phases (four weeks each). Non-applicable moments were scored as “compliant by default” according to the institutional protocol. A sensitivity analysis was performed excluding these moments to calculate pure adherence. Compliance proportions were summarized using exact 95% Clopper–Pearson confidence intervals without inferential testing. Results: A total of 942 audit episodes (471 per phase) generated 4710 moment-level assessments were generated. Composite hand hygiene compliance increased from 63.1% pre-intervention to 82.0% post-intervention [absolute increase: 18.9 percentage points (pp)]. Sensitivity analysis excluding non-applicable moments demonstrated pure adherence improvement from 54.2% to 82.5% (+28.3 pp), confirming a genuine behavioral change rather than a measurement artifact. Compliance improved across all five WHO moments, with the largest gains in awareness-dependent moments targeted by the intervention: before touching the patient (+27.0 pp) and after touching patient surroundings (+40.0 pp). Week-by-week compliance remained stable within both phases, without immediate post-intervention decay. Conclusions: A pragmatic, low-cost multimodal intervention embedded in routine ICU workflows was associated with substantial short-term improvements in hand hygiene compliance over a four-week observation period, particularly for awareness-dependent behaviors. Episode-based audit systems can support directional process monitoring in resource-limited critical care settings without the need for electronic surveillance. However, its long-term sustainability beyond one month and generalizability to other settings remain unknown. Sensitivity analyses are essential when using “compliant by default” scoring to distinguish adherence patterns from measurement artifacts. Full article

Background/Objectives: This pilot study explored the applicability and preliminary clinical outcomes of cognitive stimulation therapy (CST), an evidence-based cognitive intervention for people with mild and moderate dementia, in elderly individuals with concurrent dementia and visual impairment. Methods: Seven participants received 14 group CST sessions. Their cognitive and language functions were measured and compared pre-/post-therapy. Results: The treatment adherence was satisfactory. Significant improvements in various cognitive domains and language measures were observed after therapy. Conclusions: The findings suggest that CST can be applied to visually impaired individuals with dementia with seemingly positive outcomes in various cognitive domains. Further studies with a larger sample with an emphasis on multisensory stimulation to facilitate therapy delivery are warranted. Full article

Background/Objectives: Infant acute malnutrition increases the risk of morbidity and mortality but also has adverse effects on growth, cognitive development, and quality of life. Ready-to-use therapeutic foods (RUTFs) represent the standard treatment in moderate (MAM) or severe acute malnutrition (SAM) cases, but acceptability and adherence in culturally diverse settings remain poorly understood. To evaluate the acceptability and adherence to RUTF treatment among children with MAM or SAM in rural and indigenous communities of three Mexican states. Methods: We conducted a mixed-methods study in Chihuahua, Guerrero, and Chiapas between February and August 2024. A total of 66 children aged 6–59 months with confirmed MAM or SAM diagnoses were enrolled, with 48 completing the study. Acceptability was assessed by weighing leftovers of the consumption RUTF sachet and using 5-point hedonic scales evaluating taste, texture, appearance, and smell. Adherence was measured by comparing consumed versus prescribed RUTF sachets. Semi-structured interviews with primary caregivers explored perceptions, barriers, and facilitators of RUTF use. Results: Consumption-based acceptability was achieved by 85% of participants. On the 5-point hedonic scale, 77% of participants rated RUTF as pleasant or very pleasant. Overall treatment adherence was adequate (≥70%) in 79.2% of cases. Qualitative information revealed primary caregivers’ perceptions about weight gain and increased appetite as benefits. Conclusions: Since acceptability and adherence were adequate and a high score was obtained on the hedonic scale, which led to an improvement in the nutritional status of MAM or SAM cases, the feasibility and acceptability of RUTFs in highly vulnerable community contexts in Mexico was reaffirmed. Full article

Background: Functional impairments associated with bipolar disorder have a significant impact on daily life, including work, social relationships, and independent living. Bipolar disorder is treated with many approaches, with pharmacotherapy being the first choice; however, cases of relapse and side effects have been reported. The literature suggests that psychosocial interventions are effective in improving treatment adherence, recognizing early warning signs, enhancing self-management skills, and fostering open communication. The effects of interpersonal and social rhythm therapy (IPSRT) on circadian rhythm stability and social functioning in people with bipolar disorder remain uncertain. Therefore, this study is needed. Methods: This quasi-experimental study was conducted in the psychiatric outpatient clinic of a university hospital. Participants were recruited using convenience sampling from the psychiatric outpatient clinic. Eligible participants were then randomly allocated to either the intervention or control group using a coin-flip method. The dose of the intervention averaged 75 min per session with a weekly frequency over 12 weeks. Outcome measures included the Interpersonal Problem Areas Rating Scale, the Social Rhythm Metric Scale-II-5, and the Multnomah Community Ability Scale. Data were collected at baseline (week 0), post-intervention (week 12), and at follow-up (12 weeks post-intervention), and analyzed using repeated-measures ANOVA. Results: Participants in the IPSRT group demonstrated significant improvements in social rhythm regularity (SRM-II-5: 2.9 ± 1.3 at baseline, 3.7 ± 1.2 post-intervention, and 4.0 ± 1.5 at three-month follow-up; F = 18.5, p < 0.05, η² = 0.37). A significant between-group difference favoring IPSRT emerged at three months (t = 3.01, p < 0.05, d = 0.76). Social functioning also improved significantly in the intervention group (MCAS: 55.5 ± 7.4 at baseline, 63.7 ± 7.1 post-intervention, and 62.3 ± 6.9 at follow-up; F = 29.4, p < 0.05, η² = 0.49). Between-group differences were significant immediately post-intervention (t = 4.10, p < 0.001, d = 1.05) and at three-month follow-up (t = 2.73, p = 0.008, d = 0.72). Conclusions: IPSRT produced sustained improvements in social rhythm stability and social functioning, demonstrating its clinical value in the management of bipolar disorder. Full article

This paper proposes the development of an IEC 61850-compliant platform that is readily programmable and deployable for future digital twin applications. Given the compatibility between IEC-61850 and digital twin concepts, a focused case study was conducted involving the robust development of a Raspberry Pi platform with protection relay functionality using the open-source libIEC61850 library. Leveraging IEC-61850’s object-oriented data modelling, the relay can be represented by fully consistent virtual and physical models, providing an essential foundation for accurate digital twin instantiation. The relay implementation supports high-speed Sampled Value (SV) subscription, real-time RMS calculations, IEC Standard Inverse overcurrent trip behaviour according to IEC-60255, and Generic Object-Oriented Substation Event (GOOSE) publishing. Further integration includes setting group functionality for dynamic parameter switching, report control blocks for MMS client–server monitoring, and GOOSE subscription to simulate backup relay protection behaviour with peer trip messages. A staged development methodology was used to iteratively develop features from simple to complex. At the end of each stage, the functionality of the added features was verified before proceeding to the next stage. The integration of the Raspberry Pi into Curtin’s IEC = 61,850 digital substation was undertaken to verify interoperability between IEDs, a key outcome relevant to large-scale digital twin systems. The experimental results confirm GOOSE transmission times below 4 ms, tight adherence to trip-time curves, and performance under higher network traffic. Such measured RMS and trip-time errors fall well within industry and IEC limits, confirming the reliability of the relay logic. The takeaways from this case study establish a high-performing, standardised foundation for a digital twin system that requires fast, bidirectional communication between a virtual and a physical system. Full article

Essential hypertension is a leading cause of chronic kidney disease (CKD) and is frequently complicated by hypertensive nephropathy, characterized by nephroangiosclerosis and increased intrarenal vascular resistance, assessable by renal resistive index (RRI). Oxidative stress and endothelial dysfunction contribute to CKD progression, and the Mediterranean diet (MD) has been associated with a more favorable oxidative and endothelial profile, although data linking diet to renal microcirculation in hypertensive nephropathy remain limited. The aim of this study is to evaluate the relationship between RRI, oxidative stress, endothelial function, and adherence to the Mediterranean diet in patients with essential hypertension and hypertensive nephropathy. We performed a cross-sectional single-center study and we enrolled 99 patients with essential hypertension, hypertensive nephropathy, and CKD stages G1–G4 (KDIGO). All patients underwent laboratory testing, measurement of oxidative stress markers (sNOX2-dp, H₂O₂) and endothelial function (NO), renal ultrasound with interlobar RRI assessment, and PREDIMED questionnaire for MD adherence. A significant direct correlation was observed between RRI and oxidative stress markers (sNOX2-dp and H₂O₂) (p = 0.002, r = 0.302; p = 0.002, r = 0.322), while a significant inverse correlation was found between RRI and the endothelial function marker (NO) (p = 0.013, r = −0.302). The correlation between RRI and PREDIMED questionnaire scores did not reach statistical significance, but there was a trend toward an inverse association (p = 0.06, r = −0.18). In addition, a significant inverse correlation was observed between RRI and eGFR (p = 0.005, r = −0.27), consistent with published data. We also found a significant inverse correlation between sNOX2-dp and PREDIMED scores (p = 0.034, r = −0.21); no statistically significant correlations with H₂O₂ and NO were observed in this analysis. Higher intrarenal vascular resistance is associated with heightened oxidative stress, impaired endothelial function, and lower eGFR. Adherence to the Mediterranean diet is linked to lower NOX2-mediated oxidative stress, supporting a potential association between higher MD adherence and lower NOX2-related oxidative stress. These findings are hypothesis-generating and require confirmation in adequately powered longitudinal and interventional studies before any clinical inference on CKD progression can be made. Full article

This protocol details an optimized step-by-step procedure for performing the Seahorse XF Cell Mito Stress Test on human umbilical vein endothelial cells (HUVECs) using the Agilent Seahorse XF Pro Analyzer. Designed to address practical challenges often overlooked in standard manuals, the method preserves the native adherent state of HUVECs—a key in vitro model in vascular aging (VA) research—enabling real-time, label-free measurement of mitochondrial respiration and glycolytic function without cell detachment. The workflow is presented chronologically, covering instrument preparation, cell seeding, compound loading, assay execution, and post-assay normalization, with integrated notes and troubleshooting tips refined through hands-on experience based on the official manuals. This protocol aims to set up a detailed, rearranged standard workflow to improve experimental efficiency, reduce operator error, and support reproducible and well-organized metabolic profiling of HUVECs in aging and cardiovascular studies. Full article