Search Results (12,927)

Background/Objectives: Family caregivers in palliative care often face complex physical, emotional, and logistical challenges, which can result in a significant caregiving burden. Dyadic interventions—designed to support both the patient and the caregiver simultaneously—have emerged as a promising holistic approach to enhancing well-being and quality of life. This systematic review aimed to evaluate the effects of dyadic support interventions in reducing caregiver burden among middle-aged and older adults receiving palliative care. Methods: A systematic literature search was conducted following PRISMA guidelines across five databases (CINAHL, MEDLINE, Web of Science, Scopus, and Google Scholar for grey literature) covering the period from 2019 to January 2025. Results: Of 653 records identified, 8 studies met the inclusion criteria. Interventions were typically delivered by multidisciplinary teams and included weekly in-person consultations, telephone follow-up, telemedicine, physical exercise sessions, laughter therapy, and music therapy over durations ranging from 16 weeks to 6 months. These programs resulted in reduced anxiety and depressive symptoms (PHQ-4, HADS, SDS, BAI, SAS), improved functional and social performance (SF-36), and/or enhanced quality of life (MQLQ, QOL-AD, KCCQ-12, EORTC QLQ-C30). In patients, they contributed to better symptom control (ESAS, CFS), while in caregivers, they effectively reduced burden (ZBI-12, FCBSI, CBI) and/or supported the anticipatory grief process (PGQ, AGS). However, not all studies reported consistently positive outcomes. Conclusions: Structured dyadic interventions that involve both patients and caregivers significantly improve outcomes in palliative care for middle-aged and older adults. Future research should examine their long-term impact and explore the integration of artificial intelligence to optimize intervention delivery. Full article

Background: Mobility plays a fundamental role in causal reasoning (causal inference or cause–effect learning), which is essential for brain development at early ages. Children naturally develop causal reasoning through interaction with their environment. Therefore, children with severe motor disabilities (GMFCS levels IV–V), who face limited opportunities for interaction, often show delays in causal reasoning. Objective: This study investigates how a wheelchair-mounted, semi-autonomous mobility platform operated via a simple switch may enhance causal learning in children with severe disabilities, compared with traditional therapies. However, due to the scarcity of participants who meet the inclusion criteria and the need for long-term evaluation, recruitment poses a significant challenge. This study aims to provide an initial assessment of the platform and collect preliminary data to estimate the required sample size and number of sessions for future studies. Methods: We conducted a pilot randomized controlled trial (RCT) to assess platform usability and its effect on reaction time and keystroke accuracy. Four children, aged 8.5 ± 2.38, participated in seven 30 min sessions. They were randomly assigned in equal numbers, with two participants in the intervention group (using the platform) and two in the control group (receiving standard therapy). Usability was evaluated through a questionnaire completed by two therapists. Key outcome measures included the System Usability Scale (SUS), reaction time (RT), and keystroke accuracy (NIS). Results: Despite the small sample size and recruitment challenges, the data allowed for preliminary estimates of the sample size and number of sessions required for future studies. Therapists reported positive usability scores. Children using the platform showed promising trends in RT and NIS, suggesting improved engagement with cause–effect tasks. Conclusions: The findings support the feasibility and usability of the mobility platform by therapists, although some improvements should be implemented in the future. No conclusive evidence was found regarding the platform’s effectiveness on causal learning, despite a positive trend over time. This pilot study also provides valuable insights for designing larger, statistically powered trials, particularly focused on NIS. Full article

Background/Objectives: Although people with schizophrenia appear to experience emotions like healthy individuals, previous studies suggest that their ability to engage in empathic emotional responses might be impaired. As per our knowledge, no studies in the Arab world have investigated empathy in patients with schizophrenia, which is likely due to the lack of valid and reliable measures to assess the empathy construct among Arabic-speaking people. The aim of this research is to validate the Arabic version of the Pictorial Empathy Test (PET) in patients with schizophrenia from Lebanon. Methods: A two-month cross-sectional study was carried out at the Psychiatric Hospital of the Cross during January and February of 2024. The average age of the 113 participants in this study was 57.52 ± 10.35 years and 63.5% of them were men. Data were collected through in-person interviews. A confirmatory factor analysis (CFA) was conducted using SPSS AMOS version 29. Parameter estimation utilized the maximum likelihood approach. In order to examine sex invariance in PET scores, a multi-group CFA was conducted. Measurement invariance was assessed across configural, metric, and scalar levels. Evidence of invariance was determined based on the criteria: ΔCFI ≤ 0.010, ΔRMSEA ≤ 0.015, or ΔSRMR ≤ 0.010. Results: CFA revealed that the Arabic PET exhibited a unidimensional factor structure. The PET demonstrated solid internal consistency (ω = 0.93, α = 0.93). Measurement invariance testing confirmed that the scale performed equally well across sexes. A linear regression analysis found that female sex and higher levels of alexithymia were significantly correlated with lower levels of affective empathy. Conclusions: The findings indicate that the Arabic version of the PET is a reliable and valid tool for measuring affective empathy in Arabic-speaking patients with schizophrenia. The culturally adapted and validated Arabic PET would help detect affective empathy deficits, design and implement context-tailored interventions, and encourage future research in this area in the Arab region. Future research should aim to validate the PET against behavioral tasks like the Empathic Accuracy Task to improve its ecological validity. Full article

The growing number of older adults with cancer confront practical and organizational limitations that hinder their ability to obtain care that is adapted to their health status, needs, expectations, and life choices. The integration into practice of evidence-based and institutional recommendations for a geriatric approach and person-centered high-quality care remains incomplete. This study uses an action research design to explore stakeholders’ perspectives of the challenges involved in translating the established care priorities into a compassionate geriatric approach in oncology and identify promising pathways to improvement. Fifty-three stakeholders participated in focus groups to create cognitive maps representing perceived relationships between concepts related to compassionate care of older adults with cancer. Combining maps results in a single model constructed in Mental Modeler software to weigh relationships and calculate concept centrality (importance in the model). The model represents stakeholders’ collective perspective of the determinants of compassionate care that need to be addressed at different decision-making levels. The results reveal pathways to improvement at systemic, organizational, practice, and societal levels. These include connecting policies on ageing and national cancer programs, addressing fragmented care through interdisciplinary teamwork, promoting person-centered care, cultivating relational proximity, and combatting ageism. Translating evidence-based practices and priority orientations into compassionate care rests on collective capacities across multiple providers to address the whole person and their unique trajectory. Full article

Background/Objectives: Intraoperative frozen biopsies are essential during surgery for Hirschsprung’s disease (HD). However, this method has several limitations with the need for a faster and real-time diagnostic alternative. For this, consistent histoanatomical and morphometric differences between aganglionic and ganglionic bowel must be established. The primary objective was to compare dimensions of bowel wall layers between aganglionic and ganglionic segments histopathologically in resected rectosigmoid specimens from children with HD. Secondary objectives were to design a diagnostic algorithm to distinguish aganglionosis from ganglionosis and assess whether full bowel wall thickness correlates with patient weight and age. Methods: Each histoanatomic bowel wall layer—mucosa, submucosa, and muscularis propria’s layers—was delineated manually on histopathological images. Mean thicknesses were calculated automatically using an in-house image analysis software. Paired parametric tests compared measurements in aganglionic and ganglionic segments. Results: Resected specimens from 30 children with HD were included. Compared to aganglionic bowel, ganglionic bowel showed a thicker muscularis interna (mean 0.666 mm versus 0.461 mm, CI −0.257–(−0.153), p < 0.001), and a higher muscularis interna/muscularis externa ratio (2.047 mm versus 1.287 mm, CI −0.954–(−0.565), p < 0.001). An algorithm based on these features achieved 100% accuracy in distinguishing aganglionosis from ganglionosis. No significant difference in full bowel wall thickness was found between aganglionic and ganglionic segments, nor any correlation with patient weight or age. Conclusions: Histoanatomic layer thickness differs between aganglionic and ganglionic bowel, forming the basis of a diagnostic algorithm. Full bowel wall thickness was independent of patient weight and age. Full article

Enhancing system durability and fuel economy stands as a crucial factor in the energy management of fuel cell hybrid vehicles. This paper proposes an Equivalent Consumption Minimization Strategy (ECMS) based on the Genetic Algorithm (GA), aiming to minimize the overall operating cost of the system. First, this study establishes a dynamic model of the hydrogen–electric hybrid vehicle, a static input–output model of the hybrid power system, and an aging model. Next, a speed prediction method based on an Autoregressive Integrated Moving Average (ARIMA) model is designed. This method fits a predictive model by collecting historical speed data in real time, ensuring the robustness of speed prediction. Finally, based on the speed prediction results, an adaptive Equivalence Factor (EF) method using a GA is proposed. This method comprehensively considers fuel consumption and the economic costs associated with the aging of the hydrogen–electric hybrid system, forming a total operating cost function. The GA is then employed to dynamically search for the optimal EF within the cost function, optimizing the system’s economic performance while ensuring real-time feasibility. Simulation outcomes demonstrate that the proposed energy management strategy significantly enhances both the durability and fuel economy of the fuel cell hybrid vehicle. Full article

Smallholder farmers play a pivotal role in food production and rural development in South Africa. However, their productivity is often constrained by reliance on rainfed agriculture and the underutilisation of innovative technologies such as irrigation systems. This study assessed the impact of innovative irrigation system (IIS) use on crop yield among smallholder crop farmers (SCFs) in Mbombela Local Municipality. Focusing on vegetables and agronomic crop producers. Primary data was collected from 308 SCFs using a structured questionnaire through descriptive and cross-sectional survey design. A Probit regression model was used to estimate the probability of using an IIS, while Propensity Score Matching (PSM) estimated the average treatment effect on the treated (ATT) in terms of yield. The results reveal that age group (p = 0.080), main source of off-farm income (p = 0.042), and high input costs (p = 0.006) significantly determined IIS use. Impact analysis confirms that users of IISs achieved higher yields than non-users. The study concludes that innovative irrigation technologies can significantly improve smallholder productivity. It recommends that policymakers and government bodies prioritise scaling up access to IIS, introduce subsidies or low-interest financing schemes to alleviate the IIS usage costs, and strengthen extension services to provide targeted training on irrigation scheduling, system maintenance, and water-use efficiency. Full article

High manganese steel can improve its microstructure after aging treatment, which is beneficial for enhancing strength, toughness, and wear resistance. This study aims to explore the effect of aging treatment on mechanical properties and wear resistance of high manganese steel (containing 25% Mn, called Mn25 steel) by designing different aging temperatures (450 °C, 500 °C, and 550 °C) with the same aging time (1 h). The results indicated that with the increase in aging treatment temperature, the surface hardness of Mn25 steel first increased and then decreased, but was still higher than that of untreated Mn25 steel. In addition, the impact toughness of steel decreased first and then increased with the increase in aging temperature, with the optimal hardness and impact toughness exhibited at 550 °C. The impact abrasive wear test results showed that the weight loss of Mn25 steel decreased with the increase in aging treatment temperature. After aging treatment at 550 °C, the weight loss is the lowest, which shows the optimal wear resistance performance. Under a high-impact load of 5.0 J, the hardness increased by nearly 49.96% after impact abrasive wear, and the effective hardening layer of the steel was the thickest, about 3800 μm. This is mainly related to the best match between the hardness and impact toughness of high manganese steel after aging treatment. The wear morphology is often caused by various wear mechanisms working together to cause the wear loss of Mn25 steel during the impact wear process. The wear morphologies of the Mn25 steel were mainly characterized by press-in particles, furrow, spalling, and strain fatigue. Through experimental analysis, a suitable aging treatment process has been determined, providing a theoretical basis for the practical application of high manganese steel. Full article

Fast, spark-free detection of hydrogen leaks is indispensable for large-scale hydrogen deployment, yet electronic sensors remain power-intensive and prone to cross-talk. Optical schemes based on surface plasmons enable remote read-out, but single-metal devices offer either weak H₂ affinity or poor plasmonic quality. Here we employ full-wave finite-difference time-domain (FDTD) simulations to map the hydrogen response of nanohole arrays (NAs) that can be mass-produced by colloidal lithography. Square lattices of 200 nm holes etched into 100 nm films of Pd, Mg, Ti, V, or Zr expose an intrinsic trade-off: Pd maintains sharp extraordinary optical transmission modes but shifts by only 28 nm upon hydriding, whereas Mg undergoes a large dielectric transition that extinguishes its resonance. Vertical pairing of a hydride-forming layer with a noble metal plasmonic cap overcomes this limitation. A Mg/Pd bilayer preserves all modes and red-shifts by 94 nm, while the predicted optimum Ag (60 nm)/Mg (40 nm) stack delivers a 163 nm shift with an 83 nm linewidth, yielding a figure of merit of 1.96—surpassing the best plasmonic hydrogen sensors reported to date. Continuous-film geometry suppresses mechanical degradation, and the design rules—noble-metal plasmon generator, buried hydride layer, and thickness tuning—are general. This study charts a scalable route to remote, sub-ppm, optical hydrogen sensors compatible with a carbon-neutral energy infrastructure. Full article

Objectives: Anagrelide, an oral phosphodiesterase-3 inhibitor, is widely used to treat thrombocythemia. Evaluating the bioequivalence of low-dose formulations is essential to ensure consistent therapeutic outcomes while minimizing adverse effects, particularly cardiovascular events such as palpitations, tachycardia, and potential arrhythmias, which are known concerns with anagrelide therapy. This study aimed to compare the pharmacokinetics and bioavailability of a newly developed 0.5 mg anagrelide capsule with the reference product under fasting conditions y. Materials and Methods: In a randomized, open-label, two-period crossover design, 42 healthy Turkish male volunteers received a single oral dose (0.5 mg) of either the test or reference anagrelide capsule, with a seven-day washout period between treatments. Serial blood samples were collected over a 10 h post-dose period. Plasma concentrations of anagrelide were analyzed using a validated LC-MS/MS method. Key pharmacokinetic parameters (AUC₀–t, AUC₀–∞, Cmax, tmax, λz, t½, AUC–extrapol) were calculated and subjected to ANOVA-based bioequivalence analysis. Results: A total of 42 healthy male participants (mean age: 34.1 ± 8.9 years; BMI: 25.7 ± 2.9 kg/m²) completed the study without any protocol deviations. Pharmacokinetic analysis demonstrated that the test and reference formulations of anagrelide 0.5 mg were bioequivalent. The mean AUC₀–t values were 4533.3 ± 2379.3 pg·h/mL for the test formulation and 4515.0 ± 2392.3 pg·h/mL for the reference (p > 0.05), while the mean Cmax values were 1997.1 ± 1159.2 pg/mL and 2061.3 ± 1054.0 pg/mL, respectively (p > 0.05). The 90% confidence intervals for the geometric mean ratios of AUC₀–t (94.09–104.75%), Cmax (85.62–104.03%), and AUC₀–∞ (94.50–105.10%) were all within the predefined bioequivalence range of 80–125%, with corresponding point estimates of 99.28%, 94.37%, and 99.66%, respectively. Intra-subject variability was 14.68% for AUC₀–t and 26.98% for Cmax. No statistically significant differences were observed between the formulations for any of the primary or secondary pharmacokinetic parameters (ANOVA, p > 0.05). Regarding safety, 13 treatment-emergent adverse events were reported in 11 participants (26.2%), mostly moderate-intensity headaches, all of which resolved without complications. No serious adverse events occurred, confirming the tolerability of both formulations. Conclusions: This study demonstrates that the test and reference formulations of low-dose 0.5 mg anagrelide are bioequivalent under fasting conditions, with similar safety and tolerability profiles. The findings support the use of the test product as a safe and effective alternative. Full article

Supporting dementia carers is a global priority. As a Randomised Controlled Trial (RCT) (n = 352) of the Word Health Organization recommended, an internationally disseminated ‘iSupport’ e-health intervention was conducted, revealing no measurable benefits to the wellbeing of adult dementia carers. This process evaluation contributes original insights of the trial outcomes. Its aims were to ascertain the usability and acceptability of iSupport, participant engagement and adherence to iSupport, and contextual factors influencing its implementation and potential impact. The process evaluation followed a mixed-method design. The following data were collected from all participants randomised to iSupport (n = 175): (1) post-intervention evaluation questionnaire (n = 93) containing the 10-item System Usability Scale and bespoke items exploring acceptability, engagement, and perceived impact; (2) qualitative interviews (n = 52) with a sub-sample of participants who were purposively sampled according to age, scores on the outcome measures, and gender, as these interviews aimed to generate contextual detail and explanatory accounts; and (3) ‘Access’ data from the iSupport platform (n = 175). Descriptive statistics was used to report on the frequency of survey responses whilst a thematic analysis approach was followed to identify themes from the qualitative interview data. Data sets were analysed independently and then used with respect to one another in order to generate explanatory pathways related to the usability, acceptability, and the impact of iSupport. Despite good trial retention, 8.3% of participants (n = 32) did not spend any time on iSupport, and 54% (n = 94) spent between 30 min and 1.5 h. Factors driving this were the following: time constrains, method of delivery, and content characteristics. Positive impacts of iSupport were also described. Participants, including those with extensive caring experience, reported how iSupport had made them feel reassured, valued, and more able to ask for help. They also reported having an improved outlook on their caring role and on the needs and feelings of the person living with dementia. Research and practice should focus on exploring blended delivery, including self-directed and interactive components, such as regular contact with a health professional. These insights are critical for supporting the global implementation and adaptation of iSupport and offer valuable directions for future research. Full article

Acanthopanax senticosus is an essential medicinal herb in traditional Chinese medicine, with its pharmacological properties largely attributed to bioactive flavonoids. The types and amounts of these flavonoids act as vital quality markers for both the raw materials and the resultant products. In this work, we introduce a TiO₂@AgNP nanocomposite designed as a surface-enhanced Raman scattering (SERS) sensor aimed at the preliminary quantification and identification of flavonoids. This is achieved by leveraging the effective molecular adsorption properties of TiO₂ alongside the ‘hot spots’ generated by AgNPs. By optimizing SERS performance through adjustment of the molar ratio between TiO₂ and Ag, we can quantitatively evaluate four flavonoids—luteolin, kaempferol, quercetin, and rutin—with low detection concentrations of 10⁻⁶ M, 10⁻⁵ M, 5 × 10⁻⁶ M, and 10⁻⁶ M, respectively. Additionally, we observe a nearly linear relationship between the SERS signals and the flavonoid concentrations, allowing for dual or multiplex analysis of these compounds. Furthermore, we successfully differentiated Acanthopanax senticosus samples from six different geographical regions in China based on the detection of significant flavonoid constituents. This serves as a proof of concept for practical applications that can enhance the identification and distinction of traditional Chinese medicine, as well as assess quality and medicinal efficacy. Full article

The rapid demographic transition in middle-income countries creates unprecedented challenges for age-friendly urban development, as cities experience compressed aging within severe resource constraints—a phenomenon termed “getting old before getting rich.” This study develops a preliminary Resource-Constrained Age-Friendly City (RC-AFC) framework through empirical analysis of Bangkok’s urban aging challenges, addressing the need for context-specific approaches in resource-constrained environments. Using convergent parallel mixed-methods design, the research analyzed data from 1000 older adults and 195 multi-sectoral stakeholders to examine age-friendly service gaps and collaboration potential within Bangkok’s rapidly aging context. Importance-Performance Analysis revealed significant service disparities (average gap: 1.34) with Communication and Information (2.03), Housing (1.93), and Outdoor Spaces (1.78) identified as priority areas in Bangkok’s setting. The study proposes three initial RC-AFC principles based on Bangkok findings: Priority Hierarchy Adaptation suggesting systematic resource allocation approaches; Multi-Sectoral Resource Optimization indicating collaboration as structural necessity; and Leapfrog Innovation Potential demonstrating potential for constraint-driven solutions. This proof-of-concept study provides initial conceptual foundation specifically developed from Bangkok’s context, though systematic validation across different urban environments remains essential before any broader consideration. The research offers a Bangkok-derived starting point for understanding resource-constrained age-friendly development that requires substantial further testing and adaptation for application in other contexts. Full article

This study investigates the flexural performance, tensile splitting strength, and fracture behaviour of self-compacting concrete (SCC) reinforced with polypropylene (PP) and basalt (BF) fibres. A total of eleven SCC mixtures with varying fibre types and volume fractions (0.025–0.25%) were tested at 7 and 28 days. In this study, the term high-performance concrete (HPC) refers to SCC mixtures with a 28-day compressive strength exceeding 60 MPa, as commonly accepted in European standards and literature. The control SCC achieved 68.2 MPa at 28 days. While fibre addition enhanced the tensile and flexural properties, it reduced workability, demonstrating the trade-off between mechanical performance and flowability in high-performance SCC. The experimental results demonstrate that both fibre types improve the tensile behaviour of SCC, with distinct performance patterns. PP fibres, owing to their flexibility and crack-bridging capability, were particularly effective at early ages, enhancing the splitting tensile strength by up to 45% and flexural toughness by over 300% at an optimal dosage of 0.125%. In contrast, BF fibres significantly increased the 28-day toughness (up to 15.7 J) and post-cracking resistance due to their superior stiffness and bonding with the matrix. However, high fibre contents adversely affected workability, particularly in BF-reinforced mixes. The findings highlight a dosage-sensitive behaviour, with optimum performance observed at 0.05–0.125% for PP and 0.125–0.25% for BF. While PP fibres improve crack distribution and early-age ductility, BF fibres offer higher stiffness and energy absorption in post-peak regimes. Statistical analysis (ANOVA and Tukey’s test) confirmed significant differences in the mechanical performance among fibre-reinforced mixes. The study provides insights into selecting appropriate fibre types and dosages for SCC structural applications. Further research on hybrid fibre systems and long-term durability is recommended. The results contribute to sustainable concrete design by promoting enhanced performance with low-volume, non-metallic fibres. Full article

Optical fiber composite insulators are essential for photoelectric current measurement, yet insulation failure at embedded optical fiber interfaces remains a major challenge to long-term stability. This study proposes a strategy to replace conventional silicone rubber with cycloaliphatic-like epoxy resin (CEP) as the shed-sheathing material. Three optical fibers with distinct outer coatings, ethylene-tetrafluoroethylene copolymer (ETFE), thermoplastic polyester elastomer (TPEE), and epoxy acrylate resin (EA), were evaluated for their interfacial compatibility with CEP. ETFE, with low surface energy and weak polarity, exhibited poor wettability with CEP, resulting in an interfacial tensile strength of 0 MPa, pronounced dye penetration, and rapid electrical tree propagation. Its average interfacial breakdown voltage was only 8 kV, and the interfacial leakage current reached 35 μA after hygrothermal aging. In contrast, TPEE exhibited high surface energy and strong polarity, enabling strong bonding with CEP, yielding an average interfacial tensile strength of approximately 46 MPa. Such a strong interface effectively suppressed electrical tree growth, increased the average interfacial breakdown voltage to 27 kV, and maintained the interfacial leakage current below 5 μA even after hygrothermal aging. EA exhibited moderate interfacial performance. Mechanism analysis revealed that polar ester and ether groups in TPEE enhanced interfacial electrostatic interactions, restricted the mobility of CEP molecular chain segments, and increased charge traps. These synergistic effects suppressed interfacial charge transport and improved insulation strength. This work offers valuable insight into structure–property relationships at fiber–resin interfaces and provides a useful reference for the design of composite insulation materials. Full article