Search Results (297)

The intravenous low-dose dexamethasone suppression test (IV-LDDST) is considered the most accurate method for diagnosing Cushing’s syndrome (CS) in dogs, but its intravenous administration and repeated hospital sampling are stressful and time-consuming for both dogs and owners. This study evaluated an oral LDDST (O-LDDST) as a minimally invasive alternative. The approach is based on the urinary corticoid-to-creatinine ratio (uCC) measured in urine samples collected at home at baseline (B-uCC) and 8 h after administering a low oral dose of dexamethasone (0.01 mg/kg; 8h-uCC). A total of 168 client-owned dogs were prospectively recruited: 42 healthy dogs (HD), 40 dogs with disease mimicking CS (DMCS), and 86 dogs with confirmed CS. An ROC curve analysis showed that dogs with CS had significantly higher B-uCC and 8h-uCC and a lower suppression percentage (%S) compared with HD and DMCS (all p < 0.0001). Optimal cut-offs were B-uCC > 14.2 × 10⁻⁶, 8h-uCC > 6.7 × 10⁻⁶, and %S < 48.6%, yielding sensitivity/specificity of 82.9%/83.3%, 95.3%/92.6%, and 86.0%/85.3%, respectively. O-LDDST was preferred by 85.9% of owners, although it did not distinguish pituitary- from adrenal-dependent CS. The O-LDDST proved to be a reliable, accurate, and minimally invasive diagnostic option for CS in dogs, with 8h-uCC providing the highest accuracy. Full article

Background/Objectives: Socially assistive robots effectively support elderly care when they incorporate personalization, person-centered principles, rich interactions, and careful role setting with psychosocial alignment. Hyodol, a socially assistive robot designed for elderly people, embodies a grandchild’s persona, emulating the grandparent–grandchild relationship. Based on the behavioral activation principles and a human-centered approach, this robot continuously supports users’ emotional well-being, health management, and daily routines. Methods: The current study evaluated Hyodol’s impact on depressive symptoms and other quality of life factors among older adults living in medically underserved areas. A total of 278 participants were assessed for depressive symptoms, loneliness, medication adherence, and user acceptance. Results: After six months of use, participants showed significant reductions in overall depressive symptoms, with a 45% decrease in the proportion of individuals at high risk of depression. Significant improvements were also observed in loneliness and medication adherence. Participants reported high levels of user acceptance and satisfaction, exceeding 70% of the total score. Participants who engaged more frequently in free chat with Hyodol showed greater improvements in depressive symptoms. Conclusions: These results highlight Hyodol’s potential as a promising tool for enhancing mental healthcare and overall well-being in this population. This at-home mental-healthcare framework can complement primary care and, if its effects are confirmed in controlled trials, could contribute to reducing healthcare burden and preventing the onset and escalation of depressive symptoms. Full article

Background/Objectives: Mini-tablets have gained popularity as a pediatric dosage form owing to their high acceptability. Since 2022, the Showa University Hospital has prescribed acetylsalicylic acid (ASA) mini-tablets to pediatric patients with Kawasaki disease (KD). In this study, we investigated the real-world, at-home administration status of ASA mini-tablets in pediatric patients with KD. Methods: This retrospective study included 14 pediatric patients with KD on ASA mini-tablet therapy between November 2022 and October 2024. Medication administration completeness, mood changes during administration, administration patterns, beverages consumed, and swallowing-related events were analyzed. Associations between changes in the administration pattern or beverage consumption and swallowing events or mood changes were evaluated. Serious adverse events and coronary artery aneurysms were assessed using medical records. Results: Patients were prescribed ASA mini-tablets for a mean duration of 60.9 days. No serious adverse events or coronary aneurysms were observed. Among the 679 medication records, 5 swallowing-related events were identified. No mood changes following administration were observed in >90% of cases. The mood worsened to “Bad” once, with no further deterioration. The “All at once” administration pattern occurred in 64% of occasions across 12 patients (age: 9–79 months). Patients aged <3 years used medication-assisted jelly, whereas older patients mostly used water. Conclusions: ASA mini-tablets can be safely administered at home with minimal swallowing problems. Patients completed full doses irrespective of tablet number, age, administration pattern, or beverage, supporting ASA mini-tablets as an acceptable dosage form option for ASA in KD. Full article

Digital Twins (DTs) are digital replicas of physical entities. The use of DTs in healthcare is a growing area of research. With DTs, there is potential to revolutionize healthcare with the assistance of Artificial Intelligence. This can lead to achieving precision, personalization, and value addition in healthcare. Contributing to this field, we present one of the first attempts of uncovering time series models of decompensation of heart failure. This was performed using some of the first data collected from the pilot phase of the SmartHeart study, in which an at-home, wearable, wireless sensor-based digital self-monitoring system for people with heart failure was tested. Full article

In individuals with Parkinson’s disease (PD), bradykinesia severity is related to physical activity (PA) inside homes. We aimed to investigate the effectiveness of the Lee Silverman Voice Treatment (LSVT)^® BIG intervention in increasing at-home PA in individuals with PD. To evaluate the effect of the intervention, we compared pre- and post-intervention scores on the Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Parts 3 and 2, as well as the time spent at home in three categories of PA intensity. For statistical testing, paired t-tests were used when the data met the assumptions of normality, and the Wilcoxon signed-rank test was applied otherwise. Differences were considered statistically significant at p < 0.05. This preliminary retrospective observational study included 10 eligible individuals with PD (4 males). The participants’ mean age was 71.0 ± 10.8 years, with median Hoehn and Yahr stage 3 [interquartile range: 1 to 4]. The MDS-UPDRS Part 3 score, bradykinesia score calculated from a part of that score, and the MDS-UPDRS Part 2 score significantly improved after the intervention (Wilcoxon signed-rank test, p < 0.05). The time spent in sedentary behavior (SB) significantly decreased from 516.4 ± 72.6 to 484.0 ± 70.0 min, whereas that spent in light PA (LPA) significantly increased from 137.8 ± 46.2 to 169.5 ± 32.1 min (paired t-test, p < 0.05). The time spent on moderate-to-vigorous PA (MVPA) did not change significantly (paired t-test, p = 0.533). The results suggested that LSVT^® BIG is an effective intervention for increasing at-home PA in individuals with PD. In addition, regarding the specific details of the increase, the time spent on MVPA may not change, and the increase may be mainly attributed to increased LPA and reduced sedentary time. Full article

Out-of-school time (OST) STEM programs are well-positioned to strengthen family engagement, yet practical, theory-aligned tools remain limited. This early-stage mixed-methods study tests parent/caregiver (P/C) and staff (S) surveys based on Clover for Families developmental theory expressed through the CARE framework: Connect (welcoming climate, clear communication), Act (hands-on participation, at-home supports), Reflect (shared meaning-making, feedback), and Empower (family voice, decision-making). Nine OST STEM programs (eight U.S. states) co-designed/piloted CARE plans, activities, and surveys over six months. Quantitative data included baseline experiences (CARE practice frequency; n = 67 P/C, 42 S across nine programs), program-end reflection (retrospective perceptions of change; n = 26 P/C, 29 S), and forced-ranking (most/least important domains; n = 67 P/C, 42 S). Qualitative data from meetings, open responses, and interviews were analyzed to contextualize quantitative findings, which included strong internal consistency (P/C α = 0.83–0.95; S α = 0.77–0.95) and large retrospective gains in both groups across domains. Forced-ranking elevated Connect and Act over Reflect and Empower, highlighting a need to scaffold family involvement. Staff described CARE as useful and actionable. Findings show that CARE supports measurement and continuous improvement of STEM family engagement. Future work should test large-sample validity, link results to observed practice and youth outcomes, and refine Empowerment-related items for everyday agency. Full article

Background: Cefiderocol (CFD) is a novel cephalosporin targeting multidrug-resistant Gram-negative bacterial (GNB) infections. It mimics siderophores to enter into GNB through iron transport receptors. However, evidence on its use in Hospital at Home (HaH) and outpatient parenteral antibiotic therapy (OPAT) programs remains scarce. Objectives: The primary objective was to evaluate feasibility and efficacy of CFD in HaH setting. The secondary objective was to assess its safety. Methods: A retrospective, observational study was conducted across six Spanish centers between January 2023 and December 2024. Adult patients with documented GNB infections treated with CFD in HaH units were included. Demographic, clinical and microbiological data, treatment characteristics, and outcomes were collected. Statistical analysis was descriptive; no inferential or correlation tests were performed. Results: 27 patients were included; 70.4% were male, with a median age of 69 years. Most infections were nosocomial (65.4%), particularly skin and soft tissue (37%). Septic shock occurred in 14.8% of patients. Pseudomonas aeruginosa (66.7%) and Klebsiella pneumoniae (14.8%) were the most frequent pathogens involved, with Verona Integron-encoded metallo-B-lactamase (VIM, 50%) being the predominant resistance mechanism. CFD was used as a first-line therapy in 63% of cases and in combination with other antibiotics in 40.7%. Median treatment duration was 21.7 days. Administration was mainly via peripherally inserted central catheters (PICC, 33.3%) and electronic pumps (52%). Adverse effects occurred in 7.4% of patients, leading to discontinuation in one case. A total of 88.8% of patients achieved clinical success, with 7.7% recurrence within a month. Escalation of care occurred in 7.7% and 19.2% were readmitted within a month after HaH discharge. No infection-related deaths were reported. Conclusions: CFD is a feasible, safe, and effective treatment for difficult-to-treat GNB infections in HaH settings. Full article

Background: Clinical Learning Environments (CLEs) are essential to nursing education as a platform for students to develop professional identity; consolidate knowledge with clinical practice; and to gain cognitive, communication, and psychomotor skills. Experience in CLEs significantly impacts nursing students’ satisfaction with education and graduate career preferences. The Clinical Learning Environment, Supervision and Nurse Teacher scale (CLES+T) is widely used to measure the quality of professional experience placements (PEPs), but it has limited evidence of psychometric performance in rural and regional Australian contexts. Aim: To assess the psychometric properties of the CLES+T scale in the Australian context of rural and regional undergraduate nursing PEPs. Methods: A cross-sectional observational study of a convenience sample of 165 undergraduate nursing students from regional Victoria, Australia, who undertook PEPs between January and June 2020. Participants completed the CLES+T scale post-PEP. Statistical analyses included a test of survey tool reliability using Cronbach’s alpha and exploratory factor analysis to investigate instrument dimensionality and validity. Results: The CLES+T scale displayed adequate validity and reliability levels and demonstrated internal consistency similar to previous studies. The most important factor in the CLE was revealed as “pedagogy atmosphere and the content of supervisory relationship” followed by “role of the nurse educator”. Conclusions: The CLES+T shows adequate psychometric properties as a valid tool for use with undergraduate nursing students undertaking PEPs in Australian regional, rural, and remote settings. Full article

Objectives: To compare the safety and efficacy of a prototype electronic heating device, Meiboleyes^®, with the BRUDER Moist Heat Eye Compress for the treatment of Meibomian Gland Dysfunction (MGD). Methods: Adults with evidence of active MGD (Ocular Surface Disease Index [OSDI] score ≥ 13, fluorescein tear break-up time [TBUT] < 10 s and meibomian gland secretion score ≤ 12 for 15 glands of the lower lid) were enrolled in this prospective, randomised, parallel group, investigator-masked dispensing study (Australian New Zealand Clinical Trials Registry–ACTRN12624000175572). Meibomian gland secretion (MGS) score and number of meibomian glands yielding liquid secretion (MGYLS), lipid layer thickness, TBUT, ocular physiology and subjective symptoms were measured at baseline, and 2 weeks and 6 weeks following treatment. Linear mixed model analysis was conducted to compare the two groups and changes over time. Results: Ten participants (average age 38.7 ± 14.5 years) in the Meiboleyes^® test group, and 10 participants (average age 38.9 ± 14.8 years) in the BRUDER control group completed the study. MGS and MGYLS significantly improved in both treatment groups from baseline to the 2-week and 6-week follow-up visits (p ≤ 0.006). Significant improvements in TBUT (5.5 ± 1.8 vs. 8.3 ± 2.1 s, p = 0.044), OSDI scores (45.2 ± 15.1 vs. 27.4 ± 12.9, p = 0.027) and visual analogue scale dryness (55.3 ± 27.2 vs. 28.0 ± 23.9, p = 0.023) were observed in the Meiboleyes^® group only after 6 weeks of treatment. No other significant differences were observed over time or between groups. Eight treatment-related adverse events were reported in the Meiboleyes^® group compared to seven in the BRUDER group. All resolved without sequalae. Conclusions: The prototype Meiboleyes^® device was safe and effective for use as an at-home treatment for MGD when used twice daily for six weeks. Improvements in meibomian gland function were comparable to the BRUDER Moist Heat Eye Compress, but significant improvements in tear film stability and subjective comfort after 6 weeks of treatment were observed in the Meiboleyes^® group only. Full article

One of the most important factors in how infants and young children learn to move is postural control. This systematic review aims to evaluate the machine learning methods in posture-related applications for children aged 0–12. Following PRISMA guidelines, we systematically searched the PubMed, Web of Sciences, SCOPUS, and ProQuest Central databases. Twenty-two studies were included in the qualitative synthesis following screening of 199 articles, with methodological quality assessed as moderate to good using the MINORS scale (scores ranging from 8/16 to 19/24). The reviewed research involved diverse samples of infants and children up to 12 years old, employing sensor-based technologies such as inertial measurement units, force plates, pressure mats, and video cameras to extract kinematic and postural features for machine learning applications. Reported accuracies, typically exceeding 85%, reflected considerable methodological heterogeneity related to sensor modality, data quality, and model architecture. Algorithms such as Random Forest, SVM, and CNN were most frequently and effectively applied for posture classification, early detection of developmental delays, and diagnosis of conditions such as cerebral palsy and autism spectrum disorder, demonstrating promising potential for at-home monitoring and clinical interventions. Full article

People with Parkinson’s disease (PD) experience mobility impairments that impact daily functioning, yet conventional clinical assessments provide limited insight into real-world mobility. This study evaluated motor-state classification and the concurrent validity of mobility metrics derived from augmented-reality (AR) glasses against a markerless motion capture system (Theia3D) during gamified AR exercises. Fifteen participants with PD completed five gamified AR exercises measured with both systems. Motor-state segments included straight walking, turning, squatting, and sit-to-stand/stand-to-sit transfers, from which the following mobility metrics were derived: step length, gait speed, cadence, transfer and squat durations, squat depth, turn duration, and peak turn angular velocity. We found excellent between-systems consistency for head position (X, Y, Z) and yaw-angle time series (ICC_(c,1) > 0.932). The AR-based motor-state classification showed high accuracy, with F1-scores of 0.947–1.000. Absolute agreement with Theia3D was excellent for all mobility metrics (ICC_(A,1) > 0.904), except for cadence during straight walking and peak angular velocity during turns, which were good and moderate (ICC_(A,1) = 0.890, ICC_(A,1) = 0.477, respectively). These results indicate that motor states and associated mobility metrics can be accurately derived during gamified AR exercises, verified in a controlled laboratory environment in people with mild to moderate PD, a necessary first step towards unobtrusive derivation of mobility metrics during in-clinic and at-home AR neurorehabilitation exercise programs. Full article

Food loss and waste in school food services generate economic cost, environmental impacts, and social effects. Waste occurs in the final stages of the supply chain. It is particularly critical in educational institutions, leading to low nutrient intake during early stages of development and negatively impacting food security. Aiming to design a waste reduction strategy for the meal service of a preschool serving children aged 0–5 years, a descriptive observational study was conducted over a 6-month period. This study combined the measurement of the primary outcome (proportion of the served portion not consumed by food group) with the assessment of menu acceptability, the children’s food preferences, and the exploration of perceptions of both at-home caregivers and preschool professionals. Overall, the most frequent reasons for rejection were texture, preparation methods, and unfamiliarity with the food. The highest levels of waste were found in fruits and vegetables, with 17% left uneaten; protein-rich foods had a 15% waste rate, and cereals and tubers showed a 10% waste rate. Based on these findings, a family–school strategy is proposed that would increase household exposure to a wider variety of foods and establish periodic menu reviews to identify critical foods and ensure proper use in school food services. These results demonstrate that by enhancing food acceptance, we can decrease food waste, and in early stages, strengthen food security and nutritional use. Full article

This study proposes a low-cost, wearable multimodal system for comprehensive cardiovascular monitoring, integrating electrocardiogram (ECG), phonocardiogram (PCG), and photoplethysmogram (PPG) signals. By leveraging the complementary strengths of these modalities, the system extracts key physiological markers: pre-ejection period (PEP) from ECG–PCG fusion to assess myocardial electromechanical timing; pulse transit time (PTT) from PCG–PPG fusion to reflect arterial stiffness; and pulse arrival time (PAT) from ECG–PPG fusion to characterize heart–arterial coupling. Experimental results show that PEP is significantly associated with body mass index (BMI) but not age, suggesting that age-related changes primarily affect the arterial system rather than myocardial function. In contrast, both PTT and PAT demonstrate moderate negative correlations with age and BMI, supporting their relevance as noninvasive indicators of vascular aging. Additionally, PAT exhibits a significant sex-based difference, highlighting physiological disparities between male and female cardiovascular systems. Overall, the proposed fusion-based approach demonstrates technical feasibility and clinical potential for scalable, preventive cardiovascular healthcare, enabling early risk detection, continuous at-home monitoring, and improved long-term health management. Full article

The “summer slide,” the well-documented tendency for students to lose academic skills during the extended summer break, remains a persistent challenge for educational equity and achievement. Although traditional summer school programs can mitigate these losses, an emerging body of research suggests that summer book distribution initiatives, which provide students with free, high-quality books to read at home, represent a cost-effective and scalable alternative. This study presents results from a quasi-experimental evaluation of Kids Read Now (KRN), an at-home reading program designed to sustain elementary students’ literacy engagement over the summer months. The program’s central feature is the delivery of nine free books directly to students, supported by school-based components that foster home–school connections and promote shared reading between parents and children. Across two districts, five schools, four grade levels (1–4), and 110 KRN and 156 comparison students, we used propensity score matching and doubly robust regression analyses, indicating that KRN participants outperformed their non-participating peers, with an average effect size of nearly d = 0.15. Further, two-stage least squares regression analyses revealed that students who benefited from all nine books achieved an effect size of d = 0.21. These impact estimates correspond to approximately two months of additional learning for the average participant and more than three months for full participants. Collectively, the results contribute to a growing evidence base indicating that book distribution programs are an effective and sustainable means of mitigating summer learning loss and promoting continued growth in reading achievement. Full article

Background/Objective: Few treatment options improve symptoms and the quality of life of Parkinson’s disease (PD); more treatment choices are needed. This study examined the effectiveness of photobiomodulation therapy (PBMt) combined with exercise to improve PD symptoms and quality of life. Methods: Participants were randomised into Active (n = 32) or Sham (n = 31) PBMt groups. Stage 1 was an 8-week double-blind, randomised, placebo-controlled trial using either active or sham PBMt to the head, back of the neck and abdomen three times weekly at home, followed by a 4-week washout. Stage 2 was 8 weeks of active PBMt for all participants. In Stage 3, participants chose to continue active PBMt treatment (‘continuers’) or receive no PBMt treatment (‘non-continuers’) for up to 48 weeks. Participants continued vigorous exercise throughout the study. Participants were assessed on enrolment and after each stage. The primary outcome measure was timed up-and-go, with a range of secondary motor and non-motor outcomes, including UPDRS. Results: There was no significant difference between the Active and Sham Groups after Stages 1 or 2, apart from minimal increase in MoCA score/cognition (Sham Group) in Stage 1. After Stage 3, continuers showed a significant improvement in the primary outcome measure compared to non-continuers. Anxiety and the motor experiences of daily living (MDS-UPDRS Part II) were also significantly improved, while other outcomes approached significance, including MDS-UPDRS Total score (p = 0.062). Conclusions: As the largest study to date, results add increasing weight to previous clinical trials and highlight potential for at-home, scalable treatment as adjunctive therapy alongside medication and exercise. Full article