Search Results (459)

Background/Objectives: Bronchiolitis is the leading cause of hospitalization in infants under 12 months. While often self-limiting, a subset of cases evolves into severe disease requiring intensive care. This study aimed to identify risk factors for severe bronchiolitis in two consecutive respiratory syncytial virus (RSV) seasons (before and after the introduction of nirsevimab) in Southern Italy. Methods: A retrospective, multicenter cohort study was conducted on all infants ≤12 months hospitalized with bronchiolitis from October 2023 to March 2025. Patients were categorized by disease severity: those requiring Sub-Intensive or Intensive Care (IC group) and others (n-IC group). Demographic and clinical data, virological testing, and therapeutic interventions were analyzed. Multivariable logistic regression was used to identify independent risk factors for severe disease. Results: Among 1056 hospitalized infants, 10.5% required intensive care. RSV was detected in 73.5% of tested patients and was significantly associated with severe outcomes. Independent risk factors for IC admission included younger age (<3 months), comorbidities, and RSV infection. A 33% reduction in bronchiolitis admissions was observed in the second season (post-nirsevimab), although the rate of severe cases remained stable (about 10% in both seasons). Conclusions: Younger age, comorbidities, and RSV infection are significant predictors of severe bronchiolitis. Although overall admissions decreased post-nirsevimab, severe cases persisted. These findings underscore the need for targeted preventive strategies and highlight the potential role of intermediate care approaches in managing bronchiolitis severity. Full article

In light of pressing global nutritional needs, the valorization of agri-food waste constitutes a vital strategy for enhancing human health and nutrition, while simultaneously supporting planetary health. This integrated approach is increasingly indispensable within sustainable and equitable food systems. Recently, a sustainability-driven focus has shifted attention toward the valorization of the agri-food by-products as rich sources of bioactive compounds useful in preventing or treating chronic diseases. Agri-food by-products, often regarded as waste, actually hold great potential as they are rich in bioactive components, dietary fiber, and other beneficial nutrients from which innovative food ingredients, functional foods, and even therapeutic products are developed. This review aims to provide a comprehensive analysis of the current advances in recovering and applying such compounds from agri-food waste, with a particular focus on their roles in human health, sustainable packaging, and circular economy strategies. Methods: This review critically synthesizes recent scientific literature on the extraction, characterization, and utilization of bioactive molecules from agri-food by-products. After careful analysis of the PubMed and Scopus databases, only English-language articles from the last 10 years were included in the final narrative review. The analysis also encompasses applications in the nutraceutical, pharmaceutical, and food packaging sectors. Results: Emerging technologies have enabled the efficient and eco-friendly recovery of compounds such as polyphenols, carotenoids, and dietary fibers that demonstrate antioxidant, antimicrobial, and anti-inflammatory properties. These bioactive compounds support the development of functional foods and biodegradable packaging materials. Furthermore, these valorization strategies align with global health trends by promoting dietary supplements that counteract the effects of the Western diet and chronic diseases. Conclusions: Valorization of agri-food by-products offers a promising path toward sustainable development by reducing waste, enhancing public health, and driving innovation. This strategy not only minimizes waste and supports sustainability, but also promotes a more nutritious and resilient food system. Full article

Opioid use disorder (OUD) is a chronic disease that remains difficult to treat, even with significant improvements in available medications. While current treatments work well for some, they often do not account for the unique needs of individual patients, leading to less-than-ideal results. Precision medicine offers a new path forward by tailoring treatments to fit each person’s genetic, psychological, and social needs. This review takes a close look at medications for OUD, including methadone, buprenorphine, and naltrexone, as well as long-acting options that may improve adherence and convenience. Beyond medications, the review highlights the importance of addressing mental health co-morbidities, trauma histories, and social factors like housing or support systems to create personalized care plans. The review also explores how emerging technologies, including artificial intelligence and digital health tools, can enhance how care is delivered. By identifying research gaps and challenges in implementing precision medicine into practice, this review emphasizes the potential to transform OUD treatment. A more individualized approach could improve outcomes, reduce relapse, and establish a new standard of care focused on recovery and patient well-being. Full article

Background: Postoperative pulmonary embolism (PPE) is a critical complication that can significantly affect patient outcomes. This study aimed to assess knowledge, attitudes, and practices (KAP) of thoracic healthcare professionals toward PPE. Methods: A cross-sectional study was conducted from September to December 2022. Results: A total of 222 thoracic healthcare professionals participated in the study; the majority were aged 30–40 years (40.54%) and had over 10 years of work experience (47.75%). Participants completed a self-designed questionnaire assessing demographic data and KAP scores: knowledge (0–11), attitudes (11–55), and practices (9–45). The main measures included the mean scores for knowledge, attitudes, and practices, along with correlation analyses and path analysis to assess relationships among the KAP components. Mean scores were 9.03 ± 1.13 for knowledge, 50.09 ± 4.23 for attitudes, and 35.78 ± 7.85 for practices. Participants showed strong awareness of PPE definitions and risk factors, but only 24.77% correctly identified its classic clinical triad. Attitudinally, while most expressed a willingness to engage in PPE training and risk assessment, 55.41% remained cautious about anticoagulation due to bleeding risks. In practice, although 72.52% consistently supported postoperative mobilization, only 30.63% frequently acquired updated PPE knowledge. Significant positive correlations were found between knowledge and attitudes (r = 0.218, p < 0.001) and between attitudes and practices (r = 0.234, p < 0.001). Path analysis showed that knowledge positively influenced attitudes (path coefficient 0.748, p = 0.002), and attitudes positively influenced practices (path coefficient 0.374, p = 0.003). Conclusions: Thoracic healthcare professionals exhibited adequate knowledge, positive attitudes, and proactive practices regarding PPE, indicating a strong foundation for enhancing postoperative care. Full article

Gene therapy has emerged as a promising treatment for several eye diseases since it may restore vision and stop blindness. Many eye diseases, including retinitis pigmentosa and macular degeneration, have historically been rather difficult to treat and usually cause permanent vision loss. However, thanks to advances in gene therapy, many disorders can now be effectively targeted and genetically changed, providing a safer, more direct, maybe even curative approach. By introducing, altering, or repairing specific genes inside the eye, gene therapy seeks to fix the defective genes causing these disorders, thereby improving general eye health and visual ability. Voretigene neparvovec is one FDA- and EMA-approved treatment for RPE65 mutations. Retinitis pigmentosa, age-related macular degeneration, X-linked retinoschisis, choroideremia, and Stargardt disease are among the several eye disorders still under clinical trials, and experimental treatment is in progress. As research on gene therapy develops, it opens the path for groundbreaking treatments that could fundamentally change the ophthalmic care scene. Full article

Most existing cloud base height (CBH) retrieval algorithms are only applicable for daytime satellite observations due to their dependence on visible observations. This study presents a novel algorithm to retrieve day and night CBH using infrared observations of the geostationary Advanced Himawari Imager (AHI). The algorithm is featured by integrating deep learning techniques with a physical model. The algorithm first utilizes a convolutional neural network-based model to extract cloud top height (CTH) and cloud water path (CWP) from the AHI infrared observations. Then, a physical model is introduced to relate cloud geometric thickness (CGT) to CWP by constructing a look-up table of effective cloud water content (ECWC). Thus, the CBH can be obtained by subtracting CGT from CTH. The results demonstrate good agreement between our AHI CBH retrievals and the spaceborne active remote sensing measurements, with a mean bias of −0.14 ± 1.26 km for CloudSat-CALIPSO observations at daytime and −0.35 ± 1.84 km for EarthCARE measurements at nighttime. Additional validation against ground-based millimeter wave cloud radar (MMCR) measurements further confirms the effectiveness and reliability of the proposed algorithm across varying atmospheric conditions and temporal scales. Full article

Technology-based strategies for the prevention and management of suicidal behavior are widely referenced for identifying vulnerable groups and for supporting clinical reasoning, decision-making, and appropriate referrals. In this study, we estimated the interface and content validity evidence of an interactive mobile application developed for managing suicidal behavior. This methodological study employed psychometric parameters to evaluate the content and interface of the mobile application, following five action phases: analysis, design, development, implementation, and evaluation. A total of 27 healthcare professionals participated, selected by convenience sampling, all working within the Psychosocial Care Network across different regions of Brazil. Data were collected using an electronic form, the Delphi technique for evaluation rounds, and a Likert scale to achieve consensus. The validity analysis was based on a Content Validity Index (CVI) equal to or greater than 0.80. The results showed that GerenciaVida, a technology developed for healthcare workers—regardless of their level of care or professional category—can be used to screen for suicide risk in the general population and indicate preventive alternatives. The app demonstrated satisfactory indicators of content validity (0.974) and interface validity (0.963), reflecting clarity (0.925), objectivity (1.00), adequacy (0.925), coherence (0.962), accuracy (0.962), and clinical relevance (1.00). The development path of this mobile application provided scientific, technological, and operational support, establishing it as an innovative care tool. It consolidates valid evidence that supports the identification, risk classification, and prevention of suicidal behavior in various healthcare contexts. Full article

During centralizer hydroforming, internal pressure and axial feed critically influence the forming outcome. Insufficient feed causes excessive thinning and cracking, while excessive feed causes thickening and wrinkling. Achieving uniform wall thickness necessitates careful design of the pressure and feed curves. Using max/min wall thickness as objectives and key control points on these curves as variables, the study integrated Non-dominated Sorting Genetic Algorithm (NSGA-II), Multi-Objective Particle Swarm Optimization (MOPSO), Neighborhood Cultivation Genetic Algorithm (NCGA), and Archive-based Micro Genetic Algorithm (AMGA) with LS-DYNA to automatically optimize loading paths. The results demonstrate the following: ① NSGA-II, NCGA, and AMGA successfully generated optimized paths; ② NSGA-II and AMGA produced larger sets of higher-quality Pareto solutions; ③ AMGA required more iterations for satisfactory Pareto sets; ④ MOPSO exhibited a tendency towards premature convergence, yielding inferior results; ⑤ Multi-objective optimization efficiently generated diverse Pareto solutions, expanding the design space for process design. Full article

Objective: This study aimed to examine the mediating and moderating roles of quality of life, mindfulness, and savoring in the relationship between sugar intake and depression among women with breast cancer undergoing active treatment. Methods: This prospective observational study recruited seventy-eight women diagnosed with breast cancer within six months from a medical center in Taiwan. The participants completed patient-reported health surveys and dietary recalls. Results: Sugar consumption (β = 0.22, p < 0.01) and breast symptoms (β = 0.28, p < 0.01) were significantly associated with depressive symptoms. Simple mediation analysis indicated that quality of life fully mediated the relationship between sugar intake and depression (indirect effect = 0.15, 95% CI = 0.05 to 0.25), while breast symptoms played a partial mediating role (indirect effect = 0.10, 95% CI = 0.02 to 0.18). Moderated mediation analysis revealed that after-event savoring moderated the path between quality of life and depression (interaction effect = −0.04, 95% CI = −0.08 to −0.01). Furthermore, non-judgment mindfulness significantly attenuated the indirect effect of sugar consumption on depression via quality of life functions (moderated mediation index = −0.03, 95% CI = −0.06 to −0.00). Conclusions: Mindfulness and momentary savoring may act as protective factors, moderating the relationship between sugar consumption and depression. These findings support the proposal to integrate nutrition and mindfulness-based support into clinical care for women receiving active breast cancer treatment. Full article

Background: Hospitalization during the COVID-19 pandemic has been linked with increased psychological distress, cognitive impairment, and reduced quality of life (QoL). Posttraumatic stress symptoms (PTSS) and rumination may significantly influence QoL outcomes, yet the mechanisms underlying these effects remain poorly understood. Based on the Cognitive Aging Model, this study examines the mediating effects of cognitive and emotional functioning, loneliness, and posttraumatic growth (PTG) on the connection between PTSS/rumination and QoL among patients hospitalized with COVID-19, including the moderator effect of sex, time since discharge, and admission to the intensive care unit (ICU). Methods: A cohort of 258 patients previously hospitalized with COVID-19 as the primary or secondary diagnosis was assessed 6 to 24 months post-discharge. Participants completed validated self-report and neuropsychological assessments of PTSS, rumination, cognitive function, psychological morbidity (depression and anxiety), loneliness, PTG, and QoL. Path analysis and multigroup analysis were employed to assess mediating and moderating effects. Results: PTSS and rumination were associated with reduced physical and mental QoL, primarily via increased psychological morbidity, impaired cognitive functioning, loneliness, and reduced PTG. Rumination showed strong direct and indirect effects on multiple mediators. Only sex and time since discharge significantly moderated pathways, with women showing a strong association between rumination and cognitive impairment/loneliness, while the association between loneliness and mental QoL was significant only in men and in recently discharged patients. Conclusions: PTSS and rumination contribute negatively to QoL in post-discharged patients with COVID-19 through emotional, cognitive, and social pathways, influenced by sex and duration since discharge. The findings underscore the significance of comprehensive long-term care methods focused on cognitive rehabilitation, psychosocial sT, and social reintegration for COVID-19 survivors. Full article

Spinal cord injury (SCI) represents a complex pathological event, which requires continuous and highly specialized territorial interventions. The literature highlights disadvantages faced by people with SCI in accessing local services. This study aimed to investigate the concept of territorial continuity for SCI, reconstructing patients and healthcare professionals’ perspectives, to identify facilitators, barriers and opportunities. Methods: a Focus Group (FG) qualitative study was conducted at Piacenza Ausl; four FGs were carried out; a research team member moderated FGs using thematic guides, while an observer was responsible for noting non-verbal aspects. Meetings lasted between 90 and 120 min and were audio-recorded. Transcript analysis involved the identification of units of meaning, which were grouped into general themes. Results: Final analysis highlighted 435 verbatim, grouped into 21 initial themes, that converged into 5 emerging themes: “SCI continuity as multidisciplinary teamwork”; “The need for rehabilitation as a driver of territorial continuity”; “Reinventing everyday life after SCI”; “Barriers and facilitators”; and “The future of territorial care”. Discussion: Patients and healthcare professionals highlighted the absence of a defined treatment path and the lack of reference points, thus generating disorientation and need for information. Among the proposals, telemedicine, empowering the case manager’s role, promoting specific training courses and rethinking community hospitals were supported. Full article

This study presents a comprehensive review of risk assessment and scheduling techniques in highway construction, addressing the complex interplay between uncertainty, project planning, and decision-making. The research critically reviews key risk assessment methods, including Probability–Impact (P-I), Monte Carlo Simulation (MCS), Fuzzy Set Theory (FST), and the Analytical Hierarchy Process (AHP), alongside traditional scheduling approaches such as the Critical Path Method (CPM) and the Program Evaluation and Review Technique (PERT). The findings reveal that, although traditional methods like CPM and PERT remain widely used, they exhibit limitations in addressing the dynamic and uncertain nature of construction projects. Advanced techniques such as MCS, FST, and AHP enhance decision-making capabilities but require careful adaptation. The review further highlights the growing relevance of hybrid and integrated approaches that combine risk assessment and scheduling. Bayesian Networks (BNs) are identified as highly promising due to their capacity to integrate both qualitative and quantitative data, offering potential for greater reliability in risk-informed scheduling while supporting improvements in cost efficiency, schedule reliability, and adaptability under uncertainty. The study outlines recommendations for the future development of intelligent, risk-based scheduling frameworks suitable for industry adoption. Full article

Pediatric palliative care (PPC) is an evolving field that focuses on supporting children with life-limiting conditions, where the quality of care is vital. This study is a retrospective observational investigation that examines the experiences of caregivers to inform health and social service planning and enhance PPC quality. Methods: Data of pediatric patients aged 3 months to 18 years admitted to a PPC inpatient unit over two years were retrospectively reviewed. Sociodemographic characteristics of primary caregivers, including age, gender, number of siblings, education, income, occupation, and marital status, were recorded. Caregiver burden and burnout were assessed using the Zarit Burden Interview and the Maslach Burnout Inventory, respectively. Associations between caregiver characteristics and these measures were analyzed. Results: A total of 118 patients and caregivers were evaluated; 54.2% of patients were male. The most common diagnoses were neurological diseases (44.9%), followed by syndromic–genetic disorders (28.8%). About 34% of patients required more than three medical devices. Most caregivers were female (91.5%), mainly mothers and 53% had only primary education. No significant differences in care burden or burnout were found based on caregiver gender, marital status, or child’s diagnosis. However, the use of nasogastric tubes and multiple medical devices was associated with higher burnout. Lower income was significantly linked to higher care burden, while longer caregiving duration correlated with both increased burden and burnout. A moderate positive correlation was found between Zarit and Maslach scores. Conclusions: The complexity of PPC patients’ care increases caregiver burden and burnout. Expanding specialized PPC services is crucial to support caregivers and sustain home-based care. Full article

Background/Objectives: The COVID-19 pandemic has placed intensive care unit (ICU) nurses under intense psychological pressure, increasing emotional and psychological stress. Two constructs—difficulties in emotion regulation and psychological inflexibility (i.e., low contact with the present moment and a lack of committed action based on personal values)—have been associated with increased perceived stress levels but remain underexplored in this population. Aims: This study investigated whether psychological inflexibility mediates the relationship between emotion regulation difficulties and perceived stress in ICU nurses. It also examined whether years of ICU work experience moderate the direct relationship between emotion regulation difficulties and perceived stress. Methods: A cross-sectional study was conducted with 210 ICU nurses (65.2% women; 34.8% men; mean age = 40.25 years ± 11.36) from Italian public hospitals. The participants completed the Difficulties in Emotion Regulation Scale, the Acceptance and Action Questionnaire-II, and the Perceived Stress Scale. A moderated mediation model was tested to examine whether psychological inflexibility mediates the relationship between emotion regulation difficulties and perceived stress and whether years of ICU work experience moderate the path between these variables. Results: Higher difficulties in emotion regulation predicted greater psychological inflexibility, which, in turn, predicted higher perceived stress. Psychological inflexibility fully mediated the relationship between emotion regulation difficulties and perceived stress. Additionally, years of ICU work experience significantly moderated the direct link between emotion regulation difficulties and perceived stress. This relationship was strongest for nurses with 1–15 years of ICU experience. The model explained 33% of the variance in perceived stress. Conclusions: This study highlights the importance of the novel construct of psychological inflexibility in the context of healthcare professionals and its role in shaping perceived stress. Addressing psychological inflexibility through targeted interventions may help mitigate stress and promote well-being among ICU nurses. Full article

A new control system implemented with a single-stage DC-DC controller to power an LED headlamp for automotive applications is presented in this work. Daytime running light (DRL), low beam (LB), high beam (HB) and adaptive driving beam (ADB) are typical functions requiring a dedicated LED driver solution to fulfill car maker requirements for front-light applications. Single-stage drivers often exhibit a significant overshoot in LED current during transitions from driving a higher number of LEDs to a lower number. To maintain LED reliability, this current overshoot must remain below the maximum current rating of the LEDs. If the overshoot overcomes this limit, it can cause permanent damage to the LEDs or reduce their lifespan. To preserve LED reliability, a comprehensive system has been proposed to minimize the peak of LED current overshoots, especially during transitions between different operating modes or LED string configurations. A key feature of the proposed system is the implementation of a parallel discharging path to be activated only when the current flowing in the LEDs is higher than a predefined threshold. A prototype incorporating an integrated test chip has been developed to validate this approach. Measurement results and comparison with state-of-the-art solutions available in the market are shown. Furthermore, a critical aspect to be considered is the proper dimensioning of the discharging path. It requires careful considerations about the gate driver capabilities, the discharging resistor values, and the thermal management of the dumping element. For this purpose, an extensive study on how to size the relative components is also presented. Full article