Search Results (620)

Osteoarthritis (OA) remains a major contributor to pain and disability; however, the current management is largely reactive, focusing on symptoms rather than preventing irreversible cartilage loss. This review first examines the mechanistic foundations for pharmacological chondroprotection—illustrating how conventional agents, such as glucosamine sulfate and chondroitin sulfate, can potentially restore extracellular matrix (ECM) components, may attenuate catabolic enzyme activity, and might enhance joint lubrication—and explores the delivery challenges posed by avascular cartilage and synovial diffusion barriers. Subsequently, a practical “What–How–When” framework is introduced to guide community pharmacists in risk screening, DMOAD selection, chronotherapeutic dosing, safety monitoring, and lifestyle integration, as exemplified by the CHONDROMOVING infographic brochure designed for diverse health literacy levels. Building on these strategies, the P4–4P Chondroprotection Framework is proposed, integrating predictive risk profiling (physicians), preventive pharmacokinetic and chronotherapy optimization (pharmacists), personalized biomechanical interventions (physiotherapists), and participatory self-management (patients) into a unified, feedback-driven OA care model. To translate this framework into routine practice, I recommend the development of DMOAD-specific clinical guidelines, incorporation of chondroprotective chronotherapy and interprofessional collaboration into health-professional curricula, and establishment of multidisciplinary OA management pathways—supported by appropriate reimbursement structures, to support preventive, team-based management, and prioritization of large-scale randomized trials and real-world evidence studies to validate the long-term structural, functional, and quality of life benefits of synchronized DMOAD and exercise-timed interventions. This comprehensive, precision-driven paradigm aims to shift OA care from reactive palliation to true disease modification, preserving cartilage integrity and improving the quality of life for millions worldwide. Full article

Person-centered navigation (PCN) in healthcare refers to a proactive collaboration among professionals, researchers, patients, and their families to guide individuals toward timely access to screening, treatment, follow-up, and psychosocial support. PCN—which includes professional, peer, and virtual guidance, is particularly crucial for rare cancers, where affected individuals face uncertainty, limited support, financial strain, and difficulties accessing relevant information, testing, and other services. The Canadian Cholangiocarcinoma Collaborative (C3) prioritizes PCN implementation to address these challenges in the context of Biliary Tract Cancers (BTCs). C3 uses a virtual PCN model and staffs a “C3 Research Navigator” who provides clinical and research navigation such as personalized guidance and support, facilitating access to molecular testing, clinical trials, and case reviews through national multidisciplinary rounds. C3 also supports a national network of BTC experts, a patient research registry, and advocacy activities. C3’s implementation strategies include co-design, timely delivery of support, and optimal outcomes across its many initiatives. Future priorities include expanding the C3 network, enhancing user engagement, and further integrating its innovative approach into routine care. Full article

The integration of artificial intelligence (AI), big data analytics, and blockchain technologies within the digital economy presents transformative opportunities for promoting low-carbon urban development. However, a systematic understanding of how these digital innovations influence urban carbon mitigation remains limited. This study addresses this gap by proposing two research questions (RQs): (1) What are the key success factors for artificial intelligence, big data, and blockchain in urban carbon emission reduction? (2) How do these technologies interact and support the transition to low-carbon cities? To answer these questions, the study employs a hybrid methodological framework combining the decision-making trial and evaluation laboratory (DEMATEL) and interpretive structural modeling (ISM) techniques. The data were collected through structured expert questionnaires, enabling the identification and hierarchical analysis of twelve critical success factors (CSFs). Grounded in sustainability transitions theory and institutional theory, the CSFs are categorized into three dimensions: (1) digital infrastructure and technological applications; (2) digital transformation of industry and economy; (3) sustainable urban governance. The results reveal that e-commerce and sustainable logistics, the adoption of the circular economy, and cross-sector collaboration are the most influential drivers of digital-enabled decarbonization, while foundational elements such as smart energy systems and digital infrastructure act as key enablers. The DEMATEL-ISM approach facilitates a system-level understanding of the causal relationships and strategic priorities among the CSFs, offering actionable insights for urban planners, policymakers, and stakeholders committed to sustainable digital transformation and carbon neutrality. Full article

Industrial Vision Inspection Systems (VISs) often struggle to adapt to increasing variability of modern manufacturing due to the inherent rigidity of their hardware architectures. Although the Reconfigurable Manufacturing System (RMS) paradigm was introduced in the early 2000s to overcome these limitations, designing such reconfigurable machines remains a complex, expert-dependent, and time-consuming task. This is primarily due to the lack of structured methodologies and the reliance on trial-and-error processes. In this context, this study proposes a novel theoretical framework to facilitate the design of fully reconfigurable handling systems for VISs, with a particular focus on fixture design. The framework is grounded in Model-Based Definition (MBD), embedding semantic information directly into the 3D CAD models of the inspected product. As an additional contribution, a general hardware architecture for the inspection of axisymmetric components is presented. This architecture integrates an anthropomorphic robotic arm, Numerically Controlled (NC) modules, and adaptable software and hardware components to enable automated, software-driven reconfiguration. The proposed framework and architecture were applied in an industrial case study conducted in collaboration with a leading automotive half-shaft manufacturer. The resulting system, implemented across seven automated cells, successfully inspected over 200 part types from 12 part families and detected more than 60 defect types, with a cycle below 30 s per part. Full article

Background: Despite significant advancements in diabetes care, many individuals with type 2 diabetes (T2D) do not receive optimal care and treatment. Digital interventions promoting behavioral changes have shown promising long-term results in supporting healthier lifestyles but are not implemented in most healthcare offerings, maybe due to lack of general practice support and collaboration. This study evaluates the efficacy of the Digital, Individualized, and Collaborative Treatment of T2D in General Practice Based on Decision Aid (DICTA), a randomized controlled trial integrating a patient-centered smartphone application for lifestyle support in conjunction with a clinical decision support (CDS) tool to assist general practitioners (GPs) in optimizing antidiabetic treatment. Methods: The present randomized controlled trial aims to recruit 400 individuals with T2D from approximately 70 GP clinics (GPCs) in Denmark. The GPCs will be cluster-randomized in a 2:3 ratio to intervention or control groups. The intervention group will receive one year of individualized eHealth lifestyle coaching via a smartphone application, guided by patient-reported outcomes (PROs). Alongside this, the GPCs will have access to the CDS tool to optimize pharmacological decision-making through electronic health records. The control group will receive usual care for one year, followed by the same intervention in the second year. Results: The primary outcome is the one-year change in estimated ten-year cardiovascular risk, assessed by SCORE2-Diabetes calculated from age, smoking status, systolic blood pressure, total and high-density lipoprotein cholesterol, age at diabetes diagnosis, HbA1c, and eGFR. Conclusions: If effective, DICTA could offer a scalable, digital-first approach for improving T2D management in primary care by combining patient-centered lifestyle coaching with real-time pharmacological clinical decision support. Full article

Purpose: Cancer immunotherapy has transformed oncology, but underserved populations face persistent disparities in access and outcomes. This review explores how artificial intelligence (AI) can help mitigate these barriers. Methods: We conducted a narrative review based on peer-reviewed literature selected for relevance to artificial intelligence, cancer immunotherapy, and healthcare challenges, without restrictions on publication date. We searched three major electronic databases: PubMed, IEEE Xplore, and arXiv, covering both biomedical and computational literature. The search included publications from January 2015 through April 2024 to capture contemporary developments in AI and cancer immunotherapy. Results: AI tools such as machine learning, natural language processing, and predictive analytics can enhance early detection, personalize treatment, and improve clinical trial representation for historically underrepresented populations. Additionally, AI-driven solutions can aid in managing side effects, expanding telehealth, and addressing social determinants of health (SDOH). However, algorithmic bias, privacy concerns, and data diversity remain major challenges. Conclusions: With intentional design and implementation, AI holds the potential to reduce disparities in cancer immunotherapy and promote more inclusive oncology care. Future efforts must focus on ethical deployment, inclusive data collection, and interdisciplinary collaboration. Full article

Parkinson’s disease (PD), a progressive neurodegenerative disorder, imposes growing clinical and socioeconomic burdens worldwide. Despite landmark discoveries in dopamine biology and α-synuclein pathology, translating mechanistic insights into effective, personalized interventions remains elusive. Recent advances in molecular profiling, neuroimaging, and computational modeling have broadened the understanding of PD as a multifactorial systems disorder rather than a purely dopaminergic condition. However, critical gaps persist in diagnostic precision, biomarker standardization, and the translation of bench side findings into clinically meaningful therapies. This review critically examines the current landscape of PD research, identifying conceptual blind spots and methodological shortfalls across pathophysiology, clinical evaluation, trial design, and translational readiness. By synthesizing evidence from molecular neuroscience, data science, and global health, the review proposes strategic directions to recalibrate the research agenda toward precision neurology. Here I highlight the urgent need for interdisciplinary, globally inclusive, and biomarker-driven frameworks to overcome the fragmented progression of PD research. Grounded in the Accelerating Medicines Partnership-Parkinson’s Disease (AMP-PD) and the Parkinson’s Progression Markers Initiative (PPMI), this review maps shared biomarkers, open data, and patient-driven tools to faster personalized treatment. In doing so, it offers actionable insights for researchers, clinicians, and policymakers working at the intersection of biology, technology, and healthcare delivery. As the field pivots from symptomatic relief to disease modification, the road forward must be cohesive, collaborative, and rigorously translational, ensuring that laboratory discoveries systematically progress to clinical application. Full article

This study presents a cost-effective, carbon-negative construction material for affordable housing, developed entirely from locally available agricultural wastes: rice husk ash, wood ash, and rice straw—materials often problematic to dispose of in many African regions. Rice husk ash provides high amorphous silica, acting as a strong pozzolanic agent. Wood ash contributes calcium oxide and alkalis to serve as a reactive binder, while rice straw functions as a lightweight organic filler, enhancing thermal insulation and indoor climate comfort. These materials undergo natural pozzolanic reactions with water, eliminating the need for Portland cement—a major global source of anthropogenic CO₂ emissions (~900 kg CO₂/ton cement). This process is inherently carbon-negative, not only avoiding emissions from cement production but also capturing atmospheric CO₂ during lime carbonation in the hardening phase. Field trials in Kenya confirmed the composite’s sufficient structural strength for low-cost housing, with added benefits including termite resistance and suitability for unskilled laborers. In a collaboration between the University of Tartu and Kenyatta University, a semi-automatic mixing and casting system was developed, enabling fast, low-labor construction of full-scale houses. This innovation aligns with Kenya’s Big Four development agenda and supports sustainable rural development, post-disaster reconstruction, and climate mitigation through scalable, eco-friendly building solutions. Full article

The 100-Day Mission, coordinated by the Coalition for Epidemic Preparedness Innovations (CEPI) and endorsed by significant international stakeholders, aims to shorten the timeframe for developing and implementing vaccines to 100 days after the report of a new pathogen. This ambitious goal is outlined as an essential first step in improving pandemic preparedness worldwide. This review highlights the mission’s implementation potential and challenges by examining it through the lens of low- and middle-income countries (LMICs), which often face barriers to equitable vaccine access. This article explores the scientific, economic, political, and social aspects that could influence the mission’s success, relying on lessons learned from previous pandemics, such as the Spanish flu, H1N1, and COVID-19. We also examined important cornerstones like prototype vaccine libraries, accelerated clinical trial preparedness, early biomarkers identification, scalable manufacturing capabilities, and rapid pathogen characterization. The review also explores the World Health Organization (WHO) Pandemic Agreement and the significance of Phase 4 surveillance in ensuring vaccine safety. We additionally evaluate societal issues that disproportionately impact LMICs, like vaccine reluctance, health literacy gaps, and digital access limitations. Without intentional attempts to incorporate under-resourced regions into global preparedness frameworks, we argue that the 100-Day Mission carries the risk of exacerbating already-existing disparities. Ultimately, our analysis emphasizes that success will not only rely on a scientific innovation but also on sustained international collaboration, transparent governance, and equitable funding that prioritizes inclusion from the beginning. Full article

Virtual reality interaction design and story co-creation design for multiple users is an interdisciplinary research field that merges human–computer interaction, creative design, and virtual reality technologies. Story co-creation design enables multiple users to collectively generate and share narratives, allowing them to contribute to the storyline, modify plot trajectories, and craft characters, thereby facilitating a dynamic storytelling experience. Through advanced virtual reality interaction design, collaboration and social engagement can be further enriched to encourage active participation. This study investigates the facilitation of narrative creation and enhancement of storytelling skills in virtual reality by leveraging existing research on story co-creation design and virtual reality technology. Subsequently, we developed and evaluated the virtual reality card-based collaborative storytelling platform Co-Relay. By analyzing interaction data and user feedback obtained from user testing and experimental trials, we observed substantial enhancements in user engagement, immersion, creativity, and fulfillment of emotional and social needs compared to a conventional web-based storytelling platform. The primary contribution of this study lies in demonstrating how the incorporation of story co-creation can elevate storytelling proficiency, plot development, and social interaction within the virtual reality environment. Our novel methodology offers a fresh outlook on the design of collaborative narrative creation in virtual reality, particularly by integrating participatory multi-user storytelling platforms that blur the traditional boundaries between creators and audiences, as well as between fiction and reality. Full article

Background: The European League Against Rheumatism (EULAR), in collaboration with the European Scleroderma Trial and Research group (EUSTAR), published the first set of treatment recommendations for systemic sclerosis (SSc) in 2009, with subsequent updates in 2016 and 2023. Objectives: This study aimed to evaluate how rheumatologists’ clinical approaches to the treatment of SSc evolved following the 2016 update of the clinical management guidelines. Methods: Medication use for SSc was analyzed in a cohort of 378 patients. The patients were stratified based on enrollment before (233 patients) and after (145 patients) the guideline update, and medication usage was compared between the two groups. Results: Although all patients presented with Raynaud’s phenomenon (RP), only 35% received calcium channel blockers. Medications such as iloprost, phosphodiesterase type 5 (PDE-5) inhibitors, fluoxetine, and bosentan, recommended for the treatment of RP and digital ulcers, were not approved for SSc by the Republic Health Insurance Fund. Treatment for pulmonary arterial hypertension (PAH) was administered to only 16 patients (4.2%), including 2 who received bosentan, 10 who received PDE-5 inhibitors, and 4 who were treated with riociguat. The use of PDE-5 inhibitors increased following the 2016 update of the guidelines. Cyclophosphamide was consistently prescribed for interstitial lung disease (ILD), with an increased frequency observed after the guideline update. No significant differences were observed in the use of methotrexate for skin involvement, ACE inhibitors for scleroderma renal crisis, or antibiotics for gastrointestinal symptoms. Proton pump inhibitors (PPIs) were prescribed to 87.3% of patients with gastrointestinal involvement, with an increase in use of both PPIs and prokinetic agents following the guideline update. Conclusions: Rheumatologists’ adherence to the EULAR/EUSTAR guidelines varied considerably, with 25% to 100% of eligible patients receiving the recommended treatments. Concordance improved in the management of PAH, ILD, and gastrointestinal involvement after the 2016 guideline update. Full article

Breast cancer-related lymphedema (BCRL) is a debilitating complication in breast cancer survivors, with axillary lymph node dissection (ALND) as the greatest independent risk factor. Beyond non-surgical therapies such as complete decongestive and compression therapy, there has been increased interest in immediate microsurgical reconstruction via immediate lymphatic reconstruction (ILR) anastomosing transected lymphatic vessels to a local venous recipient at the time of ALND to mitigate the risks of BCRL. This work provides a scoping review of the landscape surrounding ILR, spanning the updated literature investigating patient outcomes, current accepted best practices, and critical components of surgical techniques for a successful multidisciplinary approach. While limited by heterogeneity in the methods of lymphedema detection, a growing body of work demonstrates the protective effects of ILR. From the pioneering work by Boccardo et al. in 2009 and his introduction of Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) using an intussusception-type end-to-end microanastmosis, to the first randomized control trial by Coriddi in 2023, which importantly employed relative upper extremity volume change as an outcome measure to circumvent the confounding effects of body size and BMI, the current literature supports ILR following ALND in the prevention of BCRL. Collaboration between the oncologic breast surgeon and reconstructive microsurgeon are central to the success of ILR. Critical components for operative success include preoperative and intraoperative lymphatic mapping, preservation of suitable venous targets, availability of supermicrosurgical instruments and sutures, as well as aptitude with a variety of microsurgical anastomotic techniques. Full article

Group A Streptococcus (GAS) imposes a significant global health burden across all age groups, annually causing over 600 million cases of pharyngitis and more than 18 million severe invasive infections or sequelae. The resurgence of scarlet fever globally and streptococcal toxic shock syndrome (STSS) outbreaks in Japan have brought GAS infections back into the spotlight as a pressing global health concern. Unfortunately, no licensed vaccine against GAS is yet available for clinical use. Our comprehensive review examines the developmental history of GAS vaccines, outlining the research trajectory from early inactivated vaccines to contemporary multivalent, conjugate, multi-antigen, and mRNA-based vaccine platforms. It systematically analyzes clinical trial outcomes of GAS vaccines, highlighting recent advances in both M protein-based and non-M protein vaccine candidates while summarizing promising target antigens. The review concludes with critical strategies to accelerate vaccine commercialization, including enhanced investment in research and development, expanded collaborations, leveraging advanced vaccine technologies, streamlined clinical trials, and strengthened public health advocacy. This review critically evaluates the current evidence and future prospects in GAS vaccine development, emphasizing innovative strategies and engaging broader stakeholders to accelerate GAS vaccine development. Full article

Multi-agent large language models promise flexible, modular architectures for delivering personalized educational content. Drawing on a pilot randomized controlled trial with middle school students (n = 23), we introduce a two-agent GPT-4 framework in which a Profiler agent infers learner-specific preferences and a Rewrite agent dynamically adapts science passages via an explicit message-passing protocol. We implement structured system and user prompts as inter-agent communication schemas to enable real-time content adaptation. The results of an ordinal logistic regression analysis hinted that students may be more likely to prefer texts aligned with their profile, demonstrating the feasibility of multi-agent system-driven personalization and highlighting the need for additional work to build upon this pilot study. Beyond empirical validation, we present a modular multi-agent architecture detailing agent roles, communication interfaces, and scalability considerations. We discuss design best practices, ethical safeguards, and pathways for extending this framework to collaborative agent networks—such as feedback-analysis agents—in K-12 settings. These results advance both our theoretical and applied understanding of multi-agent LLM systems for personalized learning. Full article

Ship seismic wave signals represent one of the most critical physical field characteristics of vessels. To achieve the high-precision detection of ship seismic wave field signals in marine environments, an underwater seismic wave signal detection system was designed. The system adopts a three-stage architecture consisting of watertight instrument housing, a communication circuit, and a buoy to realize high-capacity real-time data transmissions. The host computer performs the collaborative optimization of multi-modal hardware architecture and adaptive signal processing algorithms, enabling the detection of ship targets in oceanic environments. Through verification in a water tank and sea trials, the system successfully measured seismic wave signals. An improved ALE-LOFAR (Adaptive Line Enhancer–Low-Frequency Analysis) joint framework, combined with DEMON (Demodulation of Envelope Modulation) demodulation technology, was proposed to conduct the spectral feature analysis of ship seismic wave signals, yielding the low-frequency signal characteristics of vessels. This scheme provides an important method for the covert monitoring of shallow-sea targets, providing early warnings of illegal fishing and ensuring underwater security. Full article