Search Results (200)

Purpose: We aimed to evaluate the safety and feasibility of a remote electrocardiogram (ECG) monitoring-based cardiac rehabilitation (CR) program during an early postoperative period in patients who underwent cardiac surgery. Methods: Five days after cardiac surgery, patients were referred to a CR department and participated in a low-intensity inpatient CR program while wearing an ECG monitoring device. Prior to discharge, the patients underwent a cardiopulmonary exercise test (CPET) and squat endurance test to determine the suitable intensity and target heart rate (HR) for home-based CR (HBCR). During 2 weeks of the HBCR period after discharge, patients participated in aerobic and resistance exercises. Electrocardiogram data were transmitted to a cloud, where researchers closely monitored them through a website and provided feedback to the patients via telephone calls. Grip strength (GS), 6 min walk distance (6 MWD), EuroQol-5 dimension (EQ-5D), short-form 36-item health survey (SF-36), and Korean Activity Scale/Index (KASI) were measured at three different time points: 5 d post-surgery (T1), pre-discharge (T2), and 2 weeks after discharge (T3). Squat endurance tests and CPET were performed only at T2 and T3. Result: Sixteen patients completed the study, seven (44%) of whom underwent coronary artery bypass graft surgery (CABG). During the study period between T2 and T3, peak VO₂ improved from 12.39 ± 0.57 to 17.93 ± 1.25 mL/kg/min (p < 0.01). The squat endurance test improved from 16.69 ± 2.31 to 21.81 ± 2.31 (p < 0.01). In a comparison of values of time points between T1 and T3, the GS improved from 28.30 ± 1.66 to 30.40 ± 1.70 kg (p = 0.02) and 6 MWD increased from 249.33 ± 20.92 to 387.02 ± 22.77 m (p < 0.01). The EQ-5D and SF-36 improved from 0.59 ± 0.03 to 0.82 ± 0.03 (p < 0.01) and from 83.99 ± 3.40 to 122.82 ± 6.06 (p < 0.01), and KASI improved from 5.44 ± 0.58 to 26.11 ± 2.70 (p < 0.01). In a subgroup analysis, the CABG group demonstrated a greater increase in 6 MWD (102.29 m, p < 0.01) than the non-CABG group. At the end of the study, 75% of the patients expressed satisfaction with the early CR program guided by remote ECG monitoring. Conclusions: Our findings suggest that early remote ECG monitoring-based CR programs are safe and feasible for patients who have undergone cardiac surgery. Additionally, the program improved aerobic capacity, functional status, and quality of life. Full article

Nowadays, a pedestrian navigation system using a smartphone has become popular as a useful tool to reach an unknown destination. When the destination is the office of a person, a detailed map information is necessary on the target area such as the room number and location inside the building. The information can be collected from various sources including Google maps, websites for the building, and images of signs. In this paper, we propose a map information collection tool for a pedestrian navigation system. To improve the accuracy and completeness of information, it works with the four steps: (1) a user captures building and room images manually, (2) an OCR software using Google ML Kit v2 processes them to extract the sign information from images, (3) web scraping using Scrapy (v2.11.0) and crawling with Apache Nutch (v1.19) software collects additional details such as room numbers, facilities, and occupants from relevant websites, and (4) the collected data is stored in the database to be integrated with a pedestrian navigation system. For evaluations of the proposed tool, the map information was collected for 10 buildings at Okayama University, Japan, a representative environment combining complex indoor layouts (e.g., interconnected corridors, multi-floor facilities) and high pedestrian traffic, which are critical for testing real-world navigation challenges. The collected data is assessed in completeness and effectiveness. A university campus was selected as it presents a complex indoor and outdoor environment that can be ideal for testing pedestrian navigations in real-world scenarios. With the obtained map information, 10 users used the navigation system to successfully reach destinations. The System Usability Scale (SUS) results through a questionnaire confirms the high usability. Full article

Introduction: Humanitarian Corridors are part of Protected Entry Procedures (PEPs), which allow for the safe and legal arrival in Europe of refugees in need of protection (art. 25 of Regulation (CE) n.810/2009) and were implemented for the first time in Italy in 2015. They represent an alternative to dangerous journeys, and they also bring benefits to local communities. The National Institute for Health, Migration and Poverty (NIHMP) represents the first filter at entry with regard to health needs, as it guarantees an overall individual health assessment to verify the possible presence of ongoing infectious pathologies and of issues that may require management and medical investigation. The aim of this study is to expose the organizational activity and analyze the sociodemographic and health data relating to the Humanitarian Corridors implemented in Italy and in which the NIHMP has participated from 2018 to 2024. Materials and Methods: The organizational lists and health data of each corridor were collected. The analysis was carried out in relation to trend, sociodemographic characteristics of the sample, identification, reception and health. The p-value was considered statistically significant if less than 0.01. In all cases in which the p-value was found to be statistically significant, Cramer’s V was calculated to evaluate the strength of the individual correlation. Results: The NIHMP has participated in 14 Humanitarian Corridors, allowing 1250 refugees to enter Italy; a total of 174 unaccompanied foreign minors (UFMs) arrived, and there were 451 refugees reported as vulnerable (36.1%). Contagious infectious conditions were identified in 223 refugees (17.8%), and other health findings were identified in 414 refugees (33.1%). In the analysis by sex, there are statistically significant differences in the reports of vulnerability and in nationality and education. The inferential analysis carried out by age groups presents statistically significant differences in the reports of vulnerability and in sex and nationality. The analysis relating to the differences by nationality shows statistically significant results in the individual corridors in the reports of vulnerability and in schooling, skin manifestations and infectious diseases and the presence of other health findings. Conclusions: The data reported and analyzed in this work can be considered the first attempt at a complete and detailed analysis regarding the actual implementation and effectiveness of Humanitarian Corridors as programs for legal and safe entry into Italy. The significant gap in research is the reason why there are characteristics of our sample that have no counterpart in the literature. Despite this, for other characteristics, it is possible to find statistical significance and scientific value in line with the data reported both on the websites dedicated to the topic and on the limited scientific literature on the subject. Full article

Background: Teaching methodology has recently undergone significant evolution from traditional apprenticeship models as we adapt to ever-increasing rates of technological advancement. Big data, artificial intelligence, and machine learning are on the precipice of revolutionising all aspects of surgical practice, with far-reaching implications. Robotic platforms will increase in autonomy as machine learning rapidly becomes more sophisticated, and therefore training requirements will no longer slow innovation. Materials and Methods: A search of published studies discussing surgeon training and computer-enhanced simulation robotics and emerging technologies using MEDLINE, PubMed, EMBASE, Scopus, CRANE, CINAHL, and Web of Science was performed in January 2024. Online resources associated with proprietary technologies related to the subject matter were also utilised. Results: Following a review of 3209 articles, 91 of which were published, relevant articles on aspects of robotics-based computer-enhanced simulation, technologies, and education were included. Publications ranged from RCTs, cohort studies, meta-analysis, and systematic reviews. The content of eight medical technology-based websites was analysed and included in this review to ensure the most up-to-date information was analysed. Discussion: Surgeons should aim to be at the forefront of this revolution for the ultimate benefit of patients. Surgical exposure will no longer be due to incidental experiences. Rather, surgeons and trainees will have access to a complete database of simulated minimally invasive procedures, and procedural simulation certification will likely become a requisite from graduation to live operating to maintain rigorous patient safety standards. This review provides a comprehensive outline of the current and future status of surgical training in the robotic and digital era. Full article

Background/Objectives: The presence of Ehlers–Danlos Syndromes (EDSs) has significant effects on overall health and results in varying levels of pain and disability. The effects of sleep are not well documented in this population. The purpose of this study is to report the sleep characteristics of people with EDS. Methods: An electronic survey regarding sleep characteristics was created and distributed through the EDS website. Results: Sleep disturbance is common in people with EDS, with 65.3% of respondents sleeping fewer than 8 h and 26.2% averaging fewer than 6 h. Those who slept fewer than 6 h reported more days of poor mental and physical health days. Sleep aids were commonly used with 41.40% of patients regularly taking prescription medication to get to sleep. Sleep latency of greater than 30 min was also found in 67.5% of subjects. Conclusions: The results demonstrate an association between people with EDS and poorer sleep duration, increased sleep latency, and increased use of sleep aids including prescription sleep medication compared to the general population. While more research needs to be completed in this area, sleep may be an important aspect to address in the management of EDS. Full article

Despite having the world’s largest HIV burden, South Africa has yet to attain the 95-95-95 targets. Accurate, complete, and timely data are critical for monitoring a country’s HIV progress. The integration of unique identifier codes (UICs) for key populations (KPs) into routine health information management systems (RHIMS) strengthens data accuracy and completeness, facilitating more targeted HIV interventions and greater accountability. This systematic review assessed how Sub-Saharan African (SSA) countries have integrated KPs’ UICs into RHIMS, highlighting key enablers, challenges, and opportunities. A comprehensive search was conducted across PubMed, Scopus, Google Scholar, MEDLINE, PLOS ONE, and various government and non-government websites to identify the published and grey literature relevant to the study objective from June 2013 to December 2024. References were managed using Zotero version 6.0.36. Two authors independently screened studies using Covidence software. The review was done in accordance with the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines and was registered with the “International Prospective Register of PROSPERO) Systematic Reviews” with the registration number CRD42023440656. Out of 1735 studies screened, 361 duplicates were removed. The review found that only nine of the fifty-three SSA countries have incorporated UICs for KPs into their RHIMS through alphanumeric codes. They include Burundi, Burkina Faso, Ghana, Mali, Kenya, Uganda, Togo, Malawi, and Liberia. Facilitators for KPs’ UIC adoption included strong data security and political will, whereas barriers encompassed compromised privacy, stigma and discrimination. In South Africa, the UIC for KPs can be integrated into the new electronic medical record (EMR) system. Full article

This study investigated the factors influencing search efficiency on travel websites, focusing on the effects of gender, website design, and the distribution of effective versus ineffective areas in page layout on visual search efficiency and task performance. Using eye-tracking technology, three experiments were conducted with 48 participants (19 males, 29 females; Mage = 26.73). Among the tested websites, TC exhibited the highest efficiency in task completion time, followed by QN and TN (40.10 s < 83.88 s < 95.27 s). Analysis of fixation distributions indicated that participants focused on effective areas at rates of 20.53% (TC), 55.31% (QN), and 62.42% (TN), underscoring the significant impact of effective and interference area distribution on search efficiency. These findings provide empirical evidence for optimizing travel website design through visual layout improvements to enhance information retrieval and user experience, with TC serving as a prime example of a site with lower cognitive load that better aligns with sustainable tourism principles. Full article

Background: Dementia is a syndrome with a high global prevalence that includes a number of progressive diseases of the brain affecting various cognitive domains such as memory and thinking and the performance of daily activities. It manifests as symptoms which often include significant mood and behaviour changes that are highly varied. Changed moods and behaviours due to dementia may reflect distress and may be stressful for both the person living with dementia and their informal and formal carers. To provide dementia care support specific to mood and behaviour changes, the Behaviours in Dementia Toolkit website (BiDT) was developed using human-centred design principles. The BiDT houses a user-friendly, digital library of over 300 free, practical, and evidence-informed resources to help all care partners better understand and compassionately respond to behaviours in dementia so they can support people with dementia to live well. Objective: (1) To characterize the users that visited the BiDT; and (2) to understand the platform’s early impact on these users. Methods: A multi-method, descriptive study was conducted in the early post-website launch period. Outcomes and measures examined included the following: (1) reach: unique visitors, region, unique visits, return visits, bounce rate; (2) engagement: engaged users, engaged sessions, session duration, pages viewed, engagement rate per webpage, search terms, resources accessed; (3) knowledge change; (4) behaviour change; and (5) website impact: relevance, feasibility, intention to use, improving access and use of dementia guidance, recommend to others. Data was collected using Google Analytics and an electronic survey of website users. Results: From 4 February to 31 March 2024, there were 76,890 unique visitors to the BiDT from 109 countries. Of 76,890 unique visitors to the BiDT during this period, 16,626 were engaged users as defined by Google Analytics (22%) from 80 countries. The highest number of unique engaged users were from Canada (n = 8124) with an engagement rate of 38%. From 5 March 2024 to 31 March 2024, 100 electronic surveys were completed by website users and included in the analysis. Website users indicated that the BiDT validated or increased their dementia care knowledge, beliefs, and activities (82%) and they reported that the website validated their current care approaches or increased their ability to provide care (78%). Further, 77% of respondents indicated that they intend to continue using the BiDT and 81.6% said that they would recommend it to others to review and adopt. Conclusions: The BiDT is a promising tool for sharing practical and evidence-informed information resources to support people experiencing dementia-related mood and behaviour changes. Early evaluation of the website has demonstrated significant reach and engagement with users in Canada and internationally. Survey data also demonstrated high ratings of website relevance, feasibility, intention to use, knowledge change, practice support, and its contribution to dementia guidance. Full article

Advancements in large language models have significantly transformed higher education by integrating AI chatbots into course design, teaching, administration, and student support. This study evaluates the use, effectiveness, and perceptions of chatbots in a Python-based graduate-level GIS programming course at a U.S. university. Students self-reported perceived improvements in skills and the use of different help resources across three home assignments of varying complexity and spatial context. In group discussions, students shared their experiences, strategies, and envisioned future applications of chatbots in GIS programming and beyond. The results indicate that prior programming experience enhances students’ perception of assignment usefulness, and that chatbots serve as a partial replacement for traditional help resources (e.g., websites) in completing assignments. Overall, students expressed positive sentiments regarding chatbot effectiveness, especially for complex spatial tasks. While students were optimistic about the potential of chatbots to enhance future learning, concerns were raised about overreliance on AI, which could hinder the development of independent problem-solving and programming skills. In conclusion, this study offers valuable insights into optimizing chatbot integration in GIS education. Full article

With the increasing online activity of Arabic speakers, the development of effective CAPTCHAs (Completely Automated Public Turing Tests to Tell Computers and Humans Apart) tailored for Arabic users has become crucial. Traditional CAPTCHAs, however, are increasingly vulnerable to machine learning-based attacks. To address this challenge, we introduce a method for generating adversarial handwritten Arabic CAPTCHAs that remain user-friendly yet difficult for machines to solve. Our approach involves synthesizing handwritten Arabic words using a simulation technique, followed by the application of five adversarial perturbation techniques: Expectation Over Transformation (EOT), Scaled Gaussian Translation with Channel Shifts (SGTCS), Jacobian-based Saliency Map Attack (JSMA), Immutable Adversarial Noise (IAN), and Connectionist Temporal Classification (CTC). Evaluation results demonstrate that JSMA provides the highest level of security, with 30% of meaningless word CAPTCHAs remaining completely unrecognized by automated systems falling to 6.66% for meaningful words. From a usability perspective, JSMA also achieves the highest accuracy rates, with 75.6% for meaningless words and 90.6% for meaningful words. Our work presents an effective strategy for enhancing the security of Arabic websites and online interfaces against bot attacks, contributing to the advancement of CAPTCHA systems. Full article

In the second decade of the 21st century, escape rooms became one of the primary forms of leisure entertainment. Poland was one of Europe’s largest and most innovative markets for this type of entertainment. However, two unpredictable events (a fatal fire and the COVID-19 pandemic) resulted in a dramatic decline in the escape room sector. The main aim of this study is to provide an in-depth characteristic of the development of the escape room sector in Poland in 2014–2024, from the creation of the first room through booming popularity to the rapid decline and crisis in recent years. The author used statistical data obtained from the lockme.pl website, an industry report from 2018, their own research, and the available academic and popular science publications. The conducted cause-and-effect analysis allowed for the identification and definition of the main factors that contributed to the escape room sector’s unprecedented development and the factors responsible for its subsequent fall. The obtained results enabled the author to analyse and describe the unique life cycle of the escape room sector in Poland. Furthermore, spatial analysis allowed the author to find certain regularities in the location of this type of attraction, as well as the course of the geographic spread and shrinkage of the analysed phenomenon (in the territory of the country and 10 of its biggest cities). The presented results carry essential theoretical and practical implications. They point, among other things, to the need for the management to take paradoxical, apparently mutually contradictory actions (coopetition) and sometimes measures that might seem completely irrational (planning responses to unlikely threats as part of strategic crisis management). Full article

Background: Tinnitus can significantly impact a patient’s quality of life. As no evidence-based curative treatments exist, therapies such as cognitive behavioral therapy, tinnitus retraining therapy, acceptance and commitment therapy, and mindfulness-based interventions aim to minimize tinnitus severity and have been shown effective. Since traditional delivery can be costly and time-consuming and often has limited accessibility, therapies might also be provided via eHealth. This study investigates the change in tinnitus severity measured by the Tinnitus Functional Index (TFI) score after participation in an online self-paced tinnitus (“Still Tinnitus”) course. The secondary aim was to identify predictors for the clinically relevant improvement after participation in this course. Methods: This retrospective record study included patients from Still Tinnitus course between March 2023 and July 2024. Patients were recruited via the Still Tinnitus website. Differences in the TFI scores from baseline and after completing the fifth (last) module of the course were calculated to investigate the change in tinnitus over time. Multivariate logistic analyses were performed to identify the possible predictors for the clinically relevant improvement after completion of the Still Tinnitus course. Results: In total, 122 patients were included in the study. The analysis revealed a clinically relevant reduction in the TFI score of 27.2 points. Multiple regression analyses showed that the “duration of the tinnitus” (OR 5.0; 95%CI: 1.537–16.240; p = 0.007) and “female sex” (OR 1.9; 95%CI 0.111–7.637; p = 0.030) are predictors for a clinically relevant improvement. Conclusions: In a convenience sample of tinnitus patients, the Still Tinnitus course may contribute to a clinically relevant reduction in tinnitus severity. A shorter duration of tinnitus and female sex were identified as significant predictors. Full article

Background: Several studies highlighted that tailored health communication interventions improve cervical screening participation, vaccination coverage, and awareness about self-sampling benefits. The “COMUNISS” project was aimed at increasing awareness about cervical cancer prevention, identifying barriers to screening, and promoting screening uptake in under-screened women. Methods: A dedicated website with a Q&A session regarding HPV-associated diseases has been set up. Participants were invited to complete a questionnaire to gather demographic information, knowledge about HPV and cervical cancer, and attitudes toward screening based on the Health Beliefs Model (HBM). Women can also require a vaginal self-sampling kit at your home to perform the HPV-DNA analysis. Results: The website registered over 1000 users over 6 months, and 256 women completed the survey. Nearly half were under-screened. The HBM revealed a high susceptibility and severity perception of diseases, regardless of screening participation, whereas older women declared a high perception of barriers. One-quarter of the women who had requested the self-collection kit returned it for the HPV-DNA testing. Conclusions: The project found significant gaps in knowledge regarding extra-cervical HPV-related cancers, interpretation of screening results, and effectiveness of self-collection. These findings highlight the need to plan targeted information campaigns to enhance awareness and adherence to screening programs. Full article

Human rabies is preventable but almost always fatal once symptoms appear, causing 59,000 global deaths each year. Limited awareness and inconsistent access to post-exposure prophylaxis hinder prevention efforts. To identify gaps and opportunities for improvement in online rabies information, we assessed the readability, understandability, actionability, and completeness of online public rabies resources from government and health agencies in Australia and similar countries, with the aim of identifying gaps and opportunities for improvement. We identified materials via Google and public health agency websites, assessing readability using the Simple Measure of Gobbledygook (SMOG) index and understandability and actionability with the Patient Education Materials Tool for Print materials (PEMAT-P). Completeness was assessed using a framework focused on general and vaccine-specific rabies information. An analysis of 22 resources found a median readability of grade 13 (range: 10–15), with a mean understandability of 66% and mean actionability of 60%; both below recommended thresholds. Mean completeness was 79% for general rabies information and 36% for vaccine-specific information. Visual aids were under-utilised, and critical vaccine-specific information was often lacking. These findings highlight significant barriers in rabies information for the public, with most resources requiring a high literacy level and lacking adequate understandability and actionability. Improving readability, adding visual aids, and enhancing vaccine-related content could improve accessibility and support wider prevention efforts. Full article

Methods and materials: Patients with ongoing or planned anticancer treatment at 19 Italian Radiation Oncology centers were included in the study retrospectively from 3 February 2020 to 31 December 2020 and prospectively from 1 January 2021 to 31 May 2021. Anonymized data were processed through a specific website and database. Antineoplastic treatment characteristics and timing and outcomes of COVID-19 and its impact on radiotherapy or systemic therapy were described. Results: The retrieved cohort included 41,039 patients that received treatment or were planned for therapy in the study period. Overall, 123 patients had a confirmed COVID-19 diagnosis during antineoplastic treatment (group A) and 99 patients before treatment start (group B). The incidence of COVID-19 across the whole cohort in the index period was 0.54% (groups A + B) and 0.30% considering only group A. A total of 60 patients developed severe COVID-19, and a total of 45 patients died as a consequence of the infection (incidence of 0.15% and 0.11%, respectively). Nonetheless, mortality among COVID-19 patients was high, with an attributable death rate after confirmed infection of 20.27%. Among the 123 patients in group A, 37.4% required temporary treatment suspension, 32.5% definitive suspension and 37 patients continued treatment while positive. As for the 99 patients in group B, 53.5% experienced temporary delay, 20.2% experienced definitive treatment suspension and 26.3% had no delay. Conclusions: Most of the patients with a COVID-19 diagnosis in our cohort recovered and completed their treatment; nonetheless, the attributable death rate after confirmed infection was 20.27%, and mortality was high among cancer patients with severe COVID-19 presentation. The global incidence of death due to COVID-19 or severe COVID-19 was low and decreased over time. Radiation oncology activity could be safely continued during the COVID-19 pandemic with the adoption of adequate preventive measures. Full article