Search Results (1,650)

Background/Objectives: The rising prevalence of multimorbid and complex chronically ill young and middle-aged adults necessitates the implementation of innovative care models and the creation of roles that can meet the complex healthcare needs of this patient group. Advanced Practice Nurses (APNs) can play a crucial role in the care of multimorbid and complex chronically ill young and middle-aged adults in APN-led clinics; however, in Switzerland, these roles are still evolving. The aim of this study was to explore APNs’ perspectives on the planned development of their roles in an APN-led clinic. Methods: To gain insights into the experiences of APNs in caring for this patient group, a qualitative study design was chosen. Data were collected through interviews with APNs from Switzerland, the USA, and Canada. In total, 19 APNs (12 from Switzerland and 7 from the United States and Canada) participated in the study. The data were collected through semi-structured online interviews. These data were analyzed using reflective thematic analysis in accordance with the approach presented by Braun and Clarke. Results: The analysis identified 10 themes that describe the competencies, components, and framework conditions required for the work of APNs in an APN-led clinic for multimorbid and complex chronically ill young and middle-aged adults within the Swiss clinical context. Required competencies include direct clinical practice, guidance and coaching, collaboration, and psychosocial support. Essential components include person-centered care, transitional care, and continuity of care. Key framework conditions include regulations of the legal and regulatory framework and eligibility for reimbursement of services, resources, and extended competencies and scope of practice. Conclusions: The perspectives of the APNs involved in this study show that multimorbid and complexly chronically ill young and middle-aged adults require complex and long-term care that extends beyond the hospital setting. The findings of this study show that Swiss APNs may be well positioned to contribute to this role. Full article

Wearable healthcare technologies are transforming the healthcare landscape by enabling remote, real-time health data collection, supporting early diagnosis, personalizing treatment plans, and reducing healthcare costs and medical burdens. Central to these advancements are wearable sensors, which continuously capture physiological data such as heart rate, temperature, activity levels, and biomarker concentrations. However, the large volume and complexity of this data demand effective processing to extract meaningful medical insights. Artificial intelligence (AI) and machine learning (ML) have significantly enhanced the capabilities of wearable sensors by enabling advanced data analysis, pattern recognition, and predictive modeling. AI-enhanced wearable sensors can detect early signs of health issues, such as heart attacks, chronic diseases, and mental health conditions like stress, often before clinical symptoms become apparent. This review examines the integration of AI/ML models with wearable sensors across physical activity recognition, stress assessment, cardiovascular monitoring, personal exposure monitoring, and sweat biomarker detection. Unlike prior application-centered reviews, we emphasize methodological and translational evaluation by comparing task formulations, sensing modalities, dataset scale, validation protocols, performance metrics, and deployment constraints across domains. We further discuss advanced architectures, multimodal fusion, explainable AI, edge deployment, privacy and regulatory considerations, and the translational gap between research prototypes and clinically deployable wearable AI systems. Full article

Offshore wind turbine blades are chronically exposed to complex marine environments with high humidity, salt spray, strong wind, waves, and intense radiation. Under such conditions, blade defects often exhibit small sizes, weak visual features, and heterogeneous visible infrared manifestations. Conventional single-sensor monitoring and empirically weighted fusion methods are insufficient for reliable defect diagnosis and risk grading. To address this problem, this paper proposes a cross-sensor consistency-guided dual-spectrum fusion framework, termed CG-DSF, for offshore wind turbine blade defect diagnosis and risk assessment. First, visible-light images and infrared thermal images are acquired by UAV-mounted imaging sensors, and sensor-specific branches are constructed to extract surface structural features and thermal anomaly responses. Second, visible and infrared features are aligned at the feature token level, and cross-sensor evidence is evaluated for spatial consistency, diagnostic semantic consistency, and anomaly consistency. A reliability-aware fusion strategy is then used to suppress low-quality or conflicting observations and construct a unified defect representation. Finally, a series of representative simulation case studies are carried out to comprehensively assess the overall performance and practical applicability of the constructed model. Experimental results reveal that the proposed framework possesses evident advantages in blade defect identification for offshore wind turbines, offering a feasible solution for advancing proactive and intelligent condition-based operation and maintenance of offshore wind assets in complex marine environments. Full article

Multiple sclerosis (MS) is a neuro-inflammatory disease characterized by demyelination in the central nervous system (CNS). Although a substantial endogenous capacity for remyelination has been demonstrated, this process is frequently incomplete and exhibits marked intra- and inter-individual heterogeneity. Several factors influence the extent of spontaneous myelin regeneration, including age, sex, disease course, and lesion localization. Oligodendrocytes (OL), derived from oligodendrocyte progenitor cells (OPCs), are the principal myelinating cells of the CNS. The regenerative cascade involves several key stages, including OPC activation, recruitment, differentiation into oligodendrocytes (OL), and myelin deposition. This process is orchestrated in a spatiotemporal manner by a complex interplay of intracellular signaling pathways, genetic determinants, and dynamic microenvironmental cues, which together balance inhibitory and pro-remyelinating influences. Several lines of evidence indicate that chronically demyelinated axons are vulnerable to degeneration, whereas successful remyelination may confer neuroprotection. These observations underscore remyelination as a promising neuroprotective therapeutic target for preventing or slowing disability progression in MS, a condition in which gradual neuroaxonal degeneration is believed to underlie irreversible disability progression. In this review, we aim to bridge the gap between fundamental biological mechanisms of remyelination and their clinical relevance. We examine recent advances in in vivo techniques for assessing remyelination and discuss how these measures correlate with clinical and disability outcomes. In addition, we review recent clinical trials of remyelination-promoting therapies and analyze the challenges that have limited their advancement beyond phase II. Overall, we seek to provide a comprehensive overview of the remyelination process from bench to bedside, highlighting both the obstacles and the therapeutic potential of remyelination strategies in MS. Full article

Background/Objectives: Embryo implantation is a highly regulated, multistep process requiring precise synchronization between a developmentally competent blastocyst and a receptive endometrium. Despite advances in reproductive medicine, implantation failure remains a major limiting factor in assisted reproductive technology (ART), particularly in cases of recurrent implantation failure (RIF). This review aims to summarize current knowledge on the molecular, cellular, and immunological mechanisms governing embryo–endometrial interaction and to evaluate contemporary strategies for optimizing implantation outcomes. Methods: This narrative review synthesizes the current literature on embryo implantation, including studies addressing uterine receptivity, etiological factors contributing to implantation failure, and emerging diagnostic and therapeutic approaches. The review integrates findings from molecular biology, clinical ART practices, and bioengineering-based models. Key areas include transcriptomic tools such as endometrial receptivity analysis, time-lapse imaging, artificial-intelligence-based embryo selection, and advanced in vitro models (e.g., microfluidic “womb-on-a-chip” systems and three-dimensional embryo–endometrial platforms). The literature was identified through major biomedical databases, following a structured but non-systematic approach. Results: Implantation success is dependent on a complex interplay of hormonal regulation, gene expression, immune modulation, and embryo quality. Disruption of uterine receptivity during the window of implantation is a critical contributor to infertility and RIF. Multiple factors—including genetic abnormalities, maternal age, lifestyle influences, immunological imbalance, uterine pathology, and chronic endometrial conditions—are implicated in implantation failure. Emerging technologies, such as AI-assisted embryo selection, transcriptomic profiling, and advanced in vitro implantation models, provide enhanced insight into implantation dynamics and offer potential for improved clinical outcomes. Conclusions: Advances in understanding embryo implantation and the development of innovative diagnostic and therapeutic technologies hold significant promise for improving reproductive success. However, further research, validation, and standardization are required before these approaches can be fully integrated into routine clinical practice. A more personalized and mechanism-based approach to implantation may ultimately enhance ART outcomes and reduce the burden of infertility. Full article

Obstructive sleep apnea (OSA) constitutes a chronic disorder characterized by recurrent upper airway collapse during sleep. This condition is prevalent among patients with cardiac rhythm disturbances and represents a potent independent risk factor for arrhythmia. Although most studies have concentrated on the association between OSA and atrial fibrillation (AF), numerous investigations have established connections with ventricular and supraventricular arrhythmias. Arrhythmogenesis in OSA represents a complex multifactorial phenomenon. Acute mechanisms involve induction of negative intrathoracic pressure during the effort to breathe, which triggers recurrent episodes of hypoxia, hypercapnia, alterations in carbon dioxide and acid–base equilibrium, as well as surges in sympathetic nervous system activity. Chronic intermittent hypoxia (CIH) and negative thoracic pressure (NTP) induce atrial stretch, chronic structural remodeling, and elevated vagal tone, thereby heightening susceptibility to bradycardic and conduction arrhythmias. Intermediate pathways through which OSA may precipitate arrhythmia encompass heightened systemic inflammation, oxidative stress, a prothrombotic state, and vascular dysfunction. Long-term OSA is linked with atrial enlargement and fibrosis, ventricular hypertrophy, hypertension, and coronary artery disease. These factors predispose to cardiac arrhythmias through the following mechanisms: shortening of the atrial effective refractory period, abnormal automaticity, promotion of slowed and heterogeneous conduction, enhancement of reentrant arrhythmia persistence, and prolongation of the QT interval. In this paper, we aim to present the pathophysiological mechanisms underpinning the association between obstructive sleep apnea and cardiac arrhythmias. Understanding the precise pathophysiological pathways by which obstructive sleep apnea contributes to arrhythmogenesis will enable targeted preventive stratification of patients at risk for cardiovascular events and promote the development of innovative therapies to attenuate OSA-induced arrhythmogenicity. Full article

Eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD) are immune-mediated disorders of the gastrointestinal (GI) tract that, despite involving different tissues, are increasingly recognized to coexist. Epidemiologic studies demonstrate a bidirectional association, with patients affected by one condition showing a higher-than-expected prevalence of the other, suggesting shared susceptibility rather than incidental overlap. Genetic and epigenetic data support partial convergence in immune regulatory pathways, while epithelial barrier dysfunction and antigen-driven immune activation emerge as common upstream features. Overlapping cytokine networks, including IL-4, IL-13, and IL-23 signaling, contribute to chronic inflammation in both diseases, although differences in tissue environment and immune dominance give rise to distinct inflammatory phenotypes and clinical behavior. Clinical outcomes in patients with dual diagnoses appear heterogeneous, with available data suggesting neither uniformly worsened nor clearly protective disease courses, underscoring the complexity of shared immune mechanisms operating within different anatomic contexts. Beyond inflammatory activity, coexistence of EoE and IBD poses important nutritional and quality-of-life challenges, as overlapping dietary restrictions and chronic symptoms increase the risk of malnutrition, micronutrient deficiencies, and psychosocial burden. Current therapies remain disease-specific, with strong evidence supporting proton pump inhibitors, swallowed topical steroids, dietary therapy, and dupilumab in EoE, and biologics and small molecules targeting TNF-α, IL-12/23, IL-23, integrins, and JAK–STAT signaling in IBD, while evidence guiding treatment in patients with dual diagnosis remains limited. Together, current evidence supports a framework of shared immune machinery with tissue-specific expression that explains coexistence while preserving the distinct identities of EoE and IBD. By integrating emerging genetic, immunologic, and clinical evidence, this review aims to provide a framework for understanding and managing patients with coexisting EoE and IBD. Full article

The Mediterranean diet (MedDiet) has emerged as a promising dietary strategy for the prevention and management of type 2 diabetes mellitus (T2DM). This narrative review provides a comprehensive synthesis linking the biological pathways of the MedDiet with established clinical evidence. Adherence to this traditional dietary pattern—characterized by a high intake of fiber, complex carbohydrates, antioxidants, and healthy fats—has demonstrated significant benefits in terms of glycemic control, enhanced insulin sensitivity, and overall metabolic health. Mechanistically, the review explains how the MedDiet improves health by modulating key physiological processes, including anti-inflammatory and antioxidant pathways, the regulation of branched-chain amino acid metabolism, the enhancement of short-chain fatty acid production via gut microbiota modulation, and upregulated incretin effects. Importantly, this review explains how the MedDiet complements modern medications, including glucagon-like peptide-1 (GLP-1) receptor agonists and sodium–glucose cotransporter-2 (SGLT-2) inhibitors. By integrating molecular mechanisms with human clinical outcomes, this narrative review addresses multiple aspects of the MedDiet in both the prevention and management of T2DM including glycemic control, weight management, and cardiovascular risk reduction, rendering it a valuable dietary strategy for both the prevention and treatment of this chronic condition. Full article

Particulate emerging contaminants (PECs) pose increasing ecological risks due to their widespread occurrence and complex environmental behaviors, yet their heterogeneous toxic mechanisms remain poorly understood, especially under environmentally relevant conditions and concentration gradients. Here, Chlorella vulgaris was used as a model organism to systematically compare the effects of polystyrene nanoparticles (PSNPs), silver nanoparticles (AgNPs), and titanium dioxide nanoparticles (TiO₂NPs) across environmentally relevant and elevated concentrations (100 μg/L and 10 mg/L). Distinct toxicity pathways were identified among PEC types. PSNPs primarily induced chronic interference via particle–cell interactions, heteroaggregation, sedimentation-driven shading, and extracellular polymeric substance (EPS) regulation, rather than ROS-dominated toxicity. In contrast, AgNPs exhibited transformation-driven toxicity, undergoing intracellular speciation into Ag₂S, AgCl, and Ag⁺, which triggered oxidative stress, membrane damage, and lipid peroxidation. TiO₂NPs showed relatively high bioavailability and persistent oxidative stress effects. These results demonstrate that PEC toxicity evolves with particle type and concentration. Importantly, oxidative stress alone is insufficient to capture PEC ecotoxicity, which also involves the long-term impacts on algal behavior, sedimentation dynamics, and energy metabolism. This study provides mechanistic insights into PEC-induced algal toxicity and supports the source-oriented management of particulate pollutants in aquatic environments, particularly in hotspot scenarios such as wastewater discharge and sediment resuspension. Full article

Soccer is a complex sport with significant physical, physiological, psychological, technical, and tactical demands on players. This review presents an ergonomics-based model of soccer performance, emphasizing that no single component operates in isolation. Building on the foundational ergonomic framework, this review integrates contemporary evidence on training load monitoring, ecological dynamics, and cognitive-perceptual performance dimensions not systematically addressed in prior frameworks. Elite outfield players cover 9–14 km·h⁻¹ per match, with high-speed running (19.8–24.8 km·h⁻¹) making up about 20% of total distance and sprinting (>25 km·h⁻¹) around 2%. These outputs vary by playing position, tactical formation, possession dynamics, and environmental conditions. Longitudinal data from the English Premier League indicate a 35% increase in high-speed running over the past decade, suggesting intensifying physical demands. Physiological responses, including average heart rates of 156–175 bpm, reflect the aerobic and anaerobic demands on players. The review also examines benchmarks like VO₂max, sprint velocity, and anthropometry, highlighting their utility and limitations as performance indicators. Regarding training load management, the review evaluates frameworks such as the Acute:Chronic ratio and high-speed running exposure protocols, noting limitations and risks of over-relying on external load metrics. Periodization approaches, including tactical periodization, are discussed for integrating physical, technical, tactical, and psychological components in training. The proposed ergonomic model conceptualizes elite soccer performance as an emergent property of interacting physical, physiological, tactical, psychological, and environmental subsystems, with direct implications for training design, selection, and load management. Selection decisions should consider cognitive and perceptual competencies like decision-making, anticipation, and situational awareness, alongside physical and physiological profiles, aligned with the team’s game model. Full article

Down syndrome (DS), caused by trisomy 21, is associated with a wide spectrum of endocrine and gastrointestinal disorders that often arise early in life and significantly impact long-term health. This narrative review examines the pathophysiological mechanisms underlying these conditions, with a particular focus on their bidirectional interactions. Endocrine abnormalities in DS, including thyroid dysfunction, type 1 diabetes mellitus, growth impairment, and altered bone metabolism, occur at higher rates than in the general population and are largely driven by immune dysregulation, chronic inflammation, and gene dosage effects. Similarly, gastrointestinal disorders—ranging from congenital malformations to autoimmune conditions such as celiac disease—are highly prevalent and often present with atypical clinical features. Emerging evidence highlights the central role of gut dysbiosis, characterized by reduced microbial diversity and increased pro-inflammatory taxa, in modulating immune and metabolic pathways. This altered gut environment contributes to a chronic inflammatory state and may promote autoimmunity and endocrine dysfunction through the gut–endocrine–immune axis. Nutritional deficiencies and epigenetic factors, including microRNA dysregulation, further influence disease expression. Understanding this complex cross-talk is essential for improving clinical management. Integrated, multidisciplinary approaches and early screening strategies are crucial to optimize outcomes and guide future research in DS. Full article

Background/Objectives: Dietary assessment tools are essential for quantifying food and nutrient intake, characterising dietary patterns, and informing nutrition research. Food Frequency Questionnaires (FFQs) and Food Records (FRs) are widely implemented in observational studies, but completion rates vary, which may compromise data quality, introduce bias, and limit the interpretation of findings. This review is intended to synthesise evidence from observational studies on completion rates of these tools in populations with chronic conditions. Methods: A systematic search of Medline, PubMed, Scopus, and Google Scholar was completed. Eligible studies were observational studies using an FFQ or FR published from January 2015 to May 2025 in people with a chronic condition. Methodological quality was evaluated using the Hoy Risk of Bias tool for observational studies of prevalence. Subgroup meta-analyses estimated pooled mean completion proportions with 95% confidence intervals, and heterogeneity was assessed using the I² statistic. This study was registered with the International Prospective Register of Systematic Reviews and reported according to PRISMA guidelines. Results: Of the 8921 records screened, 88 studies (n = 84,579 participants) met inclusion criteria. The combined FFQ and food record mean pooled completion rate was 79.1% (95% Confidence Interval (CI): 74.37–83.43%). However, substantial heterogeneity was observed, indicating considerable variability across studies. Subgroup analyses highlighted important differences by tool type, format, age group, and disease category. FFQs demonstrated higher completion rates (80.6%) than FRs (74.3%). Electronic formats had higher completion rates than paper formats. Completion rates were higher in adults than in pediatric cohorts, and varied by chronic condition type, with kidney disease associated with the highest completion rates. Conclusions: These findings highlight the importance of considering tailored dietary data collection strategies, particularly for paediatric and medically complex populations, and provide direction for enhancing the feasibility of dietary assessment collection in future research. Full article

Bronchopleural fistula is a rare but severe complication of lung resection, associated with significant morbidity and mortality, especially when an open-window thoracostomy is required. The clinical and surgical management is complex and becomes even more challenging in the presence of underlying conditions such as recurrent infections or malignancy. Postoperative management is equally demanding, as local compression may help prevent fistula recurrence but can compromise flap perfusion. A 65-year-old male with a history of right upper lobectomy and subsequent sublobar resection for lung adenocarcinoma presented with an 8 × 4 cm open-window thoracostomy complicated by chronic bronchopleural fistula and empyema. Extensive fibrosis of the surrounding tissues, including the ipsilateral latissimus dorsi muscle, limited the available reconstructive locoregional options. Reconstruction was performed using primary fistula closure reinforced with a contralateral free latissimus dorsi musculocutaneous flap and a fascia patch graft secured with cyanoacrylate-based bioadhesive. Postoperatively, continuous near-infrared spectroscopy monitoring enabled safe application of compressive bandage while minimizing the risk of flap perfusion compromise. Complete fistula closure was achieved. Apart from a surgical site abscess requiring debridement on postoperative day 7, no further complications occurred. At the 2-year follow-up, the patient remains free of fistula recurrence, wound dehiscence, or oncological relapse. We describe a novel approach for open-window thoracostomy closure combining a free musculocutaneous flap with a fascia patch graft reinforced by bioadhesive, together with postoperative perfusion monitoring using near-infrared spectroscopy. This strategy may help address both the reconstructive and postoperative challenges associated with complex bronchopleural fistulas. Full article

Background/Objectives: Children of families facing unmet social needs experience higher rates of adverse outcomes compared to those not experiencing unmet social needs. This study aimed to identify factors associated with families’ unmet social needs as reported by parents or guardians at their children’s primary care visits. Methods: This cross-sectional study recruited English-speaking primary caregivers of children less than 18 years of age from the Southwestern Ohio Ambulatory Research Network (SOAR-Net) who were surveyed between January 2023 and August 2024. Surveys included the Maternal Social Support Index, Social Capital Scale, RAND Depression Screener, Children with Special Health Care Needs Screener, Medical Expenses of Children Survey, a 10-item social needs screener, and demographics. Data were analyzed with chi-square or Fisher’s exact tests, adjusted logistic regression, and ANOVA. Results: Among 1167 respondents (78% response rate), 1114 provided complete data. Primary caregivers were predominantly mothers (79.9%) or fathers (13.6%), White (72.0%) or Black (16.0%), and had an associate’s degree or less (65.1%). The mean (SD) index child’s age was 6.4 (5.3) years, and 52.4% were female. Underinsurance, positive depression screens, and poor child health were positively associated with unmet social needs. Higher scores for social support and social capital were associated with fewer social needs. Multinomial logistic regression revealed significant relationships with reporting two or more unmet social needs with the following variables: childhood underinsurance, household annual income < $50,000, positive depression screens, raising a child with a chronic health condition, and Black race/ethnicity. Conclusions: Several significant social factors were independently associated with a greater number of unmet social needs. These findings highlight the complex interplay among social factors in children’s healthcare. Future research should explore the putative longitudinal stability of these relationships. Full article

Military burn pits used during post-9/11 U.S. military deployments functioned as uncontrolled combustion systems and were widely utilized to dispose of large volumes of outdoor waste by burning. Burn pits involved heterogeneous waste materials burned under variable temperature and oxygen conditions. These combustion environments generated complex, toxic, multipollutant airborne emission mixtures that included particulate matter (PM_2.5), polycyclic aromatic hydrocarbons (PAHs), and volatile organic compounds (VOCs). This narrative review synthesizes epidemiologic, experimental, and mechanistic evidence linking burn pit emissions to disruption of the lung–brain axis and adverse neurological outcomes. We specifically aim to address a critical gap in understanding how combustion-derived toxicants impact brain health and are associated with unfavorable neuropsychiatric outcomes, including increased risk of post-traumatic stress disorder (PTSD) and depression. Combustion-related exposures promote pulmonary inflammation and system-wide immune signaling that propagate to the central nervous system, contributing to neuroinflammation and dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis. These interconnected mechanisms are associated with toxic encephalopathy and related cognitive and mood disturbances, underscoring the need to integrate fire science with military and environmental health services research to better define the systemic and neurological consequences of acute and chronic fire-derived inhalation exposures. Full article