Search Results (167)

Manual wheelchair users with spinal cord injury (SCI) often experience upper-limb strain and pain due to repetitive propulsion. A detachable dual-propulsion add-on device has been developed to mitigate this issue by offering an alternative propulsion mechanism, but its user acceptability and practical benefits must be rigorously evaluated. This study will implement a structured mixed-methods usability assessment of the new device with 30 adult wheelchair users with SCI. The evaluation will combine quantitative surveys, objective task-based performance metrics, and qualitative interviews to capture a comprehensive picture of usability. We will conduct a single-arm mixed-methods protocol using a device-specific 45-item usability questionnaire and semi-structured interviews, followed by convergent triangulation to integrate quantitative scores and qualitative themes. Participants will use the dual-propulsion device in realistic scenarios and then complete a 45-item questionnaire covering effectiveness, efficiency, safety, comfort, and psychosocial satisfaction. In addition, semi-structured interviews will explore users’ experiences, perceived benefits, challenges, and suggestions. During a standardized mobility task course (doorway navigation, ramp ascent, threshold crossing, and 50 m level propulsion), objective performance indicators—including task completion time, task success/error rate, number of lever strokes, and self-selected speed—will be recorded as secondary usability outcomes. The use of both a standardized questionnaire and in-depth interviews will ensure both broad and nuanced assessment of the device’s usability. Data from the survey will be analyzed for usability scores across multiple domains, while interview transcripts will undergo thematic analysis to enrich and validate the quantitative findings. This protocol is expected to provide robust evidence of the device’s usability, inform iterative improvements in its design, and highlight the importance of structured usability evaluations for assistive technologies. Full article

Although shale gas is an important energy source in the energy transition, its development faces multidimensional challenges across economic, environmental, social and technological domains. Traditional evaluation methods struggle to quantify interdependencies among indicators or capture their overall benefits. To address this, we propose a sustainable development evaluation framework for shale gas that integrates 25 indicators across four dimensions: economic, environmental, social and technical. Entropy weighting is used to determine indicator weights, and principal component analysis (PCA) is applied to reduce dimensionality, Gaussian copula functions are then used to model inter-indicator dependencies, and Monte Carlo simulation (10,000 iterations) is used to quantify the distribution of comprehensive benefits under uncertainty. The key findings are as follows: (1) the environmental and technological dimensions carry the highest weights at 29% and 28%, respectively; (2) the PCA–Monte Carlo (PMC) development model achieves a comprehensive benefit score of 0.567, and 22% higher than the traditional model’s score of 0.467 with a 90% confidence interval of [2%, 46%]; and (3) sensitivity analysis identifies the most influential drivers as the hazardous waste compliance rate (impact coefficient 0.92), the community conflict resolution rate (0.367), and community satisfaction (0.26). The marginal benefits of environmental compliance and social governance substantially exceed those of traditional economic indicators, offering scientific guidance for the green transformation of the shale gas industry. The integrated PCA–copula–Monte Carlo framework also provides a methodological reference for the sustainable assessment of other unconventional resources. Full article

Background: The emergence of telehealth has transformed healthcare delivery across multiple disciplines, with tele-nutrition representing a rapidly evolving field that addresses nutritional assessment, counseling, and management through digital platforms. Objective: This narrative review examines the current landscape of pediatric tele-nutrition services, exploring technological platforms, clinical applications, evidence for effectiveness, implementation considerations, and future directions. Methods: A comprehensive literature search was conducted across PubMed, CINAHL, Embase, and Web of Science databases from January 2010 to October 2025. A total of 114 relevant sources were selected, encompassing randomized controlled trials, observational studies, systematic reviews, implementation studies, clinical guidelines, and policy documents. Results: This review synthesized 114 sources, predominantly from the United States (54%) and European nations (21%), with evidence expansion accelerating post-COVID-19 pandemic. Evidence suggests pediatric tele-nutrition demonstrates clinical outcomes comparable to traditional in-person care across diverse populations including obesity management, diabetes, gastrointestinal disorders, feeding difficulties, metabolic conditions, and preventive nutrition services. Multiple technology platforms are utilized, with synchronous video consultations most common (60–85% of encounters). Benefits include enhanced access to specialized care, increased frequency of contact, reduced family burden, and high satisfaction rates (>80% across most studies). Challenges include limitations in physical assessment, digital equity concerns affecting vulnerable populations, variable reimbursement policies, and the need for provider training. Hybrid models combining virtual and in-person care appear optimal for many conditions. Conclusions: Pediatric tele-nutrition represents a viable and effective care delivery model with particular advantages for families facing geographic, logistic, or access barriers. Continued attention to digital equity, provider training, regulatory frameworks, sustainable reimbursement policies, and rigorous evidence generation will optimize implementation and outcomes. Future directions include artificial intelligence applications, precision nutrition approaches, and expanded global health applications. Full article

Helicobacter pylori infects about half of the global population and is a major cause of peptic ulcer disease and gastric cancer. Improving patient education can increase screening participation, enhance treatment adherence, and help reduce gastric cancer incidence. Recently, large language models (LLMs) such as ChatGPT, Gemini, and DeepSeek-R1 have been explored as tools for producing patient-facing educational materials; however, their performance compared to expert gastroenterologists remains under evaluation. This narrative review analyzed seven peer-reviewed studies (2024–2025) assessing LLMs’ ability to answer H. pylori-related questions or generate educational content, evaluated against physician- and patient-rated benchmarks across six domains: accuracy, completeness, readability, comprehension, safety, and user satisfaction. LLMs demonstrated high accuracy, with mean accuracies typically ranging from approximately 77% to 95% across different models and studies, and with most models achieving values above 90%, comparable to or exceeding that of general gastroenterologists and approaching senior specialist levels. However, their responses were often judged as incomplete, described as “correct but insufficient.” Readability exceeded the recommended sixth-grade level, though comprehension remained acceptable. Occasional inaccuracies in treatment advice raised safety concerns. Experts and medical trainees rated LLM outputs positively, while patients found them less clear and helpful. Overall, LLMs demonstrate strong potential to provide accurate and scalable H. pylori education for patients; however, heterogeneity between LLM versions (e.g., GPT-3.5, GPT-4, GPT-4o, and various proprietary or open-source architectures) and prompting strategies results in variable performance across studies. Enhancing completeness, simplifying language, and ensuring clinical safety are key to their effective integration into gastroenterology patient education. Full article

Traditional stone cave dwellings in northern Shanxi exhibit distinct differences from conventional cave dwellings in terms of form and material, characterized by their freestanding stone-built structures that possess unique value. In the context of rapid urbanization, these dwellings encounter issues related to decreasing quantities and a lack of comprehensive systematic research. This research utilizes a mixed objective–subjective methodology to assess the indoor environment of the stone cave dwellings in Dongwa Village, Shuozhou City. Thermal comfort is evaluated using the PMV-PPD and TSV models, whereas air quality is assessed through gray correlation analysis. Results indicate: (1) The thermal inertia of stone cave dwellings’ envelopes significantly surpasses that of brick structures. However, their exterior wall and roof thermal conductance coefficients exceed national standard limits, respectively, by 4 times and 1.7 times; (2) The PMV thermal neutral temperature (21.32 °C) was notably higher than the TSV thermal neutral temperature (10.96 °C), suggesting that residents have developed cold adaptation. The thermal preference temperature (12.75 °C) exceeded the TSV value, reflecting strong resident demand for improvements; (3) Winter pollutant exceedance rates were markedly higher than those in summer, with air quality classified as experiencing “heavy pollution” levels. Residents reported a high level of subjective satisfaction, suggesting the presence of a cognitive bias. This study aims to reveal environmental issues in traditional local stone cave dwellings under modern residential demands, providing references for sustainable improvements in rural building environments. Full article

Background/Objectives: Homeless populations have higher rates of chronic illness and mortality than more advantaged peers but have low primary care engagement. Nurse-managed clinics emerged as a possible solution to increase healthcare access for marginalized populations. This paper presents a comprehensive evaluation of feasibility (conceptualized as patient recruitment and retention) and acceptability (conceptualized as patient satisfaction) of a nurse-managed primary care clinic tailored to people experiencing homelessness and poverty. Methods: This is a three-year retrospective chart review study of the clinic’s services, patient characteristics, and patient satisfaction. All adult patients for the three-year period were included (N = 514). Feasibility was measured by the number of unique patients seen and visits completed, ratio of completed to scheduled visits, and number of returning patients. Acceptability was measured by a 19-item Likert format (1–5) patient satisfaction survey. Patient characteristics were captured from intake forms. Results: Most patients were male, African American or White, and non-Hispanic. Regarding social determinants of health (SDOH), most patients did not have college education, were unemployed or unable to work, experienced homelessness, had no primary care provider, and no health insurance. Over three years, 1972 visits were scheduled and 1372 (69.6%) completed. A total of 514 patients were seen (37.5% of all visits), with 858 follow-up visits (62.5%). Returning patients (≥2 visits) totaled 59.1%. Yearly data shows steady growth in recruitment and retention. Patient satisfaction with facets of care (access, communication, interpersonal relations) was very high (Mrange = 4.63–4.69), including with Nurse Practitioner care, as was global satisfaction (M = 4.71; SD = 0.61; 76.3% very satisfied). Conclusions: Results indicate that a homeless-tailored nurse-managed clinic can recruit and retain homeless and working poor patients (feasibility), with high patient satisfaction with its services and staff (acceptability), independently of patient demographics or SDOH. Challenges related to retention deserve further study as well as the impact of services on the continuity of care, health, and well-being. Full article

Background/Objectives: Oman Vision 2040, the national blueprint for socio-economic transformation, aims to elevate the Sultanate to developed nation status, with the “Health” priority committed to building a “Leading Healthcare System with International Standards” via a Health in All Policies (HiAP) approach. This paper critically reviews Oman’s strategic health directions and implementation frameworks under Vision 2040, assessing their alignment with global Sustainable Development Goals (SDGs) and serving as a case model for health system transformation. Methods: This study employs a critical narrative synthesis based on a comprehensive literature search that included academic, official government reports, and international organization sources. The analysis is guided by the World Health Organization’s (WHO) Health Systems Framework, providing a structured interpretation of progress across its six building blocks. Results: Key interventions implemented include integrated governance (e.g., Committee for Managing and Regulating Healthcare), diversified health financing (e.g., public private partnership (PPPs), Health Endowment Foundation), and strategic digital transformation (e.g., Al-Shifa system, AI diagnostics). Performance metrics show progress, with a rise in the Legatum Prosperity Index ranking and an increase in the Community Satisfaction Rate. However, critical challenges persist, including resistance to change during governance restructuring, cybersecurity risks from digital adoption, and system fragmentation that complicates a unified Non-Communicable Disease (NCD) response. Conclusions: Oman’s integrated approach, emphasizing decentralization, quality improvement, and investment in preventive health and human capital, positions it for sustained progress. The transformation offers generalizable insights. Successfully realizing Vision 2040 demands rigorous, evidence-informed policymaking to effectively address equity implications and optimize resource allocation. Full article

Background: Anxiety disorders are common in childhood, yet access to cognitive behavioral therapy (CBT) is often limited. Internet-delivered CBT (iCBT) can help overcome these barriers, but evidence in younger children remains scarce. This pilot study describes the development and preliminary evaluation of an Italian iCBT platform for children with mild to moderate anxiety. Methods: Five children aged 8–12 years and their caregivers were recruited through pediatricians. Eligibility was assessed using the MASC-2 and a psychiatrist interview. Each child completed a supervised session with the WebApp, which delivers CBT modules combining psychoeducation, cognitive restructuring, relaxation, and gamified activities. Usability was evaluated using the ita-MAUQ, observation, and interviews. Results: All participants completed the session without dropouts. Mean ita-MAUQ scores were consistently above the midpoint, with the highest ratings for interface design and satisfaction. Children appreciated the interactive, game-like features, while caregivers valued the clarity and practicality of content. Qualitative feedback indicated good comprehensibility and engagement, with suggestions for improving navigation flow and language adaptation. No adverse events occurred. Conclusions: This pilot study supports the feasibility, safety, and acceptability of the new iCBT platform and provides essential insights for its refinement and future large-scale clinical trials. Full article

Objective: This cross-sectional survey aimed to comprehensively gather data on radial forearm free flap (RFFF) utilization and practices in head and neck reconstructive surgery. Methods: An online questionnaire was organized into seven sections: demographics, surgeon experience, harvesting techniques, microsurgical considerations, postoperative care, flap monitoring, and outcomes. It was distributed by email to 216 head and neck reconstructive surgeons who attended the International Federation of Head and Neck Oncologic Societies (IFHNOS) congress in Rome (21–25 June 2023) using the congress mailing list. Responses were collected from 54 surgeons (25% response rate), representing 15 countries across Europe, Asia, the Americas, and Oceania, underscoring the international scope of the survey between 5 February and 25 March 2024. The questionnaire was not formally piloted or validated. Missing data were managed on a per-question basis. Descriptive statistics were used, and 95% confidence intervals (CIs) were calculated for key surgical outcomes to indicate estimate precision. Associations between categorical variables were analyzed using Pearson’s χ² test with Cramér’s V as an effect size, and relationships between continuous variables were examined using Spearman’s rank correlation (ρ) with 95% confidence intervals (CIs). Given the exploratory design and limited sample size, no correction for multiple comparisons was applied, and the risk of both Type I and Type II errors was acknowledged. Results: Variations were observed in harvesting techniques, microsurgical preferences, and postoperative care protocols. Most surgeons initiated flap harvesting concurrently with tumor resection, primarily preserving superficial sensory nerves. Regarding venous outflow, 50% of respondents preferred the cephalic vein, 19% used comitant veins, and 29% utilized both systems when possible. Perioperative antibiotic use was standard practice, though anticoagulant preferences and flap monitoring methods varied. The study achieved a high success rate for RFFF procedures, exceeding 95%, with venous thrombosis identified as the main cause of flap failure. No significant correlations were found between flap failure rate and training method (p = 0.21), specialty (p = 0.37), annual number of RFFF procedures (p = 0.89), surgeon age (p = 0.42), or hospital type (p = 0.48). Effect sizes were small to moderate, indicating weak or negligible associations. Similarly, perioperative factors such as anticoagulant use (p = 0.84), preoperative antibiotics (p = 0.42), surgical instruments (p = 0.61), suture techniques (p = 0.51), and donor vein selection (p = 0.20) showed no statistically significant associations with flap loss. Patient satisfaction assessments were inconsistent, with only 39% of surgeons routinely performing them. Conclusions: The study provides valuable insights into current RFFF practices and outcomes across an international cohort of head and neck surgeons, highlighting patterns and variability in techniques, perioperative care, and monitoring strategies. Full article

Background/Objectives: Family members who provide care play a central but often underestimated role in the healthcare system and are frequently exposed to considerable physical, emotional, and social stress. To better understand and support their needs, a structured self-assessment tool (SSA-PA) was developed. This development addresses the current lack of practical, validated instruments that enable caregivers to systematically reflect on their own stress levels and resources, which is becoming increasingly important in view of the growing demand for care and the risk of caregiver burnout. This tool aims to promote self-reflection, identify individual stresses and resources, and enable more targeted support for family caregivers. Methods: The development process (September–December 2024) followed a multi-phase design that integrated theoretical foundations from nursing, health, and psychology, in particular Orem’s theory of self-care deficit, Lazarus and Folkman’s stress and coping model, and Engel’s biopsychosocial model. Four core dimensions were defined: (1) health and self-care, (2) burden and stress, (3) support and resources, and (4) satisfaction and quality of life. The final tool comprises 37 items (mostly 5-point Likert scales), supplemented by multiple-choice and open-ended questions. Content validity was ensured through expert review and testing with nine family caregivers. Internal consistency was assessed using Cronbach’s alpha (α = 0.998), indicating very high reliability, although possible item redundancies were identified. The evaluation took place in January 2025 with 33 family caregivers to assess user-friendliness, relevance, and perceived usefulness. Results: The majority of participants rated the tool as user-friendly and clearly structured. Around 80% reported a high level of comprehensibility, and over half stated that the tool provided new insights into their own health and care burden. Qualitative feedback highlighted the value of the tool for self-reflection and motivation to seek external support. Suggestions for improvement included shorter item formulations, improved visual feedback (e.g., progress bars or charts), and expanded question areas on financial burdens and digital support options. Conclusions: The SSA-PA is a theoretically grounded and user-centered tool for assessing and reflecting on the situation of family caregivers. It not only enables systematic self-assessments but also promotes awareness and proactive coping strategies. Future research should focus on conducting factor analyses to further validate the construct, testing the tool in larger samples, and exploring its integration into structured care consultations to improve the quality of home care. Full article

To achieve a scientific and efficient emergency response, a dynamic route-planning strategy for emergency vehicles based on government–enterprise collaboration was studied. Firstly, a hybrid evaluation approach was developed, integrating the Analytic Hierarchy Process, Entropy Weight Method, and Gray Relation Analysis-TOPSIS to quantitatively assess the urgency of demands at disaster sites. Secondly, a government–enterprise coordinated route-planning strategy was designed, leveraging the government’s strong mobilizing capabilities and enterprises’ flexible operational mechanisms. Thirdly, to optimize scheduling efficiency, a dynamic route-planning model was proposed, incorporating multiple distribution conditions to minimize scheduling time, delay penalties, and unmet demand rates. A two-stage cellular genetic algorithm was employed to address realistic constraints such as demand splitting, soft time windows, open scheduling, and differentiated services. Numerical simulations of potential flooding in Hunan Province revealed that the collaborative strategy significantly improved performance: the demand satisfaction rate rose from 70.1% (government-led) to 92.3%, while the material transportation time per unit decreased by 23.6% (from 1.61 to 1.23 min/unit). Vehicle path characteristics varied under different operational behaviors, aligning with theoretical expectations. Even under sudden road disruptions, the model maintained a 98% demand satisfaction rate with only a negligible 0.076% increase in system loss. This research fills the gaps in previous studies by comprehensively addressing multiple factors in emergency vehicle route planning, offering a practical and efficient solution for post-disaster emergency response. Full article

Background: Healthcare 5.0 represents a shift toward intelligent, human-centric care systems. Intensive care units generate vast amounts of data that require real-time decisions, but current decision support systems lack comprehensive frameworks for safe integration of artificial intelligence. Objective: We developed and validated the Learn–Predict–Monitor–Detect–Correct (LPMDC) framework as a methodology for systematic artificial intelligence integration across the critical care workflow. The framework improves predictive analytics, continuous patient monitoring, intelligent alerting, and therapeutic decision support while maintaining essential human clinical oversight. Methods: Framework development employed systematic theoretical modeling integrating Healthcare 5.0 principles, comprehensive literature synthesis covering 2020–2024, clinical workflow analysis across 15 international ICU sites, technology assessment of mature and emerging AI applications, and multi-round expert validation by 24 intensive care physicians and medical informaticists. Each LPMDC phase was designed with specific integration requirements, performance metrics, and safety protocols. Results: LPMDC implementation and aggregated evidence from prior studies demonstrated significant clinical improvements: 30% mortality reduction, 18% ICU length-of-stay decrease (7.5 to 6.1 days), 45% clinician cognitive load reduction, and 85% sepsis bundle compliance improvement. Machine learning algorithms achieved an 80% sensitivity for sepsis prediction three hours before clinical onset, with false-positive rates below 15%. Additional applications demonstrated effectiveness in predicting respiratory failure, preventing cardiovascular crises, and automating ventilator management. Digital twins technology enabled personalized treatment simulations, while the integration of the Internet of Medical Things provided comprehensive patient and environmental surveillance. Implementation challenges were systematically addressed through phased deployment strategies, staff training programs, and regulatory compliance frameworks. Conclusions: The Healthcare 5.0-enabled LPMDC framework provides the first comprehensive theoretical foundation for systematic AI integration in critical care while preserving human oversight and clinical safety. The cyclical five-phase architecture enables processing beyond traditional cognitive limits through continuous feedback loops and system optimization. Clinical validation demonstrates measurable improvements in patient outcomes, operational efficiency, and clinician satisfaction. Future developments incorporating quantum computing, federated learning, and explainable AI technologies offer additional advancement opportunities for next-generation critical care systems. Full article

Background: Patient satisfaction with diabetes technology is increasingly recognized as a key factor in therapeutic success. Patient-reported outcomes (PROs) are gaining importance in diabetes care and in the evaluation of advanced insulin delivery systems. Objectives: This study aimed to design and validate a new questionnaire, the Insulin Pump Infusion Sets Satisfaction Scale (IPISS), to assess satisfaction with insulin infusion sets among individuals with type 1 diabetes. Methods: The questionnaire was developed by our Diabetology Unit in two versions: one for patient self-reporting and one for caregivers when the patient is too young to complete it autonomously. Content validity was assessed by six healthcare professionals (three diabetologists and three nurses) based on Polit and Beck’s methodology. The Item Content Validity Index (I-CVI) was calculated for both relevance and comprehensibility and was considered satisfactory if expert agreement reached ≥83%. The Scale Content Validity Index (S-CVI) was computed as the average of I-CVIs, with a cut-off value > 90% deemed acceptable. Results: Almost all items achieved 100% positive agreement for both relevance and comprehensibility, except one item in the caregiver version, for which one rater did not provide a rating for comprehensibility (I-CVI = 83.3%). The S-CVI was 100% for relevance in both versions, 99.24% for comprehensibility in the caregiver version, and 100% in the patient version. Conclusions: The IPISS is a content-validated, self-reported tool, suitable for evaluating satisfaction with infusion sets in individuals using insulin pumps, with versions adapted for both patients and caregivers. Full article

This study presents a comprehensive assessment of lighting conditions in the Intensive Care Units (ICUs) of two major hospitals in the Democratic Republic of Congo (DRC): Hospital du Cinquantenaire in Kinshasa and Jason Sendwe Hospital in Lubumbashi. A mixed-methods approach was employed, integrating continuous illuminance monitoring with structured staff surveys to evaluate visual comfort in accordance with the EN 12464-1 standard for indoor workplaces. Objective measurements revealed that more than 52.2% of the evaluated ICU workspaces failed to meet the recommended minimum illuminance level of 300 lux. Subjective responses from healthcare professionals indicated that poor lighting significantly reduced job satisfaction by 40%, lowered self-rated task performance by 30%, decreased visual comfort scores from 4.1 to 2.6 (on a 1–5 scale), and increased the prevalence of well-being symptoms (eye fatigue, headaches) by 25–35%. Frequent complaints included eye strain, glare, and discomfort with posture, with these issues often exacerbated during the rainy season due to reduced natural daylight. The study highlights critical deficiencies in current lighting infrastructure and emphasizes the need for urgent improvements in clinical environments. Moreover, inconsistent energy supply to these healthcare settings also impacts the assurance of visual comfort. To address these shortcomings, the study recommends transitioning to energy-efficient LED lighting, enhancing access to natural light, incorporating circadian rhythm-based lighting systems, enabling individual lighting control at workstations, and ensuring a consistent power supply via the integration of solar inverters to the grid supply. These interventions are essential not only for improving healthcare staff performance and safety but also for supporting better patient outcomes. The findings offer actionable insights for hospital administrators and policymakers in the DRC and similar low-resource settings seeking to enhance environmental quality in critical care facilities. Full article

This study evaluates the impact of using group concept maps in the teaching of Applied Thermodynamics in the Bachelor’s Degree in Industrial Electronics and Automation Engineering. The methodology consisted of selecting topics with a high conceptual load, collaboratively creating concept maps, and subsequently evaluating them by both students and teaching staff. Students achieved average scores above 7/10 in the concept map activity, with teacher and student evaluations averaging 7.8 and 7.3, respectively. Knowledge assessment via pre- and post-tests revealed a 20% increase in concept comprehension. For example, in the topic of Principles of Thermodynamics, the percentage of correct answers on the most complex question increased from 13% in the Pre-Test to 40% in the post-test. In the topic of Refrigeration Cycles, some questions showed an improvement from 18% to 25%. The students’ perception of the activity was positive, with an average satisfaction rating of 6.9 out of 10. Furthermore, most students acknowledged that the activity helped them stay engaged with the subject matter and identify errors in their own learning. The high participation in the activity, despite its low impact on the final grade, demonstrates the students’ strong motivation for this study approach. Therefore, the implementation of concept maps not only facilitated the understanding of key concepts but also promoted critical reflection and collaborative learning, establishing itself as an effective strategy in the teaching of Applied Thermodynamics. Full article