Search Results (227)

Background/Objectives: Despite its proven benefits, skin-to-skin contact (SSC) after caesarean section faces significant barriers to implementation. Complementing two previous randomised controlled trials conducted by our group, this descriptive qualitative study aimed to identify barriers and facilitators experienced by multidisciplinary healthcare teams, providing frontline insights into factors contributing to the inconsistent implementation of SSC. Methods: Following a phenomenological approach and the COREQ guidelines, 40 semi-structured interviews were conducted with healthcare professionals involved in caesarean care at a Spanish tertiary hospital, including anaesthetists, gynaecologists, neonatologists, midwives, nurses and nursing assistants. The data were thematically categorised at the semantic and pragmatic levels using MAXQDA software. Results: SSC implementation remains inconsistent in routine care. Despite the existence of an established institutional protocol, systematic adherence is hindered by high clinical workload, infrastructure constraints and inconsistent dissemination of guidelines. Professional barriers included gaps in training and entrenched routines, while attitudinal barriers stemmed from safety concerns following major abdominal surgery. Key facilitators included the absence of clinical complications and the positive emotional impact of SSC on family bonding. These findings provide critical diagnostic insights into implementation barriers, informing future strategies to enhance adherence to established institutional protocols. Conclusions: Although safe and feasible, post-caesarean SSC remains inconsistently implemented due to addressable barriers. Its routine adoption requires targeted multidisciplinary training, commitment from healthcare teams and infrastructural adaptations in post-anaesthesia care units (PACU). Full article

The aorta is a single arterial organ, yet the clinical response to its diseases is fragmented across specialties, institutions, and nations. Acute aortic syndromes remain lethal at every stage of the care continuum: a large share of patients with type A dissection die before reaching any hospital, roughly half die before reaching a specialist centre, a substantial proportion are misdiagnosed at first medical contact, and untreated mortality has historically been estimated at approximately one to two percent per hour. Reported 30-day mortality differs across surgical registry cohorts—for example, 7.6% in the Japan Cardiovascular Surgery Database and 16.9% in the cited GERAADA cohort—but such ecological comparisons are descriptive and cannot identify the contribution of organisational, biological, clinical, or ascertainment differences. This review synthesises registry, population, and health-services data from Europe, Japan, North America, and low- and middle-income settings to characterise where the pathway fails and what each system has already demonstrated. We argue that the next material advance in aortic care will come not from any single innovation in isolation but from the architecture that connects prevention, diagnosis, treatment, and follow-up and that system redesign and technological progress are complementary rather than competing; we propose a five-pillar framework (Prevention, Presentation, Pathway, Person, and Learning) mapped throughout to published exemplars and future research priorities. Full article

The flexural behaviour of body-centred cubic (BCC) lattice beams fabricated by stereolithography remains supported by limited experimental evidence, and available homogenized beam models are rarely confronted with data in the combined regime of high relative density, non-slender struts, and low span-to-depth ratios. This work presents an experimental campaign on polymeric BCC lattice beams with three unit-cell edge lengths ($L=3$, 4, and 5 mm) and a constant strut-to-cell ratio $R/L=1/6$, yielding a relative density ${\rho }^{*}\approx 0.423$. Specimens were tested under uniaxial compression and three-point bending for nine combinations of geometry. The experimental data are compared with three analytical frameworks: a classical Euler–Bernoulli homogenized beam model and a BCC-specific shear-corrected formulation at the structural level, both evaluated without calibration to the bending tests, together with a strain-gradient extension whose intrinsic length scale is calibrated against them. For the effective Young’s modulus, the closed-form expression of Lee et al. reproduces the compression data within 10%, whereas the Tancogne-Dejean and Mohr model remains markedly stiffer even after the strut-level Timoshenko correction is included. In bending, none of the models proves adequate over the full geometric range: the Euler–Bernoulli model is accurate for several configurations (errors below 16% in five of nine cases) but overestimates the stiffness by up to 108% for the deepest specimen; the shear-corrected model reduces the global root mean square error from 97.94 to 24.44 N/mm (approximately a factor of four), but introduces excessive flexibility in some slender and intermediate configurations; and the strain-gradient correction, being strictly stiffening, yields no appreciable improvement. To avoid assigning the discrepancy to a single mechanism, the bending data are further analysed through an experimental compliance decomposition. The additional compliance relative to Euler–Bernoulli theory is small or negative in several cases, showing that shear flexibility alone cannot explain the full dataset, but becomes dominant for the deepest beams. The results therefore delineate the range of validity of simple homogenized beam models for dense finite BCC lattice structures and identify the combined influence of structural shear, non-slender struts, nodal-region morphology, finite-cell and boundary effects, local roller-contact compliance, and the discrete distribution of struts across the cross-section as the main mechanisms requiring more refined descriptions. These findings correspond to a single relative density (${\rho }^{*}\approx 0.423$) and a single strut-to-cell ratio ($R/L=1/6$), so the resulting span-to-depth indicator ($L_0/h\approx 2.5$) should be regarded as indicative for this class of dense lattices rather than as a general design rule. Full article

Despite decades of surface science research, there is a lack of an universal approach to define the adsorption geometry in catalysis on metal nanoparticles and surfaces. The unified framework introduced in this work allows the comparison of binding sites across different facets and particle-size metals, including stepped surfaces, adatoms and surface vacancies. In this study, we identify 18 adsorption sites on metal nanoparticles and surfaces that have either a face-centred cubic (FCC) or hexagonal close-packed (HCP) structure. Most metals in the periodic table have these structures and we determined the adsorption site geometry on a nanoparticle using a geometric approach with physical magnetic ball-and-stick models. These geometric models include the existence of an octahedral or tetrahedral hole beneath the adsorption site, as these can affect the adsorption site strengths of adsorbates. Furthermore, these adsorption sites are a combination of three-fold hollows and four-fold hollows, which are adsorption sites known to activate diatomic molecules (e.g., N₂ and CO). In addition, adsorption of large-molecular-weight adsorbates can be defined on these sites as they provide multiple contact points in contrast to the typical four-fold hollow, three-fold hollow, and bridge and atop adsorption sites used in heterogeneous catalysis. We find that there are nine geometrically distinct adsorption site topologies composed of square (i.e., 100) and triangular (i.e., 111) motifs. These adsorption site topologies, when combined with a characteristic zeta angle (ζ), result in 18 distinct adsorption site geometries that can be found on metal nanoparticles and surfaces. A systematic naming system for these adsorption sites is provided that defines the adsorption site geometry explicitly. Using this approach, we find that there are five different types of B5 sites, an adsorption site that has been previously found to activate dinitrogen on ruthenium for the ammonia synthesis reaction. Full article

Industrial heritage sites have predominantly been examined through visual, material, and conservation-oriented frameworks, while the haptic and embodied ways in which contemporary users experience reused industrial heritage environments remain comparatively underexplored. Focusing on Tophane-i Amire Culture and Art Centre, a historically significant Ottoman industrial heritage site repurposed as a contemporary cultural and artistic centre, this study examines how material contact, bodily movement, and tactile encounters contribute to the sensory heritage experience. Rather than proposing haptic sensewalking as a new method, the study uses an existing sensewalking approach in a haptic-centred way within the specific context of an Ottoman industrial heritage site undergoing adaptive reuse. Sensory data were generated through in situ walking observations, embodied sensory narratives, tactile descriptions, researcher field notes, and post-walk reflective accounts. The findings suggest that, within this haptic-focused protocol, participants did not describe the site merely as a visual-historical object. Instead, they articulated Tophane-i Amire as an embodied haptic environment in which rough stone textures, participant-perceived coldness and material heaviness, spatial thresholds, uneven walking surfaces, and movement-based encounters made architectural space bodily noticeable. The study does not claim that ordinary visitors naturally prioritise haptic experience; rather, it examines what participants articulated when their sensory attention was deliberately oriented toward tactile, thermal, kinaesthetic, and embodied aspects of the reused industrial heritage environment. The article makes two main contributions. Empirically, it shows how participants described haptic experience at Tophane-i Amire through encounters with rough stone surfaces, participant-perceived thermal qualities, thresholds, floors, and bodily movement. Conceptually, it interprets industrial heritage not only as a visual or material object but also as an embodied haptic environment in which historical meaning is sensed through touch, temperature, movement, and spatial negotiation. Full article

Background/Objectives: Primary care clinics increasingly receive urgent and semi-urgent requests from patients who may otherwise attend emergency departments or urgent care centres when timely appointments are unavailable. This article describes and evaluates the Cranston Ridge Medical Clinic Registered Nurse Prescriber-led Triage–Treatment–Continuity model in Calgary, Alberta, Canada. Methods: The manuscript is reported as a single-clinic practice innovation and service evaluation using aggregate, non-identifying operational data from 1 April 2025 to 31 March 2026. The model combines medical office assistant emergency recognition, RN prescriber-led stability assessment, traffic-light urgency classification, a booking-contingency algorithm, clinical support tools, diagnostic test ordering and prescribing within authorized scope, safety-netting, and communication with the patient’s primary care provider through the electronic medical record. Results: During the evaluation period, 5032 pathway contacts were managed. Of 5030 stable contacts assigned traffic-light categories, 4950 (98.4%) were Code Red same-day contacts, 55 (1.1%) were Code Yellow 24–48-h contacts, and 25 (0.5%) were Code Green non-urgent contacts. Two contacts triggered EMS/911 activation before traffic-light classification. Following RN prescriber assessment, 9 emergency department referrals, 2 urgent care referrals, 85 primary care provider follow-up appointments, and 5 patient refusals were recorded; no safety incidents or complaints were recorded in the aggregate monitoring dataset. A CIHI-informed 15% reference scenario corresponds to approximately 755 potentially avoided ED/UCC visits, but no confirmed diversion or monetary savings are claimed. Conclusions: The model reframes triage as an integrated primary care intervention that combines assessment, treatment, escalation, and continuity. Further ethics-approved research is required to evaluate patient-level outcomes, safety, confirmed health-system utilization effects, stakeholder experience, and cost-effectiveness. Full article

Background: Prolonged occupational standing is associated with increased plantar pressure, impaired postural stability and fatigue, contributing to lower-limb musculoskeletal disorders. Passive lower-limb exoskeletons have been proposed as an ergonomic solution to reduce mechanical load without external power. Objective: To evaluate the effects of a passive lower-limb exoskeleton (Chairless Chair^® 2.0) on plantar pressure distribution, postural stability, perceived fatigue and user satisfaction in workers exposed to prolonged standing. Methods: A quasi-experimental pre–post study was conducted in 25 asymptomatic restaurant workers. Participants performed static standing and walking trials on a baropodometric platform with and without the exoskeleton. Plantar pressures were recorded in static and dynamic conditions and postural stability was assessed by centre-of-pressure (COP) displacement and velocity. Perceived fatigue was measured with the Borg CR10 scale, and usability and comfort with the QUEST 2.0 questionnaire. Repeated-measures ANOVA and non-parametric tests (p < 0.05) were applied. Results: Compared with standard footwear, the exoskeleton significantly reduced plantar contact area and peak and mean plantar pressures during standing and walking. Posturographic analysis revealed a significant effect of condition on COP-related variables, with significantly lower oscillation and velocity measures observed in the exoskeleton condition. Perceived fatigue remained low to moderate and did not differ significantly between tasks (p = 0.96). QUEST 2.0 scores reflected high perceived effectiveness, ease of use and comfort, although device weight was the least favourable characteristic. Conclusions: The Chairless Chair^® 2.0 improved plantar pressure redistribution and was associated with lower COP displacement and velocity values without increasing perceived exertion. The device was generally well accepted by participants, supporting its potential use as an ergonomic aid in occupations requiring prolonged standing. Full article

Dengue is a rapidly spreading mosquito-borne viral disease with increasing incidence in Europe, driven by international travel and climate-related expansion of Aedes mosquito habitats. Data on imported dengue in Central Europe remain limited. The aim of this study was to characterize clinical and epidemiological features of imported dengue infections in Austria and identify factors associated with dengue warning signs. A retrospective, single-centre observational study conducted from January 2013 to October 2024. We retrospectively analyzed 175 adults with confirmed travel-associated dengue treated in Vienna, Austria. Demographics, travel history, symptoms, laboratory values, and clinical outcomes were extracted from electronic records. WHO criteria were applied to classify dengue severity. Most infections were acquired in Southeast Asia (72.6%), particularly Thailand. Common symptoms were fever (97.1%), fatigue (97.1%), arthralgia (59.4%), and rash (53.8%). Dengue warning signs were observed in 16% of cases and associated with significantly prolonged leukopenia (p = 0.003), increased hospitalization rates (50.0% vs. 23.8%, p = 0.005), and higher frequencies of vomiting, abdominal pain, mucosal bleeding, and petechiae at first medical contact. Women reported rash, arthralgia, and retro-orbital pain more frequently, while men showed lower platelet counts. No cases of severe dengue or deaths occurred. Dengue should be considered in febrile returning travellers, particularly from Southeast Asia. The presence of warning signs predicts more complicated disease courses and should prompt closer clinical monitoring. These findings underscore the importance of awareness and preparedness for dengue in non-endemic European settings. Full article

Background: Injury epidemiology in women’s football has primarily focused on elite athletes, whereas the amateur level, representing the vast majority of female players worldwide, remains largely under-explored. We aimed to provide a first prospective one-season characterisation of injuries in German amateur women’s football. Methods: In this prospective observational cohort study, 26 clubs comprising 450 female amateur players in Bavaria were monitored over the 2023/24 season using standardised time-loss injury questionnaires as used in current professional registry studies. Injuries were characterised by anatomical location, type, mechanism, and activity context (match vs. training); proportions are reported with 95% binomial exact confidence intervals (CI). Results: A total of 68 injuries were recorded. Regarding injuries with documented information, 66.7% (95% CI 54.0–77.8) were acute traumatic and 78.2% (95% CI 65.0–88.2) occurred during matches. Lower-extremity injuries dominated (80.3%; 95% CI 71.2–90.5), led by the knee as the single most frequent region (28.2%; 95% CI 18.1–40.1). Ligament injuries were the most common injury type (27.9%). Seven ACL ruptures were documented (10.3%; 95% CI 4.2–20.1), all of which occurred during match play. Indirect-contact mechanisms were significantly over-represented among all knee injuries (OR 6.92, 95% CI 1.52–31.6; p = 0.012). Conclusions: Amateur injury profile in this study reproduced the knee-centred, match-dominated pattern of elite female football while carrying a relative ACL burden at the upper end of professional reference data; given the small number of ACL events (n = 7), this signal is hypothesis-generating. These findings support the extension of structured neuromuscular prevention programmes into German amateur women’s football. Full article

Domestic cats (Felis catus) are ubiquitous companion animals that provide substantial psychological and social benefits to children and adults alike, but they also serve as reservoirs and vectors for a wide range of zoonotic pathogens. Close physical contact between cats and children, frequent use of shared environments such as homes, playgrounds, and sandboxes, and still-developing hygiene behaviours increase opportunities for exposure to protozoa, helminths, bacteria, fungi, and ectoparasite-borne agents. This review synthesizes current evidence on key feline-associated zoonoses of pediatric concern—including Toxoplasma gondii, Toxocara cati, Ancylostoma spp., Dipylidium caninum, Bartonella henselae, Salmonella enterica, Campylobacter jejuni, Pasteurella multocida, Microsporum canis, flea-borne Rickettsia species, and rabies—with emphasis on transmission routes, clinical manifestations, and risk modifiers in children, pregnant women, and immunocompromised individuals. Within a One Health framework, we also summarize global publication trends on feline zoonoses, discuss how urban cat ecology and management (including free-ranging cats in child-frequented environments) may shape pediatric risk, and outline practical prevention strategies centred on hygiene, veterinary care, and targeted education for caregivers and children. Full article

Background/Objectives: A structured follow-up after out-of-hospital cardiac arrest (OHCA) is recommended, but implementation across regional networks remains challenging. REVIVE introduced a hub-and-spoke survivorship pathway in Lombardy. This 12-month formative implementation evaluation aimed to describe staged pathway progression, operational reach, attrition points, centre-level variation, and documented barriers to assessment completion. Methods: Adult OHCA survivors with Cerebral Performance Category (CPC) 1–2 or Modified Rankin Scale (mRS) ≤ 3 were considered eligible. The evaluation was structured using Proctor et al.’s implementation outcomes framework. Implementation outcomes were operationalised using prospectively collected pathway indicators: eligibility ascertainment, successful contact, T0 assessment completion, completion of planned assessment components, timeliness where available, and documented reasons for non-progression. Analyses were descriptive and used chi-square or Fisher’s exact tests for unadjusted centre-level comparisons. Results: Of the 1663 patients hospitalised, 1458 (87.7%) were recorded as deceased or having an unfavourable neurological outcome and were therefore outside the intended REVIVE target population. Among the remaining 205 patients, eligibility could not be determined for 78 (4.7% of the total cohort), and 127 (7.6%) met eligibility criteria. Of eligible survivors, 96 (75.6%) were contacted and 64 completed the T0 assessment (66.7% of contacted; 50.4% of eligible). Pavia showed higher observed rates of eligibility ascertainment, contact, and assessment completion than spoke centres, but these differences were unadjusted and should be interpreted as centre-level implementation variation rather than evidence of causal superiority. Conclusions: REVIVE initiated a structured regional pathway for post-OHCA follow-up, but first-year implementation was partial rather than definitive. The 50.4% T0 completion rate among eligible survivors should be interpreted as an initial internal implementation indicator, not as evidence of established feasibility, effectiveness, or regional benchmarking. Priorities for further optimisation include eligibility ascertainment, transfer of contact information, patient engagement, and spoke-site support for assessment delivery. Full article

Controlling macro-geometrical errors in the dry drilling of ductile cast iron remains a critical challenge for sustainable and cost-efficient automotive component manufacturing. This paper investigates the influence of cutting speed (v_c) and feed per revolution (f_n) on the dimensional and shape accuracy of holes drilled in EN-GJS-500-7 ductile cast iron using an HSS DIN 338 helical drill (Ø 11.8 mm, Ceratizit) on an AVIA VMC800 CNC milling centre. A one-factor-at-a-time (OFAT) experimental design was applied: the feed effect was evaluated at v_c = 10 m/min with f_n ∈ {0.10, 0.15, 0.20} mm/rev, while the speed effect was evaluated at f_n = 0.20 mm/rev with v_c ∈ {10, 25, 30} m/min. Cutting forces, torques, and vibration accelerations were recorded using an HBM MSC 10 transducer and a PCB 356A01 tri-axial accelerometer. Hole geometry was assessed on a Zeiss Contura G2 coordinate-measuring machine (CMM), and surface texture was evaluated with a TOPO 01P contact profilometer. The expanded measurement uncertainty (k = 2) was estimated based on duplicate test specimens. All drilled holes fell within the IT12 dimensional tolerance (PN-EN 22768-1:1999 grade c), with diameter oversizes ranging from +0.26 mm to +0.46 mm relative to the nominal bore. Cutting speed was identified as the dominant factor affecting both diameter oversize and cylindricity, which increased by 60% (from 0.10 to 0.16 mm) as v_c rose from 10 to 30 m/min. Vibration accelerations increased nonlinearly between v_c = 25 and 30 m/min (by a factor of 2.5×), indicating an approach to a structural resonance condition. The lowest surface roughness (R_a = 6.6 µm) was obtained at v_c = 25 m/min. These findings establish clear physical baselines for tool deflection limits, demonstrating that managing dynamic process stability is vital for optimising macro-geometrical accuracy in the dry machining of cast iron alloys. Full article

Background/Objectives: Survivors of sexual violence and domestic violence/intimate partner violence (IPV) often require support beyond the immediate emergency encounter; however, post-acute care remains inconsistently defined, unevenly organised or conceptualised, and fragmented across service systems. This scoping review mapped international post-acute follow-up, care, assistance, and support pathways, with particular attention to organisational models, continuity mechanisms, loss to follow-up after first access, and implications for the Italian context. Methods: We conducted an international health-services scoping review of post-acute follow-up, care, assistance, and support interventions for survivors of sexual violence and domestic violence/IPV. Searches were performed in PubMed/MEDLINE, Scopus, Web of Science Core Collection, Embase, APA PsycINFO via EBSCOhost, and CINAHL via EBSCOhost. Eligible studies were published from 2013 onward and had to describe an identifiable post-acute component beyond the initial emergency, forensic, or first-contact phase. The review followed a Population–Concept–Context framework and was reported in accordance with PRISMA-ScR. Results: Forty-four studies were included in the core synthesis, comprising 16 studies on sexual violence/sexual assault, 27 on domestic violence/IPV, and one mixed domestic, family, and sexual violence outreach model. The sexual violence literature clustered around early trauma-focused interventions, sexual assault care centre pathways, medical follow-up, follow-up attendance, and digital continuity tools. The IPV literature was broader and included psychotherapy, advocacy and case-management models, housing-first and trauma-informed stabilisation approaches, nurse-led and clinic-based services, outreach and safety-contact programmes, digital interventions, and programmes for system-involved survivors. Across both fields, the pathways most consistently described as supporting continuity combined structured re-contact, coordinated support, and multi-component responses over time. Conclusions: The mapped literature supports conceptualising post-acute responses to sexual violence and domestic violence/IPV as continuity pathways that extend beyond first contact and link healthcare, psychological, advocacy, and social supports. Systems may be better positioned to support continuity when they provide structured follow-up, warm handoffs, coordinated navigation, and context-sensitive recovery models. These findings point to provisional, evidence-informed organisational questions for strengthening post-acute pathways, including in Italy, particularly around structured re-contact, warm handoffs, survivor navigation, and integration between healthcare, anti-violence, psychological, and territorial social-support services. Full article

Background/Objectives: Quinolones are among the most frequently implicated antibiotics in immediate hypersensitivity reactions, yet diagnostic evaluation remains challenging and the real-world behaviour of patients after de-labeling has received little attention. We examined the diagnostic work-up, outcomes, and post-de-labeling drug-use behaviour of patients with suspected quinolone hypersensitivity. Methods: This single-centre ambispective study included 29 patients evaluated between January 2020 and April 2024. Clinical, demographic, skin test, and drug provocation test (DPT) data were extracted retrospectively. Patients in whom allergy had been excluded or a safe alternative identified were contacted by structured telephone interview between May and June 2025. Results: Anaphylaxis was the most common index reaction (42.9%), and ciprofloxacin was the most frequently implicated agent (57.1% of drug instances). Skin tests were positive in 84.2% of cases, but the positive predictive value in the DPT-tested subset was only 20.0%. Of the 12 reached patients, 11 had quinolone allergy excluded; among these, only 4 (36.4%) had reused the de-labeled quinolone, while 7 (63.6%) had avoided it, including 4 who declined it when clinically indicated. Conclusions: Quinolone skin tests show limited specificity, and successful de-labeling does not guarantee real-world drug use. Patient anxiety and counselling are central to effective management. Full article

To enhance immersion in virtual reality (VR) environments and improve the fidelity of virtual tactile interaction, this study proposes a perceptually grounded haptic-rendering framework for fine surface-texture simulation. The framework is centred on a Perceptual Haptic Spectrum Model (PHSM), which maps virtual surface attributes, including hardness, elasticity, roughness, friction, and microtexture periodicity, to multi-band tactile targets in perceptual frequency space. A Just Noticeable Difference (JND)-inspired parameterisation strategy is used as a design guideline to avoid imperceptible or redundant actuation, while region-specific response functions adapt the output to the fingertip centre, finger pad, and lateral edge. To improve reproducibility, the revised manuscript now specifies the flexible thin-film force/strain-sensor cell, array quantity, 320 Hz per-cell acquisition setting, signal-conditioning pipeline, contact-state classification rules, delay budget, and dual-actuation scheduling logic. The sensing design is based on a commercial flexible piezoresistive force-sensor cell with microsecond-level response time and a 12-bit ADC acquisition chain that provides a sufficient aggregate sampling margin for a 7–21 cell array. Manufacturer-supported sensor performance and prototype-level acceptance criteria are reported for response time, linearity, repeatability, hysteresis, drift, SNR, contact-state detection, latency, and durability. The system remains a proof-of-concept platform rather than a completed large-scale psychophysical validation. Within these boundaries, the results show coherent integration of perceptual modelling, multi-rate sensing, state monitoring, predictive feedforward control, and coordinated haptic actuation for fine VR texture rendering. Full article