Search Results (14,034)

Early childhood intervention and education play a central role in promoting equity, developmental outcomes, and long-term well-being for all children, particularly those experiencing those with disabilities or refugee status. In Türkiye, children at this intersection face compounded barriers to inclusive early childhood education (ECE). This paper examines how disability, and forced migration intersect to shape access to early childhood services in Türkiye, analyzing legal frameworks, programs, implementation gaps, and contextual factors. A review of policy documents, research, and program evaluations, reveals that while Türkiye has established foundational policies and achieved progress, structural barriers and governance fragmentation limit equitable service provision. The study adopts an intersectional framework and Guralnick’s Developmental Systems Model to identify leverage points for reform. The findings underscore the critical need for integrated service systems, strengthened cross-sectoral coordination, and targeted support mechanisms for families experiencing intersecting vulnerabilities in Türkiye, a country that ranks among the top five hosts of the world’s largest refugee populations. Full article

Background: Circulating cytokines and their soluble receptors in body fluids have been implicated in the pathogenesis of multiple sclerosis (MS). Alterations in serum levels of pro- and anti-inflammatory cytokines and/or their soluble receptors can dysregulate central nervous system (CNS) signaling pathways and, therefore, may serve as potential biomarkers for the diagnosis of MS. Therefore, the primary end-point of this study is to investigate the utility of various cytokines and their soluble receptors as diagnostic biomarkers in MS. The secondary outcome is also to assess whether these cytokines are useful in differentiating the severity of MS. Methods: In this case–control study, we compared a panel of pro-inflammatory interleukins (ILs), including IL18 and tumor necrosis factor-alpha (TNFα), soluble IL receptors (sIL7Rα and sIL2Rα), and insulin-like growth factor-1 (IGF-1) in 45 MS patients and in 45 healthy control individuals matched for sex and age. Associations of these biomarkers with age, disease severity (Expanded Disability Status Scale [EDSS]), disease duration, and age at first MS symptom onset were also assessed. Results: Serum levels of cytokines and soluble IL receptors were elevated in MS patients compared to healthy controls. IGF-1 was lower (p < 0.001) in the MS patients than in the healthy individuals. The serum level of IGF-1 was higher (p < 0.01) in the remitting-relapsing phase compared to the primary progression and secondary progression stages. Similarly, only IGF-1 was more elevated (p < 0.01) in the mild stage compared to the moderate stage based on the EDSS score. Receiver operating characteristic (ROC) curve analysis demonstrated that IL18 had excellent discriminatory power for the diagnosis of MS (p < 0.001), with an area under the curve (AUC) of 0.96 ± 0.017, followed by IGF-1 (p < 0.001), which showed strong diagnostic performance (AUC = 0.873 ± 0.037). Soluble (s) IL2Rα exhibited fair diagnostic accuracy (p < 0.001; AUC = 0.717 ± 0.054). In contrast, sIL7Rα and TNFα showed poor discriminatory power despite statistical significance (p < 0.01), with AUC values of 0.675 ± 0.057 and 0.687 ± 0.056, respectively. Results of regression analysis revealed that EDSS, duration of disease, and use of any treatment had no impact on the cytokines. Similarly, no significant correlations were noted between these confounders and cytokines, except a moderate negative correlation (−0.418) between IGF-1 and EDSS. Conclusions: IL18 and IGF-1 have the potential to be used as biomarkers in distinguishing MS from healthy individuals. However, both biomarkers failed to demonstrate the discrimination between various phenotypic patterns of disease, limiting their utility for disease stratification. Future studies with larger, longitudinal cohorts and multi-marker panels are warranted to validate these results and to explore whether combining cytokines with imaging or genetic markers can improve prognostic precision. Full article

Background/Objectives: Disability affects ~15.7 million children and ~67 million adults in the US, yet these individuals are typically under-represented in clinical research. Clinical research has increasingly broadened its focus on health outcomes to include “positive health,” which reflects the capacity of an individual to adapt to challenges and the absence of disease. Methods: A mixed-methods approach is used to investigate disability community perspectives on research inclusion and the use of positive health as an outcome in the context of childhood-onset disability. Results: Nationally, about one-fourth (1/4) of adults with disabilities and parents/caregivers reported participating in non-disability-specific research; overall, ~23% of adults and ~30% of parents/caregivers report exclusion because of disability, despite >80% endorsing health outcomes research. Disability stakeholders unanimously express the need to reframe positive health in a disability context, provide guidance on how to reframe it as a research outcome, and offer a roadmap for improving research inclusion. Conclusions: A paradigm shift in how positive health is framed may enhance its relevance to disabilities. An action plan for researchers is derived as a pragmatic approach to strengthen the relevance, generalizability and impact of their research. Full article

Background: Knee osteoarthritis (KOA) is one of the leading causes of chronic pain and long-term disability worldwide. Despite its high prevalence, KOA remains underrepresented in repetitive peripheral magnetic stimulation (rPMS) research. While total knee arthroplasty remains the definitive treatment, there is a growing need for non-invasive approaches to reduce symptoms in patients seeking conservative alternatives or awaiting surgery. Methods: Thirty patients with KOA underwent a non-invasive treatment program consisting of eight sessions of double-coil repetitive peripheral magnetic stimulation (rPMS) over three weeks. Outcome measures included pain intensity assessed by the Visual Analog Scale (VAS), functional ability evaluated by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Timed Up and Go test (TUG), and joint mobility measured as knee flexion and extension. Clinical relevance was evaluated using the Minimal Clinically Important Difference (MCID), and subgroup analyses were performed according to Kellgren-Lawrence (KL) grade. Results: Double-coil rPMS was associated with statistically and clinically significant improvements in all outcomes. MCID responder rates exceeded 80% for VAS and TUG, exceeded 70% for WOMAC, and approached 50% for joint mobility outcomes. Subgroup analysis indicated that patients with lower KL grades experienced greater pain reduction, whereas those with higher grades showed greater functional gains. Conclusions: Double-coil rPMS provided preliminary evidence of potential clinical benefit as a non-invasive approach in patients with KOA. Given the single-arm pilot design, the findings should be interpreted cautiously and require confirmation in adequately powered randomized controlled trials with longer follow-up. Full article

Skeletal muscle myopathy remains a significant cause of disability with limited treatment strategies. Advancements in tissue engineering have led to the development of borophosphate bioactive glasses (BPBGs) capable of enhancing skeletal muscle structure and function. Using a mouse model of severe myopathy (D2.mdx), we investigated muscle force, regeneration, angiogenesis and inflammation at 14, 70 and 140 days post-treatment (dpt). Tibialis anterior (TA) muscles of D2.mdx mice that received a single injection of cobalt oxide-doped BPBG (CoO-TRIM) particles exhibit greater active force, myofiber size, and regeneration through 70 dpt compared to control D2.mdx mice injected with Saline. Vascular endothelial growth factor (VEGF) was elevated up to 70 dpt in D2.mdx CoO-TRIM mice followed by increased muscle vascularity. As a marker of inflammation, interleukin (IL)-6 increased in D2.mdx CoO-TRIM mice compared to D2.mdx Saline controls at 14 dpt, with no differences at 70 or 140 dpt. No differences were observed in outcome measures between wild-type (WT) CoO-TRIM mice and WT Saline controls. We report that CoO-TRIM can stimulate VEGF production and promote restoration of muscle structure and function when inflammation is present. Local injection of an inorganic biomaterial alone can benefit myopathic skeletal muscle. Full article

This paper studies the supervisory control of discrete event systems (DESs) from an event observation perspective and addresses the problem of supervisor design with minimal observation. In supervisory control, a supervisor enables or disables controllable events based on its observation of the system trajectory to guarantee controllability and nonblocking behavior with respect to a given specification, while the number of observed events critically affects the implementation complexity and cost of the control logic. Rather than minimizing the state space of the supervisor, which is the focus of classical supervisor reduction, this paper is dedicated to the minimization of observable events. Specifically, it aims to reduce the observation alphabet while preserving control equivalence with the original supremal supervisor. By analyzing the consistency of disabling decisions between event-enabled and event-disabled states, necessary and sufficient distinguishability conditions are derived and represented using Parikh vectors, which enables their formulation as linear separation constraints. In addition, event-enabled circles are introduced to capture intrinsic structural observability requirements induced by cyclic behaviors of the supervisor. These results lead to a mixed-integer linear programming (MILP) formulation that minimizes the observation alphabet while preserving control equivalence with the original supremal supervisor, together with an E-closure-based construction that synthesizes an executable event-minimal supervisor. Illustrative examples demonstrate that the proposed method can significantly reduce observation requirements even when state-minimal supervisors are already available, thereby improving implementation efficiency in resource-constrained DES applications. Full article

A monolithic digital Silicon Photomultiplier (SiPM) featuring 1024 microcells with a 30-micrometer pitch and a 50% fill factor has been designed in a 110-nanometer CMOS image sensor technology. The device under consideration integrates both SPAD sensors and front-end electronics in the same substrate. It can count up to 1024 photons in less than 22 ns, while assigning timestamps to the first and last detected photons with a time resolution of less than 100 ps. A parallel counter structure combined with a fast adder tree provides photon counting in digital form with low latency, whereas a carefully balanced fast NAND tree ensures a fixed-pattern time uncertainty not exceeding 26 ps. The architecture incorporates in-pixel memory for individual cell disabling and configurable thresholding on the timing signal for noise mitigation. In order to optimize the fill factor, a part of the electronics is placed outside the array, while the most sensitive elements of the timing and counting circuits are laid out close to the sensor, in the SPAD array. A serial readout is employed to provide a single output connection per SiPM, thereby simplifying system integration. Full article

Public bus systems are vital to achieving sustainable urban mobility in developing countries; yet, the quality of bus stops, a critical interface between users and transit services, remains widely overlooked. This study evaluates bus stop quality in Sulaymaniyah, Iraq, from bus users’ perspectives by integrating importance–performance analysis (IPA) and the customer satisfaction index (CSI) with level of conformity analysis (CR) using extensive, real-world survey data. The objective was to identify priority areas to help improve the quality of public bus stop provision in the city and ensure the most efficient allocation of resources by focusing on the quality attributes that matter most to bus users. The results highlight six critical service quality attributes that require immediate improvement due to their high importance to users and low service quality performance: (i) safety barriers to prevent traffic accidents while waiting at bus stops; (ii) accessibility of bus stops for elderly and disabled users; (iii) availability of signage and timetables/maps; (iv) overall bus stop quality; (v) narrow bus stop platforms; and (vi) waiting time at bus stops. Addressing these gaps is essential to enhance user satisfaction and ensure that users have a safer, more inclusive, and reliable PT experience. This study offers evidence-based recommendations to enhance bus stop design and service quality, thus contributing to improved user satisfaction and increased ridership. More broadly, the results can be applied to other rapidly urbanizing developing cities seeking to provide equitable, safe, and user-centered bus transit systems. Full article

Background/Objectives: Stroke is a leading cause of mortality and disability in Saudi Arabia; however, national estimates of stroke-related rehabilitation needs remain limited. This study quantified temporal trends in stroke incidence, prevalence, premature mortality, and disability from 1990 to 2021. It also examined disparities in stroke-related disability by subtype, sex, and age in 2021 and projected rehabilitation demand to 2030 to inform health system planning under Vision 2030. Methods: We conducted a secondary analysis of Global Burden of Disease (GBD) 2021 estimates for Saudi Arabia. Age-standardized rates for incidence, prevalence, years of life lost (YLLs), and years lived with disability (YLDs) were extracted for overall stroke and three subtypes: ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Temporal trends were evaluated using log-linear regression to estimate the average annual percentage change (AAPC). YLDs were mapped to severity levels and four rehabilitation modalities, physiotherapy (PT), occupational therapy (OT), speech–language therapy (SLT), and multidisciplinary comprehensive rehabilitation (MCR), using utilization probabilities informed by the literature. Projections to 2030 incorporated national population forecasts and included 95% prediction intervals and sensitivity analyses. Results: From 1990 to 2021, age-standardized stroke incidence declined from 166.3 to 130.7 per 100,000 (−21.4%; AAPC, −0.86%, p = 0.004), prevalence from 982.4 to 965.2 per 100,000 (−1.8%; AAPC, −0.10%, p = 0.056), and YLL rates from 3209.0 to 1893.4 per 100,000 (−41.0%; AAPC, −1.76%, p < 0.001). In contrast, YLD rates declined modestly from 133.5 to 129.9 per 100,000 (−2.7%; AAPC, −0.13%; p = 0.032). Despite these reductions in age-standardized rates, absolute stroke-related YLDs more than tripled, increasing from approximately 10,900 (95% UI: 8100–13,900) in 1990 to 36,245 (95% UI: 26,600–46,100) in 2021, largely driven by population growth and aging. In 2021, ischemic stroke accounted for 71.1% of total YLDs, followed by ICH (20.3%) and SAH (8.5%). Among adults aged 15–49 years, females had higher hemorrhagic YLD rates than males, with particularly pronounced differences for SAH (female-to-male ratio, 1.5–1.7). By 2030, the projected YLD-equivalent workload, a standardized proxy measure of relative service demand rather than a direct headcount of required therapists, is expected to increase to 29,758 for PT, 21,809 for OT, 14,879 for SLT, and 15,083 for MCR. Sensitivity analyses showed that rehabilitation demand estimates were sensitive to assumptions regarding severity distribution, with a hemorrhagic-weighted scenario increasing projected MCR demand by 6.8%. Conclusions: The increasing absolute burden of stroke-related disability in Saudi Arabia, despite declining age-standardized rates and substantial reductions in premature mortality, highlights the necessity to expand rehabilitation capacity. Scaling community-based, outpatient, and telerehabilitation services in alignment with the Health Sector Transformation Program and integrating disability-informed planning into Vision 2030 should be prioritized. Full article

Climate hazards increasingly disrupt schooling, revealing the limits of preparedness models that treat teachers only as implementers. This study reframes teacher empowerment as a climate-resilience capability and examines how governance arrangements enable (or constrain) hazard-ready education systems. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), searches of Web of Science, Scopus, and Google Scholar (2000–2025) identified 53 eligible studies. Across diverse hazards and settings, the evidence converges on a governance-to-capability pathway: empowerment becomes resilient performance only when the delegated decision space is matched with financed capacity (time, training, contingency resources), timely risk information and functional communication/digital infrastructure, institutionalized cross-sector coordination (education–DRR–health–protection–local government), and learning-oriented accountability (after-action review and adaptive revision rather than punitive compliance). Reported outcomes include higher preparedness quality, earlier protective action, improved learning continuity and safeguarding, and more sustainable teacher well-being/retention. Predictable failure modes include mandate–resource mismatch, accountability overload, unstable centralization–autonomy dynamics, and inequitable empowerment distribution affecting rural schools, women, and contract teachers, and disability inclusion. The evidence gaps remain pronounced for chronic hazards (especially heat and wildfire smoke), high-vulnerability contexts (fragile/conflict settings and informal settlements), and standardized measures of equity, burden distribution, governance performance, and cost-effectiveness. Policies should prioritize integrated governance packages with explicit protection and equity safeguards. Full article

Background/Objectives: Sciatic nerve injuries are among the most common classes of peripheral nerve harm and have a strong impact on quality of life, as well as a significant negative economic impact for patients, society, and governments, since they represent a frequent cause of work-related disabilities and sick leave applications. Following nerve injury, neurons, Schwann, and satellite cells undergo marked changes in phenotype, metabolic activity, neuronal survival, nervous transmission, and an exacerbated activation of the inflammatory response. Leuprolide acetate (LA), a clinically available agonist of gonadotropin-releasing hormone (GnRH), has shown clear neurotrophic properties and is considered a novel potential candidate for treating neural injuries, including sciatic nerve pathologies. This study aimed to analyze the effect of LA treatment on sensory function and dorsal root ganglia (DRG) changes in a rat sciatic nerve full-transection (SNT) model. Methods: Variations in cold and heat sensitivity were assessed using the thermal plate test, while DRG tissue sections were examined for modifications in reactive gliosis by immunofluorescence analysis, and axonal transport using a retrograde tracer. Also, changes in the expression of pro-regenerative genes Stat3, Socs3, Fos, Jun, Atf4, and Limk1 were quantified by qPCR. Results: Our results showed that LA treatment exerted a distinct neurotrophic effect, since it promoted the specific recovery of cold sensitivity, improved axonal transport, regulated the inflammatory response, and modulated the exacerbated expression of pro-regenerative genes in the SNT model. Conclusions: These findings indicate that LA therapy may have the potential to improve sensory recovery in patients with sciatic nerve injuries. Full article

Cognitive impairments are a core feature of psychotic disorders and are strongly associated with long-term functional disability. Although Cognitive Remediation Therapy (CRT) is an evidence-based intervention for improving cognition in psychosis, its feasibility and preliminary effects in acute inpatient settings—particularly using web-based platforms—remain underexplored. This single-arm, pre–post pilot study evaluated the feasibility of delivering a web-based CRT program and examined preliminary cognitive outcomes in a secure psychiatric inpatient facility. Thirteen inpatients with psychotic and non-psychotic diagnoses completed a 15-week intervention comprising twice-weekly sessions that included adaptive computerized CRT exercises (Happy Neuron Pro) and therapist-led bridging discussions focused on metacognitive reflection and functional application. Cognitive performance was assessed pre- and post-intervention using the MATRICS Consensus Cognitive Battery. All participants completed the study with no withdrawals or adverse events, attending a mean of 27.77 of 30 sessions (93.0%). Pre–post improvements were observed in processing speed, verbal learning, and overall composite cognition, with large within-sample effect sizes that remained robust in sensitivity analyses. Exploratory analyses suggested potential associations between sex, history of self-harm, and cognitive change, though these findings require cautious interpretation. Findings support the feasibility of inpatient web-based CRT and provide preliminary cognitive effect-size estimates. Given the single-arm design and absence of systematic medication monitoring, results should be interpreted as exploratory signals warranting controlled validation. Overall, findings support the feasibility of inpatient web-based CRT and provide preliminary signals of cognitive benefit, warranting evaluation in larger controlled studies. Full article

Transportation-disadvantaged (TD) populations, including many older adults and people with disabilities, often face mobility barriers linked to fragmented transportation services, limited information about available ride options, and weak coordination across providers. While One-Call/One-Click (1C1C) systems have emerged as solutions to centralize transportation information, support trip planning, and coordinate services across public, nonprofit, and private actors, their capacity to scale remains limited. Using a mixed-methods design, this study examined the institutional arrangements, functional scope, and service scale of 67 operational 1C1C systems to identify systemic barriers to expanding coordinated service access. Quantitative analysis revealed substantial variation in governance, service configurations, costs, and coverage relative to conservative population-based benchmarks, with most systems operating at limited scale. Qualitative interviews with system administrators provide explanatory insight into these patterns, identifying three recurring institutional constraints: funding instability, limited capacity for technology and data integration, and shallow vendor networks for specialized transportation services. The findings indicate that limits to 1C1C performance are rooted in institutional and financial conditions rather than system design. Situating coordinated transportation within the Age-Friendly Cities framework, the study argues that mobility coordination must be treated as durable public infrastructure if equitable, age-friendly mobility is to be achieved at scale. Full article

Background/Objectives: People with mobility limitations face disproportionately high rates of chronic health conditions and demonstrate lower adherence to wellness interventions. Digital programs such as MENTOR offer accessible alternatives but often face high rates of attrition. This study applied machine learning (ML) methods to predict adherence to the eight-week MENTOR telewellness program and identify key predictors of participant attendance. Methods: Data were drawn from 1218 adults enrolled in MENTOR (2023–2024). Adherence was defined as the percentage of 40 sessions attended. Baseline demographic, socioeconomic, psychosocial, mindfulness, resilience, health status, and physical activity variables were included as predictors. Following preprocessing and imputation, 13 ML regression models were trained using an 80/20 train–test split. The best-performing model was identified using mean absolute error (MAE), followed by feature selection and SHAP interpretability analyses. Pairwise synergy analysis quantified interactions between top predictors. Results: Model performance was modest overall. Bayesian ridge regression achieved the best performance (MAE 20.98; RMSE 25.26; R² = 0.12). SHAP analyses revealed that education, race, emotional support, Area Deprivation Index, household size, mindfulness, life satisfaction, and disability onset were the strongest predictors of adherence. Higher emotional support, mindfulness, and life satisfaction were associated with greater adherence, while socioeconomic disadvantage predicted lower adherence. Synergy analyses showed the strongest predictive interactions between low education and psychosocial resources (emotional support and life satisfaction). Conclusions: Baseline characteristics alone modestly predicted adherence to a digital wellness program. However, psychosocial and socioeconomic factors emerged as meaningful predictors, underscoring the need for personalized support strategies to reduce dropout among participants with mobility limitations. Full article

As populations around the world continue to age, promoting healthy ageing has become a key public health priority. Nutrition plays a vital role in maintaining physical and cognitive function later in life, and omega-3 polyunsaturated fatty acids (PUFA) are essential components of cell membranes and are known for their anti-inflammatory and cardio-protective effects. Chronic inflammation and oxidative stress are major contributors to age-related decline, and omega-3s help mitigate these processes by modulating immune responses and improving endothelial function. This systematic review aims to examine the potential of omega-3 fatty acids to reduce inflammatory markers and improve overall health. Moreover, it aims to present the most effective dietary interventions in dairy cows that increase PUFA content in milk. PubMed, Web of Science, Scopus, and the Cochrane Library databases were searched for relevant articles published up to November 2025. Evidence suggests that older adults who consume higher levels of PUFA tend to have better cardiovascular health, preserved cognitive function, and a lower risk of age-related diseases such as Alzheimer’s and arthritis, and reduce the risk of frailty and disability in later years. Dietary manipulation to enhance PUFA in bovine milk represents a promising strategy for improving human nutrition while potentially benefiting cow health. Full article