Search Results (14,123)

Civic online participation platforms offer valuable opportunities to involve citizens in local governance and benefit from collective intelligence. Yet, vulnerable groups, such as older adults, people with disabilities, and the less educated, are often underrepresented in online political engagement. Aiming to empower these citizens to raise their voice online, we conducted two studies using an inclusive-by-design approach for developing an online civic engagement platform. In the first study, 39 individuals from two digitally low-performing European countries were surveyed about functions and features that would motivate and support their online participation. In the second study, focus groups with 13 digital and AI experts identified technical and informational requirements for effective use of the features desired by citizens. Our findings show the wishes for accessible, unbiased and secure AI-driven civic engagement platforms with transparency and user education about AI tools. In particular, chatbots require clear disclaimers and user guidance. Once citizens have been involved in the technical design process, both technical and informational feature preferences must be taken into account to avoid access and usability barriers or misunderstandings during the platform’s use. This is important to facilitate participation, especially for citizens from vulnerable groups. Full article

Background/Objectives: Fragile X Syndrome (FXS) is a neurodevelopmental disorder caused by a triplet repeat expansion in the Fmr1 gene leading to the loss of Fragile X Messenger Ribonucleoprotein (Fmr1 protein). The loss of Fmr1 protein modulates many cell biological processes and leads to the emergence of intellectual disability and autism. FXS is modeled in Fmr1-KO mice that display features consistent with human FXS, including hypersensitivity, cognitive and learning deficits, hyperactivity and audiogenic seizures. Here, we investigated the effect of auditory stimulation during a range of developmental stages on recognition memory and sociability deficits in Fmr1-KO mice. Methods: Fmr1-KO mice were subjected to auditory stimulation for 2 min three times a day at one-hour intervals for 5 days at the nursing, juvenile and adult stages. The animals were tested for social interaction and novel object recognition at 2 to 3 months old. Results: During auditory stimulation, the wild running phenotype was observed in the Fmr1-KO juvenile animals and two animals at the nursing stage experienced status epilepticus and died. Fmr1-KO animals showed social deficits compared to both the control and animals exposed to auditory stimulation at the juvenile stage. In the novel object recognition task, auditory stimulation was more effective at the nursing and juvenile stages. Conclusions: These data show that auditory stimulation may be an effective way to restore cognitive and social deficits in FXS. Full article

Caring for adult children with disabilities represents a prolonged and emotionally demanding experience for family caregivers, frequently associated with psychological distress and reduced well-being. This study examined the effects of a group-based parent training program on key psychological dimensions in caregivers of adults with disabilities. One hundred and nine caregivers participated in a psychoeducational intervention and completed measures of self-compassion, perceived self-efficacy, emotional maturity, empathy, and adult attachment. Results showed significant improvements in self-compassion and self-efficacy, with trends toward more secure attachment patterns, while empathy remained stable. Overall, findings suggest that parent training can foster emotional regulation and caregiving processes. Full article

The management of multiple sclerosis (MS) is shifting from a phenotype-based framework toward a biologically driven precision medicine model, as conventional magnetic resonance imaging (MRI) inadequately captures smoldering inflammation and progression independent of relapse activity (PIRA). This systematic review aimed to synthesize current evidence on the diagnostic and prognostic utility of fluid biomarkers in distinguishing acute inflammatory injury from chronic neurodegeneration. A comprehensive search of Web of Science, PubMed, and Scopus (January 2020–September 2025) identified 28 eligible studies including 7775 participants (6365 MS patients and 1410 controls). Biomarkers derived from serum, plasma, cerebrospinal fluid (CSF), and stool were evaluated in relation to clinical disability measured using the Expanded Disability Status Scale (EDSS) and magnetic resonance imaging (MRI) outcomes. Neurofilament light chain (NfL) consistently predicted acute inflammatory activity, gadolinium-enhancing lesions, and relapse-associated worsening, but levels were reduced by high-efficacy therapies and did not reliably predict PIRA. In contrast, glial fibrillary acidic protein (GFAP) was associated with astrogliosis, disability progression, and retinal thinning, even in patients with low inflammatory activity. Additional CSF, metabolic, and immunologic markers correlated with neurodegeneration and disease severity. Nevertheless, broader clinical use will require greater assay standardization, improved consistency across cohorts, and validation in prospective longitudinal studies. These findings compel a shift toward a multi-biomarker model to guide personalized therapeutic strategies and develop targeted neuroprotective treatments for progressive multiple sclerosis. Full article

Background and Objectives: To assess the reliability and construct validity of the Functional Rating Index (FRI) in Italian-speaking individuals with chronic non-specific low back pain (CLBP), in order to improve assessment and clinical management in this population. Materials and Methods: This cross-sectional study consecutively enrolled 75 individuals with CLBP (52 females; mean age 48.71 ± 19.18 years; mean pain duration 298.64 ± 427.52 weeks). Internal consistency and test–retest reliability were evaluated using Cronbach’s α and the intraclass correlation coefficient [ICC_2,1], respectively, while measurement error was estimated through the minimum detectable change (MDC). Construct validity was examined by testing a priori hypotheses through correlations (Pearson’s r) between the FRI and disability measures (Roland–Morris Disability Questionnaire, RMQ; Oswestry Disability Index, ODI), pain intensity (Numerical Rating Scale, NRS), and quality of life (Short-Form Health Survey, SF-36). Results: Cronbach’s α was 0.88, and test–retest reliability showed an ICC_2,1 of 0.86 (95%CI: 0.82–0.93). The MDC was 18.05, corresponding to approximately 20% of the total score. The Italian FRI demonstrated strong correlations with the RMQ (r = 0.70) and ODI (r = 0.77), and a moderate correlation with the NRS (r = 0.60). The physical and social domains of the SF-36 showed stronger negative correlations with the FRI than the mental and emotional domains. Conclusions: The Italian version of the FRI is a reliable and valid instrument for individuals with CLBP and is recommended for both clinical practice and research applications. Full article

Paralympic athletes are challenged by unique systemic strain due to impairment-related physiological and psychological stressors. This study aims to synthesize the current evidence regarding post-exercise recovery modalities in Paralympic athletes, providing an overview of their physiological considerations and practical applications. A narrative review was conducted across PubMed/MEDLINE, Scopus, and Web of Science (inception to December 2025). Inclusion criteria prioritized original research on competitive para-athletes evaluated through physiological or performance-based markers. Evidence identifies four critical domains: (1) Thermoregulation: In spinal cord injury (SCI), upper-body cooling is significantly more effective than lower-body strategies for core temperature reduction; objective monitoring of playing time is essential, as subjective perception is unreliable. (2) Systemic recovery: Sleep quality is compromised by secondary complications (e.g., nocturia and spasticity), and heart rate variability (HRV) serves as a sensitive autonomic marker to validate readiness. (3) Neuromuscular restoration: The early-phase rate of force development (RFD ≤ 50 ms) is more sensitive than the peak strength for detecting neural fatigue, particularly in SCI. (4) Contextual modulators: Infrastructure accessibility and psychological resilience are primary determinants of intervention efficacy. Effective recovery in para-sports requires a shift toward “active-assisted” impairment-specific interventions. Future research must validate specialized monitoring tools and longitudinal impacts on long-term health. Full article

This study examines accessibility barriers experienced by individuals with disabilities in urban public transportation and analyzes how these barriers influence their travel behavior. Survey data were collected from 450 participants with different disability types in Alanya, Turkey, a tourism-oriented city characterized by pronounced seasonal mobility fluctuations. To ensure internal consistency and analytical robustness, the Analytic Hierarchy Process (AHP) was applied to prioritize seven accessibility criteria, and the consistency of pairwise comparisons was verified prior to analysis. Based on the AHP-derived weights, a composite accessibility-based Problem Severity Index (PSI) was constructed and integrated into regression models to quantify behavioral effects. The results show that the Problem Severity Index (PSI) is strongly associated with satisfaction (R² = 0.895), frequency of public transport use (R² = 0.924), and perceived travel difficulty (R² = 0.924), reflecting constrained mobility conditions and limited modal alternatives rather than improved service quality. Deficiencies in bus stop design and vehicle accessibility equipment were identified as the most influential barriers affecting public transport experience. Beyond the case study context, the proposed AHP–regression framework provides a structured analytical approach for evaluating accessibility performance and generating empirical evidence to inform inclusive and sustainable urban mobility planning. The findings offer empirical evidence on the relative importance of accessibility barriers and highlight critical infrastructure and service deficiencies. Rather than constituting a decision-support tool themselves, these results provide structured information that, when appropriately contextualized, can inform and guide transport authorities and urban planners in prioritizing accessibility improvements and enhancing inclusive public transport performance over time. Full article

Specific Learning Disability (SLD) describes persistent difficulties in academic skills in reading, writing, and mathematics, despite having normal intelligence. The exact origin of SLD is unknown. However, it is thought that biological factors and environmental conditions, along with genetic factors, contribute to the development of SLD. Agmatine, a neurotransmitter in the brain, plays a role in various biological processes. Agmatine has been reported to mediate antidepressant effects and neuroprotective effects, and it plays critical roles in learning and the processing of learned information into memory. Therefore, this study aimed to determine the relationship between SLD and agmatine metabolism by determining the enzyme levels of arginine decarboxylase (ADC) and agmatinase (AGMAT) in children with SLD. ADC and AGMAT levels in the blood serum of children with SLD and controls were analyzed using ELISA. When ADC levels in children with SLD (30.26 ± 5.06 ng/mL) were compared with those in the control group (29.82 ± 4.95 ng/mL), the difference was not statistically significant (p = 0.737). However, AGMAT levels in children with SLD (27.02 ± 4.46 ng/mL) were found to be statistically significantly higher than those in the control group (21.42 ± 3.98 ng/mL) (p < 0.001). In light of these findings, we can say that agmatine breakdown is significantly increased in children with SLD. Full article

Background/Objectives: Real-world evidence on ofatumumab (OFA) beyond 12 months remains limited in relapsing–remitting multiple sclerosis (RRMS). We assessed 24-month effectiveness and safety, compared treatment-naïve and previously treated patients, and explored predictors of failure to achieve No Evidence of Disease Activity-3 (NEDA-3). Methods: This multicenter retrospective cohort study included adult RRMS patients treated with OFA in routine clinical practice. Effectiveness analyses were restricted to patients with complete 24-month follow-up and full clinical and magnetic resonance imaging (MRI) assessment (complete-case analysis). Outcomes included relapses, MRI activity, Expanded Disability Status Scale (EDSS) progression, NEDA-3, and adverse events (AEs). Exploratory multivariable logistic regression was used to assess baseline predictors of NEDA-3 non-achievement. Results: Of 258 patients who initiated OFA, 148 had completed 24-month clinical and MRI follow-up and were evaluable for effectiveness. Over 24 months, 71.5% achieved NEDA-3; relapses occurred in 15.5% of patients, MRI activity in 15.5%, gadolinium-enhancing lesions (GELs) in 4.7%, and EDSS progression in 17.6%. Disease activity was minimal during months 12–24, with relapses in 2.7%, MRI activity in 2.0%, and no GELs. In unadjusted analyses, no statistically significant differences were observed between treatment-naïve and previously treated patients. Higher baseline EDSS was associated with failure to achieve NEDA-3. In the 24-month safety subgroup, AEs were recorded in 28.4% of patients; infections occurred in 26.4% of patients (all grade 1–2), and no serious adverse events were observed. Conclusions: In this multicenter real-world cohort, OFA was associated with low inflammatory disease activity over 24 months in RRMS patients with complete follow-up. These findings should be interpreted cautiously because the effectiveness analysis was restricted to a complete-case cohort and safety data were collected retrospectively. Full article

Background/Objectives: The peroneus longus tendon (PLT) is increasingly used as an autograft for anterior cruciate ligament reconstruction (ACLR). However, during PLT harvest, the necessity of distal peroneus longus-to-peroneus brevis (PL-to-PB) tenodesis for the potential preservation of donor ankle function and medial longitudinal arch alignment remains unclear. This study compared ankle function, donor-site morbidity, complications, and weight-bearing radiographic foot alignment after PLT harvest with and without distal tenodesis. Methods: Between January 2020 and December 2024, 92 primary ACLR cases using an ipsilateral PLT autograft were retrospectively screened; 60 patients with available bilateral weight-bearing comparative foot radiographs were included and categorized into a tenodesis group (n = 30) or a non-tenodesis group (n = 30). Ankle outcomes included American Orthopedic Foot and Ankle Society (AOFAS) Ankle–Hindfoot and Foot and Ankle Disability Index (FADI) scores, ankle range of motion (ROM), and donor-site complications. Radiographic alignment was assessed using Meary’s angle and calcaneal pitch angle on bilateral weight-bearing lateral foot radiographs, including side-to-side differences. Results: Follow-up duration was comparable between groups (18.5 ± 4.4 vs. 16.8 ± 3.4 months, p = 0.113). No patient demonstrated clinically relevant loss of ankle range of motion or strength at final follow-up. AOFAS (97.3 ± 4.9 vs. 95.0 ± 5.5, p = 0.078) and FADI (96.8 ± 5.2 vs. 95.3 ± 5.5, p = 0.091) scores were similarly high in the tenodesis and non-tenodesis groups, respectively. Sural nerve sensory disturbance occurred in 6/30 (20.0%) versus 5/30 (16.7%) patients (p = 0.739), and no harvest-site infection was observed. On weight-bearing radiographs, Meary’s angle and calcaneal pitch angle did not differ significantly between groups on the operated side (Meary: 7.99 ± 6.76 vs. 4.76 ± 6.32°, p = 0.061; calcaneal pitch: 23.19 ± 5.94 vs. 21.41 ± 4.64°, p = 0.201) or intact side (Meary: 7.05 ± 6.89 vs. 5.36 ± 6.11°, p = 0.320; calcaneal pitch: 23.33 ± 5.43 vs. 22.00 ± 4.48°, p = 0.305). Side-to-side differences were small and comparable (Δ Meary: 0.94 ± 3.97 vs. −0.60 ± 3.58°, p = 0.120; Δ calcaneal pitch: −0.14 ± 3.35 vs. −0.59 ± 3.29°, p = 0.603). Conclusions: Distal PL-to-PB tenodesis did not appear to provide measurable advantages in donor-ankle patient-reported outcomes or weight-bearing radiographic foot alignment compared with no tenodesis after PLT harvest for ACLR. Full article

Objectives: Myofascial pain syndrome (MPS) is a common musculoskeletal condition, and while percutaneous needle electrolysis (PNE) and intramuscular electrical stimulation (IMES) are emerging therapies for myofascial pain syndrome and tendinopathies, their effects remain unclear. This systematic review aimed to characterize the methodological features and synthesize the evidence on the clinical improvement and adverse events rates of PNE and IMES in treating MPS and tendinopathies. Data Sources: PubMed, Scopus, Web of Science, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, Google Scholar, and reference lists. Searches were carried out on 10 July 2025 and repeated on 16 March 2026, just before final analysis. New results found during final searches were screened for inclusion to ensure currency of the review. Methods: We selected studies based on the PICOS framework and predefined selection criteria: Population: adults with MPS or active myofascial trigger points (TrPs), or tendinopathies; Intervention: PNE or IMES; Comparator: sham procedures, other interventions, or no intervention; Outcomes: pain intensity (e.g., Visual Analogue Scale or Numeric Pain Rating Scale), pressure pain threshold (PPT), and functional measures; and Study Design: experimental studies. Studies focused exclusively on post-surgical or neuropathic pain, studies without a relevant comparator, and studies not reporting clinically meaningful outcomes were excluded. We assessed the risk of bias of included studies and performed a narrative synthesis. Results: From 737 identified records, 30 studies met the selection criteria. PNE was generally effective in reducing pain and improving function in tendinopathies and MPS, although results varied across outcomes and follow-ups. IMES showed moderate evidence for reducing pain and enhancing function, particularly cervical range of motion and PPT. However, both interventions had inconsistent clinical improvement and adverse events rates on disability indices and quality of life. Most studies had a high risk of bias due to challenges in blinding. Reported adverse events were minor and self-limiting, indicating that both therapies are generally safe when performed by trained clinicians. Conclusions: PNE and IMES may improve pain and some functional outcomes in MPS and tendinopathies; however, these findings should be interpreted cautiously because most included studies had a high risk of bias. Full article

Background: Frailty is highly prevalent among older adults with cardiovascular disease (CVD) and strongly predicts disability and mortality after cardiac events. Although cardiac rehabilitation (CR) improves prognosis, frail older patients often face barriers to participating in in-person programs. eHealth-based, home-delivered CR programs incorporating tele-rehabilitation and remote monitoring may improve accessibility, yet evidence regarding their effectiveness on frailty status remains limited. Methods: We designed a multicenter, randomized, parallel-group trial enrolling people ≥65 years recently hospitalized for acute heart failure (AHF) and/or acute coronary syndrome (ACS). Participants were randomized 1:1 to an eHealth home-based tele-rehabilitation program or the usual care. The primary endpoint is frailty prevalence at follow-up, defined by an Essential Frailty Toolset (EFT) score ≥3, with co-primary outcomes being between-group differences in the mean levels of EFT and Short Physical Performance Battery (SPPB) scores after 3–6 months. Secondary endpoints include mortality and hospitalization, among others. Results: The full protocol and study procedures are reported. Between May 2024 and December 2025, 589 patients were screened at the two Italian centers involved; 442 met eligibility criteria and 209 were enrolled and randomized. Baseline characteristics were largely comparable between groups. The mean age was 77 ± 9 years, 70% were male, and 55% had ACS. Lower-than-expected enrollment was mainly attributable to refusal related to difficulties in using digital devices. Conclusions: This randomized trial will evaluate whether a multidomain, eHealth-based CR intervention can reduce the prevalence or degree of frailty in older people after AHF or ACS. We report the study protocol and baseline characteristics of the enrolled cohort, highlighting the challenge of digital illiteracy in contemporary older populations. Full article

Brain stroke (BS) and heart disease (HD) are leading causes of global mortality and long-term disability, underscoring the critical need for early and accurate diagnostic tools. This research addresses the dual challenge of developing high-performance predictive models while ensuring the privacy of sensitive patient data. We propose a framework that integrates ensemble machine learning (ML) models with a formal differential privacy (DP) mechanism. Using a dataset of 5110 samples with clinical features, we evaluate Extreme Gradient Boosting (XGB), Random Forest (RF), Light Gradient Boosting Machine (LGBM), and Categorical Boosting (CAT) for BS and HD prediction. To protect individual privacy, we apply the Gaussian mechanism of DP with two probabilities of failure (POF) parameters (10–5 and 10–6) and a privacy budget ranging from 0.5 to 5.0. A key novelty of this work is the application of Pareto frontier multi-objective optimization (PFMOO) to systematically identify the optimal trade-off between model accuracy and privacy constraints. Our approach successfully identifies optimal, privacy-preserving models: XGB achieves top performance for BS prediction (92.3% accuracy, 92.29% F1 score), with a POF of 10–6, while RF excels for HD detection (95.61% accuracy, 97.8% precision), with a POF of 10–5. Furthermore, we employ explainable AI (XAI) techniques, SHAP and LIME, to provide interpretability of the model decisions, enhancing clinical trust. This research delivers a robust, interpretable, and privacy-conscious framework for early disease detection, offering a significant advancement over existing methods by holistically balancing accuracy, data security, and transparency. Full article

Background: Sarcopenia is an age-related syndrome characterized by progressive loss of skeletal muscle mass and strength, representing a major contributor to disability and increased mortality in older adults. Current diagnostic frameworks increasingly emphasize muscle quality alongside quantity, creating a clinical need for bedside tools that can objectively assess muscle mechanical properties. Shear-wave elastography (SWE), an ultrasound-based technique that quantifies muscle stiffness, has emerged as a promising biomechanical biomarker of muscle quality. Aim: This narrative review evaluates the evidence supporting SWE for assessing muscle quality and its association with aging, sarcopenia, and functional outcomes. Methods: We searched PubMed, Embase, and Web of Science (from January 2010 to December 2025) using terms related to elastography and sarcopenia. Based on relevance and methodological quality, approximately 50 key studies were selected for in-depth discussion and synthesis. Synthesis: Observational studies consistently demonstrate that SWE detects age-related reductions in muscle stiffness, which correlate significantly with declines in muscle strength and physical performance. Unlike conventional B-mode ultrasound, which primarily provides morphological parameters, SWE directly reflects intrinsic tissue mechanics, enabling more direct assessment of muscle quality. In high-risk populations such as patients with type 2 diabetes, reduced muscle stiffness is also associated with sarcopenia and poor functional outcomes. However, reported stiffness trends with aging remain heterogeneous, and validated diagnostic thresholds are lacking. Stiffness changes vary by muscle group, acquisition protocol, and loading state. Clinical implementation is currently limited by inter-device variability, operator dependence, and sensitivity to muscle loading conditions. Conclusions: Current evidence suggests that SWE holds promise as an adjunctive research tool for assessing muscle quality and risk stratification, but it is not yet ready for standalone clinical diagnosis due to methodological heterogeneity, lack of validated cutoffs, and limited longitudinal data. Future large-scale, longitudinal, multicenter studies with standardized protocols are needed to establish its definitive diagnostic utility. Full article

Background: Corticosteroid injections provide short-term relief for chronic subacromial bursitis but are associated with high recurrence rates. This study investigates the efficacy of a mobile health-supported home-based resistance exercise program compared with exercise education in patients with chronic recurrent subacromial bursitis after ultrasound-guided corticosteroid injections. Methods: Participants with chronic subacromial bursitis were assigned via computer-generated block randomization to either an intervention group receiving ultrasound-guided corticosteroid injections followed by a 12-week home-based exercise program (50 min strengthening and resistance/session, 5 days per week) supported via instant messaging applications, or a control group receiving the same injection followed by printed educational materials covering the same exercise protocol. Shoulder Pain and Disability Index (SPADI) scores, Visual Analog Scale (VAS) pain scores and active pain-free range of motion (ROM) were evaluated by a blinded assessor at weeks 4 and 12. Between-group comparisons were analyzed using two-way ANOVA after confirming normality and homoscedasticity. Results: Fifty-three patients (mean age: 55.6 ± 10.5 years; 47.2% female) were randomized to the intervention (n = 27) or control (n = 26) groups. Significant interaction effects were identified for SPADI (p = 0.040) and ROM (abduction: p = 0.036/ flexion: p = 0.032). Post hoc analysis revealed that the intervention group exhibited a significantly greater reduction in SPADI scores (p = 0.007, d = 0.72) and greater increase in abduction ROM (p = 0.004, d = 0.84) at 12 weeks; both gains surpassed the MCID. Conclusions: A mobile health-supported home-based resistance exercise program can significantly extend the benefits of corticosteroid injections in patients with chronic subacromial bursitis. Trial Registration: NCT06220643, registered 14 December 2023. Full article