Search Results (15,299)

Children with Down syndrome may experience developmental differences in communication, social participation, adaptive functioning and peer interaction. However, they also possess individual strengths, learning potential and adaptive capacities that can be enhanced through structured, responsive and contextually relevant early intervention. This study aimed to design and develop an Early Intervention Module for Social Skills of Children with Down Syndrome in Malaysian Taska OKU settings. A Design and Development Research approach was applied across three phases: needs analysis, module design and development, and usability evaluation. Phase 1 involved semi-structured interviews with teachers to identify contextual challenges, existing strengths, available practices and support needs in teaching social skills to children with Down syndrome. Phase 2 focused on module development through expert consensus using the Fuzzy Delphi Method. Phase 3 examined the usability of the developed module among teachers in real daycare settings. The findings from the needs analysis showed that teachers required a structured module that could support children’s social participation, communication, turn-taking, emotional expression and interaction with peers and adults. At the same time, the findings highlighted the importance of recognising children’s strengths, including their responsiveness to visual cues, enjoyment of routine-based activities, imitation skills and ability to participate when appropriate support is provided. The developed module consists of structured social skill domains, learning outcomes, teaching activities, visual support, play-based strategies, parental involvement components and progress monitoring tools. The usability evaluation indicated that the module was practical, understandable and relevant for use in Taska OKU settings. Teachers reported that the module supported clearer planning, more consistent implementation and better opportunities for children to participate socially. This study contributes to the development of a locally adapted early intervention module that is grounded in stakeholder input, expert consensus and inclusive education principles. The module also reflects strength-based and functioning-oriented terminology aligned with the International Classification of Functioning, Disability and Health framework. The findings suggest that contextually developed modules can support teachers and caregivers in enhancing the social participation of children with Down syndrome in Malaysian early childhood settings. Full article

Hypotonia, Ataxia, Developmental Delay, and Tooth Enamel Defect Syndrome (HADDTS; OMIM #617915) is an ultra-rare autosomal dominant disorder caused by predominantly de novo pathogenic variants in CTBP1, encoding a NAD(H)-dependent transcriptional corepressor. We reviewed all HADDTS cases reported from database inception to July 2026, searching PubMed/MEDLINE, Google Scholar, ClinVar, DECIPHER, OMIM, preprint servers, and the HADDTS Foundation, identifying 25 peer-reviewed cases from at least 11 countries; registries indicate at least 50 known individuals. Global developmental delay and language impairment were universal (25/25, 100%), followed by intellectual disability (24/25, 96%), hypotonia (22/25, 88%), ataxia and enamel defects (19/25, 76% each), cerebellar atrophy (18/25, 72%), feeding difficulties (15/25, 60%), myopathy (15/25, 60%), regression (10/25, 40%), oculomotor apraxia (7/25, 28%), scoliosis (6/25, 24%), respiratory chain dysfunction (5/25, 20%), skeletal anomalies (4/25, 16%), and seizures (2/25, 8%). The recurrent p.Arg342Trp (NM_001328.2; p.Arg331Trp, MANE Select NM_001012614.2) accounts for 84%, with severity from mild impairment to profound disability. In all four non-recurrent-variant carriers the canonical tetrad was incomplete; seizures and classifying skeletal anomalies occurred only in that group. Mutant CTBP1 acts dominant-negatively and heterodimerises with the essential paralog CTBP2, explaining the multisystem severity. HADDTS is a neurodevelopmental-mitochondrial overlap disorder; registries, mitochondrial evaluation, and allele-specific therapies are priorities. Full article

Background: Individuals with complex communication needs (CCNs) require comprehensive communication profiles to guide effective interventions, yet the clinical literature offers limited tools to support this process. To address this gap, the “Italian CP & Language Network”—a multidisciplinary group of speech–language pathologists, psychologists, and child neuropsychiatrists—developed a novel, comprehensive clinical instrument specifically designed to evaluate the communication skills of children and adolescents with CCNs. Methods: The development process was informed by an initial preliminary survey conducted across participating clinical centres to map out the observation tools routinely used in daily practice. Results: Based on these insights, the network designed a structured clinical interview named the Italian IVCAA (Intervista sulla Valutazione delle Competenze e delle Abilità Comunicative). The instrument was structured to systematically assess four core areas: core communication abilities, communicative behaviours, communicative functions, and communicative modalities (vocal, gestural, graphic/symbolic, and written). The Italian IVCAA provides a structured framework that successfully describes an individual’s unique communication profile. It maps out specific strengths and weaknesses across diverse modalities, establishing a standardized baseline for clinical use. Conclusions: The Italian IVCAA serves as a valuable clinical tool for identifying communication profiles in individuals with CCNs. It offers a practical starting point for setting tailored goals in augmentative and alternative communication (AAC) interventions and establishes a reliable framework for monitoring changes in communicative competence over time. Full article

Civilian communication systems often fail during armed conflicts, political unrest, and large-scale Internet disruptions—precisely when reliable communication is most needed. This paper presents HERMES, a resilient hybrid communication architecture that integrates HTTP/IP networking, Bluetooth Low Energy (BLE) mesh communication, and Delay-Tolerant Networking (DTN) within a unified adaptive routing framework. Unlike conventional approaches that treat alternative transports as backup solutions, HERMES dynamically selects the most efficient transport path based on current network conditions using a transport-aware forwarding policy whose cost function combines round-trip time, transport preference, and observed link risk. The architecture is built on distributed microservices that support topology discovery, shortest-path routing, and fault-tolerant message delivery. Reliability is enhanced through acknowledgments, bounded retransmissions, duplicate suppression, and graceful degradation mechanisms, while end-to-end authenticated encryption (Noise XX with a Double Ratchet) ensures secure communication across transport changes. A prototype implementation developed in C# on .NET 9 was evaluated on a five-node testbed, and a custom Network Simulator 3 (NS-3) module was used to extend the evaluation to networks of up to 500 nodes, under multiple failure scenarios, including node crashes, network partitioning, and complete Internet outages. Experimental results show that HERMES maintains perfect or near-perfect delivery in static topologies, including during a complete Internet blackout that disables IP-only messaging. Compared with the published Delay-Tolerant Networking protocols Epidemic and PRoPHET at one hundred nodes, HERMES exceeds their delivery ratio in static and failure scenarios and remains within 0.06 of them under pedestrian mobility during blackout, while transmitting roughly 35× fewer bytes– and about 21× fewer even relative to the more bandwidth-efficient MaxProp baseline. Under coordinated drop attacks by adversarial relays, HERMES degrades gracefully where flooding-based baselines collapse. This approach demonstrates that resilient civilian communication can be effectively achieved through metric-driven adaptive multi-transport routing, making it suitable for disaster recovery, contested environments, and connectivity-limited regions. Full article

Background and Objectives: Osteoarthritis (OA) is the most common degenerative joint disease and a leading cause of pain and disability worldwide. Increasing evidence indicates that dysregulated iron metabolism contributes to joint degeneration by promoting inflammation, oxidative stress, and cartilage damage. Hemophilic arthropathy (HA), a severe complication of hemophilia caused by recurrent hemarthroses, represents a unique model of iron-driven joint degeneration. This narrative review summarizes current evidence on the contribution of iron deposition to the pathogenesis of hemophilic arthropathy and discusses its relevance to knee osteoarthritis (KOA). Materials and Methods: The literature was reviewed using the PubMed, Scopus, and Web of Science databases, focusing on published studies addressing iron deposition, synovial inflammation, angiogenesis, oxidative stress, cartilage degeneration, subchondral bone remodeling, and dysregulated iron metabolism. Results: Current evidence indicates that iron stored primarily as hemosiderin promotes persistent synovial inflammation and progressive joint destruction. Several pathological pathways associated with iron accumulation, including chronic low-grade inflammation, extracellular matrix degradation, and altered bone remodeling, are shared by HA and KOA. Conclusions: These findings suggest that iron-mediated mechanisms may provide important insights into OA pathogenesis and support further investigation of iron as a potential diagnostic and therapeutic target in degenerative joint diseases. Full article

Background/Objectives: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) can produce comparable short-term clinical outcomes, but their regional effects on cervical muscle morphology are incompletely characterized. This study compared 12-month clinical outcomes and quantitative magnetic resonance imaging (MRI) changes after single-level C6–7 ACDF and CDA. Methods: This retrospective longitudinal cohort included 100 age-, sex-, and body mass index-matched patients (50 ACDF and 50 CDA). Neck and arm pain were assessed on 0–10 scales, and the Neck Disability Index (NDI) was analyzed as a 0–50-point score. Regional muscle cross-sectional area (CSA) and fatty infiltration (FI) were quantified on standardized preoperative and 12-month axial T2-weighted turbo spin-echo images at C6–7. The primary analysis included four posterior muscles. CSA change was expressed relative to baseline, whereas FI change was expressed in percentage points. Results: Clinical outcomes were statistically indistinguishable at 12 months (neck-pain score, 0.50 vs. 0.36, p = 0.318; NDI, 2.6 vs. 2.2 points, p = 0.479; perfect-outcome rate, 68.0% in both groups). Both groups showed significant regional posterior muscle CSA reduction and FI increase; however, the magnitude was greater after ACDF than after CDA (CSA reduction, −15% to −19% vs. −5% to −9%; absolute FI increase, +5.1 to +8.2 vs. +1.1 to +2.3 percentage points; all between-group q < 0.001). Surgical technique was independently associated with both MRI change metrics. Greater regional CSA reduction was modestly associated with higher concurrent 12-month neck-pain scores (β = −0.26, p = 0.022). This concurrent association does not establish causation or predict outcomes beyond 12 months. Conclusions: ACDF and CDA produced equivalent measured clinical outcomes at 12 months, while CDA showed a more favorable regional posterior muscle MRI profile. Differential device-related artifact was not quantitatively assessed and cannot be completely excluded, although concordant findings across four implant-remote posterior muscles make artifact unlikely to be the sole explanation. The functional and longer-term clinical significance of this imaging difference is not established and requires prospective longitudinal study. Full article

Background: Mesothelioma is a rare but highly aggressive malignancy strongly associated with asbestos exposure. Owing to its long latency and poor prognosis, its burden requires systematic evaluation. Methods: Data on prevalence, incidence, deaths, disability-adjusted life years (DALYs), and age-standardized rates were extracted from the Global Burden of Disease Study 2023. The estimated annual percentage change, Joinpoint regression, Das Gupta decomposition, and Nordpred forecasting were used to assess temporal trends, identify turning points, quantify demographic and epidemiological contributions, and project future burden through 2045. Results: From 1990 to 2023, the absolute burden of mesothelioma in China increased substantially. Prevalent cases rose by 189%, incident cases by 150%, DALYs by 98%, and deaths by 142%. Males consistently showed a higher burden than females, and the burden was concentrated mainly among middle-aged and older adults. The age-standardized prevalence rate and age-standardized incidence rate increased, whereas the age-standardized DALY rate and age-standardized mortality rate remained stable or declined slightly. Decomposition analysis indicated that population growth and aging were the principal drivers of increased DALYs and deaths, while epidemiological change contributed negatively. Projections suggested that deaths may continue to increase through 2045, despite declining age-standardized fatal burden. Conclusions: This is the first update of the burden of mesothelioma in China over the past thirty-four years. The absolute burden of mesothelioma in China, as estimated by the GBD study, increased markedly, largely driven by demographic changes. Strengthening asbestos exposure surveillance, diagnostic standardization, and cancer registration systems would enable burden estimates to be derived from directly observed and certified data rather than relying primarily on model-based assumptions, while potentially identifying previously unrecognized sources of asbestos exposure. Full article

Osteosarcopenia—defined as the coexistence of sarcopenia and osteoporosis—is increasingly recognized as a clinically important geriatric syndrome associated with falls, fractures, frailty, disability, and mortality. Beyond the simple coexistence of bone and muscle loss, emerging data suggest that osteosarcopenia may reflect systemic dysregulation of the bone–muscle–immune–metabolic network. In this narrative review, we synthesize evidence linking inflammaging, immune-cell polarization, mitochondrial dysfunction, nutrient metabolic dyshomeostasis, and gut-derived metabolites to the pathogenesis of osteosarcopenia. Multiple pathological processes—including chronic low-grade inflammation, Th17/Treg imbalance, macrophage polarization, oxidative stress, impaired mitophagy, insulin resistance, ectopic fat accumulation, and altered microbial metabolites—may converge to disrupt bone–muscle crosstalk. Notably, direct evidence from osteosarcopenic populations remains limited, and many mechanistic insights are extrapolated from osteoporosis, sarcopenia, and aging models. We further discuss current and emerging therapeutic strategies, including exercise, nutritional interventions, anti-osteoporotic agents, metabolic modulators, mitochondrial-targeted therapies, and gut-directed approaches. Longitudinal cohorts, multi-omics studies, and randomized controlled trials are urgently required to validate immunometabolic biomarkers and develop integrated interventions for osteosarcopenia. Full article

Background/Objectives: In traditional Chinese culture, grandparents often help care for grandchildren, especially in urban areas where parents face high work and life pressures. However, the physical and psychological impacts of grandchild care on older adults remain debatable. This study explored the associations between grandchild care, disability, and depressive symptoms among urban older adults, and examined whether disability mediates this link. Methods: Data were from the 2018 CHARLS study, including 1872 urban participants aged ≥60 years with grandchildren. Disability and depressive symptoms were assessed using the Activities of Daily Living (ADL) scale and Center for Epidemiologic Studies Depression Scale (CES-D), respectively. Group comparisons, multivariable logistic regression, and mediation analysis were performed. Results: Among caregivers, the prevalence of depressive symptoms was 19.2% and the prevalence of disability was 20.4%, both lower than among non-caregivers in unadjusted comparisons, though grandchild care was not independently significant in multivariable models. Female, disability, and depressive symptoms were significant risk correlates, while higher education, greater physical activity, and social participation were protective. The mediation analysis suggested that functional status partially mediated the relationship between grandchild care and depressive symptoms (proportion mediated = 33.70%). Conclusions: Grandchild care was associated with better physical and mental health among urban older adults in descriptive comparisons, though this association was attenuated in adjusted models. While moderate intergenerational involvement may offer social and psychological benefits, excessive caregiving burden should be prevented. Full article

The treatment of osteoarthritis (OA), a leading cause of disability worldwide, is increasingly integrating nutritional strategies that appear to offer the opportunity to significantly improve the quality of care. Patients are also aware of this and often seek clarification and advice from OA professionals. However, it is still too early to formulate definitive recommendations, as the scientific evidence is still heterogeneous. This can create a gap between patients’ need for clear guidance and the necessarily prudent communication of professionals. As a result, some patients may make decisions on their own, forgoing the opportunity to receive nutritional care personalised according to their dietary habits and disease severity. This commentary presents an expert interpretation of the currently available evidence and proposes a practical framework to support clinical discussions with patients. It is not intended as a formal clinical practice guideline but aims to help OA professionals navigate conversations about the role that nutritional strategies may play in disease management. Full article

Objectives and Background: Individuals with Phelan–McDermid Syndrome (PMS) present with a variety of symptoms, including a breadth of behavioral issues. Clinically assessing behavior in PMS remains challenging due to the overabundance of behavioral assessments and the lack of tools validated explicitly for use in individuals with intellectual disability (ID) and neurodevelopmental disorders. This review sought to suggest which assessment tools would best clinically assess behavior in individuals with PMS. Methods: Validated behavioral assessment tools were identified using a systematic search of the literature, and relevant data for each assessment were extracted. The consensus guidelines for PMS were reviewed. Results: This review identified 131 validated assessment tools that were categorized by the intended age group and into specific behavioral domains: Autism spectrum disorder (ASD) screening, adaptive behavior, restricted and repetitive behaviors, challenging/disruptive behaviors, mental health screening, and other miscellaneous behaviors such as avoidance and impulsivity. Discussion: Based on the 2023 consensus guidelines, suggestions were given on which tools would be best for assessing various symptoms and behaviors in PMS. Choosing the best assessment tools to appraise behavior and related symptoms in individuals with PMS will aid clinicians in decision-making and lead to more personalized treatment plans. Full article

Background/Objectives: Osteoporotic vertebral fractures (OVFs) can cause persistent pain and loss of independence. This study quantified impairment in basic and instrumental activities of daily living and identified independent cross-sectional correlates in postmenopausal women with OVFs. Methods: This cross-sectional analysis included 184 postmenopausal women from a 200-patient OVF cohort at a spine clinic in Vietnam. Functional status was assessed using the Barthel Index (BI) and Lawton Instrumental Activities of Daily Living (IADL) scale. Primary analyses used multivariable linear regression with HC3 robust inference; ordered-logistic and model-specification analyses assessed robustness. Results: Mean age was 69.95 ± 7.78 years and mean visual analog scale (VAS) pain score was 6.69 ± 1.58. Basic-activity dependence was present in 81.5% of participants (mean BI, 82.96 ± 16.45), and 66.8% had at least one IADL limitation (mean IADL, 5.84 ± 2.04). In the adjusted BI model, higher VAS pain intensity was the strongest observed correlate of poorer function (B = −7.996; β = −0.769; p < 0.001), and higher body mass index was associated with lower BI. In the adjusted IADL model, higher VAS pain intensity (B = −0.694; β = −0.538; p < 0.001) and older age were associated with lower scores. Ordinal sensitivity analyses confirmed the pain association, whereas the BMI finding was attenuated. Conclusions: Pain intensity was the strongest observed cross-sectional correlate of both functional domains. The findings support comprehensive functional assessment and hypothesis-driven longitudinal studies, but they do not establish that pain reduction will cause functional recovery. Full article

Gender-based violence may be considered a failure or absence of care across the interpersonal, symbolic, and structural levels. Feminist scholars have called for closer attention to an ethic of care as one vital pathway to shared solidarity for social justice and relations of non-violence. Works from Black, Indigenous, queer and disability writers and activists have similarly illustrated the transformative potential of collective care for building community and ending systems of oppression. In this paper, we draw on this critical literature to argue for framing collective care as both a practice and a long-term objective in work to prevent gender-based violence. To illustrate this framing, we share empirical data from two Australian studies: one with young people using social media to prevent gender-based violence, and one with prevention practitioners who work with men and boys. Our findings are organised around four central themes: care as collaboration; transformative care; a politic of care; and collective care in structural change. These findings represent patterns in practice, political approach, and imagined futures among our research participants that we suggest are reflective of ongoing commitments to empathy, compassion, and accountability. These patterns are substantively distinct from much mainstream programmatic and policy approaches to gender-based violence prevention, which often reproduce individualistic frames and are constrained by funding and governance models. We argue that violence prevention is fundamentally a shared project of collective care: supporting one another to recognise, interrogate, and challenge the gendered norms and structures that perpetuate gender-based violence. This work is inescapably relational, political, personal, and motivated by a shared sense of caring for each other. Full article

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune astrocytopathy in which antibodies against the aquaporin-4 (AQP4) water channel produce a stereotyped group of syndromes determined by the anatomical distribution of AQP4 expression. Six core clinical presentations are recognized: optic neuritis, longitudinally extensive transverse myelitis, area postrema syndrome, acute brainstem syndrome, diencephalic syndrome, and cerebral syndrome. Because disability in NMOSD almost always accrues at discrete, treatable relapses rather than through insidious progression, early recognition, supported by prompt AQP4-IgG testing and pattern recognition on MRI, is essential to preserving vision, mobility, and independence. This review summarizes the pathophysiology, clinical and radiologic features, diagnostic evaluation, and differential diagnosis of each core syndrome and synthesizes contemporary evidence for relapse prevention. Over the past decade, the therapeutic landscape has been transformed: agents targeting complement (eculizumab, ravulizumab), the interleukin-6 receptor (satralizumab, tocilizumab), and B cells (rituximab, inebilizumab) now have randomized evidence of efficacy in seropositive disease, with complement inhibitors ranking highest across indirect treatment comparisons. Evidence in seronegative disease remains limited, no approved agents have been compared head-to-head, and the optimal role of early plasma exchange is unsettled. Emerging neuroprotective strategies and chimeric antigen receptor T-cell therapy, both of which remain experimental, may further expand options for refractory disease. Once uniformly disabling, AQP4-IgG NMOSD is now a highly treatable condition in which timely diagnosis and sustained immunotherapy can meaningfully alter long-term outcomes. Full article

Background/Objectives: Stroke is a major cause of long-term disability worldwide. Wearable devices have shown potential in supporting rehabilitation, yet evidence on their safety, feasibility, and adherence remains fragmented. This scoping review aimed to evaluate the safety, feasibility, and adherence of wearable devices in stroke rehabilitation. Methods: A systematic search of PubMed, EMBASE, Web of Science, and CINAHL Complete was conducted in January 2026. Studies involving participants with a confirmed diagnosis of stroke were included regardless of study design. Studies were eligible if wearable devices were used as part of rehabilitation interventions and reported outcomes related to safety, feasibility, or adherence. Adverse events were categorized according to severity, while feasibility was assessed using indicators such as recruitment rate, dropout rate, and adherence rate. Results: A total of 38 studies involving 1121 participants were included in this review. Available evidence generally suggested a favorable safety profile for wearable device-assisted rehabilitation, with most reported adverse events being mild and primarily consisting of skin irritation, pressure-related discomfort, muscle fatigue, localized pain, and transient discomfort. Recruitment rates ranged from 5.8% to 100%, indicating substantial variability in implementation feasibility across studies. Only four studies reported adherence-related outcomes, and considerable variation existed in the definitions and assessment methods used. Most included studies reported intervention completion, attendance, or dropout outcomes rather than directly evaluating adherence. Conclusions: Current evidence suggests that wearable devices are generally safe and potentially feasible for stroke rehabilitation. However, substantial heterogeneity across studies, inconsistent adverse event reporting, and limited adherence data restrict the strength of current conclusions. Adherence remains an important evidence gap, as it was infrequently reported and inconsistently defined. Future research should establish standardized reporting criteria for safety, feasibility, and adherence outcomes and evaluate wearable device interventions in larger and more diverse populations with longer follow-up periods. Full article