Search Results (13,756)

Background: Cardiovascular disease (CVD) remains a major global health concern and the leading cause of mortality and disability. Early detection and prevention strategies rely heavily on evaluating coronary artery calcification, traditionally assessed using the coronary artery calcium score (CACS). However, CACS is limited by its dependence on strictly fixed tube voltage and slice thickness, sensitivity to changes in scanning parameters, and the need for an additional dedicated coronary calcium scan that increases radiation exposure. Methods: To address these challenges, we developed a novel two-compartment coronary artery calcium score system (TACS) for quantitative calcium assessment. TACS was established and validated using a QRM Thorax phantom scanned on a GE Revolution CT at 70–140 kVp. Volumetric calcium density (VCD) derived from TACS was compared with conventional CACS under varying slice thickness, pitch, and iterative reconstruction algorithms. Additionally, coronary artery calcium scans from 15 patients were retrospectively analyzed to assess correlations between TACS and CACS. Results: TACS demonstrated stable performance across tube voltages, with VCD errors ranging from 3.8% to −19.0% and maintained consistency under different slice thicknesses (23.9% to −2.3%) and reconstruction algorithms, showing near-zero residual percentages. Patient analyses revealed a strong correlation between TACS and CACS (r = 0.932). Conclusions: These findings suggest that TACS provides robust and reliable quantification of coronary calcium, supporting its potential use for opportunistic coronary artery disease screening, particularly in routine CT imaging. Further studies with larger cohorts are warranted to confirm its clinical applicability. Full article

Wheelchair provision remains an essential component of rehabilitation and participation support for children with disabilities, yet there is limited evidence on how wheelchairs are incorporated into daily activities and schooling decisions in rural low-resource contexts where environmental, social, and service constraints are substantial. This study employed a strictly exploratory multiple case study design involving two children with disabilities. Two home visits were conducted for each case, and a qualitative, descriptive cross-case analysis was conducted by integrating semi-structured interview data with WeeFIM scores and ICF Environmental Factors ratings. Wheelchair provision supported short-distance mobility and engagement in household and community activities and reduced some caregiving demands. Positive experiences during outdoor mobility and community interactions contributed to enjoyment and confidence. However, inaccessible housing, limited transportation, and family concerns about safety and readiness continued to inhibit broader independence and school enrollment. Both children remained outside formal schooling, while activities offered by Special Education Centers provided meaningful but limited opportunities for social interaction and development. The findings highlight not only practical implications but also the conceptual importance of environmental constraints and the ambivalent role of family support in shaping participation in rural settings. Full article

A persistent challenge for Deaf and Hard-of-Hearing individuals is the communication gap between sign language users and the hearing community, particularly in regions with limited automated translation resources. In Saudi Arabia, this gap is amplified by the reliance on Saudi Sign Language (SSL) and the scarcity of real-time, sentence-level translation systems. This paper presents a real-time system for sentence-level recognition of continuous SSL and direct mapping to natural spoken Arabic. The proposed system operates end-to-end on live video streams or pre-recorded content, extracting spatio-temporal landmark features using the MediaPipe Holistic framework. For classification, the input feature vector consists of 225 features derived from hand and body pose landmarks. These features are processed by a Bidirectional Long Short-Term Memory (BiLSTM) network trained on the ArabSign (ArSL) dataset to perform direct sentence-level classification over a vocabulary of 50 continuous Arabic sign language sentences, supported by an idle-based segmentation mechanism that enables natural, uninterrupted signing. Experimental evaluation demonstrates robust generalization: under a Leave-One-Signer-Out (LOSO) cross-validation protocol, the model attains a mean sentence-level accuracy of 94.2%, outperforming the fixed signer-independent split baseline of 92.07%, while maintaining real-time performance suitable for interactive use. To enhance linguistic fluency, an optional post-recognition refinement stage is incorporated using a large language model (LLM), followed by text-to-speech synthesis to produce audible Arabic output; this refinement operates strictly as post-processing and is not included in the reported recognition accuracy metrics. The results demonstrate that direct sentence-level modeling, combined with landmark-based feature extraction and real-time segmentation, provides an effective and practical solution for continuous SSL sentence recognition in real-time. Full article

The coronavirus disease 2019 (COVID-19) pandemic has disrupted both health and occupational functioning in participants with multiple sclerosis (PwMS). This review synthesizes evidence from 55 studies (30,830 PwMS) on psychological, social, and work-related outcomes during the pandemic. The findings indicate elevated depression and stress, variable anxiety, and substantial employment disruption, including job loss, reduced hours, and shifts to remote work. Socioeconomic stressors compound these effects, while workplace accommodations are rarely assessed. There are gaps in evidence regarding occupation-specific hazards, lived experiences, and long-term outcomes. These results underscore the need for disability-inclusive employment policies, mental health support, and longitudinal research to guide interventions for PwMS in crisis contexts. Full article

Background: Adolescent migraine is highly prevalent and associated with substantial functional and psychosocial burden. Conventional oral preventives are widely used off-label with limited pediatric efficacy and frequent tolerability problems. Real-world data on calcitonin gene-related peptide (CGRP) monoclonal antibodies in adolescents are scarce. Methods: We conducted an exploratory, retrospective cohort analysis of depersonalized routine-care data from adolescents with migraine in the German Pain e-Registry. Patients were eligible if they had at least one 6-month episode with high-evidence conventional oral preventives (HECP) and one 6-month episode with a CGRP monoclonal antibody (CGRP-mAb), each with baseline and follow-up documentation, enabling intra-individual descriptive comparisons. The primary endpoint was a pragmatic composite of 6-month treatment persistence and ≥50% reduction in monthly migraine days (MMD). Secondary outcomes included MMD, MMD with acute medication (MMDAM), migraine-related sick-leave days (MMSLD), disability (MIDAS), and patient-reported psychosocial outcomes. Results: A total of 422 adolescents contributed 1448 HECP and 422 CGRP-mAb episodes. Premature discontinuation occurred in 68.8% (HECP) and 11.9% (CGRP-mAb) of episodes; corresponding 6-month persistence was 30.6% and 88.2%, respectively. Mean MMD decreased from 11.7 to 9.4 during HECP episodes and from 11.6 to 4.4 during CGRP-mAb episodes. A ≥50% MMD reduction occurred in 25.4% (HECP) and 70.9% (CGRP-mAb) of episodes; the composite endpoint was met in 23.7% and 69.9%, respectively. CGRP-mAb episodes were associated with numerically larger improvements across secondary outcomes. Conclusions: In this high-burden adolescent cohort, CGRP-mAb treatment episodes were associated with higher persistence and broader improvements than prior conventional preventive episodes. Given the retrospective, non-randomized, sequential design, these findings are hypothesis-generating and do not constitute evidence of comparative effectiveness. Controlled pediatric trials and long-term safety studies are warranted. Full article

Background: Acute ischemic stroke (AIS) remains a major cause of morbidity and mortality, with an unmet need for reliable blood-based biomarkers. Glial fibrillary acidic protein (GFAP), an astrocytic structural protein, is established in hemorrhagic stroke and traumatic brain injury, but its role in AIS remains incompletely defined. Methods: In this retrospective case-control study, we enrolled AIS patients and healthy controls. Serum GFAP was measured within 24 h using the Lumipulse G1200 automated assay. Stroke severity and outcome were assessed with the National Institutes of Health Stroke Scale (NIHSS) and functional outcome with the modified Rankin Scale (mRS). Associations with clinical measures were explored using Spearman correlation, and diagnostic accuracy was determined by ROC analysis. Results: GFAP levels were significantly higher in AIS patients than controls (median 132.9 vs. 30.0 pg/mL, p < 0.001). The ROC analysis yielded an AUC of 0.88 (95% CI 0.81–0.96). A cutoff of 71 pg/mL achieved 74% sensitivity and 92% specificity, while 150 pg/mL and 32 pg/mL optimized positive and negative predictive values (95% and 96%). GFAP was correlated with stroke severity (NIHSS, ρ = 0.37–0.40, p < 0.001) and disability (mRS, ρ = 0.48–0.49, p < 0.001). No significant differences appeared across TOAST subtypes. Conclusions: Serum GFAP is significantly elevated in AIS and demonstrates strong diagnostic and prognostic value. Integration of GFAP into clinical workflows may enhance early stroke detection and outcome prediction, supporting its role as a promising biomarker in AIS. Full article

The metabolic control analysis (MCA) was applied to several subsystems selected from the model of human erythrocyte energy metabolism. These subsystems represent varying degrees of simplification of energy metabolism, from the simplest subsystem of the first three glycolytic reactions that determine the steady-state rate of glycolysis, to an expanded subsystem that includes all glycolytic reactions plus passive and active ion transport across the cell membrane. The control coefficients of enzyme activities for the rate of glycolysis are found to be very different in different subsystems. However, no specific trend is observed in changes in control coefficients as the subsystem becomes more complex. Thus, in subsystems containing only glycolysis, the control coefficients of hexokinase (HK) and phosphofructokinase (PFK) together amount to 0.99. When ATPases are added, this value decreases to 0.18 and below, and the maximum control coefficient goes to ATPase (0.82–1.00). It would seem that there is a natural decrease in the contribution of HK and PFK to the regulation of the rate of glycolysis as the dimension of the system increases. However, disabling the allosteric regulation of PFK by AMP completely changes the picture. In a subsystem containing only glycolysis, disabling this regulation does not affect the control coefficients. After adding ATPase to such a subsystem, the HK and PFK control coefficients increase, and the control coefficient of ATPase takes on a negative value. Thus, we found that in extended subsystems involving glycolysis and ATPase or transmembrane ion transport, information on the initial regulation of glycolysis may not be revealed in the MCA results. It appears that the MCA alone cannot reveal regulatory mechanisms of metabolic systems in the presence of strong allosteric and feedback regulation. Full article

Background: Spasticity is a common and disabling feature of several neuromotor disorders. Repetitive transcranial magnetic stimulation (rTMS) has been proposed as a non-invasive approach to modulate corticospinal excitability and reduce spasticity, although its clinical effectiveness remains debated. This systematic review evaluated the efficacy and safety of rTMS in reducing spasticity in stroke and other neuromotor conditions. Methods: A systematic search of PubMed, Scopus, and Cochrane Library was conducted up to June 2025 in accordance with PRISMA 2020 guidelines. Eligible studies were randomized controlled trials (RCTs) comparing rTMS with sham stimulation or conventional therapy and assessing spasticity using validated scales, primarily the Modified Ashworth Scale. Included populations comprised patients with stroke, spinal cord injury, multiple sclerosis, cerebral palsy, and hereditary spastic paraplegia. Risk of bias was assessed using the RoB 2.0 tool, and certainty of evidence was evaluated with GRADE. Results: Twenty-six RCTs were included, mainly involving stroke patients. Most studies reported a significant reduction in spasticity with rTMS compared with control interventions. Low-frequency stimulation was commonly used after stroke, while excitatory protocols predominated in other conditions. Benefits generally persisted for up to 12 weeks. Evidence quality was moderate, and no serious adverse events were reported. Conclusions: rTMS appears to be a safe and promising adjunctive treatment for spasticity across neuromotor disorders. However, protocol heterogeneity and small sample sizes limit definitive clinical recommendations, highlighting the need for standardized, larger-scale studies. Full article

Central nervous system disorders drive disability, yet many neuroactive candidates fail because the brain is a hard compartment to dose. Plant-derived molecules spanning polyphenols, alkaloids, terpenoids, and cannabinoids are attractive because their pleiotropic actions can engage oxidative stress, neuroinflammation, and circuit dysfunction. In practice, the blood–brain barrier (BBB) restricts most native phytochemicals through tight-junction selectivity, rapid metabolism, low solubility, and transporter-mediated efflux. Key gaps include poor standardization of exposure metrics, limited human-relevant BBB models, and few head-to-head studies that compare delivery platforms on the same payload and outcome. This review tackles the mismatch between mechanistic promise and reliable brain exposure that stalls translation. The objectives are to link phytochemical liabilities to enabling strategies in nanomedicine, alternative routes, and transporter-targeted prodrugs, and to propose decision-grade endpoints for translation. We synthesize evidence on BBB transport logic, nanocarrier families, targeting ligands, intranasal delivery, focused ultrasound-mediated opening, and prodrug approaches that hijack influx transporters, while foregrounding safety and chemistry, manufacturing, and controls (CMC) constraints. Here we highlight that effective neurotherapeutics emerge when chemistry, carrier, route, and measurement are co-designed rather than optimized in isolation. This framework can guide platform selection, de-risk first in-human studies, and sharpen trial endpoints. More broadly, it offers a transferable playbook for barrier-limited drug development across neurology, psychiatry, and oncology. Full article

Educational inclusion remains a global challenge, with teachers’ attitudes toward disability being crucial for the implementation of inclusive classroom practices. This study compares the attitudes toward disability of 252 teachers from Spain and Ecuador, two countries whose educational systems promote inclusion but differ in the maturity of their legislative and institutional frameworks. The aim was to examine cross-national differences in attitudes and analyze how personal and professional variables relate to these attitudes. A descriptive, observational, cross-sectional design was used. Data were collected through an online administration of the Attitudes Toward Persons with Disabilities Scale, Form G via non-probabilistic. The instrument assesses five attitudinal dimensions: capacity assessment, rights recognition, personal involvement, generic rating, and role assumption. Results showed that Spanish teachers reported significantly more positive attitudes than Ecuadorian teachers in all dimensions except role assumption. Among sociodemographic and professional variables, only Early Childhood Education training and prior experience working with individuals with disabilities consistently correlated with more favorable attitudes, while age and teaching experience demonstrated weak and inconsistent associations across countries. These findings underscore the influence of cultural, educational, and institutional contexts on teachers’ attitudes toward disability and highlight the need to reinforce both initial and ongoing preparation in inclusive education. Strengthening structured practicum experiences, socio-emotional competencies, and inclusion-focused coursework may contribute to more positive attitudes, while adapting training policies and inclusive practices to each country’s cultural characteristics is essential for effective and sustainable implementation. Full article

Introduction: Occipital neuralgia [ON] is a primary headache disorder that contributes to a significant proportion of facial pain cases. Occipital neuralgia is an uncommon but disabling headache disorder with an estimated annual incidence of approximately 3.2 per 100,000 individuals. The pathophysiology of ON involves both sensitization of the greater occipital nerve and central mechanisms, including the sensitization of the trigeminocervical pain pathway. Objective: The aim of this study was to evaluate the effectiveness of occipital nerve stimulation (ONS) in patients with refractory occipital neuralgia after six months of treatment. Materials and Methods: StimO is a prospective, open-label, controlled, randomized, and parallel-group study comparing two groups: ONS (occipital nerve stimulation) and OMM (optimized medical management). Results: The percentage change in maximum pain between baseline (D0) and month 6 (M6) showed a significantly greater reduction (p = 0.04) in the ONS group compared to the OMM group. The EQ5D scores revealed that the ONS group had a better quality of life than the OMM group at month 1 (p = 0.01). Medication Quantification Scale (MQS) scores were significantly lower at M1, M3, and M6 [p = 0.03]. However, ONS did not significantly impact anxiety or depression, as assessed by the HAD scale [p > 0.05]. Conclusions: ONS appears to be safe and effective therapy, decreasing pain and medication use and improving quality of life at six months. Trial Registration: The study protocol is registered on ClinicalTrial.gov under the following registration number: NCT03475797 Full article

The purpose of this study is to explore how adolescents in self-contained classrooms or schools for students with autism or ADHD, with no prior involvement in criminality, perceive and interpret different forms of early offending behavior through fictional case stories. The study specifically aims to examine their ability to discern what constitutes offending behavior, based on the double empathy problem. In total, 13 participants currently receiving secondary-level education (grades 10–12, aged 16–20 years) in self-contained classes at schools for adolescents with autism or ADHD participated. No student had cognitive disabilities or had been involved in any criminal act or criminal justice issues. The students were individually given three fictional written cases of offending behavior (theft, physical assault, and sexual assault). Audio-recorded stimulated recall interviews were obtained while the students solved tasks in relation to the cases, and these were analyzed to capture whether and what aspects of early offending were discerned. Overall, the results indicated limited awareness and enhanced social vulnerability, risking unwitting engagement in early offending behavior. Adapting social science education to students’ special educational needs to understand social interactions might be used to prevent and enhance their awareness of early offending behavior. Full article

Introduction: Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating disease of the central nervous system with a highly heterogeneous clinical course. Early identification of patients at risk of aggressive disease progression is crucial for optimizing therapeutic strategies, including eligibility for highly effective treatments. Objective: The aim of this review was to synthesize current data on prognostic factors in multiple sclerosis, with particular emphasis on their significance in the early stages of the disease and potential clinical implications. Methods: A narrative systematic review of the literature was conducted, including observational studies, cohort studies, meta-analyses, and systematic reviews on the natural course of MS, prognostic factors, and clinical, neuroimaging, and laboratory biomarkers. We comprehensively reviewed PubMed and Scopus databases, focusing on English-language publications. Study selection prioritized longitudinal studies and meta-analyses with clear outcome definitions and sufficient follow-up. Formal quality scoring was not applied due to the narrative design of the review. Results: Key adverse prognostic factors include older age at onset, polysymptomatic onset, high relapse activity in the first years, incomplete remission after relapses, and the primary progressive form. Magnetic resonance imaging features, including the number and location of T2 lesions, contrast activity, the presence of spinal cord lesions, PRLs and SELs, and severe brain atrophy, also have significant predictive value. Increasing importance is being attached to laboratory biomarkers, such as oligoclonal bands, light neurofilaments, free kappa light chains, and GFAP. Conclusions: An integrated assessment of clinical, neuroimaging, and laboratory factors enables more effective risk stratification in patients with newly diagnosed MS. Early identification of an unfavorable prognostic profile may provide a basis for individualizing treatment and considering the use of highly effective therapies early in the course of the disease. Full article