Search Results (65)

Background/Objectives: Assistive technologies are commonly used as a compensatory strategy for individuals with neurological conditions. However, several negative factors have been associated with their use, leading to their non-use or interruption. Therefore, the aim of the present study was to examine the potential of the Assistive Technology Device Predisposition Assessment (ATD-PA) as an outcome measure to identify psychosocial and user-perceived factors associated with the non-use or interruption of assistive technology, particularly mobility devices. Methods: A descriptive, cross-sectional and non-experimental design was employed, as no variables were manipulated. The sample was selected using non-probability convenience sampling and consisted of 80 participants, of which 14 participants discontinued or interrupted the use of assistive technology. An ad hoc sociodemographic questionnaire was administered, along with the Assistive Technology Device Predisposition Assessment, based on the Matching Person and Technology (MPT) model. Results: Factors related to non-use or interruption appeared to be associated with higher perceived levels of global health, self-care, and physical well-being. Findings from the ATD-PA, used as an indicator of subjective satisfaction, showed strong associations between the perceived level of loss and the need for assistive technologies in domains such as comfort, self-care, and general health (r = 0.72–0.90). The perceived benefit of the device was closely linked to knowledge of its use, safety, fit with personal habits, and perceived capability and stamina (r = 0.69–0.94). Comfort using the device was mainly reported in familiar environments such as with family and friends. In contrast, comfort in broader community contexts did not demonstrate meaningful associations. Conclusions: Findings are consistent with Lauer’s model of non-use and highlight the importance of psychosocial determinants such as perceived health, safety, support, and contextual comfort in understanding the interruption or non-use of assistive technology, in line with the International Classification of Functioning, Disability and Health framework. The ATD-PA shows potential as an outcome-oriented tool to support follow-up and the early identification of risk factors for non-use. Longitudinal studies are needed to better understand usage patterns over time. In Spain, the lack of standardized outcome evaluation protocols and systematic follow-up processes underscore the need for structured monitoring strategies in assistive technology provision. Full article

Background: The BEST study investigated the effectiveness of a 12-week digital treatment program for male LUTS. Here, we report on the long-term outcomes of the patients involved in this trial. Methods: The randomized controlled BEST trial enrolled 237 patients (intervention group, IG: n = 112, hereafter referred to as the direct intervention group [DIG]; control group, CG: n = 125, hereafter referred to as the postponed intervention group [PIG]). The intervention consisted of pelvic floor muscle training, behavioral training, completion of a micturition diary, bladder training, urge suppression techniques, fluid and dietary management, and structured educational content. Patients in the DIG received the intervention immediately, Patients in the PIG after a 12-week waiting period. Patients in both groups were offered the option to complete additional treatment cycles at their discretion. The primary endpoint was change from baseline in the International Prostate Symptom Score (IPSS). Secondary endpoints included the symptom severity (OAB-q SF1) and quality-of-life (OAB-q SF2) subscales of the Overactive Bladder Questionnaire, among others. Long-term follow-up assessments at 24, 36, and 48 weeks for participants in both study arms were prospectively specified in the study protocol. Results: Baseline data from 236 patients were available for the follow-up analyses. In a linear mixed-effects model, the fixed effect of time on IPSS was found to be statistically significant (F(4, 515.245) = 89.77, p < 0.001), indicating differences across measurement time points. Compared with the baseline, IPSS scores were lower at all subsequent follow-up assessments. The mean difference between the baseline and 12 weeks after was −6.32 points (95% CI: −7.60 to −5.04; p < 0.001). Differences between the baseline and 24 weeks (−7.81 points; 95% CI: −9.37 to −6.25; p < 0.001), baseline and 36 weeks (−8.62 points; 95% CI: −10.46 to −6.79; p < 0.001), and baseline and 48 weeks (−9.56 points; 95% CI: −12.66 to −6.46; p < 0.001) were also statistically significant. Comparable patterns of improvement were observed for both subscales of the OAB-q Short Form questionnaire. In a separate linear mixed-effects model, the fixed effect of time on IPSS after the discontinuation of app usage was not statistically significant (F(2, 19.750) = 0.01, p = 0.992), suggesting stable effects after discontinuation. Conclusions: Long-term outcomes of the structured app-based therapeutic program demonstrated that a multimodal digital intervention for male LUTS induces a rapid and clinically meaningful symptom reduction within the first 12 weeks, with consolidating and sustaining benefits over up to 48 weeks. Full article

Background/Objectives: Malignant melanoma is a highly aggressive cancer associated with significant mortality, underscoring the need for continued research efforts. COMBI-EU (NCT03944356) is a prospective, non-interventional study that aims to assess adjuvant dabrafenib and trametinib usage in clinical practice, the impact of AE management, and the usage of app-based documentation on treatment adherence. Methods: Adults with complete surgical resection of stage III BRAF V600-mutant cutaneous melanoma were included. The primary endpoint was median time on treatment (TOT). Adverse event (AE) management was classified as either a high or low level of management. The rating of AE management based on a self-developed algorithm and rules from COMBI-APlus was used to analyze the impact of AE management on TOT. App-based documentation of medication intake and patient-reported outcomes (CANKADO PRO-React; version 6.0, 06.03.2019) was offered. Results: For 225 patients, the median TOT was 11.8 months (95% confidence interval [CI]: 11.7, 12.0). Treatment was completed by 138 patients (61.3%); 37 (16.4%) discontinued due to treatment-related AEs (TRAEs). TRAEs (≥1) were experienced by 181 patients (80.4%); the most common was pyrexia (38.2%). High-level AE management showed a trend toward improved treatment adherence (high versus low level: hazard ratio [HR]: 0.74; 95% CI: 0.49, 1.14); this improvement was significant with pyrexia management (HR: 0.52; 95% CI: 0.29, 0.93). Seventy-nine (35%) and 33 patients (15%) intended to use and eventually used the app, respectively. A similar proportion of patients remained on treatment for 12 months irrespective of app usage (use, 39.4% vs. non-use, 36.5%). Conclusions: High-level TRAE management showed a trend toward improved treatment adherence, which was statistically significant for pyrexia. Optional use of an app did not influence treatment adherence. Full article

High-strength oil and gas pipeline girth welds exhibit significant material and geometric discontinuities with high susceptibility to defects, making them a critical weak link in oil and gas pipelines. Researching the fracture assessment technology pipeline’s girth welds is essential for enhancing the pipeline’s inherent safety and protection levels. Key issues and research progress related to fracture assessment technology are systematically addressed from the perspectives of pipeline fracture behavior and fracture assessment methods in this paper. The core focus of fracture behavior research is determining the crack driving force at the girth weld and the material’s fracture toughness. Fracture assessment methods include failure assessment diagrams and limited tensile strain capacity models. The development of single-parameter and multi-parameter fracture mechanics theories in establishing the relationship between in-plane and out-of-plane constraints and material fracture toughness is reviewed. Four commonly used methods for calculating crack driving forces in pipelines are presented. Moreover, the usage scenarios of various failure assessment diagrams in pipeline fracture assessment are analyzed. A comparison of the parameter ranges and applicability of commonly used international tensile strain capacity models is also provided. The paper highlights existing issues in current research on the fracture assessment of high-strength pipelines and outlines directions for further study. Lastly, this paper aims to provide theoretical and technical support for improving the inherent safety level of high-strength pipeline girth welds. Full article

Preventable medication harm in oncology is often driven by drug-related adverse events (AEs) that trigger order changes such as holds, dose reductions, delays, rechallenges, and enhanced monitoring. Much of the evidence needed to make these decisions lives in unstructured clinical texts, where large language models (LLMs), a type of artificial intelligence (AI), now offer extraction and reasoning capabilities. In this narrative review, we synthesize empirical studies evaluating LLMs and related NLP systems applied to clinical text for oncology AEs, focusing on three decision-linked tasks: (i) AE detection from clinical documentation, (ii) Common Terminology Criteria for Adverse Events (CTCAE) grade assignment, and (iii) grade-aligned actions. We also consider how these findings can inform pharmacist-facing recommendations for order-level safety. We conducted a narrative review of English-language studies indexed in PubMed, Ovid MEDLINE, and Embase. Eligible studies used LLMs on clinical narratives and/or authoritative guidance as model inputs or reference standards; non-text modalities and non-empirical articles were excluded. Nineteen studies met inclusion criteria. LLMs showed the potential to detect oncology AEs from routine notes and often outperformed diagnosis codes for surveillance and cohort construction. CTCAE grading was feasible but less stable than detection; performance improved when outputs were constrained to CTCAE terms/grades, temporally anchored, and aggregated at the patient level. Direct evaluation of grade-aligned actions was uncommon; most studies reported proxies (e.g., steroid initiation or drug discontinuation) rather than formal grade-to-action correctness. While prospective, real-world impact reporting remained sparse, several studies quantified scale advantages and time savings, supporting an initial role as high-recall triage with pharmacist adjudication. Overall, the evidence supports near-term, pharmacist-in-the-loop use of AI for AE surveillance and review, with CTCAE-structured, citation-backed outputs delivered into the pharmacist’s electronic health record order-verification workspace as reviewable artifacts. Future work must standardize reporting and CTCAE/version usage, and measure grade-to-action correctness prospectively, to advance toward order-level decision support. Full article

Background/Objectives: Myelofibrosis (MF) predominantly affects older individuals, and its incidence increases with age. Ruxolitinib (RUX), a JAK1/2 inhibitor, effectively reduces spleen volume and relieves disease-related symptoms in MF patients and can be prescribed regardless of age. Although advanced age is associated with poorer MF prognosis, the influence of patient age on RUX treatment efficacy and safety has not been fully elucidated. Methods: In this single-center, retrospective study, we included 216 adult MF patients who initiated RUX therapy between 2012 and 2024. Patients were stratified by age at the start of RUX as follows: <65 (n = 105), 65–74 (n = 64), and ≥75 years (n = 47). Clinical data were analyzed in order to assess the impact of age on RUX-associated responses, toxicities, and survival. Results: Compared to younger patients, those ≥65 years showed features of more advanced MF and 45% higher odds of not achieving SR [OR = 1.45 (95% CI, 1.10–1.91), p = 0.009]. Patients ≥65 years presented a higher incidence of drug-related anemia at 3 (p = 0.003) and 6 months (p = 0.020). These patients had a two-fold increased risk of RUX discontinuation [HR = 2.07 (95% CI, 1.30–3.31) (p = 0.002) and presented a shorter OS than younger patients [HR = 2.74 (95% CI, 1.67–4.49)] (p < 0.001). In the sub-analysis focused on patients older than 65 years, very elderly patients (≥75 years) exhibited similar baseline characteristics, SR rates, median RUX treatment duration (p = 0.22), and OS (p = 0.86) to the 65–74 years cohort. More patients in the very elderly group presented an infectious event grade ≥ 2 (19.2%) than in the 65–74 years group (3.1%) (p = 0.008). Conclusions: RUX demonstrates overall robust rates of SR and favorable OS across all age groups. However, patients aged ≥65 years experienced higher rates of adverse events and worse outcomes. Our data support RUX usage in all age cohorts while highlighting the need for tailored strategies and close clinical monitoring in older patients. Full article

The integration of composite materials into commercial aviation has transformed the industry by providing superior performance benefits, including enhanced fuel efficiency, reduced emissions, and improved structural integrity. With a significant shift towards aircraft featuring high contents of composite materials, the focus has also turned to the challenges associated with the end-of-life management of these materials. Unlike metals, composites are notoriously difficult to recycle due to the strong bonding between fibres and resin, creating significant environmental and economic challenges. The methodology employed—consisting of an extensive literature review that prioritises a holistic approach—aims to provide an overview of the status of composite recyclability in aviation. With this, the report investigates the durability of composites under operational conditions, the associated environmental factors, and their impact on the recycling potential. The dismantling processes for decommissioned aircraft are analysed to identify strategies that preserve material integrity for effective recycling. Established recycling methods are critically evaluated alongside innovative approaches. The study highlights the limitations of current techniques in terms of costs, energy consumption, and material degradation while exploring emerging technologies that aim to overcome these barriers. It is concluded that currently available techniques do not possess the industrial maturity required to handle the amount of composite materials being employed in aviation. Moreover, there is a clear discontinuity between the developments in the usage of composites and their end-of-life recycling, which can cause serious environmental and economic challenges in future years. By combining information regarding composite usage and aircraft retirements, assessing the environmental and economic implications of composite recycling as well as available techniques, and proposing pathways for improvement, this research underscores the importance of adopting sustainable practices in aviation. The findings aim to contribute to the development of a circular economy within the aerospace sector, ensuring the long-term viability and environmental responsibility of future composite-intensive aircraft designs. This is performed by calling for a multi-stakeholder strategy to drive recycling readiness and facilitate the evolution towards a circular economy in aviation, leading to more sustainable design, production, and dismantlement of aircraft in the future. Full article

Background/Objectives: Pacifier use in infants has both beneficial and harmful implications, and dipping pacifiers in sweeteners is used by some parents to soothe infants. This study aimed to assess pacifier usage among mothers in Jeddah, Saudi Arabia, and to examine its association with child demographics, maternal socioeconomic status (SES), and maternal knowledge of the risks associated with dipping pacifiers in sweeteners. Methods: A cross-sectional study was conducted among mothers of healthy children aged 2 to 4 years during community-awareness events in Jeddah. Participants completed a validated Arabic questionnaire covering pacifier use patterns, feeding practices, SES background, and knowledge regarding the adverse effects of pacifier sweetening. Results: A total of 1438 mothers participated. The mean age of children was 34.3 ± 10.7 months, with 441 children (30.7%) reported as pacifier users. Among them, 202 (45.8%) used pacifiers both during the day and at night. Most children (35.6%) discontinued use between 4 and 6 months of age. Only 6.1% of mothers reported adding sweeteners to pacifiers. Pacifier usage was significantly higher among first-born children (37.6%, p < 0.001), those who received both bottle- and breastfeeding (65.5%, p < 0.001), and children enrolled in nursery (62.1%, p = 0.007). Most mothers (75.6%) were aware of the link between sweetened pacifiers and dental caries, and 69.4% of those who had this knowledge avoided giving their child a pacifier (p = 0.077). Conclusions: Birth order, feeding practices, and nursery attendance are key predictors of pacifier use. Enhancing parental awareness and education may support early interventions to promote healthier oral and feeding habits in young children. Full article

Background: Mental health issues among medical students have gained increasing attention globally, with studies indicating a high prevalence of psychological disorders within this population. The use of antidepressants and anti-anxiety medications has become a common response to these mental health challenges. However, it is crucial to understand the extent of their usage and associated effects on students’ mental health and academic performance. This cross-sectional study explored the use of antidepressants and anti-anxiety drugs and their impact on the mental health of medical students in Saudi Arabia. Methods: A cross-sectional survey of 561 medical students from 34 universities was conducted between March and July 2024. An anonymous online questionnaire was used to collect sociodemographic, mental health, and medication usage-related information. Results: Most of the participants were female (71.5%) and aged 21–25 years (62.7%). Approximately 23.8% of them used antidepressants, 5.6% reported using anti-anxiety medications, and 14.0% used both types of medication. Among the medication users, 71.7% were using selective serotonin reuptake inhibitors (SSRIs), and 28.3% were using other medications. Adverse drug reactions were reported by 58.8% of the participants, and 39.6% changed drugs with inadequate efficacy. Notably, 49.0% of the respondents who have ever used medications discontinued their medication without consulting a healthcare professional. Despite these challenges, 62.0% of the participants felt that their medications had a positive impact on their academic performance, 73.4% believed that the benefits outweighed the drawbacks, and 76.2% expressed a willingness to continue taking their medication. In particular, 77.6% agreed that treatment with these drugs could prevent mental breakdowns. Sleep duration, physical activity, and family history of psychiatric disorders were significantly associated with medication use, with p values of 0.002, 0.014, and 0.042, respectively. Conclusions: These results shed light on the need to understand the prescribing practices of antidepressant and anti-anxiety drugs among medical students while promoting the appropriate use of these medications among the students. There is a need to incorporate mental health interventions into counseling services and awareness programs to support students. Future longitudinal studies are needed to explore long-term trends. Full article

Japan has the world’s fastest-aging population. The number of older adults living alone has increased rapidly; however, the number of people waiting for nursing care facilities is high, especially in urban areas, and home care is unavoidable. Few studies have focused on older adults living alone who require nursing care, and almost no reports have examined the factors influencing the continuation or discontinuation of living alone. Furthermore, no reports were found that classified nursing care levels for the survey. This study’s purpose was to clarify what kind of long-term care for older adults living alone in urban areas is most effective in enabling them to continue living at home. A total of 122 older adults in need of long-term care in Osaka City were divided into two groups; one group was those who continued to live alone in December 2022, the other was those who had to discontinue doing so after January 2020. A questionnaire was distributed to the care managers responsible for older adults living alone who required nursing care. The participants’ basic attributes, long-term care services usage, and the characteristics of instrumental activities of daily living (IADL) support were compared according to care level using Fisher’s exact test. The relevant effective factors for continuing to live alone were extracted using a multivariate logistic regression analysis. The results showed differences in the characteristics of both groups at both care level categories used in the study, Support Care Level 1–Nursing Care Level 2 and Nursing Care Level 3–5. Among the support items, indoor temperature control was suggested as a factor that influences continued living alone. Full article

Permanent Scatterer Interferometric Synthetic Aperture Radar (PSInSAR), with millimeter-level accuracy and full-resolution capabilities, is essential for monitoring urban deformation. With the advancement of SAR sensors in spatial and temporal resolution and the expansion of wide-swath observation capabilities, the number of permanent scatterers (PSs) in high-density urban areas has surged exponentially. To address these computational and memory challenges in high-density urban PSInSAR processing, this paper proposes an efficient method for integrating regular grid partitioning and connected component constraints. First, adaptive dynamic regular grid partitioning was employed to divide monitoring areas into sub-blocks, balancing memory usage and computational efficiency. Second, a weighted least squares adjustment model using common PS points in overlapping regions eliminated systematic inter-sub-block biases, ensuring global consistency. A graph-based connected component constraint mechanism was introduced to resolve multi-component segmentation issues within sub-blocks to preserve discontinuous PS information. Experiments on TerraSAR-X data covering Fuzhou, China (590 km²), demonstrated that the method processed 1.4 × 10⁷ PS points under 32 GB memory constraints, where it achieved a 25-fold efficiency improvement over traditional global PSInSAR. The deformation rates and elevation residuals exhibited high consistency with conventional methods (correlation coefficient ≥ 0.98). This method effectively addresses the issues of memory overflow, connectivity loss between sub-blocks, and cumulative merging errors in large-scale PS networks. It provides an efficient solution for wide-area millimeter-scale deformation monitoring in high-density urban areas, supporting applications such as geohazard early warning and urban infrastructure safety assessment. Full article

The isolated boost full-bridge converter (IBFBC) is a DC–DC conversion topology that achieves a high boost ratio and provides electrical isolation, making it suitable for applications requiring both. Its operational dynamics are often intricate due to its inherent characteristics and the prevalent usage of nonlinear switching elements, leading to bifurcation and chaos. Chaos theory was employed to investigate the impact of changes in the voltage feedback coefficient K and input voltage E on the dynamic behavior of the IBFBC when operating in discontinuous conduction mode (DCM). Based on an analysis of its operating principles, a discrete iterative mapping model of the system in DCM is constructed using the stroboscopic mapping method. The effects of two control parameters, namely the proportional coefficient and input voltage, on system performance are studied using bifurcation diagrams, fold diagrams, Poincaré sections, and Lyapunov exponents. Simulation experiments are conducted using time-domain and waveform diagrams to validate the discrete mapping model and confirm the correctness of the theoretical analysis. The results indicate that when the IBFBC operates in DCM, its operating state is influenced by the voltage feedback coefficient $K$ and input voltage $E$. Under varying values of $K$ and $E$, the system may operate in a single-period stable state, multi-period bifurcation, or chaotic state, exhibiting typical nonlinear behavior. Full article

Background: Antimicrobial resistance (AMR) has been identified as one of the top ten public health threats facing humanity. Aim: The purpose of this study was to assess the effect of an antimicrobial stewardship educational intervention on family caregivers’ knowledge and practices in primary healthcare settings in Egypt. Methods: A quasi-experimental, one-group pretest-posttest design involving a sample of 300 family caregivers attending family health centers. The data were collected using questionnaires that assessed caregiver knowledge and self-reported practices regarding AMR before and after the intervention (primary outcomes). The intervention combined tailored knowledge and practice components that carefully evaluated participants’ knowledge regarding AMR, health risk, antibiotic usage, and prevention of infection. Furthermore, their practice of using antibiotics, including previous antibiotic exposure, their antibiotic use during the past year, reasons for taking antibiotics, ways of obtaining antibiotics, and reasons for discontinuing of antibiotic therapy were also recorded. Results: The pre-intervention assessment revealed poor knowledge and practice regarding antibiotic use. Post-intervention, mean knowledge scores increased significantly from 18.36 to 23.28 (t = 19.5, p < 0.0001), while mean practice scores improved from 9.83 to 12.37 (t = 6.4, p < 0.0001). Conclusions: The intervention successfully improved caregivers’ knowledge and practices regarding AMR. However, there are some limitations that could affect the generalization, and the impact of the results such as the relatively small sample size recruited from a single center, lack of a control group, reliance on self-reported data, and lack of long-term follow-up. Future studies should aim to address these constraints in order to assess the intervention’s effectiveness. Full article

To tackle the shortage of river sand resources and excessive carbon emissions in building materials, environment-friendly concrete can be fabricated by solidifying aeolian sand and natural gravel with a fly ash-based geopolymer. Aeolian sand and natural gravel are accessible building materials, but their engineering applications are largely limited by their poor properties such as high mud content, large specific surface area, and discontinuous particle size distribution. To enhance the application of this environment-friendly concrete, in this paper, 48 sets of specimens with different geopolymer dosages, curing temperatures, and curing times are studied experimentally, and quite well-strengthened geopolymer aeolian sand mortar (GAM), geopolymer aeolian sand concrete (GAC), and an appropriate dosage of the geopolymer are finally obtained. The experimental results and the failure section of the mortar specimen indicate that the fly ash geopolymer can solidify the aeolian sand and ensure the integrity and compactness of the specimen. The 28-day compressive and flexural strength of the geopolymer standard sand mortar (GSM) reached 40.5 MPa and 4.3 MPa, respectively, at a curing temperature of 60 °C when the amount of alkali activator was improved to 100%, and the 28-day compressive and flexural strength of GAM reached 33.7 MPa and 4.2 MPa, respectively, when the amount of geopolymer material was 0.75 times that of aeolian sand. A lower compressive strength of GAC was obtained following the addition of aeolian sand. The experiment results can provide a reference for aeolian sand usage and have a certain social value in environmental protection. Full article

Immune checkpoint inhibitors (ICIs) are an effective immunotherapeutic approach for cancers affecting the lung, skin, kidney, mammary gland, or certain hematologic malignancies. Regarding the prognosis of these oncological conditions, treatments with ICIs open new therapeutic perspectives with benefits for both patients and healthcare providers. A drawback of immune checkpoint inhibition is the occurrence of immune-related adverse events that can involve a wide range of organs, such as the liver. Given widespread usage of immunotherapy, the number of patients who suffer from this unwanted condition has increased. Hepatopathy induced by ICIs can be severe and can even lead to death. Detecting liver toxicity in ICIs regiments requires a close monitorization of patients during and after the treatment. Such hepatopathies often involve discontinuation of immune checkpoint inhibitors and administration of corticosteroids. In conclusion, hepatopathies induced by immune checkpoint inhibitors require a comprehensive understanding for effective management, both to protect the patient's life during therapy and to ensure longer survival after cessation of treatment. Full article