Search Results (8,151)

Preterm infants, especially extremely preterm infants under 28 weeks of gestation, face high mortality rates due to respiratory distress resulting from pulmonary immaturity. Conventional mechanical ventilation and extracorporeal membrane oxygenation (ECMO) therapy inevitably cause irreversible lung injury or severe complications, respectively. Here, we developed a microfluidic oxygenator (MO) mimicking the human alveolar-capillary barrier to provide respiratory support for preterm infants. These structures promoted uniform flow distribution, reduced high-shear stress and flow stagnation, and improved gas exchange efficiency. In vitro experiments demonstrated that a single-layer MO raised blood oxygen saturation from 64.7% to 96.5% at 8 mL/min, with a corrected vol% oxygen transfer of 5.24% (52.4 mL O₂/L blood). Hemolysis and coagulation measurements after a 6 h circulation confirmed good hemocompatibility, with most blood damage attributable to the pump. An eight-layer stacked MO was configured with a total priming volume of approximately 5.6 mL and a pressure drop of 25–35 mmHg at 24–40 mL/min, indicating its potential in pumpless extracorporeal circulation for preterm neonates. This MO holds promise for providing minimally invasive and customizable respiratory support in an artificial uterus system. Full article

Background/Objectives: Previous literature has linked nutrition with both psychological distress and well-being. However, less is known about how psychological and spiritual resources cluster within individuals or whether distinct psychospiritual profiles are associated with dietary and lifestyle behaviors. This study examined these associations using a person-centered approach. Methods: A community sample of 522 adults from the United States completed measures of perceived stress, depressive symptoms, coping self-efficacy, gratitude, forgiveness, religiousness/spirituality, daily spiritual experiences, religious/spiritual meaning and beliefs, and dietary and lifestyle behaviors. Latent profile analysis was conducted to identify psychospiritual profiles. Results: Four profiles were identified: Moderate (n = 195), Flourishing (n = 199), Vulnerable (n = 70), and Maladaptive (n = 58). The Flourishing profile demonstrated the most adaptive psychological functioning and was associated with healthier dietary behaviors, including lower breakfast skipping and fast-food consumption, greater whole-grain and vegetable intake, lower salt use, and lower sweets and dessert intake. The Vulnerable profile demonstrated the highest levels of perceived stress and depressive symptoms together with relatively elevated religiousness/spirituality, whereas the Maladaptive profile was characterized by elevated distress and consistently low levels of psychological and spiritual resources. Overall, the Vulnerable and Maladaptive profiles demonstrated less favorable dietary patterns relative to the Flourishing and Moderate profiles. However, the observed effects were generally modest and selective. Conclusions: Dietary and lifestyle behaviors may be associated with broader psychospiritual configurations rather than isolated psychological characteristics alone. The findings additionally highlight the heterogeneous nature of religiousness and spirituality within psychological functioning. Full article

Introduction: College student-athletes must often balance academic responsibilities with intensive training and competition, placing them under considerable pressure and potentially increasing their risk of mental health difficulties. Against this background, the present study focused on the link between mindfulness and psychological distress and examined whether cognitive reappraisal and subjective vitality were statistically involved in this association as indirect associations. Methods: Participants were 430 college student-athletes recruited from five universities in Hunan Province, China. Using a cross-sectional survey design, the hypothesized model was tested using structural equation modeling in AMOS 23.0, and indirect associations were examined with bootstrap analysis based on 5000 resamples. Results: Mindfulness was positively associated with both cognitive reappraisal and subjective vitality. Cognitive reappraisal was positively associated with subjective vitality but negatively associated with psychological distress. Subjective vitality also showed a negative association with distress. Moreover, mindfulness showed an indirect association with lower distress through cognitive reappraisal and subjective vitality. Discussion: The findings may contribute to a better understanding of the psychological correlates associated with mental health in college student-athletes. They also suggest that mindfulness-related psychological resources may be associated with lower distress and may help guide future longitudinal and intervention research in this group. Full article

Small and medium enterprises routinely face a paradox in financial monitoring: their accounting documents exist, but the cost of converting heterogeneous PDFs into timely financial signals is prohibitive without dedicated analytical staff or specialized software. This paper presents a two-layer artifact, designed under Design Science Research, that bridges this gap using only public-web large language models (LLMs) and a parsimonious multi-criteria decision routine. Layer 1 implements a structured LLM-driven workflow that extracts account–value pairs from annual tax balance sheets without code, APIs, or fine-tuning. Layer 2 reconstructs auditable accounting aggregates and ranks yearly financial condition through TOPSIS with min–max normalization—a deliberate replacement for classical vector normalization, which fails when profitability indicators are negative, as routinely occurs in distress years. To avoid size effects and algebraic redundancy, the decision matrix uses only three criteria spanning liquidity, profitability, and solvency. The artifact is demonstrated in a four-year case study of an anonymized construction SME (2021–2024), with accountant-verified document-level match rates of 0.810, 0.998, 0.950, and 0.909. Equal weighting is the only weighting configuration used; a supplementary entropy-based dispersion diagnostic yields the same ordinal ranking—2024 > 2023 > 2021 > 2022—and 10,000 Monte Carlo replications, with uncertainty injected at the reconstructed-aggregate level, confirm that the extreme ranks are invariant across all runs. The contribution is methodological and practical: a transparent, low-infrastructure pipeline that brings first-pass financial screening within reach of SMEs operating under severe data and budget constraints. Full article

Background: Anaplasmosis is an emerging tick-borne infection that typically presents as a non-specific febrile illness, with variable degrees of cytopenias and liver tests abnormalities. Severe complications remain atypical and uncommon. Case Report: We report a case of acute pulmonary embolism (PE) occurring during confirmed anaplasmosis in a 73-year-old male with no traditional thromboembolic risk factors. The patient presented with fever, constitutional symptoms, thrombocytopenia, leukopenia, and abnormal liver tests, raising suspicion for a tick-borne illness. Despite early clinical improvement on doxycycline, persistent tachycardia triggered further evaluation and uncovered an acute PE. Comprehensive workup at admission and repeated 14 months later excluded inherited and acquired thrombophilias, malignancies, autoimmune diseases, and alternative infectious etiologies. The patient was treated with doxycycline 100 mg orally twice daily for 10 days and anticoagulation with unfractionated heparin followed by 6 months of apixaban for a first episode of provoked PE. He attained complete clinical recovery without recurrence of thrombosis at the two-year follow-up. Discussion: Infectious diseases are increasingly recognized as contributors to thrombosis through inflammation-mediated hypercoagulability and endothelial dysfunction. Pulmonary involvement in anaplasmosis typically manifests as pneumonitis, pneumonia or acute respiratory distress syndrome, but thrombotic complications such as PE are exceedingly rare. This case highlights a rare but clinically significant vascular complication of anaplasmosis and underscores the importance of considering thromboembolic events in patients with persistent or unexplained tachycardia. Conclusions: As the incidence of anaplasmosis continues to rise, greater awareness of its potential cardiovascular manifestations is essential. Early recognition and prompt treatment with doxycycline remain critical, while further studies are needed to better define the thrombotic risk associated with this infection. Full article

Background/Objective: Medication overuse headache (MOH) is a disabling secondary headache disorder that arises from an underlying primary headache, most commonly migraine. Although treatment reduces headache frequency and medication overuse, the interictal burden—the impact experienced between headache attacks—remains poorly characterized over the long term. This study evaluated interictal burden and clinical outcomes two years after MOH diagnosis. Methods: This study was derived from a prospective multicenter cohort of patients with MOH, using data from a single center. Of 149 patients enrolled between April 2020 and November 2022, 117 (78.5%) completed the two-year follow-up. Clinical characteristics, medication overuse, monthly headache days, and standardized questionnaires were assessed at baseline and follow-up. Interictal burden was evaluated at two years using the Migraine Interictal Burden Scale (MIBS-4), with scores ≥5 indicating severe burden. Results: At baseline, patients (81.2% female; median age, 45.0 years) reported a median of 16.0 monthly medication days (interquartile range, 13.0–23.0). Medication overuse decreased from 100% at baseline to 24.2% at one year and 17.1% at two years. Among 117 patients with available two-year MIBS-4 data, 25 (21.4%) had severe interictal burden. Compared with those without severe burden, these patients had greater headache-related impact and disability (HIT-6: 68.0 vs. 64.0, p = 0.019; MIDAS: 110.0 vs. 36.0, p = 0.002), higher psychological burden (PHQ-9: 11.0 vs. 8.0, p = 0.032; GAD-7: 7.0 vs. 4.0, p = 0.010), and were more likely to be current smokers (20.0% vs. 4.3%, p = 0.036). Notably, 14.4% of patients with resolved medication overuse still reported severe interictal burden. Conclusions: Two years after MOH diagnosis, severe interictal burden was observed in a substantial proportion of patients and was associated with greater baseline disability and psychological distress. These findings highlight the need for long-term monitoring and management beyond initial medication withdrawal. Full article

Background: University counselling services provide essential support for students navigating critical academic phases. These services have proven to be successful in promoting long-term psychological well-being and student retention. Methods: In a clinical and health psychology perspective, this study aims to analyze the effectiveness of the Narrative Mediation Path (NMP) counselling groups involving 85 underachieving university students, lagging behind in their studies. The intervention aims at promoting psychological well-being, Reflective Functioning, emotion regulation, and academic engagement in order to improve students’ academic performance and prevent university dropouts. At the beginning and end of counselling the following measures were administered: (a) Clinical Outcomes in Routine Evaluation—Outcome Measure, (b) SInAPSi Academic Engagement Scale, (c) Academic Performance Inventory, (d) Reflective Functioning Questionnaire, (e) Emotion Regulation Questionnaire. Results: The results showed that counselling group participation was associated with significant and clinical improvement in all the outcomes considered. Reflective Functioning showed a trend toward improvement, but this change did not reach statistical significance. Conclusions: Overall, the present study suggested that group counselling could represent a useful service supporting students’ psychological wellbeing and in facing the difficulties encountered during the academic career. Full article

The present integrative umbrella review aims to provide a comprehensive overview of the evidence and practices related to mental health and career transitions in elite sport toward the implementation of service provision through digital interventions. Following PRIO guidelines, an extensive search across five databases (2015–2025) identified 52 eligible manuscripts (e.g., conceptual, review, and position studies). Data extraction focused on mental health, dual-career pathways, career transition challenges and needs, and identity-related issues among high-performance athletes. The findings revealed a strong consensus that athlete well-being is shaped by the dynamic interaction of mental health symptoms, sport-specific stressors, identity processes, and structural conditions across the athletic lifespan. Mental health vulnerabilities (e.g., anxiety, depression, disordered eating, and distress) were consistently reported, particularly during injury, deselection, and retirement. Dual-career engagement, diversified identities, and proactive career planning emerged as key protective factors, while stigma, limited literacy, and uneven access to psychological services remained persistent barriers. Five main thematic areas (Matrix 1) operationalized in ten higher-order intervention domains (e.g., Matrix 2, screening, monitoring, literacy, and others) and 14 potential online implementation strategies (Matrix 3) were identified. However, the evidence highlights fragmented implementation and a lack of scalable, cross-national tools to support athletes during and beyond their competitive careers. Therefore, a harmonized, evidence-based, multidimensional framework for the development and implementation of digital support resources has been proposed. This integrative review underscores the need for integrated, culturally sensitive, and digitally enabled support systems to promote sustainable transitions and long-term athlete well-being. Full article

This study investigates how eco-efficiency and socio-efficiency influence firms’ default risk across the European financial, industrial, and consumer service sectors from 2010 to 2024. This study aims to determine whether integrating environmental and social performance into corporate strategies mitigates financial distress over time. The Pooled Mean Group ARDL estimator was employed to capture the short- and long-term dynamics. The results indicate that higher eco- and socio-efficiency significantly reduce long-term default risk, particularly in the financial and industrial sectors. Short-term effects were found to be insignificant, suggesting that sustainability benefits gradually emerged. This study offers novel sector-specific evidence linking sustainability efficiency to default risk in European firms and provides insights into how environmental and social efficiencies enhance corporate resilience and financial stability. Full article

Background: Menopause is associated with hormonal changes that may influence cognitive function, psychological health, and quality of life, but data on Middle Eastern populations remain scarce. Methods: A cross-sectional study was conducted among 220 Saudi women (110 perimenopausal, 110 postmenopausal) in Riyadh. Cognitive function was assessed with the MMSE-2; quality of life with SF-36 and MENQOL; and psychological distress with PHQ-4 and PSS-10. Group comparisons used the Mann–Whitney U test; associations with Spearman’s correlation; and multivariable logistic regression adjusted for age, BMI, education, and anxiety. Results: In unadjusted analyses, perimenopausal women had higher MMSE-2 scores (median 30 vs. 29, p = 0.002, r = 0.211). Postmenopausal women reported greater vasomotor symptoms (p < 0.001, r = 0.090) but better emotional well-being (p = 0.038, r = 0.140). After adjustment for age, menopausal status was not a significant predictor of lower cognitive function (OR = 1.28, 95% CI: 0.56–2.92, p = 0.560). Age was the only significant predictor (OR = 1.10, 95% CI: 1.03–1.17, p = 0.003). Conclusions: The unadjusted difference in MMSE-2 scores between perimenopausal and postmenopausal women was small and not independent of age. Age, not menopausal status, was the primary factor associated with cognitive performance. Preventive strategies should target modifiable factors such as physical activity and vasomotor symptom management. Longitudinal studies with domain-specific cognitive tests are needed. Full article

This study presents an AI-enabled framework for automated pavement condition assessment in urban environments by integrating YOLOv8-based distress detection, computational Pavement Condition Index (PCI) estimation, and comparative validation against manual PCI inspections and Pavement Surface Evaluation and Rating (PASER) scores. A YOLOv8 object-detection model, implemented in Python and trained on the publicly available N-RDD2024 dataset, was developed to identify longitudinal cracks, transverse cracks, alligator cracking, and potholes. The model achieved an accuracy of 84.6%, a precision of 89.6%, and a recall of 86.3%, demonstrating robust detection performance under heterogeneous environmental conditions. Dash-cam imagery collected along 6.3 km of urban flexible pavements was processed through an automated workflow that detects pavement distresses, estimates their severity and extent, and computes PCI values according to ASTM D6433-20 procedures. Automated PCI values were compared with manual PCI inspections and PASER ratings generated by the Blyncsy platform across 23 pavement sections. Statistical validation between automated and manual PCI assessments returned an R-squared of 0.925, a Pearson correlation coefficient of 0.962, a Spearman correlation coefficient of 0.955, a Mean Absolute Error of 5.0 PCI points, and a Root Mean Square Error of 6.1 PCI points. Compared with the proposed framework, PASER ratings exhibited lower agreement with manual PCI assessments and generally overestimated the pavement condition. The results demonstrate the potential of low-cost AI-based systems for large-scale pavement monitoring. Nevertheless, performance degradation was observed under challenging environmental conditions and in heavily deteriorated sections, highlighting the need for improved distress quantification, dataset balancing, and multimodal sensing integration. Full article

Psychological distress is increasing among university students, especially sexual minority individuals in Malaysia, who face stigma and challenges within a sociocultural and dual legal system. This study examined the relationship between sexual minority status and both negative (psychological strain, distress, suicidality) and positive (self-esteem, purpose in life, social support, religiosity) mental health indicators among Malaysian undergraduates. A cross-sectional, multi-institutional survey was conducted utilizing an existing dataset, yielding a final analytical sample of 2244 participants (1870 heterosexual and 374 sexual minority students). Data were analyzed using Welch’s ANOVA and multiple logistic regression, controlling for demographic variables. Heterosexual students reported significantly lower depressive symptoms, anxiety, stress, and suicidality compared to gay, bisexual, and participants with other sexual orientation. In the fully adjusted model, sexual minority identity remained significantly associated with higher deprivation strain (aOR: 1.043), depression (aOR: 1.025), and suicidality (aOR: 1.117). Conversely, identifying as a sexual minority was linked to lower religious commitment (aOR: 0.961) and lower perceived family support (aOR: 0.943). Self-esteem and purpose in life lost statistical significance in the fully adjusted model. Sexual minority undergraduates in Malaysia face heightened psychological distress and suicidality, underscoring the need for comprehensive campus mental health interventions. Full article

Background: Patient-reported outcome comparisons require measurement equivalence, which is seldom tested in low- and middle-income country (LMIC) diabetes research. We examined equivalence of the Diabetes Self-Management Instrument-35 (DSMI-35), Diabetes Distress Scale-17 (DDS-17), and Asian Diabetes Quality of Life (AsianDQOL) scale across sex, fasting-glucose stratum, and educational attainment in Vietnamese adults with type 2 diabetes. Methods: We conducted a secondary analysis of 374 adults (female 152, male 222; lower-FBG < 154 mg/dL, n = 212; higher-FBG n = 162; secondary-or-lower n = 202; tertiary-or-higher n = 172). Multi-group CFA (lavaan) tested configural, metric, and scalar equivalence of a parcel-level three-factor model (parcel-level equivalence does not imply item-level equivalence). Path equality was evaluated with scaled Satorra–Bentler likelihood-ratio tests; indirect effects were bootstrapped (n = 5000). Results: Scalar-equivalence change-index criteria (ΔCFI ≤ 0.010; ΔRMSEA ≤ 0.015) were met for all groupings; however, for fasting glucose the configural baseline fit was weak (RMSEA 0.117–0.119), so fasting-glucose equivalence is reported only as provisional and is not interpreted at the level of the sex and education findings. McDonald’s ω was ≥ 0.959 in every subgroup. Structural paths did not differ by sex (Δχ²(3) = 1.18, p = 0.758; not powered for equivalence) but differed by education (Δχ²(3) = 71.16, p < 0.001), with the cross-sectional association structure differing by education (distress-channelled in tertiary-or-higher and partly direct in secondary-or-lower participants); because the data are cross-sectional, these are differences in association structure, not established mediation. The fasting-glucose structural comparison was not interpretable because the lower-FBG subgroup (FBG < 154 mg/dL, n = 212) had a non-positive-definite latent covariance matrix. Conclusions: Scalar equivalence criteria were met for sex and education and only preliminarily supported for fasting-glucose stratum, where elevated configural RMSEA (0.119) cautions against firm interpretation. The self-management → distress → quality-of-life pathway showed no detected sex difference but differed by educational attainment. Measurement equivalence testing, including configural-fit assessment, should be routine in LMIC patient-reported outcome validation. Full article

Cancer-related cognitive impairment (CRCI), also known as chemobrain or chemofog, is characterized by subjective and/or objective changes in attention, executive functions, memory, and processing speed in patients with non-CNS cancers, particularly women with breast cancer. This structured narrative review synthesizes current evidence on mechanisms, neuropsychological assessment, neuroimaging correlates, clinical and demographic risk factors, emerging artificial intelligence and machine learning applications, and non-pharmacological approaches to CRCI in breast cancer. A structured literature search was conducted using PubMed/MEDLINE, PsycInfo, and Clinical Key up to May 2026, with emphasis on studies published between 2023 and 2026. Peer-reviewed English-language studies involving adult breast cancer populations and addressing predefined thematic domains of CRCI were considered. Given the heterogeneity of study designs, assessment tools, interventions, and outcomes, the findings were synthesized narratively. Current evidence supports a multifactorial model of CRCI involving neurobiological, treatment-related, psychological, and behavioral mechanisms. Neuroinflammation, endocrine disruption, oxidative stress, glial alterations, and structural or functional brain changes may contribute to cognitive symptoms; however, the strength of evidence varies, and many findings remain correlational or preclinical. Non-pharmacological interventions, including cognitive training, physical activity, mindfulness-based and psychological approaches, and multimodal digital programs, appear promising as supportive strategies. However, evidence remains heterogeneous, with benefits more consistently reported for patient-reported outcomes, fatigue, emotional distress, and quality of life than for objective neuropsychological performance. CRCI in breast cancer should be approached as a heterogeneous condition requiring early recognition, standardized assessment, and multidisciplinary supportive care. Future research should prioritize longitudinal designs, harmonized endpoints, and a clearer distinction between subjective and objective outcomes. Full article

Background: Tinnitus is a prevalent auditory disorder associated with maladaptive cortical plasticity and aberrant neural synchronization across auditory and non-auditory brain networks. Acoustic desynchronization-based sound therapies, such as coordinated reset neuromodulation, aim to counteract pathological oscillatory patterns but commonly require prolonged daily listening sessions and specialized delivery formats, which may limit their accessibility and practicality in routine clinical settings. To address this limitation, a modified desynchronization protocol embedding therapeutic tones within music was developed to improve tolerability and engagement. This study aimed to evaluate the clinical effects of modified Music-Integrated Desynchronization Sound Therapy (mMIDST) on tinnitus severity in patients with chronic tinnitus. Methods: In this prospective, randomized, controlled, single-blind pilot trial conducted at the Otolaryngology Department of Hospital Clínico Universidad de Chile (Santiago, Chile) between July 2024 and July 2025, adults aged 18–75 years with chronic non-pulsatile tinnitus were assigned to receive either mMIDST or an active control intervention consisting of low-frequency stimulation (LFS) embedded within identical music tracks. Participants listened to personalized sound files for one hour daily, five days per week. Tinnitus severity was assessed using the Tinnitus Handicap Inventory (THI), with audiometric evaluations performed at baseline and after one, two, and three months. Between-group differences were analyzed using the Mann–Whitney U test. Results: Twenty-five participants completed the study (15 mMIDST, 10 LFS). Baseline audiometric thresholds and THI scores were comparable between groups. The mMIDST group showed significantly greater reductions in THI scores than the LFS group at two and three months of treatment (p < 0.05). Conclusions: mMIDST was associated with time-dependent improvements in tinnitus-related distress compared with an active control condition. Embedding desynchronization-based tonal stimulation within music may represent a promising and well-tolerated non-invasive approach for chronic tinnitus management. Full article