Search Results (411)

Artificial intelligence (AI) can be appraised simultaneously as useful, capable, threatening, and demanding. Yet research typically treats attitudes toward AI as a single favorable-unfavorable continuum, obscuring how these evaluations coexist within individuals. Using a three-wave, time-lagged survey of 379 first-year university students in China, we examined configurations of six AI-related appraisal indicators: perceived humanlikeness, adaptability, and quality of AI; AI use anxiety; awareness of smart technology, artificial intelligence, robotics, and algorithms (STARA) as a career threat; and AI creative self-efficacy. Latent profile analysis supported four profiles: Positive Empowerment (19.2%), Anxious Acceptance (37.5%), Low-Perception Detached (37.2%), and High-Perception High-Vigilance (6.1%). R3STEP models showed that learning agility, digital literacy, future work self salience, and perceived university digital support were prospectively associated with profile membership, particularly in distinguishing the Low-Perception Detached profile from the more engaged profiles. BCH comparisons further showed that the Positive Empowerment and High-Perception High-Vigilance profiles reported relatively high levels of both career crafting and self-perceived employability, whereas the Low-Perception Detached profile reported the lowest levels of both outcomes. Notably, the High-Perception High-Vigilance profile combined elevated AI use anxiety and STARA awareness with strong career-development engagement, while the Low-Perception Detached profile combined comparatively low threat perceptions with weak career crafting and employability. These findings demonstrate that higher AI-related threat was not necessarily associated with weaker career preparation and, conversely, that low perceived threat was not necessarily associated with greater adaptive readiness. Overall, the results position students’ responses to AI as configurations of opportunity appraisal, threat, and AI creative self-efficacy rather than as uniformly positive or negative attitudes, thereby highlighting the need for differentiated university career education and AI-readiness interventions. Full article

Most active pharmaceutical ingredients (APIs) reach their target by passive systemic distribution, so the dose required for efficacy at the lesion is set by what healthy tissue can tolerate; conventional dosage forms consequently produce pharmacokinetic profiles that oscillate between toxic peaks and sub-therapeutic troughs. Nanoparticulate carriers (liposomes, lipid nanoparticles, polymeric and inorganic systems, and biomimetic carriers) and hydrogels (natural, synthetic, supramolecular, and microgel-assembled) have emerged as the dominant strategies to address this, increasingly combined as hybrid nanoparticle–hydrogel constructs in which the gel provides locoregional retention and the nanoparticles provide cargo protection, intracellular delivery and stimuli responsiveness. Stimuli-responsive chemistries (pH, redox, enzyme, ROS, hypoxia, temperature, light, magnetic, ultrasound, glucose, and multi-stimuli logic) translate the molecular signatures of a disease into spatiotemporally controlled cargo release. This narrative review consolidates the state of the art (prioritizing 2022–2026) and departs from the conventional carrier-type survey in one respect: the literature is read along an explicit chain—disease cue, sensing chemistry, carrier architecture, release mechanism and kinetics, administration route, and clinical readiness—which exposes a variable that classification by carrier type conceals. Across all three material classes, what governs release behavior is not primarily the carrier chemistry but the identity of the released species (dissolved drug, drug from an embedded nanoparticle, an intact nanoparticle, and a matrix fragment) and the transport step that limits it. This is why power-law exponent analysis developed for dissolved drug fits particulate release poorly, why statistical goodness-of-fit cannot by itself establish a release mechanism, and why carrier class predicts clinical readiness less well than administration route and regulatory product type. Translational hurdles—CMC complexity, regulatory fragmentation, anti-PEG immunogenicity, and the structural mismatch between preclinical promise and clinical efficacy—are critically appraised in light of previously reported <1% delivery efficiency analysis. This review identifies converging strategies that could move stimuli-responsive controlled release from an aspirational outcome to a routine clinical reality. Full article

Vascularized tumor organoid and tumor-on-chip models are increasingly used to examine treatment response, yet a weak therapeutic effect does not by itself identify the failed transport or biological step. Reduced efficacy may result from inadequate delivery, altered endothelial transport or signaling, stromal protection, impaired immune access or function, tumor-intrinsic resistance, or several processes acting together. A structured literature search and narrative synthesis were combined with a focused qualitative appraisal of 25 eligible primary studies to determine what evidence is needed to distinguish these explanations. Twenty-one studies included a relevant comparator, a mechanism-directed perturbation, and a functional readout; four directly tested a principal competing explanation, and three included rescue or reversal. Most studies therefore supported a contributory mechanism under the tested conditions rather than an exclusive causal attribution, leaving transport, stromal, immune, and tumor-intrinsic routes incompletely separated. The synthesis defines five candidate failed-step classes and specifies the comparisons, local-exposure or step-resolved measurements, perturbations, orthogonal readouts, and alternative tests needed for each. Mechanistic attribution is most secure when the proposed bottleneck is measured directly, manipulated experimentally, and distinguished from credible alternatives. Clinical application will additionally require context-of-use-specific evidence of analytical reproducibility, reference treatments, prespecified acceptance criteria, and association with clinically relevant outcomes. Full article

Background/Objectives: Ageing populations face complex challenges, yet many older adults maintain well-being despite adversity. Understanding resilience offers critical direction for health promotion. This integrative review takes a conceptual and methodological approach to resilience in older adults, with clear implications for geriatric care. The review addresses: (1) how resilience is conceptualised and measured; (2) individual, social, and contextual factors linked to resilience; and (3) the effectiveness of interventions that aim to promote resilience. Methods: Following Whittemore and Knafl’s framework, a systematic search of six databases (PubMed, CINAHL, MEDLINE, Scopus, Web of Science, and Cochrane CENTRAL; 2016–2025) identified 42 empirical studies across 18 countries of diverse designs. Quality was assessed using the Mixed Methods Appraisal Tool, and thematic analysis identified five convergent themes. Results: Most studies explicitly defined resilience using trait-, process-, or outcome-based frameworks and employed validated instruments, most commonly the CD-RISC. Self-efficacy, spirituality, sense of coherence, and gratitude were consistently associated with resilience. Family relationships, social networks, and community participation were important relational correlates. Health status, education, economic security, and digital literacy were key contextual factors. Six longitudinal studies linked higher resilience to reduced mortality, slower cognitive decline, and attenuated frailty progression. Seven intervention studies, including five randomised controlled trials, supported physical activity, mindfulness, positive thinking training, Tai Chi, and technology-supported exercise as promising intervention modalities, though one web-based programme yielded null findings. Conclusions: Resilience in older adults is a multifaceted and potentially modifiable construct. Growing longitudinal evidence extends its relevance beyond psychological well-being to physical health outcomes, though cross-sectional designs predominate and limit causal inference. Measurement heterogeneity across more than twenty instruments underscores the need for international consensus and culturally valid tools. Larger longitudinal studies and adequately powered trials are needed to guide definitive practice and policy for ageing populations worldwide. Full article

This study aims to develop and examine Lazarus and Folkman’s psychological stress and coping theory, utilizing scales that measure problem-focused and emotion-focused coping in the context of environmental issues, as defined by Homburg and colleagues, to predict adaptation behavior in agriculture. The goal is to analyze Iranian farmers’ problem-focused and emotion-focused coping styles in response to climate change stress. Using structural equation modeling (SEM), we examined the effects of cognitive appraisals, including demand appraisal and self-efficacy, along with collective efficacy, on problem- and emotion-focused coping. The data for this study were collected through paper-based questionnaires from 250 farmers in Iran. Our results indicate that the perception of increased threat and harm posed by water scarcity to agricultural income and health (demand appraisal), the belief in one’s ability to adapt (self-efficacy), and the perception of the effectiveness of collaborative efforts among farmers in enhancing adaptation (collective efficacy) are associated with both problem- and emotion-focused coping responses. Notably, the Cognitive Theory of Stress model was a stronger predictor of problem-focused coping, accounting for 91% of the variance, compared to just 15% for emotion-focused coping. The results from this study shed light on the cognitive processes most associated with particular types of coping styles. Our findings may inform and guide climate change policy and programs that aim to target and enhance farmers’ climate change adaptation and resilience. Full article

Background/Objectives: Melanoma remains one of the most aggressive skin cancers worldwide, with rising incidence and persistent therapeutic challenges, particularly in advanced diseases. Drug repositioning has emerged as a cost- and time-efficient strategy for identifying adjunctive treatments, and antihypertensive medications have attracted attention for their potential off-target antitumor and immunomodulatory effects. This scoping review aimed to map and critically appraise the evidence on the repositioning of antihypertensive drugs for melanoma management. Methods: The review followed the JBI methodology, and the results were reported in accordance with the PRISMA-ScR guidelines. Searches were conducted in July 2025 and updated in May 2026 in PubMed, Scopus, and Web of Science. For Methodological Quality and Risk-of-bias assessment, the SYRCLE Risk of Bias tool was employed for animal studies. Results: This review included 37 studies. β-Blockers, particularly propranolol, were the most frequently investigated agents (n = 21). Several studies reported antiproliferative, pro-apoptotic, antiangiogenic, and immunomodulatory effects; however, these findings were not uniform. Absent direct antiproliferative effects, biphasic dose responses, lack of angiogenic effects, and outcomes dependent on drug concentration, treatment schedule, and experimental model were also reported. Agents targeting the renin–angiotensin system and calcium channels similarly produced heterogeneous and context-dependent findings. The animal studies frequently presented high or unclear risk of bias, particularly because of incomplete reporting of randomization, allocation concealment, and blinding. No formal methodological quality assessment was performed for the in vitro studies. Conclusions: Antihypertensive agents, particularly β-blockers, show promising but heterogeneous preclinical signals in melanoma. However, the available evidence is not sufficient to establish reproducible efficacy or translational validity. Standardized and methodologically rigorous preclinical studies are required before these agents can be considered for clinical investigation as adjunctive melanoma therapies. Full article

Objective: Large Language Models (LLMs) are emerging as a key component for digital health systems based on Artificial Intelligence (AI). The objective of this paper is to systematically review the characteristics, effectiveness, and implementation challenges of LLM-based assistants targeting adolescent health and well-being. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. PubMed, Scopus, and Web of Science were searched in November 2025 for studies published from 2022 onwards. Eligible studies examined LLM-based assistants used directly by adolescents in health and well-being contexts and reported quantitative outcomes. Data was extracted independently by multiple reviewers and synthesised narratively. Risk of bias was assessed using the Mixed Methods Appraisal Tool (MMAT). Results: Nine studies met the inclusion criteria, involving between 3 and 40 participants and covering mental health support, physical activity promotion, treatment engagement, vaccination awareness, and academic self-efficacy. Most studies were proof-of-concept investigations or pilot studies. LLM-based assistants were associated with reductions in depression, anxiety, stress, and negative affect, improvements in emotional regulation, physical activity, treatment motivation, HPV knowledge, and academic self-efficacy. Risk of bias was generally moderate and the evidence base was limited by small samples, short follow-up periods, and heterogeneous methodologies. Conclusions: LLM-based assistants show promise as scalable and accessible tools for supporting adolescent health and well-being, particularly in mental health domains. However, the current evidence remains preliminary. Larger, long-term, and rigorously designed studies are required to establish effectiveness, safety, and implementation feasibility. Registration: This review was not pre-registered and no review protocol has been published prior to conducting the review. Full article

The growth of single-person older adult households has heightened concerns about social isolation, chronic disease management, and diminished quality of life (QoL). A systematic review with meta-analysis was conducted to examine the efficacy of human-centered AI healthcare interventions on QoL among older adults living alone. Five electronic databases (PubMed, Web of Science, CINAHL, Embase, and Cochrane CENTRAL) were searched (January 2020–March 2026) following PRISMA 2020 guidelines. Only randomized controlled trials (RCTs) were eligible. Methodological quality was appraised with the Cochrane RoB 2 tool; pooled effect estimates were derived via random-effects modeling. Fourteen RCTs (N = 2840) were included. Intervention types comprised conversational agents, socially assistive robots, remote monitoring systems, integrated platforms, and AI-driven mHealth applications. Meta-analysis demonstrated significant improvements in overall QoL (SMD = 0.40, 95% CI: 0.27–0.52, I² = 59%), depression (SMD = −0.35, 95% CI: −0.43 to −0.26), and social connectedness (SMD = 0.38, 95% CI: 0.26–0.51). Subgroup analyses showed stronger effects for interventions with personalized feedback and human interaction. GRADE certainty was moderate for all three primary outcomes. GRADE certainty for secondary outcomes was moderate for physical health but low for self-management and cognitive function. Human-centered AI healthcare interventions significantly improve QoL and psychosocial outcomes among older adults living alone. Future research should prioritize long-term effectiveness, ethical implementation, digital inclusion, and culturally adaptive models. Full article

Background/Objectives: Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA), is approved for weight management as both a weekly subcutaneous (s.c.) injection (2.4 mg) and a daily oral tablet (50 mg). Although head-to-head trials are lacking, the oral formulation offers potential advantages in adherence, patient preference, and accessibility. This systematic review critically appraised comparative and formulation-specific evidence to characterise the efficacy, safety, pharmacokinetics, and patient-reported outcomes of oral vs. s.c. semaglutide in adults with obesity or overweight with at least one weight-related comorbidity. Methods: PubMed, Google Scholar, and SciSpace were searched from inception to June 2025, applying PRISMA 2020 guidelines. Eligibility criteria (PICO): adults with BMI ≥ 27 kg/m²; intervention, oral semaglutide (any dose); comparator, s.c. semaglutide or placebo; outcomes, body weight, BMI, cardiometabolic markers, adverse events, adherence. Risk of bias was assessed with RoB 2.0 (RCTs) and AMSTAR-2 (systematic reviews). Results: Thirty studies met inclusion criteria (12 RCTs, nine systematic reviews/meta-analyses, five comparative/observational studies, four pharmacokinetic studies). OASIS 1 demonstrated −15.1% body weight reduction with oral semaglutide 50 mg at 68 weeks, comparable to s.c. semaglutide 2.4 mg (−14.9% in STEP 1). Both formulations significantly improved HbA1c, blood pressure, and lipid profiles. Oral bioavailability (~1%) requires co-administration with the SNAC absorption enhancer; s.c. bioavailability is ~89%. Oral semaglutide showed superior patient preference and equivalent adherence in needle-averse patients. Conclusions: Oral semaglutide 50 mg is a clinically valid alternative to s.c. semaglutide for obesity management, offering equivalent efficacy and an improved patient experience for individuals who prefer needle-free treatment. Robust direct comparative trials are needed. Full article

There remains a widespread lack of knowledge regarding hidradenitis suppurativa (HS) among physicians in the United States, impeding timely diagnosis and implementation of comprehensive treatment interventions. Despite the presence of supporting communities for affected adolescents and their caretakers, the overall awareness of HS remains low, and a greater consensus on the treatment of HS is needed. Current research highlights the lack of standardized pediatric guidelines for treatment of HS largely due to the varied nature of the disease and limited efficacy of current therapies. Our study aims to explore the relationship between the chronic skin condition HS and social–emotional concerns, mental health, and physical health issues in US children and adolescents. Using the Arksey and O’Malley framework and PRISMA-ScR reporting, we searched PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, and Embase for U.S. studies (2015–2025) on pediatric HS (<18 years) and social–emotional, mental health, or quality-of-life outcomes. Recommendations were synthesized, and study quality was appraised with CASP checklist methods and rigor. Ten studies (2020–2025) met inclusion criteria. Pediatric HS was associated with depression, anxiety, social withdrawal, shame, low self-esteem, and reduced quality of life. Physical comorbidities increased psychosocial burden. Socioeconomic and racial disparities worsened outcomes and access to care. Studies emphasized early diagnosis, routine screening, multidisciplinary management, and disparity-focused interventions. Findings may inform clinical practice and guide research initiatives aimed at improving outcomes for children and adolescents with HS. Full article

Lung cancer remains the leading cause of cancer-related mortality worldwide, and durable benefit from immune checkpoint inhibitors is limited by immune exclusion, microenvironmental immunosuppression, and toxicity. This narrative translational review evaluates whether endobronchial intratumoral delivery of immuno- and gene-based therapies can transform bronchoscopic access into a therapeutic platform linking local tumour intervention with systemic antitumour immunity. We synthesise evidence on endobronchial ultrasound, electromagnetic navigation bronchoscopy, and robotic-assisted bronchoscopy, together with local checkpoint blockade, cytokine and mRNA-lipid nanoparticle constructs, oncolytic virotherapy, dendritic-cell approaches, viral and non-viral gene transfer, and enzyme- or metabolite-based strategies. Current clinical evidence remains preliminary, consisting mainly of Phase I trials, small prospective cohorts, and case-based signals, with feasibility and safety observations but no completed randomised trial demonstrating efficacy against standard-of-care systemic therapy. The most plausible candidates are patients with advanced or recurrent NSCLC, bronchoscopically accessible lesions, inadequate response to systemic immunotherapy, and immune-excluded or locally immunosuppressed tumours. Biomarkers such as PD-L1, tumour mutational burden, CD8+ infiltration, tertiary lymphoid structures, radiomics, and circulating tumour DNA require validation. This review integrates delivery technology, immune mechanisms, statistical evidence appraisal, biomarker limitations, AI-guided planning, and global feasibility. Full article

Fixed orthodontic appliances promote biofilm-mediated enamel demineralization and release metallic ions, motivating surface strategies that are intrinsic to the device rather than dependent on patient compliance. Chitosan, a biodegradable polycationic biopolymer, has been proposed as a multifunctional coating. This narrative review critically appraises the evidence for chitosan-based coatings on orthodontic appliances across three pillars—antimicrobial performance, ion-release/corrosion mitigation, and clinical translation—with explicit calibration of evidentiary strength. The evidence base is heterogeneous and of markedly uneven quality across the three pillars, and the conclusions below are weighted accordingly. Consistent with its narrative design, the literature was surveyed for critical synthesis rather than exhaustively, without formal eligibility screening, risk-of-bias appraisal, or quantitative pooling. Antimicrobial efficacy is the best-supported pillar, consistent in vitro and now extended by two short in vivo randomized trials, although all endpoints are microbiological surrogates rather than white spot lesion outcomes. Ion-release mitigation remains a plausible but insufficiently demonstrated effect: it is supported only indirectly, through electrochemical corrosion proxies on predominantly implant substrates, and no study quantifies ion-release reduction from a coated appliance. Coating durability under combined enzymatic and mechanical load—and its effect on friction—remains largely uncharacterized. Chitosan coatings are promising but translationally immature; durability, not antimicrobial potency, is the rate-limiting barrier. Defined clinical-endpoint and appliance-level ion-release studies are required. Full article

Background/Objectives: Prospective studies of omega-3 supplementation during breast cancer chemotherapy differ in intervention composition, co-supplementation, dose, treatment setting, and outcomes. We summarized and critically appraised interventions comprising DHA alone, EPA + DHA, EPA + DHA + GLA, or EPA + DHA with or without vitamin D, stratified by intervention composition and outcome domain. Methods: PubMed/MEDLINE, the Cochrane Library/CENTRAL, ClinicalTrials.gov, Scopus, Web of Science Core Collection, and Embase were last searched on 8 July 2026, supplemented by citation searching. Eligible studies prospectively administered EPA and/or DHA during chemotherapy and reported inflammatory/biological, nutritional/functional, quality-of-life, treatment-related, anticancer-response, or safety outcomes. Active co-supplementation was analyzed separately. Owing to clinical and methodological heterogeneity, findings were synthesized narratively; risk of bias and outcome-specific certainty were assessed using RoB 2-informed and GRADE approaches. Results: Fourteen reports representing ten prospective interventional trials were included. No eligible EPA-only trial was found. Interventions comprised EPA + DHA/fish oil without another active nutrient, DHA alone, EPA + DHA plus gamma-linolenic acid, and a factorial trial of EPA + DHA with or without vitamin D. One trial reported lower paclitaxel-induced neuropathy, whereas another found no benefit for paclitaxel-associated acute pain or neuropathic symptoms. Biomarker, nutritional, functional, and quality-of-life findings were inconsistent and often derived from small trials, exploratory or compliance-restricted analyses, companion reports, or co-supplementation designs. No consistent improvement in treatment response or survival was demonstrated. Serious supplementation-related adverse events were not reported, although adverse-event reporting varied. Certainty was low for safety and very low for efficacy-related domains. Conclusions: Current evidence is preliminary. The evaluated interventions appeared generally tolerated, but independent clinical efficacy of DHA alone, EPA + DHA without another active nutrient, EPA + DHA + GLA, or EPA + DHA with or without vitamin D during breast cancer chemotherapy remains unproven. Full article

Chronic spontaneous urticaria (CSU) is a mast cell-driven disorder defined by recurrent wheals, angioedema, or both, persisting for longer than six weeks without an identifiable external trigger. Second-generation H1-antihistamines remain first-line therapy, yet a large share of patients stay symptomatic after the dose is raised up to fourfold, and for more than a decade, omalizumab was the only targeted option for those who failed antihistamines. This began to change in 2025, when the interleukin-4 receptor alpha (IL-4Rα) antagonist dupilumab and the oral, covalent Bruton tyrosine kinase (BTK) inhibitor remibrutinib were approved for antihistamine-refractory CSU within months of one another, while the anti-KIT monoclonal antibody barzolvolimab, which depletes mast cells, advanced into the largest phase 3 program the disease has seen. This narrative review outlines the guideline framework that still anchors CSU care, appraises the pivotal efficacy and safety data for omalizumab, dupilumab, remibrutinib, and barzolvolimab, and considers how these mechanistically distinct agents might be positioned and sequenced. The widening choice makes individualized, mechanism-informed treatment a realistic goal, but it also sharpens unresolved questions about patient selection, optimal treatment duration in a naturally remitting disease, and the long-term safety of newer oral and mast cell-depleting approaches. Full article

Adhesive capsulitis (AC) is a common fibroinflammatory shoulder disorder, affecting 2–5% of the general population and up to 20% of people with diabetes mellitus. Although historically considered self-limiting, the course frequently exceeds two years and imposes a substantial functional burden. Intra-articular corticosteroids remain the predominant first-line option, but their benefit is often short-lived and is offset by transient hyperglycemia in diabetic patients, potential tissue toxicity with repeated use, and limited durability. These limitations have prompted interest in non-steroidal, ultrasound-guided alternatives. This narrative review appraises two complementary strategies: ultrasound-guided regenerative injectates (hyaluronic acid, hypertonic dextrose prolotherapy, and platelet-rich plasma) and ultrasound-guided perineural hydrodissection of the suprascapular, axillary, and subscapular nerves. We summarize comparative efficacy with corticosteroids, durability, injection anatomy, and the subgroups most likely to benefit. We then propose—explicitly as a clinically defensible framework rather than a validated guideline—a phase-specific paradigm in which a timely non-steroidal injection provides early pain control while stage-appropriate rehabilitation drives functional recovery. The hypothesis that this sequence may compress the symptomatic course to approximately three to six months is supported by preliminary evidence and requires prospective validation. Because no head-to-head trial has compared the proposed paradigm with the corticosteroid-first standard, these recommendations warrant corresponding caution. Full article