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14 pages, 574 KiB  
Article
Implementation and Evaluation of a VR/AR-Based Assistive Technology for Dyslexic Learners: An Exploratory Case Study
by María Lozano-Álvarez, Sonia Rodríguez-Cano, Vanesa Delgado-Benito and Miguel Ángel García-Delgado
Societies 2025, 15(8), 215; https://doi.org/10.3390/soc15080215 (registering DOI) - 4 Aug 2025
Abstract
This exploratory case study investigates the implementation and educational impact of a Virtual Reality (VR)- and Augmented Reality (AR)-based assistive technology developed to support learners with dyslexia. The intervention, delivered via mobile devices and VR headsets, incorporated gamified and interactive content aimed at [...] Read more.
This exploratory case study investigates the implementation and educational impact of a Virtual Reality (VR)- and Augmented Reality (AR)-based assistive technology developed to support learners with dyslexia. The intervention, delivered via mobile devices and VR headsets, incorporated gamified and interactive content aimed at enhancing cognitive skills such as attention, inhibition, narrative memory, and phonological awareness. Two in-depth case studies were conducted with primary school students formally diagnosed with dyslexia. Cognitive performance was assessed using the NEPSY-II neuropsychological battery, and user experience was evaluated using the Technology Acceptance Model (TAM). The results showed positive trends in executive function and language-related skills, as well as high motivation and satisfaction. While these findings suggest promising benefits of immersive educational technologies in dyslexia intervention, conclusions regarding efficacy cannot be drawn due to the limited sample size. Further research with larger and controlled designs is needed to validate these initial observations. Full article
11 pages, 2491 KiB  
Article
Nudging Safety in Elementary School Zones: A Pilot Study on a Road Sticker Intervention to Enhance Children’s Dismounting Behavior at Zebra Crossings
by Veerle Ross, Kris Brijs, Dries Vanassen and Davy Janssens
Safety 2025, 11(3), 76; https://doi.org/10.3390/safety11030076 (registering DOI) - 4 Aug 2025
Abstract
In this pilot study, the crossing behavior of elementary school students commuting on bicycles was investigated with the objective of enhancing safety around pedestrian crossings within school zones. With a noticeable increase in crashes involving young cyclists near schools, this research assessed the [...] Read more.
In this pilot study, the crossing behavior of elementary school students commuting on bicycles was investigated with the objective of enhancing safety around pedestrian crossings within school zones. With a noticeable increase in crashes involving young cyclists near schools, this research assessed the effectiveness of visual nudges in the form of red strips displaying “CYCLISTS DISMOUNT” instructions. Initial observations indicated a lack of compliance with dismounting regulations. After the initial observations, a specific elementary school was selected for the implementation of the nudging intervention and additional pre- (N = 91) and post-intervention (N = 71) observations. The pre-intervention observations again revealed poor adherence to the regulations requiring cyclists to dismount at specific points. Following our targeted intervention, the post-intervention observations marked an improvement in compliance. Indeed, the visual nudge effectively communicated the necessity of dismounting at a critical location, leading to a higher rate of adherence among cyclists (52.74% pre-intervention, 97.18% post-intervention). Although it also indirectly affected the behavior of the accompanying adult, who more often held hands with their children while crossing, this effect was weaker than the direct effect on dismounting behavior (20.88% pre-intervention, 39.44% post-intervention). The findings of the current pilot study underscore the possible impact of nudging on behavior and advocate for a combined approach utilizing physical nudges to bolster safety within school zones. Follow-up research, including, for instance, multiple sites, long-term effects, or children traveling alone, is called for. Full article
19 pages, 29719 KiB  
Review
A Review of Methods for Increasing the Durability of Hot Forging Tools
by Jan Turek and Jacek Cieślik
Materials 2025, 18(15), 3669; https://doi.org/10.3390/ma18153669 (registering DOI) - 4 Aug 2025
Abstract
The article presents a comprehensive review of key issues and challenges related to enhancing the durability of hot forging tools. It discusses modern strategies aimed at increasing tool life, including modifications to tool materials, heat treatment, surface engineering, tool and die design, die [...] Read more.
The article presents a comprehensive review of key issues and challenges related to enhancing the durability of hot forging tools. It discusses modern strategies aimed at increasing tool life, including modifications to tool materials, heat treatment, surface engineering, tool and die design, die geometry, tribological conditions, and lubrication. The review is based on extensive literature data, including recent publications and the authors’ own research, which has been implemented under industrial conditions at the modern forging facility in Forge Plant “Glinik” (Poland). The study introduces original design and technological solutions, such as an innovative concept for manufacturing forging dies from alloy structural steels with welded impressions, replacing traditional hot-work tool steel dies. It also proposes a zonal hardfacing approach, which involves applying welds with different chemical compositions to specific surface zones of the die impressions, selected according to the dominant wear mechanisms in each zone. General guidelines for selecting hardfacing material compositions are also provided. Additionally, the article presents technological processes for die production and regeneration. The importance and application of computer simulations of forging processes are emphasized, particularly in predicting wear mechanisms and intensity, as well as in optimizing tool and forging geometry. Full article
(This article belongs to the Section Manufacturing Processes and Systems)
25 pages, 1212 KiB  
Review
Antioxidant Capacity and Therapeutic Applications of Honey: Health Benefits, Antimicrobial Activity and Food Processing Roles
by Ivana Tlak Gajger, Showket Ahmad Dar, Mohamed Morsi M. Ahmed, Magda M. Aly and Josipa Vlainić
Antioxidants 2025, 14(8), 959; https://doi.org/10.3390/antiox14080959 (registering DOI) - 4 Aug 2025
Abstract
Honey is a natural product of honeybees that has been consumed for centuries due to its nutritional value and potential health benefits. Recent scientific research has focused on its antioxidant capacity, which is linked to a variety of bioactive compounds such as phenolic [...] Read more.
Honey is a natural product of honeybees that has been consumed for centuries due to its nutritional value and potential health benefits. Recent scientific research has focused on its antioxidant capacity, which is linked to a variety of bioactive compounds such as phenolic acids, enzymes (e.g., glucose oxidase, catalase), flavonoids, ascorbic acid, carotenoids, amino acids, and proteins. Together, these components work synergistically to neutralize free radicals, regulate antioxidant enzyme activity, and reduce oxidative stress. This review decisively outlines the antioxidant effects of honey and presents compelling clinical and experimental evidence supporting its critical role in preventing diseases associated with oxidative stress. Honey stands out for its extensive health benefits, which include robust protection against cardiovascular issues, notable anticancer and anti-inflammatory effects, enhanced glycemic control in diabetes, immune modulation, neuroprotection, and effective wound healing. As a recognized functional food and dietary supplement, honey is essential for the prevention and adjunct treatment of chronic diseases. However, it faces challenges due to variations in composition linked to climatic conditions, geographical and floral sources, as well as hive management practices. The limited number of large-scale clinical trials further underscores the need for more research. Future studies must focus on elucidating honey’s antioxidant mechanisms, standardizing its bioactive compounds, and examining its synergistic effects with other natural antioxidants to fully harness its potential. Full article
20 pages, 1092 KiB  
Review
Ultrasound Imaging Modalities in the Evaluation of the Dog’s Stifle Joint
by Anargyros T. Karatrantos, Aikaterini I. Sideri, Pagona G. Gouletsou, Christina G. Bektsi and Mariana S. Barbagianni
Vet. Sci. 2025, 12(8), 734; https://doi.org/10.3390/vetsci12080734 (registering DOI) - 4 Aug 2025
Abstract
This review presents a comprehensive overview of various ultrasound imaging techniques employed in the evaluation of the canine knee joint. It critically analyzes studies conducted on both human and animal subjects, with a focus on the diagnostic accuracy of B-mode ultrasound, Doppler examination, [...] Read more.
This review presents a comprehensive overview of various ultrasound imaging techniques employed in the evaluation of the canine knee joint. It critically analyzes studies conducted on both human and animal subjects, with a focus on the diagnostic accuracy of B-mode ultrasound, Doppler examination, contrast-enhanced ultrasound, and elastography in both normal and pathological conditions. The review underscores the necessity of strict adherence to the protocols of each ultrasound modality and emphasizes the importance of a thorough understanding of the anatomical region to achieve optimal outcomes. The findings suggest that these ultrasound techniques can significantly enhance the diagnostic process, providing valuable insights into anatomy, size, blood supply, and tissue elasticity. Additionally, in cases where advanced imaging modalities such as computed tomography (CT) or magnetic resonance imaging (MRI) are cost-prohibitive or less accessible, ultrasound serves as a reliable alternative, delivering high diagnostic accuracy and critical information regarding mechanical changes in the joint and neovascularization. Full article
22 pages, 1351 KiB  
Article
An Optimization Design Method for Flat-Wire Motors Based on Combined Rotor Slot Structures
by Xiangjun Bi, Hongbin Yin, Yan Chen, Mingyang Luo, Xiaojun Wang and Wenjing Hu
World Electr. Veh. J. 2025, 16(8), 439; https://doi.org/10.3390/wevj16080439 (registering DOI) - 4 Aug 2025
Abstract
To enhance the electromagnetic performance of flat-wire permanent magnet synchronous motors, three different groove structures were designed for the rotor, and a multi-objective optimization algorithm combining a genetic algorithm (GA) with the TOPSIS method was proposed. Firstly, an 8-pole 48-slot flat-wire motor model [...] Read more.
To enhance the electromagnetic performance of flat-wire permanent magnet synchronous motors, three different groove structures were designed for the rotor, and a multi-objective optimization algorithm combining a genetic algorithm (GA) with the TOPSIS method was proposed. Firstly, an 8-pole 48-slot flat-wire motor model was established, and the cogging torque was analytically calculated to compare the motor’s performance under different groove schemes. Secondly, global multi-objective optimization of the rotor groove dimensions was performed using a combined simulation approach involving Maxwell, Workbench, and Optislang, and the optimal rotor groove size structure was selected using the TOPSIS method. Finally, a comparative analysis of the motor’s performance under both rated-load and no-load conditions was conducted for the pre- and post-optimization designs, followed by verification of the mechanical strength of the optimized rotor structure. The research results demonstrate that the combined optimization approach utilizing the genetic algorithm and the TOPSIS method significantly enhances the torque characteristics of the motor. The computational results indicate that the average torque is increased to 165.32 N·m, with the torque ripple reduced from 28.37% to 13.32% and the cogging torque decreased from 896.88 mN·m to 187.9 mN·m. Moreover, the total distortion rates of the air-gap magnetic flux density and the no-load back EMF are significantly suppressed, confirming the rationality of the proposed motor design. Full article
18 pages, 1942 KiB  
Article
Surveillance and Characterization of Vancomycin-Resistant and Vancomycin-Variable Enterococci in a Hospital Setting
by Claudia Rotondo, Valentina Antonelli, Alberto Rossi, Silvia D’Arezzo, Marina Selleri, Michele Properzi, Silvia Turco, Giovanni Chillemi, Valentina Dimartino, Carolina Venditti, Sara Guerci, Paola Gallì, Carla Nisii, Alessia Arcangeli, Emanuela Caraffa, Stefania Cicalini and Carla Fontana
Antibiotics 2025, 14(8), 795; https://doi.org/10.3390/antibiotics14080795 (registering DOI) - 4 Aug 2025
Abstract
Background/Objectives: Enterococci, particularly Enterococcus faecalis and Enterococcus faecium, are Gram-positive cocci that can cause severe infections in hospitalized patients. The rise of vancomycin-resistant enterococci (VRE) and vancomycin-variable enterococci (VVE) poses significant challenges in healthcare settings due to their resistance to multiple [...] Read more.
Background/Objectives: Enterococci, particularly Enterococcus faecalis and Enterococcus faecium, are Gram-positive cocci that can cause severe infections in hospitalized patients. The rise of vancomycin-resistant enterococci (VRE) and vancomycin-variable enterococci (VVE) poses significant challenges in healthcare settings due to their resistance to multiple antibiotics. Methods: We conducted a point prevalence survey (PPS) to assess the prevalence of VRE and VVE colonization in hospitalized patients. Rectal swabs were collected from 160 patients and analyzed using molecular assays (MAs) and culture. Whole-genome sequencing (WGS) and core-genome multilocus sequence typing (cgMLST) were performed to identify the genetic diversity. Results: Of the 160 rectal swabs collected, 54 (33.7%) tested positive for the vanA and/or vanB genes. Culture-based methods identified 47 positive samples (29.3%); of these, 44 isolates were identified as E. faecium and 3 as E. faecalis. Based on the resistance profiles, 35 isolates (74.5%) were classified as VRE, while 12 (25.5%) were classified as VVE. WGS and cgMLST analyses identified seven clusters of E. faecium, with sequence type (ST) 80 being the most prevalent. Various resistance genes and virulence factors were identified, and this study also highlighted intra- and inter-ward transmission of VRE strains. Conclusions: Our findings underscore the potential for virulence and resistance of both the VRE and VVE strains, and they highlight the importance of effective infection control measures to prevent their spread. VVE in particular should be carefully monitored as they often escape detection. Integrating molecular data with clinical information will hopefully enhance our ability to predict and prevent future VRE infections. Full article
(This article belongs to the Special Issue Hospital-Associated Infectious Diseases and Antibiotic Therapy)
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31 pages, 1755 KiB  
Article
Two-Stage Distributionally Robust Optimization for an Asymmetric Loss-Aversion Portfolio via Deep Learning
by Xin Zhang, Shancun Liu and Jingrui Pan
Symmetry 2025, 17(8), 1236; https://doi.org/10.3390/sym17081236 (registering DOI) - 4 Aug 2025
Abstract
In portfolio optimization, investors often overlook asymmetric preferences for gains and losses. We propose a distributionally robust two-stage portfolio optimization (DR-TSPO) model, which is suitable for scenarios where the loss reference point is adaptively updated based on prior decisions. For analytical convenience, we [...] Read more.
In portfolio optimization, investors often overlook asymmetric preferences for gains and losses. We propose a distributionally robust two-stage portfolio optimization (DR-TSPO) model, which is suitable for scenarios where the loss reference point is adaptively updated based on prior decisions. For analytical convenience, we further reformulate the DR-TSPO model as an equivalent second-order cone programming counterpart. Additionally, we develop a deep learning-based constraint correction algorithm (DL-CCA) trained directly on problem descriptions, which enhances computational efficiency for large-scale non-convex distributionally robust portfolio optimization. Our empirical results obtained using global market data demonstrate that during COVID-19, the DR-TSPO model outperformed traditional two-stage optimization in reducing conservatism and avoiding extreme losses. Full article
(This article belongs to the Section Computer)
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31 pages, 1583 KiB  
Article
Ensuring Zero Trust in GDPR-Compliant Deep Federated Learning Architecture
by Zahra Abbas, Sunila Fatima Ahmad, Adeel Anjum, Madiha Haider Syed, Saif Ur Rehman Malik and Semeen Rehman
Computers 2025, 14(8), 317; https://doi.org/10.3390/computers14080317 (registering DOI) - 4 Aug 2025
Abstract
Deep Federated Learning (DFL) revolutionizes machine learning (ML) by enabling collaborative model training across diverse, decentralized data sources without direct data sharing, emphasizing user privacy and data sovereignty. Despite its potential, DFL’s application in sensitive sectors is hindered by challenges in meeting rigorous [...] Read more.
Deep Federated Learning (DFL) revolutionizes machine learning (ML) by enabling collaborative model training across diverse, decentralized data sources without direct data sharing, emphasizing user privacy and data sovereignty. Despite its potential, DFL’s application in sensitive sectors is hindered by challenges in meeting rigorous standards like the GDPR, with traditional setups struggling to ensure compliance and maintain trust. Addressing these issues, our research introduces an innovative Zero Trust-based DFL architecture designed for GDPR compliant systems, integrating advanced security and privacy mechanisms to ensure safe and transparent cross-node data processing. Our base paper proposed the basic GDPR-Compliant DFL Architecture. Now we validate the previously proposed architecture by formally verifying it using High-Level Petri Nets (HLPNs). This Zero Trust-based framework facilitates secure, decentralized model training without direct data sharing. Furthermore, we have also implemented a case study using the MNIST and CIFAR-10 datasets to evaluate the existing approach with the proposed Zero Trust-based DFL methodology. Our experiments confirmed its effectiveness in enhancing trust, complying with GDPR, and promoting DFL adoption in privacy-sensitive areas, achieving secure, ethical Artificial Intelligence (AI) with transparent and efficient data processing. Full article
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19 pages, 14190 KiB  
Article
A Comprehensive Evaluation Method for Cement Slurry Systems to Enhance Zonal Isolation: A Case Study in Shale Oil Well Cementing
by Xiaoqing Zheng, Weitao Song, Xiutian Yang, Jian Liu, Tao Jiang, Xuning Wu and Xin Liu
Energies 2025, 18(15), 4138; https://doi.org/10.3390/en18154138 (registering DOI) - 4 Aug 2025
Abstract
Due to post-cementing hydraulic fracturing and other operational stresses, inadequate mechanical properties or suboptimal design of the cement sheath can lead to tensile failure and microcrack development, compromising both hydrocarbon recovery and well integrity. In this study, three field-deployed cement slurry systems were [...] Read more.
Due to post-cementing hydraulic fracturing and other operational stresses, inadequate mechanical properties or suboptimal design of the cement sheath can lead to tensile failure and microcrack development, compromising both hydrocarbon recovery and well integrity. In this study, three field-deployed cement slurry systems were compared on the basis of their basic mechanical properties such as compressive and tensile strength. Laboratory-scale physical simulations of hydraulic fracturing during shale oil production were conducted, using dynamic permeability as a quantitative indicator of integrity loss. The experimental results show that evaluating only basic mechanical properties is insufficient for cement slurry system design. A more comprehensive mechanical assessment is re-quired. Incorporation of an expansive agent into the cement slurry system can alleviate the damage caused by the microannulus to the interfacial sealing performance of the cement sheath, while adding a toughening agent can alleviate the damage caused by tensile cracks to the sealing performance of the cement sheath matrix. Through this research, a microexpansive and toughened cement slurry system, modified with both expansive and toughening agents, was optimized. The expansive agent and toughening agent can significantly enhance the shear strength, the flexural strength, and the interfacial hydraulic isolation strength of cement stone. Moreover, the expansion agents mitigate the detrimental effects of microannulus generation on the interfacial sealing, while the toughening agents alleviate the damage caused by tensile cracking to the bulk sealing performance of the cement sheath matrix. This system has been successfully implemented in over 100 wells in the GL block of Daqing Oilfield. Field application results show that the proportion of high-quality well sections in the horizontal section reached 88.63%, indicating the system’s high performance in enhancing zonal isolation and cementing quality. Full article
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21 pages, 3843 KiB  
Article
A Matrix Effect Calibration Method of Laser-Induced Breakdown Spectroscopy Based on Laser Ablation Morphology
by Hongliang Pei, Qingwen Fan, Yixiang Duan and Mingtao Zhang
Appl. Sci. 2025, 15(15), 8640; https://doi.org/10.3390/app15158640 (registering DOI) - 4 Aug 2025
Abstract
To improve the accuracy of three-dimensional (3D) reconstruction under microscopic conditions for laser-induced breakdown spectroscopy (LIBS), this study developed a novel visual platform by integrating an industrial CCD camera with a microscope. A customized microscale calibration target was designed to calibrate intrinsic and [...] Read more.
To improve the accuracy of three-dimensional (3D) reconstruction under microscopic conditions for laser-induced breakdown spectroscopy (LIBS), this study developed a novel visual platform by integrating an industrial CCD camera with a microscope. A customized microscale calibration target was designed to calibrate intrinsic and extrinsic camera parameters accurately. Based on the pinhole imaging model, disparity maps were obtained via pixel matching to reconstruct high-precision 3D ablation morphology. A mathematical model was established to analyze how key imaging parameters—baseline distance, focal length, and depth of field—affect reconstruction accuracy in micro-imaging environments. Focusing on trace element detection in WC-Co alloy samples, the reconstructed ablation craters enabled the precise calculation of ablation volumes and revealed their correlations with laser parameters (energy, wavelength, pulse duration) and the physical-chemical properties of the samples. Multivariate regression analysis was employed to investigate how ablation morphology and plasma evolution jointly influence LIBS quantification. A nonlinear calibration model was proposed, significantly suppressing matrix effects, achieving R2 = 0.987, and reducing RMSE to 0.1. This approach enhances micro-scale LIBS accuracy and provides a methodological reference for high-precision spectral analysis in environmental and materials applications. Full article
(This article belongs to the Special Issue Novel Laser-Based Spectroscopic Techniques and Applications)
29 pages, 431 KiB  
Article
Advanced Manifold–Metric Pairs
by Pierros Ntelis
Mathematics 2025, 13(15), 2510; https://doi.org/10.3390/math13152510 (registering DOI) - 4 Aug 2025
Abstract
This article presents a novel mathematical formalism for advanced manifold–metric pairs, enhancing the frameworks of geometry and topology. We construct various D-dimensional manifolds and their associated metric spaces using functional methods, with a focus on integrating concepts from mathematical physics, field theory, topology, [...] Read more.
This article presents a novel mathematical formalism for advanced manifold–metric pairs, enhancing the frameworks of geometry and topology. We construct various D-dimensional manifolds and their associated metric spaces using functional methods, with a focus on integrating concepts from mathematical physics, field theory, topology, algebra, probability, and statistics. Our methodology employs rigorous mathematical construction proofs and logical foundations to develop generalized manifold–metric pairs, including homogeneous and isotropic expanding manifolds, as well as probabilistic and entropic variants. Key results include the establishment of metrizability for topological manifolds via the Urysohn Metrization Theorem, the formulation of higher-rank tensor metrics, and the exploration of complex and quaternionic codomains with applications to cosmological models like the expanding spacetime. By combining spacetime generalized sets with information-theoretic and probabilistic approaches, we achieve a unified framework that advances the understanding of manifold–metric interactions and their physical implications. Full article
16 pages, 1847 KiB  
Article
Application of ANN in the Performance Evaluation of Composite Recycled Mortar
by Shichao Zhao, Yaohua Liu, Geng Xu, Hao Zhang, Feng Liu and Binglei Wang
Buildings 2025, 15(15), 2752; https://doi.org/10.3390/buildings15152752 (registering DOI) - 4 Aug 2025
Abstract
To promote the large-scale utilization of construction and industrial solid waste in engineering, this study focuses on developing accurate prediction and optimization methods for the unconfined compressive strength (UCS) of composite recycled mortar. Innovatively incorporating three types of recycled powder (RP)—recycled clay brick [...] Read more.
To promote the large-scale utilization of construction and industrial solid waste in engineering, this study focuses on developing accurate prediction and optimization methods for the unconfined compressive strength (UCS) of composite recycled mortar. Innovatively incorporating three types of recycled powder (RP)—recycled clay brick powder (RCBS), recycled concrete powder (RCBP), and recycled gypsum powder (RCGP)—we systematically investigated the effects of RP type, replacement rate, and curing period on mortar UCS. The core objective and novelty lie in establishing and comparing three artificial intelligence models for high-precision UCS prediction. Furthermore, leveraging GA-BP’s functional extremum optimization theory, we determined the optimal UCS alongside its corresponding mix proportion and curing scheme, with experimental validation of the solution reliability. Key findings include the following: (1) Increasing total RP content significantly reduces mortar UCS; the maximum UCS is achieved with a 1:1 blend ratio of RCBP:RCGP, while a 20% RCBS replacement rate and extended curing periods markedly enhance strength. (2) Among the prediction models, GA-BP demonstrates superior performance, significantly outperforming BP models with both single and double hidden layer. (3) The functional extremum optimization results exhibit high consistency with experimental validation, showing a relative error below 10%, confirming the method’s effectiveness and engineering applicability. Full article
(This article belongs to the Section Building Materials, and Repair & Renovation)
34 pages, 557 KiB  
Review
Future Pharmacotherapy for Bipolar Disorders: Emerging Trends and Personalized Approaches
by Giuseppe Marano, Francesco Maria Lisci, Gianluca Boggio, Ester Maria Marzo, Francesca Abate, Greta Sfratta, Gianandrea Traversi, Osvaldo Mazza, Roberto Pola, Gabriele Sani, Eleonora Gaetani and Marianna Mazza
Future Pharmacol. 2025, 5(3), 42; https://doi.org/10.3390/futurepharmacol5030042 (registering DOI) - 4 Aug 2025
Abstract
Background: Bipolar disorder (BD) is a chronic and disabling psychiatric condition characterized by recurring episodes of mania, hypomania, and depression. Despite the availability of mood stabilizers, antipsychotics, and antidepressants, long-term management remains challenging due to incomplete symptom control, adverse effects, and high relapse [...] Read more.
Background: Bipolar disorder (BD) is a chronic and disabling psychiatric condition characterized by recurring episodes of mania, hypomania, and depression. Despite the availability of mood stabilizers, antipsychotics, and antidepressants, long-term management remains challenging due to incomplete symptom control, adverse effects, and high relapse rates. Methods: This paper is a narrative review aimed at synthesizing emerging trends and future directions in the pharmacological treatment of BD. Results: Future pharmacotherapy for BD is likely to shift toward precision medicine, leveraging advances in genetics, biomarkers, and neuroimaging to guide personalized treatment strategies. Novel drug development will also target previously underexplored mechanisms, such as inflammation, mitochondrial dysfunction, circadian rhythm disturbances, and glutamatergic dysregulation. Physiological endophenotypes, such as immune-metabolic profiles, circadian rhythms, and stress reactivity, are emerging as promising translational tools for tailoring treatment and reducing associated somatic comorbidity and mortality. Recognition of the heterogeneous longitudinal trajectories of BD, including chronic mixed states, long depressive episodes, or intermittent manic phases, has underscored the value of clinical staging models to inform both pharmacological strategies and biomarker research. Disrupted circadian rhythms and associated chronotypes further support the development of individualized chronotherapeutic interventions. Emerging chronotherapeutic approaches based on individual biological rhythms, along with innovative monitoring strategies such as saliva-based lithium sensors, are reshaping the future landscape. Anti-inflammatory agents, neurosteroids, and compounds modulating oxidative stress are emerging as promising candidates. Additionally, medications targeting specific biological pathways implicated in bipolar pathophysiology, such as N-methyl-D-aspartate (NMDA) receptor modulators, phosphodiesterase inhibitors, and neuropeptides, are under investigation. Conclusions: Advances in pharmacogenomics will enable clinicians to predict individual responses and tolerability, minimizing trial-and-error prescribing. The future landscape may also incorporate digital therapeutics, combining pharmacotherapy with remote monitoring and data-driven adjustments. Ultimately, integrating innovative drug therapies with personalized approaches has the potential to enhance efficacy, reduce adverse effects, and improve long-term outcomes for individuals with bipolar disorder, ushering in a new era of precision psychiatry. Full article
11 pages, 379 KiB  
Article
Preoperative Suffering of Patients with Central Neuropathic Pain and Their Expectations Prior to Motor Cortex Stimulation: A Qualitative Study
by Erkan Kurt, Richard Witkam, Robert van Dongen, Kris Vissers, Yvonne Engels and Dylan Henssen
Healthcare 2025, 13(15), 1900; https://doi.org/10.3390/healthcare13151900 (registering DOI) - 4 Aug 2025
Abstract
Objective: This study aimed to improve the understanding of the lives of patients with chronic neuropathic pain planned for invasive motor cortex stimulation (iMCS) and assess their expectations towards this intervention and its impact. Methods: Semi-structured face-to-face interviews were conducted until [...] Read more.
Objective: This study aimed to improve the understanding of the lives of patients with chronic neuropathic pain planned for invasive motor cortex stimulation (iMCS) and assess their expectations towards this intervention and its impact. Methods: Semi-structured face-to-face interviews were conducted until saturation of data was reached. Patients were recruited from one university medical center in the Netherlands. All interviews were audio-recorded, transcribed verbatim, and subjected to thematic analysis using iterative and inductive coding by two researchers independently. Results: Fifteen patients were included (11 females; mean age 63 ± 9.4 yrs). Analysis of the coded interviews revealed seven themes: (1) the consequences of living with chronic neuropathic pain; (2) loss of autonomy and performing usual activities; (3) balancing energy and mood; (4) intimacy; (5) feeling understood and accepted; (6) meaning of life; and (7) the expectations of iMCS treatment. Conclusions: This is the first qualitative study that describes the suffering of patients with chronic neuropathic pain, and their expectations prior to invasive brain stimulation. Significant themes in the lives of patients with chronic pain have been brought to light. The findings strengthen communication between physicians, caregivers, and patients. Practice Implications: The insights gathered from the interviews create a structured framework for comprehending the values and expectations of patients living with central pain and reveal the impact of symptoms due to the central pain. This knowledge improves the communication between physicians and caregivers on one side and the patient on the other side. Furthermore, the framework enhances the capacity for shared decision-making, particularly in managing expectations related to iMCS. Full article
(This article belongs to the Special Issue Pain Management Practice and Research)
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