Search Results (3,941)

Background/Objectives: The emergence of biologic therapies has transformed the management of severe asthma, offering targeted treatments that improve symptom control and reduce exacerbations. However, taking a biologic solely based on the initial response may not be optimal. Clinicians must regularly reassess the suitability of the selected biologic, considering evolving patient characteristics and the growing availability of treatment options. This article aims to highlight the importance of individualized decision making in the long-term management of pediatric patients receiving biologic therapy, exploring the various reasons that may justify switching biologic treatment. Methods: We present a case to illustrate this approach: a 14-year-old adolescent girl with severe allergic asthma who initially received Omalizumab, achieving clinical, laboratory, and functional improvements. Despite this positive response, the patient reported low-level satisfaction due to the frequency of injections and hospital visits, leading to poor adherence. After a comprehensive reassessment, the treatment was switched to Tezepelumab. Results: Following the switch, the patient maintained stable disease control with a slight improvement in lung function, while adherence, satisfaction, and quality of life improved significantly. The number of hospital visits was reduced from 24 to 12 per year, and the number of injections decreased from 104 to 12 annually. The patient reported high-level satisfaction with the new treatment plan, and the economic burden of therapy was also substantially reduced. We present a table summarizing the essential and secondary factors to consider when initiating or switching biologic therapy. Conclusions: This case highlights the need to go beyond the traditional criteria, such as lack of efficacy and adverse reactions, when evaluating a switch in biologic therapy for pediatric asthma. Factors such as comorbidities, injection frequency and number, route of administration, and cost should also be considered, as they can directly influence adherence and the clinical outcomes in children and adolescents. As the therapeutic options expand, regular reassessment and personalized adjustments remain essential. Full article

Background: In healthcare education, understanding and managing cognitive load is crucial for enhancing learning outcomes for students, healthcare professionals, patients, and the general public. Despite numerous studies developing cognitive load classification models, there is a lack of comprehensive guidelines on how to effectively utilize these models in healthcare education. This study reviews cognitive load classification models using physiological data to provide insights and guidelines for their development in healthcare contexts. Methods: A scoping review was conducted on studies published between 2015 and 2024, identified through databases including Scopus, Web of Science, PubMed, EMBASE, and PsycINFO. The search terms included “cognitive load,” “physiology,” “data,” and “classification.” Inclusion criteria were peer-reviewed journal articles in English, focused on the healthcare context, utilizing experimental physiological data, and developing classification models. After screening 351 articles, ten studies met the inclusion criteria and were analyzed in detail. Results: Task design predominantly focused on measuring intrinsic cognitive load by adjusting task difficulty. Data collection mainly utilized EEG (electroencephalogram) and body movement data. SVM (support vector machine) algorithms were the most frequently used for model development, with cross-validation and feature selection employed to prevent overfitting. This study derived the importance of clearly defining cognitive load types, designing appropriate tasks, establishing reliable ground truths with multiple indicators, and selecting contextually relevant data. Conclusions: This study provides a comprehensive analysis of cognitive load classification models using physiological data in healthcare education, offering valuable guidelines for their development. Despite the study’s limitations, including a small number of analyzed papers and limited diversity in educational contexts, it offers critical insights for using and developing cognitive load classification in healthcare education. Future research should explore the applicability of these models across diverse educational settings and populations, aiming to enhance the effectiveness of healthcare education and ultimately improve learning and healthcare outcomes. Full article

Background/Objectives: Gastric, oesophageal, and pancreatic cancers are common worldwide, with low but improving survival rates due to advances in curative treatments. However, these treatments often cause long-term nutrition impact symptoms that are frequently overlooked, leading to malnutrition and poorer health outcomes. This review explored the types of nutrition impact symptoms following curative-intent treatment for upper gastrointestinal (UGI) cancers and assessed their impact on nutrition status. Methods: A systematic search of four electronic databases identified studies involving adults treated with curative intent for UGI cancers. Included studies reported both nutrition impact symptoms and nutrition outcomes using validated tools. Study quality was assessed, and results were synthesised narratively. Results: Eleven studies (n = 953 participants), predominantly from the Asia–Pacific region, met the inclusion criteria. Participants were mostly male (68%), with surgery as the primary treatment (91%). Most studies (n = 10) used validated assessment tools to identify nutrition impact symptoms. Reflux was the most commonly reported symptom (n = eight studies), followed by abdominal pain and diarrhoea. Nutrition status was assessed using various validated tools: Patient-Generated Subjective Global Assessment (n = six studies, 55%), Mini Nutritional Assessment (n = two studies, 18%), and Global Leadership Initiative on Malnutrition as well as Subjective Global Assessment and Prognostic Nutritional Index (both n = one study, 9%). Malnutrition prevalence was up to 87% one year post-treatment. Conclusions: Nutrition impact symptoms are common and persistent after curative-intent treatment for UGI cancers. Future research should incorporate validated assessment tools and extend follow-up beyond 12 months. Integrating long-term, tailored dietetic support to identify and manage symptoms post-treatment is vital to improve outcomes for patients. Full article

Background: Big data capability is a core strategic asset for enterprises, but existing studies on its relationship with enterprise value creation are fragmented, with inconsistent effect magnitudes and boundary conditions. This meta-analysis synthesized empirical evidence to clarify their overall relationship and the moderating roles of antecedent, mediating, and outcome variables. Methods: A systematic search (ending July 2025) across seven databases (CNKI, Web of Science, etc.) identified thirty-three empirical studies meeting criteria (clear sample size, correlation coefficients). Following PRISMA 2020 and OSF registration, two researchers extracted data independently. CMA 3.0 was used with a random effects model; effect sizes (Pearson’s r), heterogeneity (Q, I²), and publication bias (funnel plots, Egger’s test) were analyzed. Results: Involving 14,993 samples, big data capability showed a moderately significant positive correlation with enterprise outcomes (r = 0.486, 95% CI: 0.408–0.557, p < 0.001) with high heterogeneity (I² = 93.502). Subgroup analyses revealed: learning orientation (r = 0.883) as the strongest antecedent; organizational agility (r = 0.631) and innovation (r = 0.595) as significant mediators (resource integration not significant); enterprise innovation performance (r = 0.730) as the top outcome. No publication bias was found (Egger’s p = 0.284). Conclusions: Big data capability positively impacts enterprises, with learning orientation and innovation performance as key moderators. Enterprises should prioritize a learning culture and leverage organizational agility. Future research needs diverse samples and longitudinal designs to explore causality. Full article

Retained products of conception (RPOC) represent a significant cause of morbidity in the post-abortive and postpartum periods, potentially leading to abnormal uterine bleeding, pelvic pain, infections, and intrauterine adhesions. Accurate diagnosis is crucial to avoid unnecessary surgical interventions and to preserve future fertility. Transvaginal ultrasound constitutes the primary imaging modality for identifying RPOC, but the lack of standardized diagnostic criteria complicates clinical decision-making. This narrative review explores the current literature on sonographic findings associated with RPOC, focusing on the diagnostic value of endometrial thickness (ET), the presence of intrauterine echogenic masses, and the use of Color Doppler imaging. Although an ET ≥15 mm is frequently used to suspect RPOC, the variability in cut-off thresholds and limited specificity reduce its diagnostic reliability. The detection of an echogenic intrauterine mass appears to be the most sensitive and specific sonographic feature. Color Doppler assessment, particularly the presence of enhanced myometrial vascularity (EMV) and classification systems like the Gutenberg score, offers further insight by stratifying hemorrhagic risk and guiding therapeutic choices. However, vascular parameters such as peak systolic velocity (PSV) and resistive index (RI) demonstrate a substantial overlap between benign and pathological conditions, limiting their stand-alone utility. The review also addresses the differential diagnosis of RPOC, including blood clots, arteriovenous malformations, placental polyps, gestational trophoblastic disease, and endometrial osseous metaplasia. The role of three-dimensional ultrasound remains limited in clinical practice, offering no significant advantage over two-dimensional imaging. Finally, the timing of follow-up ultrasound after medical treatment with misoprostol is critical: delayed assessment reduces overtreatment by allowing time for spontaneous resolution. In conclusion, despite advances in ultrasound technology, the diagnosis of RPOC remains challenging due to heterogeneity in imaging findings and inter-observer variability. A multimodal approach integrating grayscale and Doppler ultrasound with clinical evaluation is essential for optimal management. Full article

Rationale: Burn injuries to the face can have devastating consequences functionally and cosmetically for individuals and can result in increased depressive symptoms and low self-esteem. Burn injuries have the potential to cause contracture of the skin, especially on the face due to multiple concave surfaces, possibly causing facial deformity. These functional and cosmetic implications can interrupt activities of daily living. Although there is consensus in the literature that early interventions contribute to improved outcomes for eyelid ectropion, there is currently limited consensus regarding the techniques used in the management of eyelid ectropion post burn injuries. Objectives: The aim of this scoping review was to explore the evidence in the literature to identify surgical and non-surgical techniques to manage and prevent eyelid ectropion post burn. Method: Five databases (PubMed, CINAHL, Embase, Cochrane, and Scopus) were searched for articles published between January 2014 and August 2024. Two reviewers completed the search. Each article was screened independently by each reviewer against the inclusion and exclusion criteria. Where disagreement arose, a third reviewer was consulted for resolution. Results: n = 56 articles were sources in the initial search. Post screening, n = 20 met the criteria for full review; n = 14 were included in the final review. All studies reported on surgical techniques used to manage eyelid ectropion post burn, and only one study reported on non-surgical techniques. All studies were observational in design. Conclusions: There is a paucity of research addressing the surgical and non-surgical techniques for the management and prevention of eyelid ectropion following burns in the adult population. The existing literature primarily consists of case studies and case series, which limits the robustness of the evidence base for the effective management of this condition post burn. Full article

Patients with First-Episode Psychosis (FEP) exhibit variable responses to antipsychotic treatment. Emerging evidence suggests that disease-related dysbiosis of gut and oropharyngeal microbiota may lead to the abnormal translocation of microorganisms via the bloodstream. This study aims to explore the blood microbiome to identify candidate biomarkers associated with treatment outcomes in FEP. To address this, blood samples were collected from twenty drug-naïve individuals with FEP, both before and after four weeks of antipsychotic medication. DNA extracted from these samples underwent 16S rRNA gene sequencing and comprehensive bioinformatics analysis. Clinical assessments were based on the Positive and Negative Syndrome Scale and standard remission criteria. Peripheral cytokines (IL1β, TNF-α, IL10) were quantified by immunoassays. Baseline comparisons showed a significantly greater microbiome alpha diversity in remitters, along with differential prevalence in five taxa and 217 metabolic pathways. Post-treatment assessments uncovered a significantly distinct impact of antipsychotics on blood bacterial composition between remission groups, while initial differences on metabolic profiles persisted. Additionally, strong correlations were observed, linking specific taxa abundances to cytokine levels. Conclusively, this pilot study suggests that blood microbiome profiling could provide novel biomarkers for predicting therapeutic response in early psychosis, paving the way for precision medicine interventions. Full article

Background: Central venous catheters (CVCs) are essential in intensive care units (ICUs) for monitoring and administering treatments; however, catheter-related bloodstream infections (CRBSIs) are significant complications, leading to severe outcomes and increased healthcare costs. The objective of this study was to evaluate the effectiveness of a simple and inexpensive impregnated dressing (intervention) compared to a non-impregnated dressing in reducing catheter-related infections among critically ill patients using vancomycin and chlorhexidine. Methods: This was a randomized, double-blind, controlled clinical trial in a university hospital in Brazil with 207 beds from June 2022 to October 2023. Patients over 18 years old admitted to the ICU and needing a CVC for a period exceeding 72 h were included. A CVC inserted outside the ICU and the need for two CVCs in the same patient simultaneously were exclusion criteria. One group received an impregnated dressing (intervention) compared to the other group, which received a standard dressing (comparator). The incidence of CRBSIs and the microbiological outcomes were evaluated. The primary endpoint was CRBSI. Results: The clinical trial included 516 patients randomized to receive either the new antimicrobial dressing or a control dressing. The dressing significantly reduced CVC colonization but not CRBSI rates. Conclusions: This new dressing provides enhanced antimicrobial protection but does not decrease CRBSI incidence. Future studies should further explore the cost-effectiveness and long-term benefits of this approach. Full article

Facing challenges of low efficiency and severe wear in deep hard formations with conventional drilling bits, this study investigates the synergistic rock-breaking technology combining a pulsed CO₂ laser with mechanical bits. The background highlights the need for novel methods to enhance drilling speed in high-strength, abrasive strata where traditional bits struggle. The theoretical analysis explores the thermo-mechanical coupling mechanism, where pulsed laser irradiation rapidly heats the rock surface, inducing thermal stress cracks, micro-spallation, and strength reduction through mechanisms like mineral thermal expansion mismatch and pore fluid vaporization. This pre-damage layer facilitates subsequent mechanical fragmentation. The research employs finite element numerical simulations (using COMSOL Multiphysics with an HJC constitutive model and damage evolution criteria) to model the coupled laser–mechanical–rock interaction, capturing temperature fields, stress distribution, crack propagation, and assessing efficiency. The results demonstrate that laser pre-conditioning significantly achieves 90–120% higher penetration rates compared to mechanical-only drilling. The dominant spallation mechanism proves energy-efficient. Conclusions affirm the feasibility and significant potential of CO₂ laser-assisted drilling for deep formations, contingent on optimized laser parameters, composite bit design (incorporating laser transmission, multi-head layout, and environmental protection), and addressing challenges, like high in-situ stress and drilling fluid interference through techniques like gas drilling. Future work should focus on high-power laser downhole transmission, adaptive control, and rigorous field validation. Full article

Background: Dentistry is undergoing a digital transformation driven by emerging technologies such as Artificial Intelligence (AI), Internet of Things (IoT), Digital Twins (DTs), and Large Language Models (LLMs). These advancements offer new paradigms in clinical diagnostics, patient monitoring, treatment planning, and medical education. However, integrating these technologies also raises critical questions around security, privacy, ethics, and trust. Objective: This review aims to provide a structured synthesis of the recent literature exploring AI, IoT, DTs, and LLMs in dentistry, with a specific focus on their application domains and the associated ethical, privacy, and security concerns. Methods: A comprehensive literature search was conducted across PubMed, IEEE Xplore, and SpringerLink using a custom Boolean query string targeting publications from 2020 to 2025. Articles were screened based on defined inclusion and exclusion criteria. In total, 146 peer-reviewed articles and 18 technology platforms were selected. Each article was critically evaluated and categorized by technology domain, application type, evaluation metrics, and ethical considerations. Results: AI-based diagnostic systems and LLM-driven patient support tools were the most prominent technologies, primarily applied in image analysis, decision-making, and health communication. While numerous studies reported high performance, significant methodological gaps exist in evaluation design, sample size, and real-world validation. Ethical and privacy concerns were mentioned frequently, but were substantively addressed in only a few works. Notably, IoT and Digital Twin implementations remained largely conceptual or in pilot stages, highlighting a technology gap in dental deployment. Conclusions: The review identifies significant potential for converged intelligent dental systems but also reveals gaps in integration, security, ethical frameworks, and clinical validation. Future work must prioritize cross-disciplinary development, transparency, and regulatory alignment to realize responsible and patient-centered digital transformation in dentistry. Full article

Background: As global populations age, the demand for effective and compassionate geriatric care has intensified. Humanized nursing emphasizes empathy and person-centered care, while community-based nursing builds on local resources and networks to support health and well-being. Together, these approaches offer promising strategies for improving care for older adults. This integrative review explores the evolution, clinical contributions, and implementation barriers of these models. Methods: A comprehensive literature search was performed using PubMed, CINAHL, Scopus, and Web of Science, targeting peer-reviewed studies, including qualitative and quantitative studies published between 2010 and 2025, that involved adults aged 60 years and older. Inclusion criteria emphasized humanized and community-based nursing interventions while excluding non-nursing and pediatric-focused studies. Quality appraisal was performed using CASP and JBI checklists, and data were thematically synthesized. Results: Evidence indicates that these care models significantly improve functional independence and psychosocial well-being and reduce hospital readmissions. For instance, community-based care in Taiwan improved activities of daily living in dementia patients by 15%, while U.S.-based programs reduced depressive symptoms by 30% among Latino older adults. Interdisciplinary, nurse-led interventions in South Korea and Puerto Rico showed a 22% reduction in readmissions and an 85% increase in care access. Despite these benefits, numerous barriers hinder widespread implementation, including workforce shortages, inadequate funding, fragmented healthcare systems, cultural resistance, digital literacy challenges, and policy constraints, particularly in low-resource settings such as the Philippines and Nepal. Conclusions: These findings underscore the transformative potential of humanized and community-based nursing while highlighting the need for targeted strategies such as task-shifting, inclusive technologies, and policy reform to advance equitable, sustainable geriatric care globally. Full article

Background/Objectives: Lucid dreaming (LD), during which the dreamer becomes aware of the dream state, offers a unique opportunity for a variety of applications, including motor practice, personal well-being, and nightmare therapy. However, these applications largely depend on the dreamer’s ability to control their dreams. While LD research has traditionally focused on induction techniques to increase dream frequency, the equally important skill of dream control remains largely underexplored. This study provides an exploration into the mechanisms of LD motor practice, dream control, and its potential influencing factors. We specifically examined whether a complex motor skill—juggling—could be performed during LD, calling for relatively high levels of dream control and access to procedural memory. Methods: Four healthy participants underwent overnight polysomnography (PSG), provided detailed dream reports, and completed questionnaires assessing dream control and self-efficacy. Dream-task success was assessed using predefined in-dream motor performance criteria. Differences between high and low LD control participants were examined, and two detailed case reports of lucid dream juggling attempts provide insight into the challenges of executing complex motor tasks during LD. Results: Dream control varied between and within participants. Both dream control and self-efficacy seemed to predict participants’ ability to execute the LD motor task. Conclusions: Despite the low sample size, this study highlights the potential roles of individual traits like self-efficacy in shaping dream control abilities and motor performance during LD. By using empirical, task-based measures, this study helps build the foundation for future research aimed at optimizing LD applications in clinical and non-clinical fields. Full article

The centre of origin of Bambara groundnut (BGN; Vigna subterranea L.) is Western Sub-Saharan Africa. Due to its high nutritional value and tolerance to biotic and abiotic stresses, this neglected and underutilised species has recently gained significant attention. However, BGN production faces several challenges, including a lack of quality varieties. This study describes a selected core collection based on phenotypic traits, investigates relevant selection criteria and identifies a set of landraces according to participants’ preferences. A core collection of landraces was generated, described, and then subjected to participatory varietal selection. Through individual semi-structured interviews, key selection criteria were identified. Focus group discussions were organised to explore group criteria and to support and validate information from personal interviews. The varietal selection involved choosing three landraces per participant. The results highlighted that seed colour, seed size, cultural value, market value, seed taste, storage, and seed cooking duration were the main selection criteria; however, specific trait preferences varied by gender and participants. Two of 14 selected BGN landraces were considered by the panel of evaluators to be most suitable for recommendation to growers and breeders. They can be disseminated in BGN production regions and used for plant breeding. Full article

Background/Objectives: The adolescent and youth phase is characterized by rapid physical, cognitive, and psychosocial development during which adolescents encounter numerous challenges. These challenges include experiences of sexual violence, sexually transmitted diseases, mental health issues, poverty, lack of education, social discrimination, and high fertility rates. The Adolescent and Youth-Friendly Services (AYFS) program in South Africa aims to enhance young people’s access to sexual and reproductive health services (SRHS). This study explores the healthcare providers’ (HCPs’) experiences in implementing the AYFS within public health facilities in eThekwini, KwaZulu-Natal. Methods: This exploratory, descriptive qualitative study employed individual in-depth interviews to gather data from eight HCPs. The target population consisted of HCPs working in the public health facilities that offer AYFS. A purposive sampling technique was utilized to select HCPs who met the inclusion criteria. Thematic analysis was conducted following the steps outlined by Braun and Clarke. Results: The participants consisted of black females and one male, aged 34 to 50, with 1 to 14 years of experience. The four main themes emerged from the study: appropriate service provision, HCPs’ competency, accessibility of AYFS, and adherence to the principles of beneficence and non-maleficence. Overall, HCPs reported a positive experience in implementing AYFS. Conclusions: The findings indicated that AYFS was delivered as a comprehensive package addressing the needs of adolescents; however, there is a pressing need to enhance demand-creation initiatives in schools and communities to raise awareness and promote service utilization among this vulnerable population. The implications of these findings are to ensure thorough implementation and utilization of AYFS in the country. Full article

Hibiscus sabdariffa (H. sabdariffa) is a high-value economic and functional crop, limited by agroclimatic conditions and low technological adoption. This systematic review examines the current state of artificial intelligence applications in agricultural management, analyzing 2111 records, selecting 82, and synthesizing 22 studies that meet the inclusion criteria. This review adopts a holistic framework aligned with three priority areas in agriculture—resource and climate management, crop productivity and quality, and sustainability—to explore how AI addresses key challenges in the cultivation and post-harvest processing of Hibiscus sabdariffa. The results show a predominance of classical machine learning techniques, with limited implementation of deep learning models. The most common applications include image classification, yield prediction, and analysis of bioactive compounds. However, limitations remain in the availability of open data, reproducible code, and standardized metrics. The narrative synthesis identified clear opportunities to integrate emerging technologies, such as deep neural networks and the Internet of Things (IoT), particularly in water management and stress monitoring. The review concludes that strengthening interdisciplinary research and promoting data openness is key to achieving a more resilient, sustainable, and technologically advanced crop. Full article