Search Results (165)

Background: Poor mental health is a major contributor to absenteeism and turnover among nurses. Psychological flexibility may act as a protective factor for work-related well-being. This early-phase feasibility study explored the delivery of an online adaptation of Acceptance and Commitment Therapy (ACT) training for UK nursing professionals. Methods: A self-guided, 4-week online adaptation of an ACT training course was delivered via Moodle. Measures of professional quality of life, work engagement, and work-related psychological flexibility were collected at baseline and post-intervention (6 weeks). Feasibility outcomes included recruitment, retention, intervention adherence, and user engagement, assessed through platform usage statistics and user experience feedback. Results: A total of 43 participants enrolled in this single-group pre–post feasibility study. Recruitment targets were met, and completion of baseline measures was high. Engagement with course content was acceptable for an early-stage digital intervention. Among the well-being outcomes, work engagement showed the clearest indication of potential measure responsiveness. Retention was acceptable for the post-intervention survey but low for the usability survey and follow-up interview, limiting further exploration of engagement drivers. Conclusions: This study supports the feasibility of delivering online ACT training to nursing professionals. Key areas for refinement were identified, including closer integration with existing workplace communication and professional development systems, ongoing stakeholder involvement across study phases, and workplace-embedded engagement mechanisms to improve retention. Future research should further explore how workplace context influences intervention acceptability in larger feasibility trials. Full article

The development of control strategies for autonomous vehicles requires a reliable and cost-effective validation approach. In this context, testbeds enabling repeatable experiments under controlled conditions are gaining relevance. Scaled vehicles have proven to be a valuable alternative to full-scale or simulation-based testing, enabling experimental validation while reducing costs and risks. This work presents a 1:5 scale modular vehicle platform, derived from a commercial Radio-Controlled (RC) vehicle and adapted as experimental testbed for control strategy validation and vehicle dynamics studies. The vehicle features an electric powertrain, operated through a Speedgoat Baseline Real-Time Target Machine (SBRTM). The hardware architecture includes a high-performance Inertial Measurement Unit (IMU) with embedded Global Navigation Satellite System (GNSS). An Extended Kalman Filter (EKF) is implemented to enhance positioning accuracy by fusing inertial and GNSS data, providing reliable estimates of the vehicle position, velocity, and orientation. Two path-following algorithms, i.e., Stanley Controller (SC) and the Linear Quadratic Regulator (LQR), are designed and integrated. Outdoor experimental tests enable the evaluation of tracking accuracy and robustness. The results demonstrate that the proposed scaled testbed constitutes a reliable and flexible platform for benchmarking autonomous vehicle controllers and enabling experimental testing. Full article

Life-history plasticity allows fishes to exploit heterogeneous freshwater networks, and proactive habitat selection enhances their capacity to cope with climatic and human-induced stressors. Coilia brachygnathus, long regarded as a freshwater resident, nevertheless has a poorly understood habitat use and selection. We reconstructed habitat use of C. brachygnathus across the middle-lower Yangtze by coupling water ⁸⁷Sr/⁸⁶Sr baselines with otolith ⁸⁷Sr/⁸⁶Sr transects. We used 60 water samples, compiled published datasets, and measured additional water samples from the mainstem, major tributaries, and connected lakes. In situ ⁸⁷Sr/⁸⁶Sr profiles were smoothed with generalized additive models, revealing significant within-profile variation for all fish. Two modes emerged: (i) residents, whose otolith values remained within local water ranges, consistent with limited movement; and (ii) migrants, whose profiles departed from local baselines, indicating exchanges among lakes, tributaries, and the mainstem. Several fish captured at Anqing and Zhenjiang possess Poyang-like core signatures that declined to mainstem values, while bidirectional shifts were common in the Dongting-Xiang system. These results overturn the residency paradigm, demonstrate flexible partial migration, and indicate proactive habitat selection in the face of environmental change, thereby supporting management that maintains river–lake connectivity and quantifies lake contributions to mainstem stocks. Full article

Dynamic errors in robotic machining can degrade part quality, particularly in flexible platforms that are susceptible to both geometric and inertial disturbances. This work introduces a data-driven digital twin for pointwise prediction of circular trajectory errors in a hexapod-based machining cell, using a compact sensing configuration that combines ballbar measurements with tri-axial vibration signals. Deviations measured by ballbar, acceleration data, and CMM-measured profiles are synchronized in the angular domain via a unified pipeline for denoising, resampling, and phase alignment. Sliding-window vibration statistics and the ballbar path error are used as inputs to XGBoost, multilayer perceptron, and random forest regressors. Model performance is evaluated under a deployment-relevant leave-one-run-out protocol and a conventional random 70:30 point split. XGBoost achieves micrometer-level accuracy on unseen runs, with RMSE around 5 µm, R² exceeding 0.80, and near-complete coverage within a ±20 µm tolerance band. Compared to baseline models, it also provides improved suppression of extreme residuals. Feature importance and ablation studies show that the ballbar path error captures the dominant geometric component, while compact hybrid feature sets—combining this anchor with selected vibration descriptors—retain most of the predictive accuracy and enable practical offline batch-level compensation. Full article

Remote island regions often depend on isolated power grids dominated by small-scale thermal power plants. Decarbonizing these systems is challenging due to limited interconnection capacity and variable renewable output, highlighting the need for flexible resource balance. This study develops an optimization model that minimizes system costs and CO₂ emissions by integrating variable renewable energy and Vehicle-to-Grid (V2G) while considering the minimum-output constraints of thermal power generation. The model is applied to Tanegashima Island, Japan. The results demonstrate that all optimized scenarios reduced the cost and emissions compared with the baseline. In the cost-minimizing scenario, the total annual cost decreased from 2.81 to 2.46 billion yen, while CO₂ emissions decreased from 56.5 to 44.4 kt. In the CO₂-minimizing scenario, V2G further reduced emissions to 43.8 kt at a lower cost (2.54 billion yen) than the system without V2G. However, renewable curtailment remained high due to the minimum-output constraint of thermal generators. These findings confirm that while V2G is a cost-effective, distributed flexibility resource, it cannot fully eliminate renewable curtailment under current operational limits. Enhanced coordination, behavioral engagement, and complementary measures—such as relaxing thermal constraints and expanding storage—are required to unlock its full potential in isolated power systems. Full article

Objectives: Pilates is frequently recommended for patients with Chronic Nonspecific Low Back Pain (CNLBP) due to its potential to enhance posture, muscle strength, trunk flexibility, and stability. However, to date, there is no robust evidence supporting the effectiveness of Pilates in managing CNLBP. This study aimed to assess the effects of 8 × 8 Pilates Matwork core exercises on pain and functioning in middle-aged adult women with CNLBP, through a flexion relaxation phenomenon (FRP) analysis. Methods: We included middle adult women (n = 21) with diagnosis of CNLBP and a Numeric Rating Scale (NRS) > 4. The experimental group underwent a treatment of eight Pilates Matwork sessions, biweekly for 4 weeks, lasting about 40 min. The control group underwent standardized exercises used for managing CNLBP. Outcome measures included NRS, Oswestry Disability Index (ODI), Quebec Back Pain Disability Scale (QBPDS), and the FRP ratio via surface electromyography during trunk maximum flexion. We evaluated the participants at the baseline (T0), at the end of the 4-week treatment (T1), and at 4 weeks after the end of the treatment, at 8 weeks from the baseline (T2). Results: In this pilot RCT, 21 middle-aged adult women affected by CNLBP were randomly allocated with a ratio of 1:1 in the Pilates group, and in parallel in the control group. The experimental group showed a significant improvement in ODI and QBPDS scores compared to the control group, maintained at follow-up for ODI, along with an NRS reduction at T2. About FRP, Pilates has proven to be comparable to conventional treatment, showing no significant difference in FRR at T1 and T2. Only the experimental group exceeded the 9.5 cutoff at T2, as a protective predictive index for CNLBP. Conclusions: This pilot RCT provided preliminary evidence that Pilates might be an effective rehabilitation method, enhancing functioning and pain management in middle-aged adult women affected by CNLBP. The FRP study proves to be efficient in translating clinical assessments into rehabilitation assessment measures. Full article

Impairments of executive function following acquired brain injury including stroke (ABI) contribute significantly to long-lasting everyday difficulties in life. Pilot work on the CO-OP Approach^TM (Cognitive Orientation to daily Occupational Performance Approach), a contextualized strategy training intervention, with ABI adults with executive dysfunction showed improved performance on untrained everyday life tasks and cognitive flexibility. Objective: Our objective was to determine the efficacy of the CO-OP Approach relative to usual occupational therapy (UOT) for community-dwelling adult survivors of ABI with executive dysfunction. Methods: Eighty-seven participants were randomized to receive CO-OP (n = 45) or UOT (n = 42) in their homes. All participants identified five personally meaningful, everyday life goals (using the Canadian Occupational Performance Measure (COPM)) and received up to 15 one-hour treatment sessions twice per week. Three goals were trained, and two were untrained. Interventions were provided by occupational therapists registered with their regulatory college. The CO-OP group was trained to apply a meta-cognitive strategy to three goals. The UOT group received therapy based on the clinicians’ (experienced in community settings) determination. Testers were masked to the participants’ group. Analysis at the primary outcome (Post-test, ~10 weeks following baseline) was on an intent-to-treat basis. Results: Participants in the CO-OP group had a mean age of 57.5 years, a mean time post-ABI of 5.3 years, and were 57.8% men. Those in the usual OT group had a mean age of 54.7 years, a mean time post-ABI of 6.2 years, and were 69.0% men. The CO-OP group reported statistically significant higher improvements on COPM performance and satisfaction scores post-test for untrained and trained goals. However, these benefits were not retained at follow-up (three months post-baseline). Conclusions: The CO-OP Approach^TM shows promise for improving performance in everyday life goals for individuals with chronic ABI relative to usual community occupational therapy. Achieving retention of these benefits remains a challenge. Full article

Deep space navigation, defined as spacecraft position tracking beyond the lunar orbit, presents significant challenges due to the extremely weak Global Navigation Satellite System (GNSS) signals and severe signal attenuation over interplanetary distances. Traditional terrestrial systems, such as NASA’s Deep Space Network (DSN) and ESA’s ESTRACK, rely on Very Long Baseline Interferometry (VLBI) for angular positioning. However, these systems are limited by relatively short baselines, atmospheric distortions requiring extensive calibration, and reduced line-of-sight (LOS) availability due to Earth’s rotation. Because VLBI angle measurements require at least two simultaneously visible stations, the measurement duty cycle is inherently constrained. This research proposes a complementary deep space navigation approach using space-based interferometry, in which radio signals from the spacecraft are received and cross-correlated onboard Geostationary Earth Orbit (GEO) satellites. By replacing terrestrial VLBI stations with dual GEO platforms, the method significantly extends the effective baseline, removes atmospheric phase errors, and provides near-continuous visibility to deep space targets. Unlike Earth-based systems, GEO-based interferometry maintains persistent mutual visibility between stations, enabling higher measurement availability and more flexible mission support. A complete system model is presented, including the principles of dual-frequency phase-based angular tracking and a structured error budget analysis. Theoretical error analysis indicates that the GEO-based system achieves a total angular error better than 4 nanoradians—within the same order of magnitude as terrestrial VLBI. In particular, the space-based architecture nearly doubles the geometric availability for interferometric tracking while eliminating the need for atmospheric calibration. These results support the feasibility of the GEO-based VLBI concept and motivate continued research, including detailed simulations, hardware implementation, and field validation. Full article

Background: Scoliosis, a three-dimensional spinal deformity, can impair posture, function, and quality of life. Conservative approaches such as structured physical therapy are widely used, but evidence from long-term, real-world settings remains limited. In this study, “structured” refers to a standardized, supervised program delivered three times per week, incorporating postural correction, Klapp-based positioning, core strengthening, flexibility training, and progressive intensity adjustments rather than ad hoc or unsupervised exercise. Methods: In this 12-month longitudinal study, 240 patients aged 15–19 years with idiopathic scoliosis (Cobb angle 15–25°) were enrolled; 222 completed the program and were included in analyses. All participants were near or beyond skeletal maturity, representing a population with low residual risk of curve progression. Spinal alignment was assessed by Cobb angle at baseline, 6 months, and 12 months, with monthly clinical evaluations to track progress. Outcomes were analyzed by baseline severity, age, sex, and skeletal maturity (Risser stage) using paired-samples t-tests, repeated-measures ANOVA, subgroup analyses, and multivariable regression. Clinically meaningful improvement was defined as a ≥20% reduction in Cobb angle from baseline. Results: Mean Cobb angle decreased from 18.59° at baseline to 14.85° at 12 months (Δ = −3.74°, 20.3% relative reduction; p < 0.001). The largest improvement occurred in the first 6 months (−3.04°, p < 0.001), followed by a smaller gain between months 6 and 12 (−0.70°, p = 0.012). Patients with milder baseline curves improved more than those with greater deviations (4.45° vs. 3.21°, p < 0.001). Monthly clinical follow-ups suggested gradual improvement between radiographic assessments, though detailed statistical analyses were limited to baseline, 6 months, and 12 months. In multivariable regression, baseline severity remained the only significant predictor of improvement (p < 0.001), while age, sex, and Risser stage were not significant (all p > 0.05). Overall, 24.3% of participants achieved clinically meaningful improvement. Conclusions: A structured 12-month physical therapy program produced significant, sustained improvements in spinal alignment across diverse patient groups. Early intervention in milder curves maximized benefit. These findings support physiotherapy exercise programs as an effective conservative option for scoliosis management. Full article

We report combined scanning probe microscopy and electrical measurements to investigate local electronic transport in reduced graphene oxide (rGO) devices. We demonstrate that quantum transport in these materials can be significantly tuned by the electrostatic potential applied with a conducting atomic force microscope (AFM) tip. Scanning gate microscopy (SGM) reveals a clear p-type response in which local gating modulates the source–drain current, while scanning impedance microscopy (SIM) indicates corresponding shifts of the Fermi level under different gating conditions. The observed transport behavior arises from the combined effects of AFM tip-induced Fermi-level shifts and defect-mediated scattering. These results show that resonant scattering associated with impurities or structural defects plays a central role and highlight the strong influence of local electrostatic potentials on rGO conduction. Consistent with this electrostatic control, the device also exhibits chemical gating and sensing: during exposure to electron-withdrawing molecules (acetone), the source–drain current increases reversibly and returns to baseline upon purging with air. Repeated cycles over 15 min show reproducible amplitudes and recovery. Using a simple transport model, we estimate an increase of about $40\%$ in carrier density during exposure, consistent with p-type doping by electron-accepting analytes. These findings link nanoscale electrostatic control to macroscopic sensing performance, advancing the understanding of charge transport in rGO and underscoring its promise for nanoscale electronics, flexible chemical sensors, and tunable optoelectronic devices. Full article

Background/Objectives: Autism Spectrum Disorder (ASD) presents complex developmental challenges that require coordinated, individualized interventions. This study aimed to evaluate the effectiveness of a transdisciplinary, family-centered approach in improving clinical and functional outcomes in children and adolescents with ASD. Methods: A longitudinal study was conducted with 53 participants aged 2 to 16 years, all with confirmed ASD diagnoses. Assessments were performed at baseline, 6 months, and 12 months. Participants received personalized, evidence-based interventions provided by a multidisciplinary team working within a transdisciplinary model. Therapies were delivered individually and in groups, with flexible intervention phases tailored to each participant’s evolving needs. Outcomes were measured using the Clinical Global Impression (CGI), Global Assessment of Functioning (GAF), and the Aberrant Behavior Checklist (ABC). Results: Clinical and functional improvements were observed over the 12-month period. Most participants reached high functional levels by the end of the study. Caregivers reported notable reductions in support needs, while therapist ratings confirmed more moderate improvements. Decreases in behavioral challenges, sensory difficulties, and sleep disturbances were observed, alongside gains in adaptability and functional play. Greater family involvement was associated with more favorable outcomes. Conclusions: A transdisciplinary, family-centered intervention model was beneficial in supporting developmental progress in children and adolescents with ASD. The findings highlight the importance of flexible, team-based care and emphasize the critical role of family engagement in achieving positive long-term outcomes. Full article

Background: Phenylketonuria (PKU) is a rare autosomal recessive metabolic disorder caused by mutations in the phenylalanine hydroxylase (PAH) gene, leading to hyperphenylalaninemia (HPA). Untreated, elevated phenylalanine (Phe) levels cause severe neurocognitive, developmental, and psychiatric complications. Management relies on a Phe-restricted diet, which is challenging to maintain, particularly in adolescents and adults. Sapropterin dihydrochloride, a synthetic form of tetrahydrobiopterin (BH4), can enhance residual PAH activity, lowering blood Phe levels and increasing dietary tolerance in responsive patients. However, real-world alignment with best practices remains underexplored. This study aims to report a tertiary referral center’s experience with sapropterin treatment in PKU and assess adherence to international guidelines. Methods: We retrospectively analyzed 23 PKU patients treated with sapropterin from 2007 to 2025. Patients with baseline Phe levels of 360–2000 µmol/L underwent a 10 mg/kg/day loading test over two weeks. Responsiveness was defined as a ≥30% reduction in blood Phe levels. Phe levels were measured pre- and post-test, and dietary tolerance was evaluated. Adherence to best practices was critically reviewed. Results: All patients showed significant Phe reductions (mean 71.43%, p < 0.0001), exceeding responsiveness thresholds. Most achieved substantial increases in dietary Phe tolerance, with three patients partially responsive (800–1200 mg/day). Responsiveness was unrespectful of the patient’s genotype, for those individuals for whom this was known (8/23 patients). Although effective, the test dose and duration differed from guideline recommendations (20 mg/kg/day). Neuropsychological and QoL assessments were not systematically performed, representing a key limitation. Conclusions: Sapropterin dihydrochloride effectively identified responders and improved dietary flexibility even with lower dosing protocols. Greater adherence to international standards, particularly regarding long-term neuropsychological monitoring, is needed to optimize patient care. Full article

Background/Objectives: Patient-reported outcome measures (PROMs) are widely used tools in orthopedic surgery for evaluating clinical outcomes, guiding research, and supporting value-based care. However, the optimal timing for collecting baseline PROMs, whether in clinic prior to surgery or on the day of surgery, remains uncertain. This study investigated whether the clinical setting (preoperative clinic vs. day of surgery) affects baseline PROMs in patients undergoing anterior cervical discectomy and fusion (ACDF). Methods: Patients undergoing elective, primary ACDF at a single institution between August 2019 and June 2021 were prospectively enrolled. Inclusion criteria included age over 18, English literacy, and eligibility for primary ACDF. Participants completed PROMIS domains, Neck Disability Index (NDI), Modified Japanese Orthopaedic Association (mJOA) score, and Visual Analog Scale (VAS) at two time points: during the preoperative clinic visit and again in the perioperative area on the day of surgery. A subgroup analysis was performed for patients with anxiety, defined as a PROMIS anxiety score ≥ 59.4. Results: A total of 63 patients were enrolled, with 48 completing both sets of surveys. The average time between the two assessments was 7.9 days (95% CI: 6.4–9.3). After Bonferroni correction (α = 0.005), no significant differences were observed in any PROMs across the two time points, including PROMIS physical function (p = 0.398), pain interference (p = 0.682), fatigue (p = 0.019), social satisfaction (p = 0.331), anxiety (p = 0.047), depression (p = 0.042), NDI (p = 0.072), mJOA (p = 0.566), VAS neck pain (p = 0.054), or VAS overall pain (p = 0.335). Subgroup analysis of anxious patients similarly revealed no statistically significant changes between settings. Conclusions: PROM scores were not meaningfully different between the preoperative clinic and the day of surgery in patients undergoing ACDF. These results are most applicable when baseline PROMs are collected within about one week of ACDF. These findings support flexibility in workflow design for PROM collection, as the timing and setting do not significantly impact baseline responses. Full article

Road accidents could result in severe or fatal neck injuries. A few surrogate necks are available to develop and test neck protectors as countermeasures, but each has its own limitations. The objective of this study was to develop a surrogate neck compatible with the Hybrid III dummy, focused on tunable flexural stiffness and integrated angular sensors for kinematic feedback during impact tests. The neck features six 3D-printed surrogate vertebral bodies interconnected by rubber surrogate discs, providing a baseline flexibility to the surrogate fundamental spinal units. An adjustable inner cable and elastic elements hooked on the sides of vertebral elements allow to increase the flexural stiffness of the surrogate and to simulate the asymmetric behavior of the human neck. Neck flexural angles and axial compression are measured using a novel system made of wires, pulleys, and rotary potentiometers embedded in the neck base. A motion capture system and a load cell were used to determine the bending and torsional stiffness of the neck and to calibrate the sensors. Results showed that the neck flexural stiffness can be tuned between 3.29 and 5.76 Nm/rad. Torsional stiffness was 1.01 Nm/rad and compression stiffness can be tuned from 39 to 193 N/mm. Sensor flexural angles were compared with motion capture angles, showing an RMSE error of 1.35° during static testing and of 3° during dynamic testing. The developed neck could be a viable tool for investigating neck braces from a kinematic and kinetic perspective due to its inbuilt sensing ability and its tunable stiffness. Full article

Background: Physical exercise has been linked to improvements in motor and cognitive functions as well as to the modulation of neurotrophic and inflammatory factors, particularly in older adults. This aim of this study was to investigate the effects of a 12-week multimodal exercise program on cognitive function, motor performance, and plasma levels of brain-derived neurotrophic factor (BDNF) and cytokines in elderly individuals with Alzheimer’s disease (AD). Methods: A non-randomized controlled trial design was employed, involving 23 participants aged 62 to 85 years diagnosed with mild to moderate AD. The intervention group (n = 7) attended 60-minute sessions three times per week, incorporating aerobic, strength, flexibility, and motor coordination exercises, while the control group (n = 8) maintained usual activities. Methods: A non-randomized controlled trial design was used, involving 23 participants aged 62 to 85 years. Of these, 15 had a clinical diagnosis of mild to moderate AD and were allocated to either an intervention group (n = 7) or and AD control group (n = 8). The remaining eight participants were cognitively healthy and formed a control group matched for age and sex, used exclusively for baseline comparisons. The intervention group participated in 60-minute sessions three times per week, including aerobic, strength, flexibility, and motor coordination exercises. The AD control group (n = 8) maintained their usual daily routines. Results: Compared to baseline, the intervention group demonstrated significant improvements in executive and attentional functions, as measured by the Frontal Assessment Battery (FAB) and Clock Drawing Test (CDT); mobility, balance, gait speed, and lower limb strength also improved (p < 0.05). Additionally, plasma BDNF levels increased significantly, and interleukin-2 (IL-2) levels decreased. Conclusions: In conclusion, the multimodal exercise program resulted in cognitive and motor benefits and positively modulated biomarkers related to neuroplasticity and inflammation, supporting its potential as a complementary intervention in elderly individuals with AD. Full article