Search Results (2,506)

Background/Objectives: Febrile illness in returning travelers presents a diagnostic and operational challenge for emergency medicine clinicians as early symptoms of high-consequence tropical infections often overlap with common viral syndromes. This review synthesizes current evidence to guide frontline clinicians in the systematic evaluation, diagnosis, and management of internally acquired febrile illnesses with a focus on pathogen of greatest relevance to United States (US) emergency departments (ED). Methods: We conducted a narrative review of the literature addressing epidemiology, clinical presentation, diagnostic testing, and management strategies for key travel-associated infections. Special consideration was given to rapid diagnostic modalities, pediatric risk factors, and infections most frequently implicated in returning travelers, including chikungunya (CHIK), dengue virus (DENV) disease, Ebola virus (EBV) disease, malaria, Mpox, typhoid fever (TF), yellow fever (YF), and Zika virus (ZIKV) disease. Results: Effective evaluation begins with a detailed travel and exposure history, recognition of epidemiologic and clinical red flags, and targeted use of rapid diagnostic tests. Malaria remains the most common life-threatening cause of post-travel fever and the only pathogen with reliable Food and Drug Administration (FDA)-cleared rapid testing available in the ED. Arboviral infections such as DENV, CHIK, ZIKV, and YFrequire region-specific consideration and phase-appropriate molecular or serologic evaluation. Emerging and high-consequence pathogens, including Mpox and EBV, necessitate strict infection control measures and coordination with public health authorities. Pediatric travelers, particularly those visiting friends and relatives, face disproportionate risk for severe systemic infections and often require broader diagnostic testing. Conclusions: A structured approach integrating travel history, focused examination, rapid diagnostics, and early recognition of high-risk features is essential to improving outcomes for febrile returning travelers. Strengthened vector control, enhanced vaccination uptake, and global surveillance are critical to reducing future disease burden. Full article

Background: Mental health problems are highly prevalent among university students in Saudi Arabia; however, help-seeking behaviors remain low despite the availability of mental health services. There is limited evidence regarding students’ intentions to seek help and preferred sources of support, especially formal or informal sources. This study examined help-seeking intentions for mental health problems among university students. Methods: This cross-sectional descriptive study was conducted using an online self-administered questionnaire. Participants were 248 undergraduate students from various Riyadh universities. Help-seeking intentions were assessed using the General Help-Seeking Questionnaire. SPSS software was used to perform independent t-tests to assess differences in preferred sources across demographic groups, and Pearson’s correlation analyses were conducted to examine relationships between preferred sources and demographic variables. Multiple linear regression analyses were conducted to examine demographic and academic predictors of intentions to seek help from formal and informal sources. Results: Students demonstrated a low overall propensity to seek help. Online sources were the most preferred help-seeking option, followed by mothers, friends, and general physicians, whereas faculty, relatives, and religious persons were the least preferred. Preferred help-seeking sources differed by gender. Seeking help from mental health specialists was positively correlated with age and grade point average. Additionally, the regression analysis for formal help-seeking was significant, explaining 8.4% of the variance, with gender as the only significant predictor. Conclusions: These findings suggest the need for targeted interventions to improve students’ help-seeking behaviors. Universities should prioritize mental health literacy initiatives, stigma reduction strategies, and accessible support pathways, particularly by integrating digital and hybrid services and enhancing the role of faculty and institutional support systems in promoting timely and appropriate help-seeking. Full article

This study examines how protective factors contribute to teacher resilience and sustainable wellbeing during remote teaching, focusing specifically on parent-teachers who are balancing professional responsibilities with childcare. Within the broader context of research on educator resilience and professional practice, it explores the associations between social and organizational support, work–family conflict (WFC), and parenting self-efficacy (SE) and satisfaction, factors linked to educators’ capacity to manage dual roles effectively. The hypotheses were that (1) WFC would negatively correlate with parenting SE and satisfaction; (2) support from friends and family and from the workplace would be associated with lower WFC and higher parenting SE and satisfaction; and (3) WFC would mediate the relationship between support and parenting outcomes. Using a mixed-methods design with quantitative scales combined with open questions, data were collected through retrospective self-report questionnaires in relation to the COVID-19 lockdowns. The sample included 474 teachers who teach in schools in Israel and have children aged 0–12. The predictive mediation model confirmed the first two hypotheses, with partial support for the third. Qualitative findings provide insight into parent-teachers’ experiences, including gender-based differences, and emphasize factors associated with their adjustment to remote instruction. These findings contribute to understanding how social and organizational support—forms of collaborative and resilience-promoting mechanisms—may have an important role in promoting educator wellbeing through their negative association with work–family conflict. The findings should be examined further in longitudinal or experimental research and in additional cultural and educational contexts to examine their generalizability, as well as causality. Nonetheless, the findings provide possible directions for policy and interventions aimed at fostering resilience and sustainable wellbeing among teachers, particularly those navigating dual roles in their personal and professional lives. Full article

Background and Objectives: Breast cancer remains the most frequently diagnosed malignancy among women worldwide. As survival rates continue to improve, rehabilitation interventions focusing on functional recovery and quality of life have become increasingly important. Emerging technologies such as virtual reality, augmented reality, and telerehabilitation have recently been integrated into physiotherapy programs. This systematic review aimed to evaluate the effectiveness of technology-assisted physiotherapy interventions on quality of life, psychological outcomes, and functional recovery in women with breast cancer. Materials and Methods: A systematic search was conducted in PubMed, CINAHL Complete, and MEDLINE Complete for randomized controlled trials published between January 2010 and March 2026. Studies were included if they investigated exercise-based physiotherapy interventions incorporating technological modalities such as virtual reality, augmented reality, mixed reality, robotics, or telerehabilitation. Outcomes included quality of life, fatigue, pain, upper limb function, and psychological health. Results: Six randomized controlled trials involving approximately 398 participants (mean age range: 30–60 years) were included in the qualitative synthesis. The studies included women across different stages of the disease trajectory, including postoperative patients and long-term survivors. Interventions comprised virtual reality-based exercise programs, Kinect-based mixed reality systems, augmented reality telerehabilitation platforms, and internet-based rehabilitation programs. Across studies, significant improvements were consistently observed within groups in outcomes such as quality of life, upper limb function, pain reduction, and shoulder range of motion (e.g., p < 0.001). However, between-group differences were not consistently statistically significant, with several studies reporting comparable improvements in both intervention and control groups. Conclusions: Technology-assisted physiotherapy interventions may support functional recovery and improve quality of life among women with breast cancer. However, the available evidence remains limited, with important methodological constraints, as improvements were predominantly observed within groups, while consistent between-group differences were not demonstrated. Therefore, the comparative effectiveness of these interventions over standard rehabilitation remains inconclusive, highlighting the need for further high-quality randomized controlled trials. Full article

Systemic lupus erythematosus (SLE) is an autoimmune disease that predominantly affects women of childbearing age, and active disease during pregnancy is associated with increased maternal and fetal morbidity. Belimumab is an effective biologic therapy for active SLE; however, its use during pregnancy has long been limited by the scarcity of safety data. Recent evidence and updated international recommendations suggest that belimumab may be considered in selected cases when required to maintain maternal disease control. We report the case of a woman with SLE who experienced three consecutive pregnancies with live births between 2019 and 2024 while receiving belimumab, allowing an intra-individual comparison of different exposure strategies. During the first pregnancy, belimumab was discontinued at conception and was followed by a disease flare in late pregnancy and postpartum. In the second and third pregnancies, belimumab was continued until gestational week 20 following shared decision-making with the patient; nevertheless, disease flares occurred during the third trimester of both pregnancies. All pregnancies resulted in live births at term, with no congenital anomalies, placental insufficiency, or fetal growth restriction. One neonate from the third pregnancy developed early-onset neonatal sepsis and meningitis, which resolved completely after antibiotic treatment. All children are currently growing and developing normally. This case supports a risk-adapted approach to belimumab use during pregnancy. In selected women with SLE at high risk of disease reactivation, continuation of belimumab until mid-gestation may contribute to improved maternal disease control without evident adverse fetal outcomes. Full article

Background/Objectives: Dupilumab is a fully human IgG4 monoclonal antibody targeting the interleukin-4 receptor α subunit, inhibiting interleukin-4 and interleukin-13 signalling, and suppressing type 2 inflammation. It is approved for several eosinophilic and type 2 inflammatory diseases, including chronic rhinosinusitis with nasal polyps, asthma, atopic dermatitis, eosinophilic oesophagitis, and, more recently, eosinophilic chronic obstructive pulmonary disease. Although generally well tolerated, dupilumab has been associated with peripheral eosinophilia and, rarely, eosinophil-mediated complications. This study aims to describe cases of eosinophilic granulomatosis with polyangiitis (EGPA) occurring after dupilumab initiation and to review available evidence on this association. Methods: We describe two cases of new-onset EGPA developing after the introduction of dupilumab therapy, analysing clinical features, laboratory findings, management, and outcomes. A narrative review of published case reports and literature addressing dupilumab-associated eosinophilia and EGPA was also performed. Results: Both patients developed EGPA after starting dupilumab, presenting with marked peripheral eosinophilia and systemic manifestations consistent with the disease. Clinical improvement was observed following dupilumab discontinuation and initiation of appropriate immunosuppressive treatment. The literature review identified a small number of similar reports describing EGPA onset or unmasking in temporal association with dupilumab, mainly in patients with underlying type 2 inflammatory disorders. Conclusions: While a causal relationship between dupilumab and EGPA remains unproven, these findings highlight the importance of clinical awareness. Dupilumab remains an effective therapy for severe type 2 inflammatory diseases; careful monitoring may allow early recognition and management of rare eosinophilic complications. Full article

The paper presents Nicholas of Cusa’s position in the debate on mystical theology, which had a place around the middle of the 15th century in monastic environments. His contribution to that debate was presented in the form of the treatise entitled On the Vision of God, complemented by a painted representation of the “All-seeing Face”. Both the treatise and the painting were designed to be aids in an experiment projected by Cusanus for his benedictine friends of Tegernsee Abbey, to help them in their progress towards mystical contemplation. The intention was to show them a way to lift their thought from the perception of the image, through meditation and prayer, to the contemplation of God. Thus, both the icon and his treatise were intended to fulfil an anagogical function for the users in inspiring them start on a journey of returning to God and teaching them how to effect that return. Besides giving an account of the experiment projected by Cusanus, the most important elements of his fascinating system are delineated, such as the way of mystical ascent, his use of paradox, his conception of God as the Infinity, and the conception of God’s seeing as the foundation of the existence of all things. Full article

Background/Objectives: Nonpharmaceutical interventions such as social distancing and face mask use were central to controlling infectious disease transmission during the early phases of the COVID-19 pandemic, particularly when vaccines and treatments were limited or unevenly available. Although public health strategies emphasized individual compliance, adherence varied widely. Empirical evidence remains limited regarding how individuals integrate influences across individual, interpersonal, and community levels when assessing their ability and readiness to socially distance. This study examined how residents evaluated, prioritized, and experienced multi-level factors shaping perceived ability and readiness to practice social distancing during the early phase of the COVID-19 epidemic. Methods: We conducted a cross-sectional online survey of adults (≥18 years) residing in St. Louis City and St. Louis County, Missouri, between April and July 2020. Participants selected and ranked individual/interpersonal and community-level factors influencing social distancing and provided open-ended explanations of their choices. Quantitative data were analyzed descriptively to assess selection frequency and ranking priority. Qualitative responses were analyzed using iterative thematic coding to examine how participants interpreted and combined these factors. Results: The analytic sample included 1692 respondents. At the individual/interpersonal level, family and friends’ distancing behavior (58.9%), desire for in-person interaction (52.4%), and personal risk of COVID-19 (48.9%) were frequently selected, while personal risk, caring for others, and ability to work from home were most often ranked as the highest priority. At the community level, others’ distancing in public spaces (66.2%), availability of COVID-19 testing (58.9%), and businesses’ ability to ensure distancing and sanitation (57.2%) were most frequently selected, with epidemic severity, testing availability, and treatment availability ranked as most influential. Qualitative findings indicated that respondents experienced these influences as interconnected, integrating personal and relational risk, local epidemic conditions, healthcare access, visible community norms, and employer policies. Conclusions: Perceived ability and readiness to practice social distancing emerge from interdependent social and structural conditions rather than isolated individual motivations. Public health responses to emerging infectious diseases may be more effective when individual-level guidance is complemented by accessible testing and treatment, supportive workplace policies, and community environments that visibly reinforce protective behaviors. Full article

Stroke, a leading cause of mortality and long-term disability, induces complex cascades of oxidative stress and neuroinflammation that exacerbate brain injury. The peroxiredoxin (Prx; Prdx) family, composed of six thiol-dependent antioxidant enzymes (Prx1–6), plays a pivotal role in regulating redox homeostasis and immune responses in the brain. This review synthesizes current knowledge on the isoform-specific roles of Prxs in both ischemic and hemorrhagic stroke, highlighting their dual and context-dependent functions. Intracellular Prxs generally protect neurons and maintain blood–brain barrier (BBB) integrity, while extracellular Prxs—particularly Prx1 and Prx2—act as damage-associated molecular patterns (DAMPs), activating toll-like receptor signaling and amplifying inflammation. Isoforms such as Prx3 and Prx4 exhibit mitochondrial and endothelial protective effects, respectively, whereas Prx6 demonstrates complex roles influenced by its acidic, Ca²⁺-independent, phospholipase A2 (aiPLA2) activity and cellular localization. We also discuss emerging tools for studying Prx biology and explore the translational potential of Prxs as biomarkers and therapeutic targets. Ultimately, a nuanced understanding of Prx dynamics offers new avenues for stroke diagnosis, prognosis, and treatment. Full article

Could there be quantum superpositions of conscious states, as suggested by the Wigner’s friend thought experiment? Mathematical theories of consciousness, notably integrated information theory (IIT), make this question more precise by associating physical systems with both quantitative amounts of consciousness and structural characterizations of conscious states. Motivated by a recent proposal that ties wave-function collapse to integrated information, we construct a simple quantum circuit that would, on that proposal, place a minimal system—a feedback dyad—into a superposition of states that differ in their associated conscious states. This “Schrödinger’s dyad” provides a controlled setting for evaluating a central desideratum of consciousness-based collapse models: that collapse rates depend on how different the experiences in the superposition are. We prove a structural constraint on collapse dynamics of a standard (Lindblad) type: if collapse is governed by too few collapse operators, collapse rates cannot in general be made to depend solely on qualitative differences between conscious states. Avoiding this limitation requires introducing many commuting operators, leading to a rapid proliferation of collapse terms even for very simple systems. This proliferation bears directly on claims that IIT-based collapse theories may be especially experimentally tractable, since the required dynamics becomes highly complex. More generally, the difficulty is not specific to IIT: any Wigner-style collapse theory that distinguishes experiences using rich internal organization (such as neural connectivity in addition to neural state) will face a comparable explosion in dynamical complexity. Full article

Understanding the role of trust in shaping pro-ecological behaviour is essential for advancing effective environmental communication, particularly in societies characterized by low institutional credibility. This study examines how different forms of trust—scientific, institutional, mediatic, and interpersonal—predict pro-ecological behaviour in Bulgaria, a context marked by historically low levels of social and institutional trust. Drawing on a nationally representative survey of 1008 adults, participants rated their trust in six sources of environmental information (experts, public servants, politicians, media, social networks, and friends or relatives) and reported their engagement in various ecological practices. Multiple regression analysis revealed that trust in experts was the strongest positive predictor of pro-ecological behaviour, followed by trust in friends and relatives. Trust in political institutions, media, and online social networks showed no significant associations. These findings suggest that in low-trust societies, interpersonal trust and trust in experts serve as primary drivers of ecological engagement, while institutional trust alone is insufficient to mobilize collective environmental action. The study underscores the importance of fostering both scientific credibility and community-based communication to enhance public participation in sustainability initiatives. Full article

Framing—how issues are communicated—can influence attitudes. This study examined (1) the impact of value-framing on attitudes toward homosexuality among Turkish university students in 2012 and 2024, (2) cohort differences over time, and (3) socio-demographic predictors. Participants were 199 psychology students (161 female; M age = 21). Attitudes were most positive after equality framing, followed by neutral, then morality framing. Cohorts did not differ in overall attitudes. Morality framing led to significantly less positive views than neutral framing. Positive attitudes were associated with being female, higher parental education, and having more gay friends (for women) or lesbian friends (for men). Findings highlight the negative impact of morality framing and suggest that personal and social factors shape attitudes toward homosexuals. Full article

Third-party punishment involves bystanders voluntarily incurring costs to punish norm violators, thereby maintaining social norms and cooperation. While prior research shows reduced punishment when the bystander and violator are friends, less is known about how the violator–victim relationship affects such punishment. Based on deterrence theory, punishment serves both to sanction violations and deter future threats. Accordingly, using the Dictator Game–third-party punishment paradigm across five experiments with a primary adult sample, this study investigated the impact of social relationships on third-party punishment, examined the mediating role of threat perception, and validated the applicability of deterrence theory within the context of third-party punishment. A pilot experiment confirmed that bystanders punish friends less than strangers. Experiment 1 showed that when the bystander and violator were friends, punishment was stronger if the violator and victim were also friends. Experiment 2 showed that congruent social relationships (e.g., all parties are friends) elicit greater punishment than incongruent ones. Experiment 3 demonstrated that threat perception mediates this effect: consistency increases threat perception, which in turn heightens punishment. In summary, consistency of social relationships increases third-party punishment, mediated by elevated threat perception. These findings support the use of deterrence theory in third-party punishment contexts and deepen our understanding of how social relationships shape punitive behavior. Full article

Background/Objectives: Assistive technologies are commonly used as a compensatory strategy for individuals with neurological conditions. However, several negative factors have been associated with their use, leading to their non-use or interruption. Therefore, the aim of the present study was to examine the potential of the Assistive Technology Device Predisposition Assessment (ATD-PA) as an outcome measure to identify psychosocial and user-perceived factors associated with the non-use or interruption of assistive technology, particularly mobility devices. Methods: A descriptive, cross-sectional and non-experimental design was employed, as no variables were manipulated. The sample was selected using non-probability convenience sampling and consisted of 80 participants, of which 14 participants discontinued or interrupted the use of assistive technology. An ad hoc sociodemographic questionnaire was administered, along with the Assistive Technology Device Predisposition Assessment, based on the Matching Person and Technology (MPT) model. Results: Factors related to non-use or interruption appeared to be associated with higher perceived levels of global health, self-care, and physical well-being. Findings from the ATD-PA, used as an indicator of subjective satisfaction, showed strong associations between the perceived level of loss and the need for assistive technologies in domains such as comfort, self-care, and general health (r = 0.72–0.90). The perceived benefit of the device was closely linked to knowledge of its use, safety, fit with personal habits, and perceived capability and stamina (r = 0.69–0.94). Comfort using the device was mainly reported in familiar environments such as with family and friends. In contrast, comfort in broader community contexts did not demonstrate meaningful associations. Conclusions: Findings are consistent with Lauer’s model of non-use and highlight the importance of psychosocial determinants such as perceived health, safety, support, and contextual comfort in understanding the interruption or non-use of assistive technology, in line with the International Classification of Functioning, Disability and Health framework. The ATD-PA shows potential as an outcome-oriented tool to support follow-up and the early identification of risk factors for non-use. Longitudinal studies are needed to better understand usage patterns over time. In Spain, the lack of standardized outcome evaluation protocols and systematic follow-up processes underscore the need for structured monitoring strategies in assistive technology provision. Full article

Background: There is limited information about treatment success and outcomes in retrovirus-positive cats diagnosed with feline infectious peritonitis (FIP). Methods: A survey was distributed to caretakers of cats with feline leukemia virus (FeLV) and/or feline immunodeficiency virus (FIV) that were treated with GS-441524 for presumptive effusive FIP based on survey responses. Results: Cats with FIV developed FIP at an older age and longer after retrovirus infection than cats with FeLV. The average starting dosage (7 mg/kg/d) was increased in 65% of cats, and treatment was extended in 35%. Three cats relapsed (18%). There was a 94% (16/17) twelve-week survival rate and 82% (14/17) one-year survival rate. Seven cats were alive at follow-up, a median of 1306 days (range 983–2069) after FIP diagnosis, but many cats succumbed to neoplasia. Conclusions: Treatment success for retrovirus-positive cats with presumptive FIP was similar to previously reported outcomes for FIP alone. This could support current evidence of successful antiviral therapy for similar populations, if noncurrent, unstandardized protocols and unlicensed product use are considered. Additional studies are needed to determine ideal protocols for rapid resolution of FIP, good long-term survival, and limited relapse in retrovirus-positive cats, and the impact of the FeLV proviral load. Full article