Search Results (13,329)

Background: Unilateral complex training has been proposed as an effective strategy to improve lower-limb neuromuscular function; however, its effects on isokinetic strength, inter-limb strength asymmetry, and athletic performance in competitive basketball players remain insufficiently investigated. This study examined the effects of an eight-week unilateral complex training program on lower-limb isokinetic strength, strength asymmetry, hamstring-to-quadriceps (H/Q) ratio, and athletic performance in young male basketball players. Methods: Twenty-nine competitive male basketball players (age: 19.14 ± 0.99 years) competing in the Turkish Basketball Youth League and U18 League were randomly assigned to an experimental group (n = 15) or a control group (n = 14). The experimental group performed unilateral complex training twice weekly for eight weeks in addition to regular basketball practice, whereas the control group continued routine basketball training only. Before and after the intervention, lower-limb isokinetic strength (60°·s⁻¹), bilateral strength asymmetry, H/Q ratio, countermovement jump (CMJ), Abalakov jump, 20-m sprint performance, and force-platform-derived jump variables were assessed. Data were analyzed using two-way mixed-design analysis of variance. Results: Significant Group × Time interactions were observed for right and left knee flexor strength and left knee extensor strength (all p < 0.05). Bilateral quadriceps and hamstring strength asymmetries were significantly reduced by approximately 47% and 63%, respectively, accompanied by an improvement in the left H/Q ratio (p < 0.05). The intervention also produced significant improvements in CMJ height, Abalakov jump performance, flight time, time to takeoff, and 20-m sprint performance (all p < 0.05), whereas no significant interaction was found for peak force (p > 0.05). Conclusions: Adding an eight-week unilateral complex training program to regular basketball training was associated with improvements in selected lower-limb isokinetic strength and athletic performance outcomes, reductions in measured inter-limb strength asymmetry indices, and a side-specific improvement in the left H/Q ratio in competitive young male basketball players. However, because the control group did not receive an additional time- and volume-matched training stimulus, these findings should be interpreted as the effects of adding the overall training program rather than as evidence of the specific effects of its unilateral or complex components. Full article

Although dementia-related stigma is well-documented, there is a paucity of research examining intergenerational activities to reduce stigma within rural settings. Using a World Café approach, the objective of this paper was to explore rural stakeholders’ ideas and perspectives on intergenerational strategies to reduce dementia-related stigma in rural communities. Seventy-five participants engaged in a facilitated workshop held in Kamloops, British Columbia, Canada, on 14 May 2025. Discussions were transcribed and analyzed using Braun and Clarke’s thematic analysis framework. The findings highlighted three themes for reducing dementia-related stigma in rural communities: (1) contact activities that promote meaningful interactions (e.g., shared hobbies, arts programs, and reminiscence activities) between people living with dementia and others across age groups; (2) educational interventions that enhance dementia knowledge and awareness (e.g., dementia information integrated into educational institutions across the life course); and (3) mixed interventions that combine contact-based and educational approaches. Moving forward, further research is needed to co-design, implement, and evaluate the impact of specific interventions. This study provides critical insights to inform the development of dementia stigma-reduction programs, policies, and interventions in rural settings. Full article

Background: Quality assurance (QA) is a cornerstone of safe and effective postgraduate training in gynecological laparoscopic surgery, where clinical outcomes depend on procedural complexity, equipment sophistication, and the coordinated competence of an entire surgical team. This article is a narrative review of the conceptual, professional, and regulatory foundations of QA in healthcare education, complemented by a structured synthesis of the collective teaching and clinical experience of the author group. It is not an empirical study, and the sections that follow present a conceptual mapping supported by expert perspective rather than original outcome data. Methods: Sources were identified through targeted searches of PubMed/MEDLINE and Google Scholar, supplemented by hand-searching of policy and curriculum documents issued by professional bodies and by backward citation tracking, without date restriction. Approximately 480 records were screened at title and abstract level, 112 were assessed as full text, and 41 sources were retained against predefined inclusion and exclusion criteria, with five further sources added during peer review. In a second and separate step, the ten co-authors, who hold teaching and supervisory roles in gynecological laparoscopy across academic centers in Romania and Germany, each completed the same six-item written prompt on training provision, trainer development, trainee assessment, and institutional QA practice; responses were coded thematically by two authors independently and consolidated into explicit points of convergence and divergence. Results: We describe how QA principles, originally articulated in general quality-management and health-promotion literature, have been adapted by professional and regulatory bodies, including the European Board and College of Obstetrics and Gynecology (EBCOG), European Society for Gynecological Endoscopy (ESGE), American Society for Gastrointestinal Endoscopy (ASGE), and the UK General Medical Council, into concrete standards for training providers, trainers, and trainees. We outline the structures used to monitor and audit training quality, including Kirkpatrick’s four-level evaluation model and periodic institutional review cycles, alongside documentation and certification pathways such as the Gynecological Endoscopic Surgical Education and Assessment (GESEA) program, with governance and financing as cross-cutting determinants of sustainability. The author synthesis converged on a consistent gap between documented standards and their routine enforcement and diverged on whether external review and formal certification should become mandatory. Conclusions: The conceptual architecture of QA in gynecological laparoscopy is coherent and broadly fit for purpose, but we identified no study linking the implementation of a specific QA standard to measurable gains in trainee competency or patient outcomes in this field. Proposals for harmonized, outcome-oriented, and where appropriate, mandatory external review should therefore be read as reasoned positions awaiting prospective evaluation rather than as evidence-based recommendations; generating that evidence, with the trainee’s own perspective collected rather than inferred, is the principal task for future research. Full article

Wearable inertial sensors have become tools for objectively assessing mobility in older people. This study analyzed whether wearable inertial sensors could detect exercise-induced mobility changes and compared the effects of multicomponent training (MCT) and elastic band training (EBT) on mobility and physical function in older women. Forty-two participants were randomly allocated to either the MCT (n = 21) or EBT (n = 21) group, where 38 (EBT: n = 19; MCT: n = 19) completed the 16-week intervention. Outcomes included instrumented Timed Up-and-Go (iTUG) assessed with a wearable inertial sensor, the Senior Fitness Test, maximal isometric handgrip strength, conventional TUG, anthropometric measurements, health-related quality of life, and blood biomarkers. Data were analyzed using age-adjusted linear mixed-effects models. The iTUG showed shorter completion time (p < 0.001), reduced middle-turn duration (p = 0.004), and increased cadence (p = 0.007). Significant time effects were also observed for chair stand (p = 0.011), arm curl (p < 0.001), and conventional TUG (p = 0.009). No significant group × time interactions were detected. After adjustment for multiple comparisons, no significant changes were observed in anthropometric measures, health-related quality of life, or blood biomarkers. Wearable inertial sensors detected training-related mobility changes, and both exercise programs improved physical function and mobility without between-group differences. Full article

Community-based digital transformation (DX) initiatives are increasingly used to promote healthy aging, although their effects are often evaluated using subjective self-reported measures. This study aimed to quantitatively evaluate a community DX health promotion initiative with Takashimadaira as its primary target area in Japan using wearable sensor data. A total of 500 community-dwelling older adults participated in the initiative, and wearable sensor data were obtained from 355 participants during the five-month observational period. The initiative combined wearable device distribution with event-information dissemination via the messaging platform. Daily step count and heart-rate indices were analyzed. Within-participant analyses showed significant increases in daily step counts in the information-provision groups, whereas the primary linear mixed-effects model showed no significant information-provision × time interaction for daily step count. Information provision was associated with differences in mean and minimum daily heart rate in cross-sectional analyses. Adherence and dropout also varied by residential area. Age, BMI, and exercise frequency were associated with several health-related indices, but these associations were not interpreted as evidence of wearable measurement validity. These findings demonstrate the potential utility of using wearable sensor data to evaluate longitudinal changes in health-related behavior and physiological signals in community-based DX initiatives, while also revealing important feasibility limitations, including substantial attrition (only 222 of 355 participants met the 14-day criterion; 90-day dropout 58.3%) and indicating that observed within-participant changes should not be interpreted as demonstrated intervention effects. Community context may also be relevant to sustained participation in such programs. Full article

The integration of occupational safety and health protection with workplace efforts to promote worker health and well-being is a well-established concept, progressively formalized through the CDC-NIOSH Total Worker Health^® (TWH) program. This scoping review aimed to map and describe the implementation and evaluation methods used in TWH approaches across occupational settings. Scopus, Web of Science, and PubMed were searched using predefined search strings based on “Total Worker Health” and “Total Worker Health approach”. The original search was conducted in January 2023 and was updated in July 2026 using the same databases and search strategies. Eligible studies were peer-reviewed articles written in English that addressed the application, implementation, assessment, or evaluation of TWH approaches in occupational settings. Sixty studies identified in the original search were fully charted and summarized using descriptive frequency tables. The updated search retained eight additional recent studies, which were reported separately and additionally charted across a focused set of core methodological domains. Across the original corpus and the updated studies, substantial heterogeneity was observed in occupational sectors, study aims, intervention components, assessment methods, analytical approaches, and reporting formats. The main tools used to evaluate TWH aspects and interventions were surveys, questionnaires, interviews, meetings, focus groups, training activities, and mixed-methods evaluations. No single standardized model for implementing or evaluating TWH approaches emerged from the mapped literature; however, more consistent reporting of implementation processes, assessment tools, study populations, and analytical approaches may improve comparability, reproducibility, and transferability across occupational settings. Full article

Background: Blood donation deferral poses a significant challenge to transfusion services worldwide, threatening blood supply adequacy and donor retention. Population-specific data on deferral epidemiology and subsequent donor return behavior in Saudi Arabia remain limited. This study aimed to characterize the prevalence, reasons, and demographic patterns of blood donation deferral at King Fahad Medical City (KFMC)—a major quaternary referral center in Riyadh—and to quantify the rate at which temporarily deferred donors re-engage with the donation process at the encounter level. Methods: A retrospective observational study was conducted on records of all registered volunteer blood donor encounters at KFMC from 1 January 2023 to 31 December 2024 (n = 60,290), extracted from the Hematos IIG blood bank information system. Donor demographics (age, sex, weight, nationality), deferral classification (temporary, permanent, indeterminate), deferral reason, pre-deferral donation frequency, and post-temporary-deferral donation frequency were analyzed. Inferential statistics employed the Chi-square test and Fisher’s exact test (significance threshold: p < 0.05). A multinomial logistic regression, restricted to the 10,681 encounters classified as temporarily deferred, identified correlates of post-deferral donation frequency, adjusted for donation frequency before deferral. Results: Of 60,290 registered donor encounters, 18,458 (30.6%) resulted in deferral. Male donors constituted 86.4% of deferrals; the 31–45-year age group accounted for 47.3%. The three leading deferral reasons were abnormal vital signs (39.4%), post-donation transfusion-transmitted infectious disease (TTID) screening reactivity (35.6%), and low hemoglobin (14.0%). Sex-stratified analysis revealed that among female donors, low hemoglobin (40.50%) exceeded abnormal vital signs (35.50%) as the leading reason. Among the 10,681 encounters classified as temporarily deferred, 86.70% did not return to donate within the observation window. In a multinomial regression restricted to this subgroup, donation frequency before deferral was the strongest correlate of return (OR 21.02, 95% CI 14.94–29.58 for three or more subsequent donations among donors with ≥3 prior donations vs. none), and deferral for abnormal vital signs was also associated with higher odds of return (OR range 3.55–4.60, all p < 0.001). Conclusions: Nearly one-third of blood donor encounters at this tertiary center resulted in deferral, with abnormal vital signs and TTID screening reactivity as the predominant reasons. The low re-engagement rate (13.30%) among temporarily deferred donors underscores a need for structured follow-up programs, particularly for first-time donors, for whom an established donation history was the strongest predictor of return. Sex-specific interventions—targeting hemoglobin optimization in female donors and cardiovascular risk factor awareness in male donors—are warranted to reduce the deferral burden and safeguard the blood supply. Full article

Background/Objectives: Person-centered care (PCC) and the Technological Competency as Caring in Nursing (TCCN) theory are increasingly emphasized in nursing leadership, but no published study has evaluated a PCC/TCCN training program among Mongolian nurse managers. This uncontrolled, single-group pilot pre–post study examined immediate changes in nurse managers’ self-reported PCC and TCCN perceptions following a one-day collective training program. Methods: The program was delivered on 30 October 2025 during the 2nd International Nursing Symposium in Mongolia. Using convenience sampling, hospitals were invited to send nurse managers who were currently in post or senior nurses who had been formally nominated for such a role. Of 50 attendees, 30 met a pre-specified role-eligibility criterion and formed the matched pre–post analytic sample. Participants completed Mongolian versions of the Person-Centered Care Instrument (PCCI) and the Perceived Technological Competency as Caring in Healthcare Providers Instrument (TCCHI) immediately before and after the program. Pre–post differences were assessed with Wilcoxon signed-rank tests, effect sizes for the Wilcoxon signed-rank test (r = z/√N), and Holm–Bonferroni correction across 16 comparisons. Results: Total and all concept-level PCCI and TCCHI scores were higher after the program than before it, all 16 comparisons remained significant after correction, and the effect sizes were moderate to large (r = 0.41–0.61). The median within-person change was +22.0 points (95% CI 7.0 to 35.5) for the total PCCI score and +24.0 points (95% CI 10.5 to 38.0) for the total TCCHI score (Hodges–Lehmann estimates). Conclusions: In this small convenience sample of Mongolian nurse managers and senior nurses formally nominated for managerial roles, self-reported PCCI and TCCHI scores increased immediately after a one-day training program. Because the study used a single-group design without a control group, employed instruments not yet fully validated in Mongolian, and included no follow-up, these findings are preliminary evidence of an association rather than proof of program effectiveness. Larger, controlled studies with follow-up are needed. Trial Registration: TCTR20260513001, registered retrospectively on 13 May 2026, after data collection had been completed. Full article

Progressive resistance exercise training (RET) enhances skeletal muscle mass in healthy postmenopausal women (HEAs) and breast cancer survivors (BCSs) undergoing endocrine therapy. MicroRNAs (miRNAs) are recognized as key epigenetic regulators of exercise-induced adaptations, functioning as tumor suppressors, oncomiRs, and modulators of skeletal muscle homeostasis. Nevertheless, the impact of RET on circulating miRNA profiles in this population remains largely unexplored. This study aimed to explore the effects of a 12-week progressive RET program on plasma miRNAs associated with tumor biology and skeletal muscle regulation in HEAs and BCSs. Five HEAs and five BCSs undergoing endocrine therapy completed a 12-week supervised progressive RET program (3 sessions/week, 60–80% 1RM). Plasma samples were collected before and after intervention, and candidate miRNA expression was quantified by qRT-PCR, normalized to hsa-miR-16-5p, and analyzed using the 2^−ΔΔCt method. At baseline, no significant differences were observed between HEA and BCS in tumor suppressor miRNAs (miR-let-7f-5p, miR-125a-5p, miR-342-3p), oncomiRs (miR-21-5p, miR-155-5p, miR-221-3p), or skeletal muscle–related miRNAs (miR-206-3p, miR-486-5p) (p > 0.05). The only exception was miR-375-3p, which showed increased expression in HEA vs BCS (p = 0.037). After 12 weeks of RET, The BCS group showed increases in miR-125a-5p (p = 0.050) and miR-342-3p (p = 0.048) with significant group × time interactions that remained significant after Benjamini–Hochberg False Discovery Rate (BH-FDR) correction (FDR-adjusted p = 0.042 for both). Both groups displayed a nominal increase in miR-375-3p (p = 0.042), which did not remain significant after FDR correction. No significant changes were detected for miR-let-7f-5p or the analyzed oncomiRs in either group. Both miR-206-3p and miR-486-5p exhibited upward trends in the BCS group (p > 0.05). In this exploratory study, 12-week RET program was associated with selective changes in plasma miRNA expression in the HEA and BCS groups, suggesting that this training regimen may act as an epigenetic modulator of circulating miRNAs involved in tumor suppression and skeletal muscle homeostasis. Full article

This study examined the effects of an eight-week core strengthening exercise program on menstrual pain, menstrual symptoms, and quality of life in sedentary female university students with self-reported primary dysmenorrhea. Sixty female students (age: 21.8 ± 3.4 years) were randomly assigned to a core strengthening exercise group (EG; n = 30) or a control group (CG; n = 30). Pain intensity was assessed using the Numerical Rating Scale (NRS) at baseline (T1), after four weeks (T2) and after eight weeks of intervention (T3). Menstrual symptoms and quality of life were evaluated using the Menstrual Symptom Questionnaire (MSQ) and the WHO Quality of Life–BREF (WHOQOL-BREF), respectively. NRS scores in the EG were significantly lower at T2 and T3 compared with T1 (p < 0.01). The EG showed significant reductions in negative symptoms, pain, management, and total MSQ scores, whereas management and total MSQ scores increased in the CG (p < 0.01). Significant improvements were observed in all WHOQOL domains (physical, psychological, social relationships, and environment) in the EG (p < 0.01). An eight-week core strengthening exercise program may help reduce menstrual pain and symptoms and improve quality of life in female university students with self-reported primary dysmenorrhea. Full article

Undergraduate residential construction programs face growing pressure to prepare graduates with competencies that reflect evolving workforce expectations. This study develops a preliminary evidence-informed framework for aligning undergraduate residential construction education with workforce expectations identified from selected U.S. residential construction markets and practitioner perspectives. Two complementary evidence streams were integrated. First, a systematic screening process informed by PRISMA reporting yielded 156 residential construction job postings collected from selected markets in the U.S. Southeast and Southwest (2024: 70; 2025: 86), which were analyzed using thematic coding to identify labor-market competency requirements. Second, a three-hour focus group involving 14 senior residential construction professionals representing 10 NAHB-affiliated firms provided practitioner perspectives on workforce competency expectations and educational preparation. Findings were integrated using Patton’s convergence model to examine convergence, complementarity, divergence, and source-specific signals across the two evidence streams. Five competency areas received cross-source support from labor-market evidence and practitioner perspectives. These findings were subsequently organized for educational interpretation within the following four domains: Technical; Professional; Management; and Safety, Quality, and Regulatory Compliance. Digital construction capability emerged as a cross-cutting practitioner-anticipated signal. The integrated findings informed six proposed educational modules and associated indicative learning outcomes. The study contributes a mixed-method approach for integrating labor-market and practitioner evidence and demonstrates how such evidence can inform preliminary curriculum design. Full article

Background and Objectives: Yoga has been proposed as a supportive intervention to enhance mindfulness and reduce stress among nursing students, but evidence from mixed-method studies remains limited. This study aimed to examine the effects of a 12-week course-based yoga intervention on mindfulness and perceived stress and to explore students’ experiences of practicing yoga. Materials and Methods: A total of 42 second-year nursing students at a university in Istanbul, Türkiye, participated in a mixed-methods study, with 22 students enrolled in the elective Health and Yoga course constituting the intervention group and 20 students enrolled in another elective course constituting the control group. Group allocation was non-randomized and determined by students’ elective-course enrollment. The intervention group attended weekly 90 min yoga sessions for 12 weeks, delivered by a certified instructor (E-RYT 200). Quantitative outcomes were measured using the Mindful Attention Awareness Scale (MAAS) and Perceived Stress Scale (PSS), with baseline-adjusted ANCOVA and change score analyses performed to control for pre-test differences and gender. Effect sizes (partial η²) were reported, and 95% CIs were calculated for the mean differences in change scores. Qualitative data were collected via semi-structured interviews and analyzed thematically, integrating findings with quantitative results. Results: Baseline-adjusted ANCOVA revealed greater improvements in mindfulness (F(1, 39) = 29.686, p < 0.001, partial η² = 0.432) and perceived stress (F(1, 39) = 158.293, p < 0.001, partial η² = 0.802) in the intervention group, controlling for baseline scores. Change score analyses confirmed these findings: mindfulness increased (MD = 10.68, 95% CI [6.62, 14.75], p < 0.001) and perceived stress decreased (MD = −11.40, 95% CI [−13.32, −9.48], p < 0.001) significantly more in the intervention group than controls. Qualitative findings complemented the quantitative results, indicating perceived physical (flexibility, posture, pain reduction), mental (positive emotions, awareness, emotion regulation), and social (motivation, interaction) benefits of yoga. Some participants reported hesitation in applying yoga in nursing practice due to cultural barriers. Conclusions: The findings suggest that participating in a course-based yoga program may help improve mindfulness and support stress reduction among nursing students. Qualitative findings complemented the quantitative results by providing insight into students’ perceived physical, mental, and social experiences of yoga. Given the small, single-center, and self-selected sample, these findings should be interpreted cautiously. Larger, multicenter randomized studies with longer follow-up are needed to confirm these findings and assess their generalizability. Full article

Background: The growing inclusion of students with developmental disabilities (SWDs) in mainstream physical education (PE) highlights the need for teaching approaches that support participation while maintaining educational effectiveness. This study examined the effects of a 12-week para-volleyball program on motor abilities in students without developmental disabilities (SWDDs). Methods: A total of 217 fifth- and sixth-grade primary school students were assigned to an experimental group (n = 110), in which students participated in a 12-week para-volleyball program, and a control group (n = 107), in which students followed the regular PE curriculum. Anthropometric characteristics and motor abilities, such as explosive strength, agility, and aerobic capacity, were assessed before and after the intervention using standardized field tests. Results: The experimental group showed significantly greater improvements in agility and explosive strength than the control group. Specifically, agility test performance improved by 0.92 s (p < 0.001, ηp² = 0.16), and standing long jump distance increased by 10.60 cm (p < 0.001, ηp² = 0.17). No significant effects were found for aerobic capacity (p > 0.05) or body composition, while flexibility improved only in the control group (+4.41 cm, p < 0.001). Conclusions: A 12-week para-volleyball program significantly improved agility and explosive strength in primary school students compared to standard PE. These findings suggest that para-volleyball is an effective tool for developing motor abilities and promoting inclusive PE. Full article

This paper examines cultural institutions as architectural infrastructures that extend beyond physical boundaries to generate events, shape collective spatial experience, and contribute to the production of urban memory. Instead of interpreting the city primarily through permanent architectural forms, this research conceptualizes the urban environment as an archive of events, arguing that urban memory emerges continuously through interactions between architecture, collective action, and temporally situated spatial practices. The study investigates the Youth Tribune (Serbian: Tribina mladih) in Novi Sad as a case study of an institutional space whose architectural configuration and program enabled neo-avant-garde artistic practices to expand into public space. Attention is given to two performative actions–Linija (English: Line) by Tomaž Šalamun and the OHO Group, and Srce-predmet (English: Heart-Object) by Bogdanka Poznanović–analyzed here as spatial sequences that reorganized relationships between architecture, public space, and the collective. Methodologically, the research combines archival analysis with cartographic mapping to reconstruct movement trajectories, spatial transitions, and points of intensity generated by these ephemeral interventions. The findings suggest that cultural institutions can operate as spatial frameworks for event generation, shifting the analytical understanding of architecture from passive enclosure towards an active framework in memory production. By establishing this infrastructure-event framework, the paper advances architectural and urban theory with an analytical tool applicable to broader studies on architecture’s role in collective urban experience. Full article

Programmed death-ligand 1 (PD-L1) expression in Grade Group 1 (GG1) prostate carcinoma biopsies has not been established as a marker of pathological upgrading at radical prostatectomy (RP). This two-center retrospective case–control study included 172 men with GG1 carcinoma in the biopsy closest to RP: all 86 patients upgraded to GG2 and 86 randomly selected non-upgraded controls from 126 eligible GG1 patients. PD-L1 was assessed with the SP263 clone using the combined positive score (CPS), with CPS ≥ 1 predefined before outcome comparison. CPS ≥ 1 occurred in 36/86 upgraded cases (41.9%) and 18/86 controls (20.9%; unadjusted odds ratio [OR], 2.72; 95% confidence interval [CI], 1.39–5.33; p = 0.005). After adjustment for serum prostate-specific antigen, positive-core count, Prostate Imaging Reporting and Data System category, and center, CPS ≥ 1 remained associated with upgrading (adjusted OR, 2.91; 95% CI, 1.47–5.97; p = 0.003). A Firth bias-reduced sensitivity model including digital rectal examination yielded a similar CPS estimate. Biopsy CPS ≥ 1 was associated with biopsy–RP grade discordance, but the study does not establish an optimal cutoff, predictive performance, or clinical utility. Prospective multicenter validation, including active-surveillance outcomes, is required. Full article