Search Results (45,612)

Effective motor neurone disease (MND) management depends on patient and carer involvement in decisions about interventions and future care. Communication and cognitive impairments are common in MND and have under-recognised consequences for shared decision making and autonomy. This narrative conceptual review draws on empirical qualitative research with people living with MND and unpaid family carers and the literature specifically concerning shared decision making and communication in MND. Themes relating to communication, information use, and decision making styles were mapped onto an ALS/MND multidisciplinary decision making model. Enhancements to the model include expanding the decision making context beyond in clinical activity, embedding communication and cognitive skills and accommodations across stages, and acknowledging risks to collaborative decision making. Practical strategies for clinicians, healthcare services, people living with MND, and family carers are proposed to ensure that communication is foregrounded in-person-centred MND care. Observational and implementation research is required to evaluate and refine the proposed approaches. Full article

The rapid deployment of Internet of Things (IoT)-enabled video surveillance systems has expanded the capabilities of real-time monitoring in smart cities, healthcare facilities, industrial environments and critical infrastructure. However, integrating resource-constrained cameras, heterogeneous communication protocols, edge/cloud analytics, and sensitive video data creates a complex cybersecurity landscape. This systematic review synthesizes recent evidence on security challenges and mitigation strategies in IoT-enabled video surveillance systems. Following the PRISMA 2020 guidelines, four bibliographic databases (Scopus, IEEE Xplore, Web of Science, and Google Scholar) were searched for peer-reviewed journal articles and conference papers published between January 2021 and July 2025. After duplicate removal, title/abstract screening, full-text assessment, and quality appraisal, 21 studies were included for qualitative synthesis. The findings show that vulnerabilities occur across three interdependent architectural layers: device/perception, network/communication, and application/cloud. The frequently reported weaknesses were default credentials, insecure firmware, unencrypted video streams, weak protocol configuration, metadata leakage, and inadequate cloud access control. Existing mitigation strategies, including multi-factor authentication, role-based access control, TLS/DTLS, lightweight encryption, intrusion detection systems, and secure boot, provide partial protection but remain constrained by latency, computational overhead, energy consumption, scalability, cost and legacy device compatibility. This review further identifies a persistent research–practice gap: only a small subset of studies provides evidence of real-world deployments, while most solutions remain evaluated in simulations, testbeds, or conceptual frameworks. This review contributes a domain-specific taxonomy of IoT video surveillance security, a comparative evaluation of mitigation strategies using technical, operational, and economic criteria, and deployment-oriented recommendations for smart city, industrial, healthcare, residential, and critical infrastructure settings. The study highlights the need for cross-layer security architectures, lightweight and post-quantum-ready cryptography, privacy preservation, edge AI, federated learning, zero-trust access control, and standardized security baselines. Full article

Introduction: Trust is a fundamental component of the therapeutic alliance in healthcare, yet research in the dental field has traditionally focused on dentists, often neglecting the distinct role of the dental hygienist. To the best of our knowledge, no validated tools exist specifically for measuring patient trust in dental hygienists. Objectives: This study aimed to develop and validate the Dental Hygienist Trust Scale (DHTS), an instrument adapted to assess patient trust specifically toward dental hygienists. Methods: Following a linguistic and contextual adaptation of the original Dentist Trust Scale, a cross-sectional study was conducted at the University Dental Clinic of Chieti. Psychometric properties were assessed using Cronbach’s alpha for internal consistency and Exploratory Factor Analysis (EFA) for factorial validity. Inferential statistics included the Shapiro–Wilk test, independent samples t-tests, and Pearson’s correlation coefficient. Results: A total of 161 participants were recruited (mean age 46.7 ± 19.1 years; 52.2% female). The DHTS showed high internal consistency (alpha = 0.88) and a robust single-factor structure (62.4% of total variance). Participants reported high trust levels (mean score 3.65 ± 0.56). No significant differences were observed regarding gender (p = 0.218) or age (r = 0.04, p = 0.612). Conclusions: The initial psychometric evaluation of the DHTS provides a preliminarily validated instrument for assessing the patient-hygienist relationship, filling a significant gap in dental literature. Further longitudinal research is recommended to explore the temporal stability and clinical impact of these trust perceptions. Full article

First-trimester prediction of preeclampsia (PE) remains a major clinical challenge, particularly outside specialized fetal medicine centers. This study aimed to identify and validate serum protein biomarkers for early PE prediction using an integrated proteomic approach. A prospective cohort of 64 first-trimester singleton pregnancies (32 future PE cases, 32 matched controls) was analyzed. Untargeted proteomics was performed using DIA-PASEF-MS, followed by targeted cross-platform verification with MRM-MS. Machine learning classifiers (support vector machines, SVM, and random forest) were trained on differentially abundant proteins (FDR < 0.01, VIP > 1.5). DIA-MS identified 33 protein markers associated with complement activation, IGF transport regulation, and platelet degranulation. An SVM model with a linear kernel achieved 95% accuracy (AUC = 0.95, sensitivity = 95%, specificity = 97%). Four markers (AFM, AHSG, C8A, IGHG1) were confirmed across platforms, confirming the discovery findings. Cross-platform correlation was high: 71% of overlapping proteins showed r > 0.5 (p < 0.001), with the highest concordance observed for potential PE marker AHSG (r = 0.8, p < 0.001). PRSS1, IGHV1-4, and SERPINC1 showed a strong correlation with proteinuria (|r| > 0.5, p < 0.05), linking the proteomic signature to clinical severity. Integrated DIA-MS and MRM-MS proteomics yields a reproducible, high-performance serum signature for first-trimester PE prediction. The identified markers reflect core pathophysiological pathways and offer potential to augment current FMF-based screening algorithms. Full article

Background/Objectives: Atopic dermatitis (AD) and food allergy (FA) frequently coexist in the concept of atopic march; however, their combined associations with psychological problems remain poorly understood. This study aimed to investigate the associations of AD and FA with psychological outcomes at age 7 and evaluate whether respiratory allergies account for part of these associations. Methods: We enrolled 1577 children aged 7 years from the Panel Study of Korean Children. The Korean version of the Child Behavior Checklist was used to assess psychological and behavioral problems. Multivariable regression and parallel mediation analyses were used to evaluate independent and interactive associations. Results: AD and FA were associated with psychological and behavioral problems, most consistently with somatic problems on the Diagnostic and Statistical Manual of Mental Disorders (DSM)-oriented scale. These associations were more pronounced in children with comorbid AD and FA than in those with single allergies. Among the 9 children with concurrent AD and FA, an interaction between the two conditions on somatic problems was observed (P for interaction = 0.033). The comorbid group showed higher eosinophil counts and total IgE levels, but no differences in SCORAD indices or C-reactive protein levels. Mediation analysis identified a direct association of AD with somatic problems (B = 1.062; 95% CI, 0.601–1.562), with a portion accounted for by allergic rhinitis (AR) (B = 0.656; 95% CI, 0.306–1.241). Conclusions: Comorbid AD and FA were associated with higher odds of somatic problems than either condition alone in 7-year-old children, with a portion of the AD association accounted for by AR. Because exposures and outcomes were assessed concurrently, these associations are exploratory and hypothesis-generating rather than causal. Clinical attention may be warranted for children with both AD and FA. Full article

Influenza remains a significant national health security threat, particularly for vulnerable populations, as existing control measures do not fully mitigate its impact. This gap in protection is especially pronounced early in a pandemic when a well-matched vaccine may not yet be available, as well as in populations unable to mount an optimal vaccine response. Clinical studies support pre-exposure prophylaxis (PrEP) therapeutics as a promising complementary strategy to reduce influenza transmission and disease severity, potentially easing the strain on healthcare systems during outbreaks. This manuscript outlines the Biomedical Advanced Research and Development Authority’s (BARDA’s) target product profile (TPP) for a long-acting influenza PrEP product, reviews the current development landscape, and models the potential impact of early PrEP product deployment using agent-based modeling in a synthetic population of 19.5 million people across pandemic scenarios resembling the 1918, 1968, and 2009 influenza pandemics. Simulations showed that early deployment of a 70%–effective PrEP reduced cumulative and peak infections, delayed the epidemic peak, and provided the greatest benefit in less transmissible pandemics; at 40–50% coverage, PrEP fully mitigated a 2009-like pandemic and substantially reduced transmission in 1918- and 1968-like scenarios. The TPP defines key characteristics of an effective PrEP option for seasonal and pandemic influenza that (1) demonstrates a strong safety and tolerability profile across all populations; (2) targets a direct-acting antiviral mechanism of action; (3) reduces the relative risk of symptomatic influenza infection by at least 70% in an unvaccinated population and (4) provides single-dose, season-long protection to optimize patient adherence. In this context, integrating PrEP into influenza prevention strategies could improve control of virus spread, strengthen protection for high-risk groups, and significantly reduce the overall public health impact of seasonal and pandemic influenza. Full article

Background: Epiretinal membrane (ERM) is a fibrocellular preretinal proliferation composed of fibroblasts, glial cells, and hyalocytes overlying the internal limiting membrane. Pars plana vitrectomy (PPV) with membrane peeling is the standard surgical treatment, but postoperative cystoid macular edema (CME) can limit visual recovery. Inflammation plays a key role in CME pathogenesis, and corticosteroids may help reduce the inflammatory response associated with both ERM-related traction and surgical trauma. Therefore, sustained-release dexamethasone (DEX) intravitreal implants have been investigated as an adjunct to surgery. Methods: This SANRA-guided narrative review evaluated studies investigating DEX implantation during PPV for ERM surgery or as treatment for persistent postoperative CME. Eligible studies included human clinical studies reporting functional, anatomical, biomarker, or safety outcomes following DEX use in the ERM surgical setting. Results: DEX implantation appears to promote faster resolution of postoperative inflammation and CME, with consistent improvements in anatomical parameters such as central macular thickness. However, the impact on visual acuity remains variable, with some studies reporting earlier functional recovery and others showing no significant long-term benefit. Reported adverse events mainly include intraocular pressure elevation manageable with medical therapy and cataract progression. Available evidence suggests that intraoperative DEX implantation is associated with more consistent anatomical benefit than superior long-term functional improvement, while delayed DEX administration may benefit selected eyes with persistent postoperative cystoid macular edema. Conclusions: Current evidence suggests that DEX implantation may represent a potentially useful adjunctive strategy in selected patients undergoing ERM surgery, particularly in eyes at higher risk of postoperative inflammation or cystoid macular edema. While available studies suggest potential anatomical benefits, evidence regarding superior long-term functional outcomes remains inconsistent. Moreover, while current evidence suggests that DEX implantation may accelerate anatomical recovery and improve postoperative inflammatory control in selected patients, long-term functional superiority over PPV alone, including sustained BCVA improvement and patient-reported visual outcomes such as metamorphopsia, remains unproven. Larger prospective randomized studies are needed to better define optimal patient selection and treatment timing. Full article

The main objective of the current study is to assess the techno-economic feasibility, climate change adaptability, and sustainability of photovoltaic energy systems in six large hospitals in Turkey (Adana, Başakşehir, Bursa, Elazig, Gaziantep, and Yozgat) to achieve United Nations recommendations as Sustainable Development Goal 7 (affordable and clean energy) and Sustainable Development Goal 13 (climate action). This study aims to determine the impact of long-term climate change on the availability of photovoltaic (PV) energy resources. To achieve this goal, this research was conducted through a multi-step approach combining (1) the detection of long-term climate trends using linear regression on the TerraClimate database, (2) the spatial analysis of photovoltaic solar energy potential using high-resolution satellite imagery (Google Maps) for roof suitability and parking areas, (3) the estimation of photovoltaic electricity generation and the calculation of the capacity factor, (4) the application of the Response Surface Methodology (RSM) based on NASA Giovanni data to model the nonlinear reciprocal relationships between precipitation (R), aerosol optical thickness (AOT), photovoltaic solar energy production, and (5) the techno-economic analysis using the Levelized energy cost (LCOE), payback period, and CO₂ emission reductions. The results show statistically consistent warming trends across all sites with trends for Tmax ranging from +0.0205 to +0.0268 °C/year and for Tmin from +0.0208 to +0.0300 °C/year. The temperature of PV cells increases at a rate of +0.0197 °C/year and the wind speed decreases by −0.0031 to −0.0149 m/s/year, which indicates a reduction in convective cooling. Solar radiation, on the other hand, is relatively constant with small trends ranging from +0.0002 to +0.0566 W/m²/year, and confirms the consistent solar resource availability. Seasonal PV resource potential varies from ~70–95 W/m² in winter to 290–310 W/m² in summer. Furthermore, the installed PV capacities are between 6 MW (Yozgat) and 47 MW (Başakşehir) with capacity factors of 17.0–19.7% and payback periods of 4.31–4.88 years. RSM models have high explanatory power (R² = 0.57–0.74) with AOT as the most important negative driver of PV performance. Consequently, the results show that while the solar resource of Türkiye is stable and highly exploitable, PV efficiency is increasingly determined by climate-induced thermal stress and reduced wind cooling. The study highlights the economic viability, environmental advantages, and strategic relevance of PV systems at hospitals for resilient, low-carbon healthcare infrastructure in future climate scenarios. Full article

Burnout and psychological distress among healthcare workers (HCWs) have become a major workforce challenge, raising an important question: should responsibility for worker wellbeing rest primarily with individuals or with the organization of work itself? This systematic review evaluated workplace mental health programs for HCWs, comparing individual-level psychological interventions with organizational-level approaches. Following PRISMA 2020 guidelines, 54 studies (2016–2026) from more than 18 countries were identified from approximately 7144 records through a PubMed/MEDLINE search. The included studies comprised 29 individually randomized controlled trials (RCTs), 11 cluster-randomized or stepped-wedge trials, and 14 additional non-randomized or contextual studies. ROBINS-I was applied only to the five eligible non-randomized intervention studies—the remaining non-randomized studies contributed contextual evidence and were not included in the ROBINS-I assessment. Here, 41 studies contributed effectiveness evidence, of which 34 (83%) reported a statistically significant improvement in at least 1 primary or key outcome, while 13 studies provided contextual, feasibility, or implementation evidence. Individual-level interventions dominated the evidence base (39/54; 72%). In contrast, organizational interventions were less frequently evaluated, rarely randomized, and showed mixed findings. Observational studies consistently identified workload, organizational trust, and other structural stressors as factors associated with burnout, although causal inferences remain limited. Risk of bias was substantial, with only 7 of 40 randomized trials (17.5%) rated as low risk. All five non-randomized intervention studies assessed using ROBINS-I were judged to have serious risk of bias. Overall, individual-level interventions were evaluated more frequently than organizational interventions and generally reported improvements in mental health outcomes. However, the evidence base was limited by the single-database search, variability in study quality, and methodological limitations. Further well-designed and adequately powered studies, particularly of organizational interventions, are needed to strengthen the evidence base. Full article

Background: Definitions of BCG-unresponsive non-muscle-invasive bladder cancer (NMIBC) have become central to therapeutic decision making and clinical trial eligibility. This perspective synthesizes regulatory frameworks with real-world observations to examine how structural conditions shape the applicability of current definitions. These definitions rely on structural prerequisites—adequate BCG exposure, routine maintenance therapy, standardized surveillance, timely access to early radical cystectomy, and complete tumour-level documentation—that are not consistently achievable across diverse health-care environments. This study examines the structural and operational factors that limit the applicability of current BCG-unresponsive criteria in real-world NMIBC care. Methods: A multilevel analysis was performed and integrated four complementary sources of evidence—regulatory frameworks, national claims datasets, multicenter clinical studies, and real-world practice observation—selected for their ability to capture distinct structural dimensions of NMIBC care. Operational assumptions embedded in contemporary definitions were compared with real-world treatment patterns. Structural barriers were categorized across macro-level system constraints, meso-level institutional practices, and micro-level clinical workflows. Results: As a result, a substantial proportion of patients cannot be classified under existing criteria because the exposure-based and time-dependent conditions required by regulatory definitions are not met in routine practice. Maintenance BCG is infrequently delivered, surveillance intervals vary widely, early radical cystectomy is limited by system-level and institutional factors, and key tumour-level variables required for classification are often missing in large-scale datasets. As a result, many patients cannot be reliably classified using existing criteria—not because of tumour biology or clinician behavior, but because the structural assumptions underlying the definitions are unmet. Conclusions: Current BCG-unresponsive criteria rely on structural conditions that are not universally present in real-world NMIBC care. These findings suggest that context-specific operational definitions, together with complementary strategies such as improving guideline implementation, enhancing data completeness, standardizing surveillance practices, and strengthening healthcare infrastructure, may help align regulatory expectations with real-world practice and support equitable access to bladder-sparing therapies. Full article

Background: Advanced endovascular procedures are increasingly used for ischemic stroke, but real-world evidence from middle-income settings remains limited, particularly regarding survival, disability, and neurorehabilitation. This study examined mortality, recorded disability, procedure-related differences, and neurorehabilitation exposure among patients receiving high-technology stroke care in Almaty, Kazakhstan. Methods: We conducted a retrospective cohort study of 328 adults with ischemic stroke who underwent endovascular or stent-based procedures between 2014 and 2024. Survival was assessed using Kaplan–Meier analysis and Cox proportional-hazards regression. Binary mortality status and recorded disability were examined using logistic regression. Procedure codes were grouped as mechanical thrombectomy/endovascular removal, intracranial stenting, and embolization/coiling/other procedures. Results: Neurorehabilitation was received by 39% of patients and was associated with better crude survival (1 year survival 93.6% vs. 76.7%; 5-year survival 69.0% vs. 60.7%; log-rank p = 0.001). In the adjusted Cox model, older age (HR = 1.069, 95% CI 1.046–1.092, p < 0.001) and greater total bed-day burden (HR = 1.071, 95% CI 1.029–1.116, p = 0.001) were associated with higher mortality hazard. Binary neurorehabilitation was not independently associated with survival (p = 0.803). Male sex was the only consistent factor associated with recorded disability (fully adjusted OR = 2.662, 95% CI 1.261–5.617, p = 0.010). Conclusions: Older age and bed-day burden were the most stable mortality-related factors. Neurorehabilitation was linked to better crude survival but not adjusted survival or recorded disability. Procedure-related and disability findings should be considered exploratory because baseline stroke severity and validated functional scales were unavailable. Full article

The human microbiota is increasingly recognized as a key contributor to pediatric and perinatal health. However, little is known about healthcare professionals’ preparedness to integrate microbiota-related concepts into routine pediatric and perinatal care. Methods: A cross-sectional online survey was conducted among Italian healthcare professionals involved in pediatric and perinatal care. The questionnaire explored microbiota-related training, self-perceived knowledge, attitudes, clinical practices, microbiota-testing-related approaches, and educational needs. Descriptive and inferential statistical analyses were performed. Results: A total of 441 participants were included in the final analysis. Participants expressed highly positive attitudes toward the clinical relevance of the microbiota, particularly regarding maternal–fetal programming, neonatal development, preventive medicine, and microbiota education. Self-perceived knowledge was generally higher for basic microbiota concepts and neonatal microbiota development, whereas lower confidence emerged for microbiota-related clinical applications, counseling competencies, and critical interpretation of scientific evidence. Significant variability in microbiota-related knowledge scores emerged across professional backgrounds and healthcare settings (p < 0.001). Previous microbiota-related training was independently associated with higher self-perceived knowledge scores and greater integration of microbiota-oriented approaches into clinical practice. Use of probiotics was reported by 72.6% of participants, whereas microbiota-related diagnostic tests were routinely used by 32.9%. Overall, 91.8% of respondents expressed interest in further microbiota-related education. Conclusions: Healthcare professionals involved in pediatric and perinatal care recognize the growing clinical relevance of microbiota science but report heterogeneous levels of translational preparedness and clinical confidence. Microbiota-related training emerged as a key factor associated with greater preparedness and implementation in clinical practice, highlighting the need for structured multidisciplinary educational pathways and evidence-based integration of microbiome science into pediatric healthcare. Full article

The coronavirus disease 2019 (COVID-19) pandemic highlighted the critical need for rapid, accessible, and accurate diagnostic tools to support timely clinical decision-making, outbreak control, and public health surveillance. Point-of-care testing (POCT) has emerged as an essential component of decentralized healthcare by enabling diagnostic testing outside conventional laboratory settings. This review was based on a structured literature search of PubMed, Scopus, and Web of Science databases covering studies published between January 2020 and January 2026. The review evaluates current advances in COVID-19 POCT technologies, including molecular assays, antigen-based tests, antibody-based assays, biosensor platforms, and artificial intelligence (AI)-assisted diagnostic approaches. Molecular POCT methods, including rapid reverse transcription polymerase chain reaction (RT-PCR), loop-mediated isothermal amplification (LAMP), and CRISPR-based technologies, provide high analytical sensitivity and specificity and are increasingly suitable for decentralized diagnostic applications. Antigen-based assays offer rapid and cost-effective screening solutions, although diagnostic performance may vary depending on viral load, symptom onset, and circulating variants. Antibody-based POCT remains valuable for seroprevalence studies, retrospective diagnosis, and immune-response monitoring rather than acute infection detection. Emerging biosensor technologies and AI-enabled diagnostic systems demonstrate promising analytical capabilities and operational advantages; however, many remain at the prototype or early-validation stage and require further clinical evaluation before widespread implementation. The findings indicate that no single POCT modality is optimal for all clinical scenarios. Instead, molecular, antigen, antibody, biosensor, and AI-assisted approaches provide complementary strengths that support different diagnostic and public health objectives. Continued advances in assay design, digital connectivity, multiplex testing, and variant-resilient detection strategies are expected to further enhance the role of POCT in COVID-19 management and future infectious disease preparedness. Full article

Background: Pharmacogenetic (PGx) testing could identify actionable drug–gene interactions, reducing the risks of inappropriate prescribing of certain medications in some patients. An area of growing public health concern is rising global rates of depression and antidepressant use over the last two decades. Prior research has elucidated perspectives of healthcare providers who prescribe antidepressants regarding the clinical utility of genetic information, including PGx testing, but there is a gap in understanding how individual perspectives and systemic contextual factors may combine to influence PGx testing adoption. Objective: The objective of this study was to elucidate combinations of individual and contextual conditions associated with willingness to adopt PGx testing for Cytochrome P450 Subfamily IID, Polypeptide 6 (CYP2D6) and Subfamily IIC, Polypeptide 19 (CYP2C19) among antidepressant prescribers. Methods: We conducted a cross-sectional, mixed-methods study using structured questionnaires and semi-structured interviews with healthcare providers who prescribe antidepressants within their scope of practice across four healthcare systems in the United States. We collected data on implementation science concepts from the Theoretical Domains Framework, the Consolidated Framework for Implementation Research (CFIR), and the Implementation Outcomes Framework. Coincidence analysis (CNA), a case-based, Boolean logic-based method that identifies minimally sufficient combinations of conditions that lead to a particular outcome, was used to identify combinations of conditions for PGx test adoption among antidepressant prescribers. Interviews were also conducted with 10 patients who received pharmacogenetic testing within these healthcare systems to contextualize findings with patient perspectives. Results: Prescribers adopted PGx testing when they believed it would be beneficial to patients and were not deterred by cost-related concerns; the combination of these conditions led to PGx adoption in the most highly supported CNA model. Patient perspectives were also consistent with the selected model, with data suggesting they may have greater willingness to tolerate costs when they perceived or experienced benefits from testing. Conclusions: Insights from this study may be used by health system administrators and public health policymakers to inform future PGx implementation strategies that enhance uptake and awareness of existing evidence for clinical benefits of PGx testing and mitigate cost-related barriers to adoption. Full article

A high-density posterior cushion coil (HDPCC) can improve the SNR in pediatric MRI by conforming to the body and minimizing distance to the imaged volume when compared to a conventional rigid built-in table coil array. Posterior coil arrays built into MRI tables are mainstays but provide suboptimal performance in pediatric imaging due to their distance from the imaged volume and lower coil density. Our goal is to improve pediatric MRI by constructing a prototype 30-channel high-density posterior cushion coil (HDPCC) incorporated into a padded cushion. Twenty-five pediatric patients were scanned with the HDPCC, and twenty-five pediatric controls served as the comparison group using standard coils. Two radiologists graded image quality on a 5-point scale. SNR was measured in the right paraspinal musculature and the liver. All images obtained with the HDPCC were diagnostic (mean score 4.13/5). SNR in the superficial tissues of the paraspinal musculature was 34% higher with the HDPCC than with standard coils, while SNR in the deeper tissues of the liver was statistically similar between the two coils. HDPCC yields improved the signal-to-noise ratio in phantoms and pediatric study participants by conforming to the body. Full article