Search Results (299)

Background/Objectives: Remote patient monitoring (RPM) has expanded the capacity of peritoneal dialysis (PD) programs to supervise home-based therapy; however, its full clinical value may be limited when patient-generated data remain disconnected from electronic medical records (EMRs). This study evaluated the implementation and impact of integrating the Sharesource RPM platform with the Versia EMR system in routine PD care. Methods: This multicenter real-world implementation study was conducted between November 2024 and February 2025 across three dialysis centers in Colombia. The integration enabled automated transfer of home treatment-related information from Sharesource to Versia and supported population health management through interactive dashboards. Workflow efficiency was assessed using a before-and-after time and motion analysis, and user experience was evaluated through structured surveys administered 12 weeks after implementation. Analyses were descriptive. Results: The integration was successfully implemented across the participating centers, achieving complete data concordance and operational stability. During follow-up of 287 patients, 501 patient-clinic communications, 159 preemptive evaluations, and 122 prescription modifications were recorded, reflecting proactive identification and management of clinical issues. Nursing consultation time decreased from 34 to 26 min per patient, and nephrologist time from 31 to 25 min per patient. Surveys showed high acceptance, supporting proactive clinical decision-making, and greater workflow efficiency. Conclusions: Real-world implementation of an interoperable RPM-EMR ecosystem in PD care was feasible, operationally stable, and was related to improvements in workflow efficiency while supporting proactive population health management. By transforming fragmented patient-generated data into actionable clinical insights, this digital ecosystem may support more efficient, data-driven, and proactive models of chronic kidney disease care. Full article

This paper provides the design and simulation of a lightweight cryptographic protocol on smart house IoT devices using ChaCha20 and Ascon-AEAD128. The protocol, implemented in Python 3.14.6 and tested on a virtual ESP32 platform using Wokwi and CloudAMQP, uses stream cipher encryption with authenticated message tagging to provide confidentiality and integrity. Two conditions, normal and tampered transmission, were experimented to confirm tag validation and successful decryption. Findings affirmed sound detection of tampering and unauthorized access prevention, proving usefulness of current AEAD ciphers on limited devices. The protocol highlights cryptographic systems that prioritize computationally efficiency and robustness, which is essential in smart homes that have limited power and memory. The hybrid design provides confidentiality and authenticity using a minimal overhead by utilizing ChaCha20 to provide lightweight encryption and Ascon-AEAD128 as authentication. The resilience to the replay and modification attacks was demonstrated in experiments based on message queues and injected packet modifications simulating real-world conditions. Even though benchmarking of hardware was not carried out, the simulated values reveal stability and flexibility to use in low-power systems. This article emphasizes the necessity of authenticated encryption as default, which is consistent with the NIST standards and reflects the appropriateness of Ascon to new IoT security requirements. It also creates a reconfigurable structure that can be used in other highly constrained systems, such as healthcare monitoring and industrial IoT. The main contribution is the gap between theoretical cryptography and practical IoT security provided by the practical prototype. Further development will include tests on physical ESP32 modules and fine performance profiling, yet already, the current implementation proves a scalable, secure model of smart home IoT. Finally, this research demonstrates that the demand of reliable and low-power-based communication in resource constrained networks can be met efficiently without sacrificing device performance by means of lightweight cryptography. In addition to the cryptographic protocol design, this study integrates a machine learning-based intrusion detection layer trained on the Edge-IIoTset dataset, in which Logistic Regression, Decision Tree, Random Forest, and Gradient Boosting classifiers are evaluated to complement the encryption–authentication framework with anomaly-aware monitoring of network traffic. Full article

Older adults commonly face challenges such as insufficient spatial accessibility and a lack of safety facilities in their home environments. This paper proposes a multi-criteria decision-making (MCDM) model integrating the Analytic Hierarchy Process (AHP) and Particle Swarm Optimization (PSO) to enhance the scientific rigor and practicality of age-friendly renovation solutions. Based on 543 valid questionnaires and interview data, an evaluation system was constructed, covering four key dimensions: safety assurance, spatial accessibility, independent living capability, and environmental comfort. The weight allocation incorporates dual-source fusion of expert judgment and sample-aggregated resident preferences to improve model rationality and stability. Results demonstrate that the AHP-PSO model outperforms comparative models in prediction accuracy (MAE = 0.121), functional reasonableness (FDR = 0.136), dimensional balance (DBR = 0.912), and robustness (FSR = 94.8%). Comprehensive adaptation analysis reveals that while most residences satisfactorily meet the needs of the elderly, emergency response facilities, kitchen convenience, and furniture adaptability remain critical shortcomings constraining overall performance. The findings validate the effectiveness of the AHP-PSO model for age-friendly home modifications, providing methodological support for resource allocation optimization and aging-in-place policy formulation. Full article

Oculomics uses ocular images, ocular biofluids and functional ocular tests to extract diagnostic information on local or systemic biological states. Most current evidence is cross-sectional: one retinal photograph, OCT scan, OCTA examination or tear sample is compared with a reference population, or converted into a diagnostic or prognostic score. This approach is useful for screening and risk enrichment, but it does not show whether the same patient is changing over time. In this review, dynamic oculomics, or oculomic kinetics, is presented as a diagnostic-monitoring approach based on repeated ocular measurements within the same individual. Its object is the personal trajectory: baseline level, short-term variability, long-term drift, response to stimulus, recovery and modification by treatment. We discuss the biological basis of ocular trajectories, the limits imposed by local ocular regulation and disease, and the technical constraints of fundus photography, structural OCT, OCTA, functional challenge tests, tear analysis, aqueous humour analysis, continuous intraocular pressure monitoring and home-based imaging. We also examine artificial intelligence, validation, governance, health-economic considerations and practical implementation. The available evidence does not support a universal ocular surrogate for systemic disease. More realistic applications include detection of unexpectedly rapid tissue change, individualised risk stratification, treatment-response assessment and recognition of discordance between systemic markers and ocular tissue behaviour. Full article

Engineered mesenchymal stem cells (MSCs) have emerged as promising therapeutic platforms for healthspan-relevant applications. As agents of tissue repair and modulators of biological aging, MSCs have been widely studied for their capacity to enhance regeneration, restore immune homeostasis, and reduce chronic inflammation associated with age-related decline. This review examines emerging bioengineering strategies designed to overcome key age-related limitations in MSC homing, survival, and paracrine signaling, which have historically constrained their in vivo efficacy. We discuss major engineering approaches, including genetic modification, surface engineering, metabolic reprogramming, and preconditioning, with particular attention to their contributions to longevity-focused applications. Preclinical studies have demonstrated that engineered MSCs and their extracellular vesicles (EVs) yield measurable improvements in therapeutic performance. Reported benefits include prolonged persistence in inflamed tissues, partial reversal of senescence-associated phenotypes, and modulation of pro-aging inflammatory pathways. While MSC-derived EVs may offer potential safety advantages and could reduce certain risks associated with live-cell administration, this remains to be confirmed in well-controlled clinical studies, and significant challenges persist in terms of manufacturing scalability, cargo consistency, and process standardization. The current literature, which is predominantly preclinical, supports the potential of engineered MSC platforms to improve healthspan-relevant outcomes; direct evidence of healthspan extension in humans is not yet available. However, successful clinical translation will require a standardized manufacturing process to ensure therapeutic safety, reproducibility, and efficacy in age-related conditions. Full article

Hip fractures are among the most devastating fragility fractures, associated with excess mortality, disability, loss of independence, and substantial healthcare costs. Although age-standardized incidence has declined in several high-income countries, absolute case numbers continue to rise because of population aging. This review summarizes contemporary PubMed-indexed evidence on the epidemiology, risk stratification, and prevention of proximal femoral fractures, with emphasis on hip-fracture outcomes rather than vertebral or composite endpoints alone. We discuss secular trends, FRAX-based case findings and screening, non-pharmacologic strategies, pharmacologic therapy, and health-system interventions relevant to both primary and secondary prevention. Among non-pharmacologic measures, long-term balance-challenging and resistance-based exercise has the most consistent evidence for reducing falls and likely contributes to fracture prevention, whereas multifactorial interventions, home hazard modification, calcium/vitamin D supplementation, and hip protectors are best targeted to selected high-risk populations and care settings. Among medications, bisphosphonates, denosumab, and romosozumab-based sequential strategies show the strongest evidence for reducing hip-fracture risk, while teriparatide and abaloparatide have important roles in very-high-risk patients despite less direct hip-fracture evidence. Menopausal hormone therapy reduces hip fractures in younger postmenopausal women but is limited by extra-skeletal risk, and selective estrogen receptor modulators are primarily vertebral-fracture agents. A major message of this review is that effective prevention depends not only on drug efficacy but also on implementation. Fracture liaison services, orthogeriatric co-management, prompt treatment after fragility fracture, and sustained adherence support are essential to close persistent care gaps. Preventing hip fractures therefore requires an integrated, risk-stratified approach that combines skeletal protection, falls prevention, and reliable health-system delivery. Full article

Internet-of-Things (IoT) devices in smart homes are vulnerable to passive traffic fingerprinting, where an adversary captures encrypted IEEE 802.11 frames and identifies devices using MAC-layer metadata such as packet sizes and inter-arrival times. Existing defenses based on padding, traffic shaping, or synthetic cover traffic can remain vulnerable because artificial timing signatures are detectable by machine learning classifiers. This paper proposes a game-theoretic framework for evaluating Wi-Fi MAC-layer cover-traffic injection defenses. We introduce donor-based mimicry injection, in which the access point injects a replica of a paired device’s authentic traffic into each device’s stream. We compare donor mimicry with fixed-rate, exponential, and uniform synthetic baselines across 198 scenario instances (156 unique defender configurations) and eight classifiers using 10-fold cross-validation. Donor mimicry at 100% bandwidth overhead reduces the best attacker’s balanced accuracy to 33.5%, whereas synthetic methods at equal overhead reach 93.9%, showing that behavioral realism, rather than injected volume alone, drives effectiveness. Modeling the interaction as a finite two-player zero-sum game yields a mixed-strategy Nash equilibrium with game value 0.247 within the evaluated strategy space; a deployable deterministic defense holds the best pairing-unaware attacker to 25.9% balanced accuracy, near the four-class random baseline of 25%. A pairing-aware robustness analysis shows that an attacker who can orient the donor-induced identity swap recovers near-baseline accuracy, so the four-class protection presumes pairing secrecy and the durable effect is pair-level anonymity. The defense operates at the access point and requires no IoT device modifications. Full article

Background: Glioblastoma (GBM) has emerged as a model of resistance to immunotherapy because of the immunosuppressive tumor microenvironment (TME), which is closely associated with tryptophan metabolism. Inhibiting the expression of indoleamine 2,3-dioxygenase-1 (IDO1, a key enzyme in tryptophan metabolism) is a promising strategy for improving the immunosuppressive TME. Meanwhile, Gasdermin B (GSDMB)-mediated pyroptosis is a newly identified mechanism for activating the immune response. Methods: We prepared a GBM cell membrane (CM)-modified lipid nanoparticle (CMLNP) to deliver CRISPR/Cas9 components and mRNA encoding the N-terminal domain of GSDMB (GSDMB^NT mRNA). Results: The CM modification endowed the LNP with a tumor homing/homotypic targeting effect. Then, CRISPR/Cas9 components realized the knockdown of the IDO1 gene, thus remodeling the TME. GSDMB^NT mRNA triggers pyroptosis, thus eliciting an immune response. Conclusions: This system generated potent antitumor immunity and offered a novel strategy for GBM immunotherapy. Full article

Background/Objectives: Rhinosinusitis (RS) is a prevalent inflammatory condition with substantial morbidity and variable response to standard therapies. Diet is a modifiable determinant of systemic inflammation, yet its role in sinonasal disease remains incompletely defined. Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, Cochrane Library, and Web of Science were searched from inception through 28 June 2026. Studies assessing dietary exposures or interventions in RS were included using predefined criteria. Risk of bias was assessed using ROBINS-I and Joanna Briggs Institute tools. Due to heterogeneity in study design and outcomes, findings were synthesized narratively. Results: Ten studies met inclusion criteria (5 adult, 4 pediatric, 1 mixed), including interventional and observational designs. Anti-inflammatory dietary patterns were associated with improved sinonasal outcomes. In children, Mediterranean diet adherence reduced recurrent inflammatory episodes, and reduced sugar intake improved sinus infection scores with decreased TNF-α concentrations. In adults, both allergen-guided elimination diets and a low-arachidonic acid, low-salicylate, high-fiber dietary intervention improved symptom severity, with accompanying improvements in endoscopic outcomes. Observational studies demonstrated that higher fruit intake was associated with lower RS prevalence, whereas higher fat intake, caloric intake, Dietary Inflammatory Index scores, frequent meals prepared away from home, and ultra-processed food intake were associated with increased disease risk or sinonasal symptom burden. Phenotype-specific associations included increased dietary salicylate sensitivity and food-triggered symptom exacerbation among patients with nasal polyposis. Conclusions: Dietary patterns and specific nutritional exposures are associated with RS outcomes across age groups. Anti-inflammatory dietary profiles demonstrate potential protective effects, whereas pro-inflammatory dietary patterns are associated with increased disease burden. However, the predominance of observational data and study heterogeneity limit causal inference. Well-designed prospective and randomized studies are needed to define the therapeutic role of dietary modification in RS. Full article

Sleep-related breathing disorders (SRBDs) encompasses a spectrum of conditions that disrupt ventilation during sleep, leading to fragmented sleep and impaired gas exchange. Their high prevalence and substantial neurocognitive and mental health outcomes make SRBD clinically significant across multiple medical disciplines. Traditional management includes lifestyle modifications and positive airway pressure (PAP). When non-surgical measures fail or anatomical factors predominate, a range of surgical approaches may be employed, such as uvulopalatopharyngoplasty (UPPP) or maxillomandibular advancement (MMA). There are many notable emerging surgical advancements, such as hypoglossal nerve stimulation (HNS), transoral robotic surgery (TORS), and minimally invasive radiofrequency technologies (RFA), that have offered improved outcomes for select patients. Advances in diagnostic tools, such as portable home sleep technologies and drug-induced sleep endoscopy (DISE), further support precision-based care. Collectively, the expanding range of therapeutic and diagnostic innovations is enabling clinicians to deliver individualized care and improve long-term outcomes for patients with SRBD. Full article

Lichen planus (LP) is a chronic T-cell-mediated interface dermatitis. Genital involvement is frequently refractory to topical corticosteroids and calcineurin inhibitors and may lead to fibrosis, architectural distortion, and substantial impairment in quality of life. We report the case of a 39-year-old male with a 15-year history of biopsy-confirmed genital LP unresponsive to high-potency topical corticosteroids and tacrolimus 0.1%, who received topical Rosa damascena stem cell-derived exosomes (RSCEs) at biweekly sessions for four months. Each session combined 2 mL of in-office application with superficial microneedling in hyperkeratotic areas, followed by 3 mL of the same-day home application. No concomitant topical corticosteroid or calcineurin inhibitor was used during the treatment period. Paired pre- and post-treatment 4 mm punch biopsies were obtained from the same anatomical region, processed using identical protocols, stained with hematoxylin and eosin, and reviewed by a board-certified dermatopathologist. After four months, we observed clinical resolution of pruritus and fissuring, progressive desquamation of hyperkeratotic plaques, and improved tissue elasticity. The post-treatment biopsy showed reduced hyperkeratosis and hypergranulosis, attenuation of the band-like lymphohistiocytic infiltrate, partial restoration of the dermoepidermal interface, and reduced basal vacuolar degeneration relative to baseline. No dysplastic changes or treatment-related adverse events were observed. These observations are based on a single uncontrolled case and cannot establish causality, isolate the contribution of microneedling, or demonstrate disease modification beyond the descriptive level. Histological assessment was qualitative; no semi-quantitative or immunohistochemical analysis was performed. The exosome preparation was used as a standardized commercial product and was not independently characterized in our laboratory. The findings are intended solely as hypothesis-generating. Independent characterization of the exosome preparation, immunohistochemical and ideally transcriptomic profiling of paired tissue, and prospective controlled studies are required before any therapeutic claim can be supported. Full article

Background: Falls among older adults are a major public health concern associated with injury, disability, reduced mobility, and loss of independence. Functional impairment, chronic diseases, and unsafe home environments may increase the risk of falls. This study examined environmental, functional, and health-related factors linked to falls among community-dwelling older adults in Iran. Methods: A comparative cross-sectional study was conducted among 329 community-dwelling older adults. Data were collected using standardized assessments of functional ability, home safety, health status, and fall history. Conventional regression and Elastic Net analyses were applied to identify significant predictors of falls. Results: Overall, 28.6% of participants reported at least one fall during the previous 12 months. Falls were significantly more common among females, adults aged ≥85 years, individuals without a spouse, and those with lower educational levels. Fallers showed poorer mobility, balance, and functional independence, greater fear of falling, and a higher risk of home accidents (all p < 0.001). Elastic Net analysis identified use of movement aids as the strongest risk factor, whereas better Performance-Oriented Mobility Assessment (POMA) scores were the main protective factor. Conclusions: Falls among community-dwelling older adults appear to result from the interaction of physical, medical, socioeconomic, and environmental factors. These findings highlight the need for multidimensional fall-prevention strategies in primary care settings. Full article

Background/Objectives: Telewellness programs can expand access to exercise and social opportunities for older adults, especially those with mobility disabilities. The TechSAge Tele Tai Chi clinical trial assessed whether the Tai Chi for Arthritis and Fall Prevention program was feasible and acceptable when delivered in a virtual format for adults aging with mobility disabilities, and examined pre-to-post changes in two primary outcomes: physical activity and social connectedness. Methods: The TechSAge Tele Tai Chi study was a single-arm clinical trial. Sixty community-dwelling adults (60–77 years of age; M = 69.2, SD = 4.8) with self-identified long-term mobility disability (≥10 years) joined the virtual classes from home twice a week for 8 weeks. Participants exercised along with pre-recorded video lessons and engaged in guided social discussion. Assessments at baseline, post-intervention, and 1-month follow-up were analyzed with linear mixed models. Results: Leisure physical activity (PASIPD) increased significantly, with back-transformed marginal means rising from 14.2 MET h/wk at baseline to 28.7 MET h/wk post-intervention (p < 0.001). The Social Participation subscale of social connectedness also increased from baseline to post-intervention (p = 0.014); the overall social-connectedness composite did not change significantly. The virtual translation was feasible with high intervention fidelity and adherence, and participants reported high acceptability, satisfaction, enjoyment, and intention to continue. Conclusions: Adults aging with mobility disabilities can safely and successfully participate in virtual group tai chi with appropriate modifications and technology support. Full article

Background/Objectives: Childhood obesity is a complex, multifactorial condition that requires comprehensive and sustained interventions. Despite the central role of dietary modification in obesity management, current approaches to dietary counselling remain heterogeneous and often fail to account for the broader environmental and social determinants of eating behavior. In pediatric populations, dietary habits are strongly influenced by family dynamics, home food environments, school settings, and peer interactions, highlighting the need for system-oriented intervention models. Methods: This structured narrative review with conceptual framework development presents an integrative framework for dietary counselling in pediatric obesity, combining evidence-based nutritional strategies with behavioral and environmental approaches. The paper synthesizes current literature on early-life habit formation, family-based behavioral treatment, feeding practices, and environmental determinants of dietary behavior. Results: The proposed framework emphasizes the role of the family as the primary therapeutic unit and highlights the importance of modifying the home food environment and implementing gradual, achievable changes through the “small steps” approach. A structured, visit-based model of dietary counselling is introduced, integrating dietary assessment, patient education, and behavioral strategies. Additionally, the influence of external environments—including schools, peer groups, and public health systems—is considered to provide a comprehensive understanding of factors shaping dietary behaviors in children. Conclusions: The proposed system-oriented framework offers practical guidance for clinicians and public health practitioners and supports the development of more effective and sustainable interventions. Integrating individual, family, and environmental perspectives may improve adherence to dietary recommendations and enhance long-term outcomes in pediatric obesity management. Full article

Background/Objectives: Improved survival rates have led to an increase in the number of children with medical complexity (CMC) receiving home-based care. However, there is a lack of clarity regarding the relationships among collaborative environments, environmental modifications, and positive family health among families of CMC in daily living settings. This study aimed to examine these relationships and identify their associated factors. Methods: This study was a secondary analysis of data derived from a self-administered questionnaire that was distributed to the families of CMC with experience in organizing the care environment. Ninety responses were included in the study, and regression analyses were performed using complete cases (n = 41–63). Results: Family-led environmental modifications (β = 0.670, p < 0.001) and physical environmental modifications (β = 0.679, p = 0.015) were positively associated with the collaborative environment, whereas professional-facilitated family-led environmental modifications were negatively associated with the collaborative environment (β = −0.775, p = 0.009). Regarding positive health in families, family-led environmental modifications (β = 0.487, p = 0.018), environmental modifications for care improvement (β = 0.597, p = 0.031), pre-modification family well-being (β = 0.464, p < 0.001), and the presence of someone to consult (β = 0.330, p = 0.011) were significantly associated with positive health in families. Because this study employed a cross-sectional design, causal relationships cannot be inferred. Conclusions: Collaborative environments in daily living settings may be associated with family involvement, physical environmental conditions, and professional engagement. Healthcare professionals may support family autonomy and participation in environmental modification processes. Full article