Search Results (1,561)

Background: Mechanical complications remain a concern after vertebral body replacement (VBR), especially during rehabilitation. Yet exercise prescription is often guided by body posture or single loading measures. This study characterized mechanical demands during rehabilitation exercises after VBR and examined the effects of posture and postoperative time. Methods: Telemetric in vivo load data from instrumented VBRs in the OrthoLoad database were analyzed. A total of 119 trials across 21 exercises, performed in supine, prone, seated, and standing positions, were collected from five patients over 0.1–63 postoperative months. Mechanical demand was quantified across six biomechanical domains and integrated into a composite SafetyIndex. Posture- and time-related effects were assessed using linear mixed-effects models. Worst-case demand was defined as the 95th percentile of SafetyIndex values. Results: SafetyIndex showed a right-skewed distribution (median 8.5, IQR 3.7–14.1), with marked inter-exercise variability. Composite SafetyIndex did not differ between postures (all p > 0.13). However, posture-dependent effects emerged at the domain level: peak shear ratio was greater in prone than in sitting, standing, and supine positions (all p < 0.05); peak force was greater in standing than prone (p = 0.007 and p = 0.013 in unadjusted and adjusted models); and peak resultant moment was smaller in supine than prone (p = 0.036 and p = 0.046). Postoperative time was positively associated with peak force (β = +0.40 %BW/month, p = 0.042), peak resultant moment (β = +0.025 Nm/month, p < 0.001), and SafetyIndex (β = +0.25/month, p = 0.011), but not peak shear ratio (p = 0.879). Worst-case SafetyIndex_P95 values ranged from 0.6 to 85.0, with stable ranking across percentile thresholds (Spearman’s ρ = 0.995–0.997). Conclusions: Mechanical demand after VBR is task-specific and domain-dependent and cannot be inferred from posture alone. Axial and bending-related components increased over postoperative time, whereas shear-related loading remained task-dependent. Full article

Background/Objectives: Retention of healthcare professionals in the workforce, their employment, and the improvement of working conditions largely depend on identifying the factors that influence their departure and their health. The study was conducted during the period from January to June 2021. This study aimed to examine the association between specific work-related stressors and work ability. The initial hypothesis was that general and specific occupational stressors negatively associate with work ability among healthcare professionals in emergency medical intervention teams. Methods: The study was designed as a cross-sectional comparative study. It was conducted among nurses and physicians in pre-hospital emergency medical services, employed full-time in intervention teams, while the control group consisted of employees from dispatch and call-receiving units. The study was conducted on the 840 participants, representing 43.3% of all healthcare professionals employed in pre-hospital emergency medical services in the Republic of Croatia. In addition to questions on participants’ personal characteristics, the following instruments were used: 1. a validated Questionnaire on Workplace Stressors among hospital healthcare professionals; and 2. the international standardized Work Ability Index (WAI) questionnaire for assessing work ability. Participants completed the questionnaires in paper form. Results: On average, the participants demonstrated lower levels of stress compared to reference values, both for overall stress and for individual stress factors, while their work ability, assessed using the Work Ability Index (WAI), ranged from very good to excellent. The control group showed higher levels of stress across all factors and lower work ability. However, the control group was older on average, generally had lower levels of education, and consisted more often of women—personal characteristics that may influence the examined variables. Lower stress levels and better work ability were associated with job satisfaction, ambition, and the fact that participants were working in their desired profession. Frequent sick leave (absenteeism) was highly correlating with both higher stress levels and poorer work ability. Conclusions: Greater job satisfaction and higher motivation have a positive impact on stress levels and employees’ work ability. The study results can serve as a starting point for institutional management in designing feasible decisions aimed at improving satisfaction, health, the work environment, and the work ability of emergency medical service personnel, as well as making these institutions more attractive for recruitment and retention of employees both in their positions and within the profession. Full article

Background: The Postural Control System is affected by sensory inputs in stabilizing posture. The impact of postural receptors can be quantitatively evaluated by baropodometry. The lack of a standardized testing environment can decrease the reliability of baropodometric results. Virtual reality (VR) might represent a useful standardization tool. This study aimed to investigate the effects of virtual environment on plantar pressure and postural stability parameters by using a Head-Mounted Display (HMD). Methods: 50 healthy young adults underwent a baropodometric exam in upright standing under four conditions: Open Eyes (OE), Closed Eyes (CE), open (HMD-OE) and closed eyes (HMD-CE) conditions while wearing an HMD. Results: a negligible effect of VR on intrasubject variability of plantar pressure and stabilometric parameters. Moreover, no significant differences in the latter ones were found between OE conditions without and with headset (OE vs. HMD-OE), highlighting no impact of VR; instead, a significant increase in body sway was found in the closed eyes condition compared to OE ones with and without headset (CE vs. OE, CE vs. HMD-OE), underlining the effect of visual deprivation, whereas no significant difference was observed between the HMD-CE and OE conditions and a significant decrease in HMD-CE compared to the CE condition, showing the sensory-proprioceptive effect of the HMD. Eventually, no significant differences in plantar pressure parameters were generally found in different conditions. Conclusions: These findings highlighted the specific effect of visual afferents differently from proprioceptive ones by headset use and the absence of the VR impact on postural stability, suggesting a possible role of virtual reality in standardizing instrumental postural exam. Full article

Background/Objectives: Established AECOPD prognostic tools (DECAF, BAP-65, PEARL) predict mortality or readmission rather than length of stay (LOS), and no admission-based instrument specifically targets prolonged hospitalization. We tested whether admission PaCO₂ and the Prognostic Nutritional Index (PNI), reflecting ventilatory failure and nutritional–immune reserve, are independently associated with prolonged LOS and examined their interaction. Methods: In this single-center retrospective cohort, 213 adults hospitalized exclusively for AECOPD were analyzed after excluding concomitant pneumonia, pulmonary embolism, decompensated heart failure, and in-hospital deaths. Prolonged hospitalization was pre-specified as LOS > 7 days. Multivariable logistic regression evaluated admission PaCO₂ (per +10 mmHg) and PNI (per +5 units) with a PaCO₂ × PNI interaction; continuous LOS was modeled by Gamma regression. Discrimination was compared with DECAF using DeLong’s test. Results: Prolonged hospitalization occurred in 83 patients (39.0%). Admission PaCO₂ was independently associated with prolonged LOS (OR 1.52, 95% CI 1.25–1.88; p < 0.001), and PNI showed a borderline association (OR 0.84, 95% CI 0.71–1.00; p = 0.049); their interaction was significant but exploratory (OR 1.16, 95% CI 1.02–1.32; p = 0.025). In Gamma regression, PaCO₂ (RR 1.18 per 10 mmHg) and PNI (RR 0.92 per 5 units) remained associated with LOS. The two-variable model achieved an AUC of 0.682, showing discrimination similar to DECAF in this cohort (AUC 0.695; DeLong p = 0.76), with optimism-corrected AUC 0.672 and calibration slope 0.96. Within moderate hypercapnia (PaCO₂ 45–60 mmHg), the prolonged-LOS rate was 44.4% in low-PNI versus 15.6% in high-PNI patients. Conclusions: In this single-center retrospective cohort of AECOPD patients surviving to discharge, admission PaCO₂ and PNI were jointly associated with prolonged hospitalization, reflecting acute ventilatory burden and nutritional–immune reserve. Using only two admission inputs, the framework showed discrimination similar to DECAF without meaningful reclassification gain (IDI −0.02; NRI 0.02). Given only moderate discrimination (AUC ~ 0.68), external validation is required before clinical use, with the main practical value likely in complementary stratification within moderate hypercapnia. Full article

Background/Objectives: Robotic-assisted bronchoscopy has emerged as an advanced technique for the evaluation of peripheral pulmonary lesions, offering improved navigation and targeting accuracy. While several studies investigating other diagnostic modalities have identified factors associated with higher diagnostic yield, such determinants remain poorly defined for shape-sensing robotic-assisted bronchoscopy (ssRAB). This study therefore aimed to identify predictors of diagnostic yield in robotic bronchoscopy. Methods: This retrospective single-center study included all consecutive patients who underwent ssRAB (ION^TM system, Intuitive Surgical, Sunnyvale, CA, USA) between August 2024 and March 2026. Lung nodules undergoing marker placement only or procedures performed without cone-beam CT (CBCT) guidance were excluded. Collected variables included demographic characteristics, lesion size, lesion density (solid, part-solid, ground-glass), biopsy modality, and number of biopsy samples obtained. Diagnostic yield was defined as a definitive pathological diagnosis of the target lesion. Predictors of diagnostic success were assessed using univariable logistic regression. Results: In total, 111 pulmonary nodules were included in the analysis. The overall diagnostic yield was 88.3% (98/111). The mean patient age was 64.94 ± 7.9 years, with a predominance of female patients (58.4%). No significant associations were observed between diagnostic yield and lesion size (odds ratio [OR] 1.014 per mm; p = 0.764), lesion density (p = 0.892), or biopsy instrument (p = 0.835). However, an increased number of biopsy samples showed a positive association with diagnostic yield, showing a statistical trend (OR 1.22 per additional sample; p = 0.084). Conclusions: Robotic-assisted bronchoscopy provides a high diagnostic yield for peripheral pulmonary lesions. The number of biopsy samples appears to be the most relevant modifiable factor influencing diagnostic success, underscoring the importance of adequate tissue acquisition. In contrast, lesion characteristics and biopsy modality did not significantly affect outcomes in this cohort. Full article

The green transition in agriculture is a key issue for achieving sustainable development. Based on panel data from 30 Chinese provinces covering the period from 2011 to 2022, this paper examines the relationship between environmental enforcement and agricultural green total factor productivity (AGTFP), with a focus on analyzing the moderating effects of land transfer and agricultural insurance, as well as their synergistic threshold characteristics. The study employs two-way fixed-effects models, moderating effect models, and Hansen threshold regression methods for empirical analysis. The baseline regression results show a significant positive association between environmental enforcement and AGTFP. This conclusion remains robust after various tests, including truncation, replacement of core explanatory variables, difference GMM, and instrumental variables. The decomposition test shows that this positive correlation is mainly reflected through the channel of technological progress, rather than the improvement in technical efficiency. Heterogeneity analysis indicates that the positive association is more pronounced in regions with high GDP, strong law enforcement capacity, and in northern regions. Moderation analysis reveals that both the land transfer rate and insurance depth positively moderate the relationship between environmental enforcement and AGTFP, and the two exhibit a synergistic effect. However, this synergistic effect exhibits nonlinear characteristics and may weaken or even reverse at extreme value intervals. A threshold model further reveals an asymmetric complementary relationship between the two institutional conditions. The moderating effect of land transfer is activated only after insurance depth crosses a threshold value, while the moderating effect of insurance depth is most effective during the small-scale farming stage. These findings suggest that environmental regulation policies should be advanced in coordination with land transfer and agricultural insurance systems, with a focus on institutional alignment and coordination. Full article

Background: The objective was to synthesize and critically appraise systematic reviews with meta-analysis evaluating the association between irrigation, instrumentation, and obturation procedures and post-operative endodontic pain. Methods: An umbrella review was conducted following PRISMA guidelines. Electronic searches identified systematic reviews published between 2016 and 2025. Eligible studies are systematic reviews that include meta-analyses, published in English and correlating the presence of post-operative pain in 3 different critical stages of root canal treatments, namely irrigation, instrumentation and obturation. Methodological quality was assessed using the AMSTAR 2 tool. Outcomes included pain prevalence and intensity at different time points. Results: Out of 368 records, 25 systematic reviews with meta-analysis met the inclusion criteria: 9 on irrigation, 8 on instrumentation, and 8 on obturation. NaOCl concentrations, irrigant activation, and intracanal cryotherapy were repeatedly reported as being associated with reduced short-term post-operative pain. For instrumentation, most reviews reported lower pain with rotary systems, but two studies found no difference or favored reciprocating kinematics. Apical patency did not appear to increase pain and foraminal enlargement may increase early pain. No clinically consistent differences were observed between bioceramic/calcium silicate-based and resin-based sealers, although calcium silicate sealers seem to support periapical healing. However, the certainty of these findings was limited by heterogeneity, methodological weaknesses, and overlap among primary studies. Methodological limitations were identified across reviews, mainly related to no protocol registration (n = 4), incomplete reporting of excluded studies with justification (n = 11), limited assessment of publication bias, and poor reporting of funding sources for primary studies. Conclusions: Based on current evidence, irrigation, instrumentation, and obturation procedures may influence short-term post-operative pain. However, these findings remain tentative because of heterogeneity, methodological weaknesses, variable review quality, and overlap among primary studies. Further high-quality reviews and clinical trials are needed. Full article

Background/Objectives: The trainer–doctor model (TDM) is a participatory paradigm in which the physician acts as a mentor and educator. Effective health communication and patient engagement are key determinants of treatment adherence and health outcomes. Based on this conceptual framework, the present study aimed to assess preferences for the Trainer–Doctor Model among dental practitioners and patients, examine the influence of demographic variables, and provide a preliminary psychometric evaluation of the TDM questionnaire in accordance with the COSMIN (COnsensus-based Standards for the selection of health Measurement Instruments) criteria. Methods: A cross-sectional survey was conducted in Romania between May 2023 and April 2024. The study included dental practitioners recruited during scientific dental conferences and patients recruited from a private dental practice in Alba Iulia, Romania. Eligible participants were adults aged 18 years or older who provided written informed consent and completed the data protection requirements. Individuals younger than 18 years of age or those who did not provide complete informed consent were excluded. Participants completed a 12-item Likert-type questionnaire assessing preferences toward the Trainer–Doctor Model. Results: Both groups showed high TDM preference (practitioners: 43.93 ± 5.56; patients: 44.77 ± 4.84; p = 0.195); 71–76% of responses were high-preference (≥4). Cronbach’s α with reverse-scored items was 0.752/0.651. EFA (KMO = 0.740; Bartlett’s p < 0.001) identified a 3-factor structure, explaining 51.3% of the variance. Patients scored significantly higher on items A (p = 0.002), B (p = 0.022), and F (p = 0.005). Conclusions: Both groups demonstrate a strong, consistent preference for TDM across demographics. The preliminary psychometric evaluation indicates acceptable internal consistency and structural validity; however, further validation, including Delphi-based content validation and confirmatory factor analysis, is required. Full article

Background/Objectives: Loneliness is a relevant social determinant of health in older age and has been associated with adverse physical, psychological and social outcomes. This study aimed to estimate the prevalence of severe loneliness and to identify its epidemiological and clinical correlates among community-dwelling older adults at risk of falls in Andalusia, Spain. Methods: A cross-sectional analytical study was conducted with 237 adults aged 65 years and older living in private households. Loneliness was assessed using the 10-item version of the UCLA Loneliness Scale, which showed excellent internal consistency in this sample (Cronbach’s alpha = 0.900). After reviewing the scoring direction of the instrument, severe loneliness was operationally defined using the corrected UCLA total score, with higher scores indicating greater loneliness. Sociodemographic and clinical variables included age, sex, living arrangements, economic level, family relationships, pain, sleep quality, depression history, physical exercise, outings from home, polymedication and analgesic use. Bivariate analyses were performed to compare participants with and without severe loneliness, and logistic regression was used to examine independent correlates of severe loneliness. Results: Severe loneliness was identified in 51 participants, corresponding to 21.5% of the analytical sample. The corrected UCLA-10 loneliness burden score ranged from 0 to 30, with higher scores indicating greater loneliness. Participants with severe loneliness were more likely to report poorer sleep quality and severe pain. In the adjusted logistic regression model including age, sex, sleep quality and severe pain, better sleep quality was associated with lower odds of severe loneliness (OR = 0.46, 95% CI: 0.30–0.72, p = 0.001), while severe pain was associated with higher odds of severe loneliness (OR = 3.15, 95% CI: 1.56–6.35, p = 0.001). Age (OR = 1.03, 95% CI: 0.99–1.07, p = 0.184) and female sex (OR = 2.00, 95% CI: 0.83–4.81, p = 0.124) were not statistically significant in the fully adjusted model. Conclusions: Severe loneliness affected a clinically relevant proportion of community-dwelling older adults at risk of falls in Andalusia. The findings should be interpreted as cross-sectional associations and not as evidence of causal pathways. Sleep quality and severe pain emerged as the main independent clinical correlates of severe loneliness in the adjusted model, supporting the relevance of multidimensional assessment in frail older adults. Full article

Background: Return to play (RTP) after total hip arthroplasty (THA) is increasingly expected by younger and more physically active patients. Current activity recommendations remain heterogeneous and are largely derived from expert opinion and indirect biomechanical modelling approaches, rather than direct in vivo biomechanical evidence. The aim of this article is to systematically map and synthesize the evidence from instrumented hip implant studies and to clarify how direct in vivo telemetry data can inform RTP counselling after THA. Methods: A scoping review was conducted according to a predefined Open Science Framework protocol and reported following PRISMA-ScR guidelines. MEDLINE (PubMed) and Scopus were searched from inception. Peer-reviewed clinical studies reporting direct in vivo biomechanical measurements obtained from instrumented hip implants were included. Conference proceedings, technical notes, reviews, and in vitro or computational-only studies were excluded. Data were extracted and synthesized descriptively according to activity domain, biomechanical variables, and implant technology. Results: Fifty studies met the inclusion criteria. Early investigations established feasibility and evolved from wired strain-gauge systems to fully implantable telemetric prostheses capable of measuring three-dimensional forces, moments, and friction-related parameters. Across cohorts, level walking consistently produced peak hip contact forces of approximately 2–3 times body weight, serving as a clinically meaningful reference loading envelope. Several recreational activities—including cycling, aquatic exercise, Nordic walking, and most gym-machine exercises—generally remained within or close to this range when performed with controlled technique. In contrast, certain rehabilitation tasks, forward-bent postures, lifting maneuvers, and perturbation events generated loads equal to or exceeding those observed during walking. Importantly, frictional moments and load direction showed substantial variability and may be more relevant to implant fixation than peak force magnitude alone. Conclusions: Instrumented hip implants provide objective biomechanical benchmarks that support principle-based and individualized RTP counselling, grounded in directly measured mechanical exposure rather than sport classification alone. Full article

This study examines the phenomenon of pseudoconfident knowledge in the context of the everyday use of generative artificial intelligence. By pseudoconfident knowledge, we mean a response that is substantively plausible, rhetorically coherent, and outwardly persuasive but is treated and understood as knowledge before its actual reliability has been established. Of course, we do not use the term “pseudoconfident knowledge” to denote knowledge in the strict epistemological sense. Rather, it denotes a special form of AI-generated content that acquires the status of knowledge in the user’s perception before its reliability, source-based justification, or factual correctness have been established. The problem here is not that such an answer is already knowledge but that it is prematurely accepted as knowledge because of its coherence, completeness, and rhetorical confidence. The aim of the study is to identify the epistemic gap between the everyday operational integration of artificial intelligence and the user’s critical ability to distinguish between persuasiveness and justification. The theoretical framework combines approaches to AI literacy, epistemic vigilance, and contemporary forms of digital mediation in the circulation of knowledge. The empirical basis of the study is an online survey of AI users. The analysis was conducted using descriptive statistics, contingency tables, and methods for testing associations between categorical variables. The results show that the key differentiating factor is not the frequency of AI use, but the strategy used in handling its responses. More epistemically robust positions are associated with practices of comparison, editing, and verification, whereas uncritical acceptance of the answer is associated with greater vulnerability to pseudoconfident knowledge. We conclude that the spread of generative artificial intelligence is producing a new socioepistemic problem that calls for a shift in emphasis from simple instrumental literacy toward a culture of verification, doubt, and epistemic responsibility. Full article

In this work, we extracted silk fibroin (SF) via a tertiary solvent system (CaCl₂:Ethanol:H₂O) and then blended it with chitosan (CS) solution to construct microparticles using the water-in-oil-emulsion–diffusion method. For the mixture of SF/CS solution aqueous phase (W) was prepared at ratios of 4:0, 3:1, 1:1, 1:3, and 0:4, using ethyl acetate as the oil phase (O). After the microparticles were prepared, their morphology was examined using scanning electron microscopy (SEM). The optimal preparation conditions were determined to be a 1% (w/v) aqueous phase with a volume of 1 milliliter, 100 milliliters of oil phase, and a stirring speed of 700 rpm. The average microparticle size was 50–100 micrometers. ATR−FTIR spectra showed unique functional groups of SF and CS, as well as interactions between the two polymers. The results of the thermal property study using a TGA instrument showed that SF microparticles had a higher maximum decomposition temperature (T_d,max) than chitosan, and the blended microparticles’ T_d,max increased with the proportion of SF. Most microparticles exhibited a semi-crystalline polymer structure, with SF microparticles being the most hydrophobic, followed by blended microparticles and CS, respectively. Testing for absorption capacity, the SF microparticles were more effective at absorbing used engine oil than vegetable oil and chloroform, while CS microparticles showed the highest capacity for vegetable oil. The experimental results indicated that all SF/CS blended particles played an efficiency of absorption variable by ratios of SF or CS blended. This suggested that the prepared microparticles might be useful for oil/water separation application. Full article

Objectives: This study used psychological network analysis to examine the interrelationships among smartphone addiction, depression, anxiety, fatigue, sleep quality, and learning engagement in nursing students. Methods: A cross-sectional survey was conducted among 200 nursing students in South Korea using validated self-report instruments. Psychological network analysis was performed using the qgraph and bootnet packages in R. A non-regularized partial correlation network based on Spearman correlations was estimated, and bootstrap was conducted to evaluate the stability and accuracy of network estimates. Results: The strongest positive association was observed between fatigue and depression, whereas smartphone addiction showed the strongest negative association with learning engagement. Depression demonstrated relatively higher centrality within the network, while anxiety showed comparatively lower centrality values. Strength and expected influence estimates demonstrated acceptable stability. Conclusions: The findings suggest meaningful associations among depression, fatigue, sleep quality, smartphone addiction, and learning engagement in nursing students. Learning engagement demonstrated relatively strong connectivity within the network, highlighting its close association with psychological and behavioral factors. These findings support the utility of network analysis for understanding complex interrelationships among psychological variables in nursing students. Full article

The majority of currently available hand kinematic databases have been gathered using expensive marker-based systems or are restricted to a particular gesture-recognition task, failing to capture the dynamic nature of joints when the hand is engaged with an object. To address this gap, we introduce the RGB-based Hand Joint Kinematics (RGB-HJK) dataset, a publicly available collection of continuous, frame-level 3D joint angle trajectories, recorded while ten healthy adults (six male, four female; age $25.8\pm 3.2$ years; BMI $22.8\pm 2.0$ kg/m²) performed five standardized object interaction grasps: Power Grasp (cylindrical bottle), Tripod Grasp (pen), Static Power Hold (smartphone), Precision Pinch (thin paper), and Lateral Pinch (book). Data were collected using a standard RGB camera and the MediaPipe Hands markerless pipeline at $26.95\pm 0.29$ Hz, a rate that was stable across all subjects. Each participant completed five trials for each grasp type. After filtering using active hold, 28,111 validated frames remained, with a 100% detection rate for all 250 trials. Intra-subject repeatability was good (mean SD $\le 7.9°$ across all joint grasp combinations) and inter-subject variability was within the range expected based on normal anatomical diversity. Importantly, kinematic validation of the Index Proximal Interphalangeal (PIP) joint (61.8° ± 18.4°) showed values consistent with ranges reported in previous studies using instrumented gloves and depth sensors. Principal Component Analysis (PCA) confirmed clear linear separability among the five grasp configurations. Unlike existing datasets, the RGB-HJK method does not compromise the natural sense of touch and is free of hardware occlusions, thereby providing an easily accessible ecological baseline. Full article

Using panel data for 135 Chinese prefecture-level cities from 2007 to 2023, this study investigates the impact of new digital infrastructure on green finance development. The new digital infrastructure indicator is constructed based on the proportion of relevant keywords appearing in government work reports, while the green finance index is reconstructed using the entropy-weighting method across seven dimensions. The estimation results indicate that new digital infrastructure exerts a significant positive effect on green finance development. This conclusion remains robust after a series of robustness checks, including alternative variable measurements, winsorization treatment, and instrumental-variable estimation. Mechanism analysis reveals that industrial structure upgrading, particularly the advancement of industrial structure, serves as an important transmission channel. Further heterogeneity analysis shows that the promoting effect is more pronounced in cities with larger economic scale, those located outside major urban agglomerations, and cities with higher levels of financial resource aggregation. These findings provide empirical evidence for the role of digital infrastructure in fostering green finance and facilitating sustainable regional development. Full article