Search Results (1,082)

Background: Ultrasound (U/S) can be used to evaluate skeletal muscle characteristics in clinical and sports settings. Handheld U/S devices have recently emerged as a cheaper and portable alternative to conventional U/S systems. However, further research is warranted on their reliability. We assessed the reliability and inter-device agreement between a handheld U/S device (Clarius L15 HD₃) and a more conventional U/S system (GE LOGIQ e) for measuring the thickness of the rectus femoris (RF) and vastus intermedius (VI). Methods: Cross-sectional images of the RF and VI muscles were obtained in 20 participants by two assessors, and on two separate occasions by one of those assessors, using the Clarius L15 HD₃ and GE LOGIQ e devices. RF and VI thickness measurements were obtained to determine the intra-rater reliability, inter-rater reliability, and inter-device agreement. Results: All intraclass correlation coefficients (ICCs) were above 0.9 for intra-rater reliability (range: 0.94 to 0.97), inter-rater reliability (ICC: 0.97), and inter-device agreement (ICC: 0.98) when comparing the two devices in assessing RF and VI thickness. For the RF, the Bland–Altman plot revealed a mean difference of 0.06 ± 0.07 cm, with limits of agreement ranging from 0.21 to −0.09, whereas for the VI, the Bland–Altman plot showed a mean difference of 0.07 ± 0.10 cm, with limits of agreement ranging from 0.27 to −0.13. Conclusions: The handheld Clarius L15 HD₃ was reliable and demonstrated high agreement with the more conventional GE LOGIQ e for assessing the thickness of the RF and VI in young, healthy adults. Full article

Background/Objectives: Benign paroxysmal positional vertigo (BPPV) is the most prevalent vestibular disorder encountered in clinical settings and is highly responsive to evidence-based diagnostic and therapeutic interventions. However, variations in practice patterns among physician specialties can compromise timely diagnosis and effective treatment. Understanding these variations is essential for improving clinical outcomes and standardizing care. This study aimed to assess the diagnostic and treatment practices for BPPV among Ear, Nose, and Throat (ENT) specialists, neurologists, general practitioners, and family physicians in Saudi Arabia and to examine how these practices are influenced by clinical experience and patient case exposure. Methods: A cross-sectional, questionnaire-based study was conducted between April 2023 and March 2024 at King Khalid University, Abha, Saudi Arabia. A total of 413 physicians were recruited using purposive sampling. Data were analyzed using IBM SPSS version 24.0. Parametric tests, including one-way ANOVA and chi-square tests, were used to assess differences across groups. A p-value of <0.05 was considered statistically significant. Results: Overall, all physician groups exhibited limited adherence to guideline-recommended positional diagnostic and therapeutic maneuvers. However, ENT specialists and neurologists demonstrated relatively higher compliance, particularly in performing the Dix–Hallpike test, with 46.97% and 26.79% reporting “always” using the maneuver, respectively (p < 0.001, Cramér’s V = 0.22). Neurologists were the most consistent in conducting oculomotor examinations, with 73.68% reporting routine performance (p < 0.001, Cramér’s V = 0.35). Epley maneuver usage was highest among neurologists (86.36%) and ENT specialists (77.14%) compared to family physicians (50.60%) and GPs (67.50%) (p = 0.044). Physicians with 11–15 years of experience and >50 BPPV case exposures consistently showed a greater use of diagnostic maneuvers, repositioning techniques, and guideline-concordant medication use (betahistine 76.67%; p < 0.001). Continuing medical education (CME) participation and the avoidance of unnecessary imaging were also highest in this group (46.67% and 3.33%, respectively; p < 0.001). Conclusions: Significant inter-specialty differences exist in the management of BPPV in Saudi Arabia. Greater clinical experience and higher case exposure are associated with improved adherence to evidence-based practices. Targeted educational interventions are needed, particularly in primary care, to enhance guideline implementation. Full article

Background/Objectives: The aim of this study was to evaluate the level of awareness among dental students and practitioners regarding the utilization of endocrowns in clinical settings, along with any differences in knowledge based on gender, educational level, and workplace. Methods: A cross-sectional online survey-based study was conducted, including 1154 participants from various dental institutions across Saudi Arabia. The questionnaire included demographic data and closed-ended questions focused on knowledge and awareness of endocrowns. Data was analyzed using statistical tests, including chi-square, to see any significant differences. Results: Most participants (81%) had knowledge about endocrowns, mainly from their colleagues. Knowledge levels and preferences (like the use of lithium disilicate and adhesive resin cement) differed based on gender, educational level, and workplace. Male participants and undergraduates showed better awareness in some areas. Faculty members mostly depend on college training, while private practitioners obtain most of their information from workshops. Conclusions: Males showed significant superiority in knowledge about endocrown usage. Colleges were the most prevalent source of information regarding endocrown restorations. Significant molar tooth loss and restricted inter-arch space were the most common reasons for utilizing endocrowns. Moreover, endocrowns were considered a viable alternative to traditional post and core. Full article

Background/Objectives: Traditional dietary screeners face significant limitations: they rely on subjective self-reporting, average intake estimates, and are influenced by a participant’s awareness of being observed—each of which can distort results. These factors reduce both accuracy and reproducibility. The Guide Against Age-Related Disease (GARD) addresses these issues by applying Assembly Theory to objectively quantify food and food behavior (FFB) complexity. This study aims to validate the GARD as a structured, bias-resistant tool for dietary assessment in clinical and research settings. Methods: The GARD survey was administered in an internal medicine clinic within a suburban hospital system in the southeastern U.S. The tool assessed six daily eating windows, scoring high-complexity FFBs (e.g., fresh plants, social eating, fasting) as +1 and low-complexity FFBs (e.g., ultra-processed foods, refined ingredients, distracted eating) as –1. To minimize bias, patients were unaware of scoring criteria and reported only what they ate the previous day, avoiding broad averages. A computer algorithm then scored responses based on complexity, independent of dietary guidelines. Internal (face, convergent, and discriminant) validity was assessed using Spearman rho correlations. Results: Face validation showed high inter-rater agreement using predefined Assembly Index (A_i) and Copy Number (N_i) thresholds. Positive correlations were found between high-complexity diets and behaviors (rho = 0.533–0.565, p < 0.001), while opposing constructs showed moderate negative correlations (rho = –0.363 to −0.425, p < 0.05). GARD scores aligned with established diet patterns: Mediterranean diets averaged +22; Standard American Diet averaged −10. Full article

Assessing teacher candidates’ self-efficacy in using reading strategies is essential for understanding their academic development. This study developed and validated the Teacher Candidates’ Self-Efficacy Scale for Informational Reading Strategies (TCSES-IRS) using a mixed-methods sequential exploratory design. Initial qualitative data from interviews with 33 candidates and a literature review guided item generation. Lawshe’s method confirmed content validity. The scale was administered to 1176 teacher candidates. Exploratory (n = 496) and confirmatory factor analyses (n = 388) supported a five-factor structure—cognitive, note-taking, exploration and preparation, physical and process-based, and reflective and analytical strategies—explaining 63.71% of total variance, with acceptable fit indices (χ²/df = 2.64, CFI = 0.912, TLI = 0.900, RMSEA = 0.069). Internal consistency was high (α = 0.899 total; subscales α = 0.708–0.906). An additional sample of 294 participants was used for nomological network validation. Convergent validity was demonstrated by significant item-total correlations and strong factor loadings. Discriminant validity was evidenced by moderate inter-factor correlations. Criterion-related validity was confirmed via significant group differences and meaningful correlations with an external self-efficacy measure. The TCSES-IRS emerges as a psychometrically sound tool for assessing informational reading self-efficacy, supporting research and practice in educational psychology. Full article

The hypothalamus belongs to the central brain structure designed for the neuroendocrine regulation of many organismal functions, including the stress response, cardiovascular system, and blood pressure, and it is well known that the serotonergic hypothalamic system plays a significant role in these processes. Unfortunately, the genetic determination of serotonergic hypothalamic mechanisms has been little studied. The aim of this article is to describe the expression profile of the genes in the hypothalamic serotonergic synapses in hypertensive ISIAH rats in comparison with normotensive WAG rats in control conditions and under the influence of a single short-term restraint stress. It was found that 14 differentially expressed genes (DEGs) may provide the inter-strain differences in the serotonergic synaptic function in the hypothalamus between the hyper- and normotensive rats studied. In hypertensive rats, downregulation of Slc18a1 gene in the presynaptic serotoninergic ends and decreased expression of Cacna1s and Htr3a genes determining the postsynaptic membrane conductance may be considered as a main factors causing differences in the function of hypothalamic serotoninergic synapses in hypertensive ISIAH and normotensive WAG rats at the basal conditions. Under basal conditions, glial cell genes were not involved in the formation of inter-strain differences in serotonergic synaptic function. The analysis of transcriptional responses to restraint stress revealed key genes whose expression is involved in the regulation of serotonergic signaling, and a cascade of interrelated changes in biological processes and metabolic pathways. Stress-dependent changes in the expression of some DEGs are similar in the hypothalamus of hypertensive and normotensive rats, but the expression of a number of genes changes in a strain-specific manner. The results suggest that in hypothalamic glial cells of both strains, restraint stress induces changes in the expression of DEGs associated with the synthesis of Ip3 and its receptors. Many of the identified serotonergic DEGs participate in the regulation of not only serotonergic synapses but may also be involved in the regulation of cholinergic, GABAergic, glutamatergic, and dopaminergic synapses. The results of the study provide new information on the genetic mechanisms of inter-strain differences in the functioning of the hypothalamic serotonergic system in hypertensive ISIAH and normotensive WAG rats at rest and under the influence of a single short-term restraint (emotional) stress. Full article

Background: Psychological problems post-stroke can negatively impact stroke survivors. Although general psychological services exist (e.g., NHS Talking Therapies), access remains limited, particularly for individuals with post-stroke communication and cognitive impairments. Stroke service staff report low confidence in managing psychological distress. This study is the first to explore the barriers and facilitators to implementing a novel intervention package comprising a cross-service care pathway and staff training to enhance post-stroke psychological provision. Methods: Staff from stroke and mental health services in four UK regions, recruited through purposive sampling to ensure diversity of services and professional roles, participated in semi-structured interviews or focus groups, guided by the Theoretical Domains Framework (TDF), before and after implementation of the intervention package. Pre-implementation interviews/groups identified anticipated barriers and facilitators to implementation and training needs, informing the development of site-specific intervention packages; post-implementation interviews/groups explored experienced barriers, facilitators and perceptions of the intervention. Interviews underwent thematic analysis using the TDF. Results: Fifty-five staff participated pre-implementation and seventeen post-implementation, representing stroke (e.g., nurse, physiotherapist, consultant) and psychology (e.g., counsellor, psychological therapist) roles across acute, rehabilitation, community, and voluntary services. Challenges anticipated pre-implementation included: limited specialist post-stroke psychological support; low staff confidence; and fragmented service pathways. Post-implementation findings indicated increased staff knowledge and confidence, enhanced screening and referral processes, and stronger inter-service collaboration. Implementation success varied across sites (with some sites showing greater ownership and sustainability of the intervention) and across staff roles (with therapy staff more likely than nursing staff to have received training). Conclusions: Effective implementation of an intervention package to increase psychological provision post-stroke requires staff engagement at all levels across all services. Staff investment influenced ownership of the intervention package, beliefs about priorities and overall enhancement of service capability. Full article

As populations age and workforces decline, the need for accessible health assessment methods grows. The merging of accessible and affordable sensors such as inertial measurement units (IMUs) and advanced machine learning techniques now enables gait assessment beyond traditional laboratory settings. A total of 52 participants walked at three speeds while carrying a smartphone-sized IMU in natural positions (hand, trouser pocket, or jacket pocket). A previously trained Convolutional Neural Network and Long Short-Term Memory (CNN-LSTM)-based machine learning model predicted gait events, which were then used to calculate stride time, stance time, swing time, and double support time. Stride time predictions were highly accurate (<5% error), while stance and swing times exhibited moderate variability and double support time showed the highest errors (>20%). Despite these variations, moderate-to-strong correlations between the predicted and experimental spatiotemporal gait parameters suggest the feasibility of IMU-based gait tracking in real-world settings. These associations preserved inter-subject patterns that are relevant for detecting gait disorders. Our study demonstrated the feasibility of extracting clinically relevant gait parameters using IMU data mimicking smartphone use, especially parameters with longer durations such as stride time. Robustness across sensor locations and walking speeds supports deep learning on single-IMU data as a viable tool for remote gait monitoring. Full article

This study proposes a computational framework that transforms eye-tracking analysis from statistical description to cognitive structure modeling, aiming to reveal the organizational features embedded in the viewing process. Using the designers’ observation of a traditional Chinese landscape painting as an example, the study draws on the goal-oriented nature of design thinking to suggest that such visual exploration may exhibit latent structural tendencies, reflected in patterns of fixation and transition. Rather than focusing on traditional fixation hotspots, our four-dimensional framework (Region, Relation, Weight, Time) treats viewing behavior as structured cognitive networks. To operationalize this framework, we developed a data-driven computational approach that integrates fixation coordinate transformation, K-means clustering, extremum point detection, and linear interpolation. These techniques identify regions of concentrated visual attention and define their spatial boundaries, allowing for the modeling of inter-regional relationships and cognitive organization among visual areas. An adaptive buffer zone method is further employed to quantify the strength of connections between regions and to delineate potential visual nodes and transition pathways. Three design-trained participants were invited to observe the same painting while performing a think-aloud task, with one participant selected for the detailed demonstration of the analytical process. The framework’s applicability across different viewers was validated through consistent structural patterns observed across all three participants, while simultaneously revealing individual differences in their visual exploration strategies. These findings demonstrate that the proposed framework provides a replicable and generalizable method for systematically analyzing viewing behavior across individuals, enabling rapid identification of both common patterns and individual differences in visual exploration. This approach opens new possibilities for discovering structural organization within visual exploration data and analyzing goal-directed viewing behaviors. Although this study focuses on method demonstration, it proposes a preliminary hypothesis that designers’ gaze structures are significantly more clustered and hierarchically organized than those of novices, providing a foundation for future confirmatory testing. Full article

Background/Objectives: The Jackson/Cubbin scale is a recommended tool to assess the risk of pressure injury in intensive care unit (ICU) patients. This scale is deemed to have superior predictive validity compared to the Braden scale. Many Italian nurses struggle with reading and applying the tool in English. This language barrier results in a lack of use of the Jackson/Cubbin scale clinically, meaning that patients potentially experience worse outcomes. This study aims to translate the original English version of the Jackson/Cubbin scale into the Italian language, conduct a cultural adaptation, and verify its content validity. Methods: An observational study was conducted using Beaton’s five-step methodology: (1) forward translation, (2) synthesis, (3) back-translation, (4) expert committee approval using Fleiss’ Kappa (κ) index, and (5) pre-testing, where participants assessed item clarity on a dichotomous scale (clear/unclear). Items deemed unclear by 20% or more of the sample were revised. Content validity was assessed using the Content Validity Index (CVI). Results: Fleiss’ κ index was 0.74. Item 3 “PMH-affecting condition” was unclear to 36% of the sample and required revision. The item-level CVI (I-CVI) was >0.78 for each item. The scale-level CVI (S-CVI) and the scale-level CVI using the average method (S-CVI-Ave) were 0.92 and 0.94, respectively. Conclusions: The translation process resulted in a linguistically accurate scale requiring content modifications to reflect current evidence and reduce inter-rater variability. This may improve implementation of the Jackson/Cubbin scale in clinical practice for Italian nurses and reduce the incidence of pressure injury for ICU patients. Full article

Wildfires are becoming an increasingly severe threat to European forests, driven by climate change, land use changes, and socio-economic factors. Integrated solutions for wildfire prevention, early detection, emergency management, and ecological restoration are urgently needed to enhance forest resilience. The Horizon 2020 SILVANUS project developed a comprehensive multi-sectoral platform combining technological innovation, stakeholder engagement, and sustainable forest management strategies. This report analyses the Slovak Republic’s participation in SILVANUS, applying a seven-criterion fit–gap framework (governance, legal, interoperability, staff capacity, ecological suitability, financial feasibility, and stakeholder acceptance) to evaluate the platform’s alignment with national conditions. Notable contributions include stakeholder-supported functional requirements for wildfire prevention, climate-sensitive forest models for long-term adaptation planning, IoT- and UAV-based early fire detection technologies, and decision support systems (DSS) for emergency response and forest-restoration activities. The Slovak pilot sites, particularly in the Podpoľanie region, served as important testbeds for the validation of these tools under real-world conditions. All SILVANUS modules scored ≥12/14 in the fit–gap assessment; early deployment reduced high-risk fuel polygons by 23%, increased stand-level structural diversity by 12%, and raised the national Sustainable Forest Management index by four points. Integrating SILVANUS outcomes into national forestry practices would enable better wildfire risk assessment, improved resilience planning, and more effective public engagement in wildfire management. Opportunities for adoption include capacity-building initiatives, technological deployments in fire-prone areas, and the incorporation of DSS outputs into strategic forest planning. Potential challenges, such as technological investment costs, inter-agency coordination, and public acceptance, are also discussed. Overall, the Slovak Republic’s engagement with SILVANUS demonstrates the value of participatory, technology-driven approaches to sustainable wildfire management and offers a replicable model for other European regions facing similar challenges. Full article

Background: The coordination between the upper and lower limbs is essential for athletic performance. However, the structural features that influence coordination difficulty remain insufficiently understood. Few studies have systematically analyzed how task components such as the directional congruence or rhythm structure affect inter-limb coordination. Objective: This study aimed to clarify the structural factors that influence the difficulty of upper–lower limb coordination tasks under rhythmic constraints and to explore the feasibility of applying such tasks in future coordination assessments. Methods: Eighty-six male high school baseball players performed six Rhythm Jump tasks combining fixed upper limb movements with varying lower limb patterns. The task performance was analyzed using three indices: full task success, partial success, and average successful series. One year later, a follow-up test involving 27 participants was conducted to evaluate the reproducibility and sensitivity to the performance change. Results: The task difficulty was significantly affected by structural features, including directional incongruence, upper limb static holding, and rhythmic asynchrony. The tasks that exhibited these features had lower success rates. Some tasks demonstrated moderate reproducibility and captured subtle longitudinal changes in the performance. Conclusions: The results highlight the key structural factors contributing to coordination difficulty and support the potential applicability of Rhythm Jump tasks as a basis for future assessment tools. Although further validation is necessary, this study provides foundational evidence for the development of practical methods for evaluating inter-limb coordination. Full article

Accurate range of motion (ROM) assessment is essential for evaluating musculoskeletal function and guiding rehabilitation, particularly in pediatric populations. Traditional methods, such as optical motion capture and handheld goniometry, are often limited by cost, accessibility, and inter-rater variability. This study evaluated the feasibility and accuracy of the Microsoft Azure Kinect-powered Monitored Augmented Rehabilitation System (MARS) compared to Kinovea. Sixty-five pediatric participants (ages 5–18) performed standardized shoulder and elbow movements in the frontal and sagittal planes. ROM data were recorded using MARS and compared to Kinovea. Measurement reliability was evaluated using intraclass correlation coefficients (ICC3k), and accuracy was evaluated using root mean squared error (RMSE) analysis. MARS demonstrated excellent reliability with an average ICC3k of 0.993 and met the predefined accuracy threshold (RMSE ≤ 8°) for most movements, with the exception of sagittal elbow flexion. These findings suggest that MARS is a reliable, accurate, and cost-effective alternative for clinical ROM assessment, offering a markerless solution that enhances measurement precision and accessibility in pediatric rehabilitation. Future studies should enhance accuracy in sagittal plane movements and further validate MARS against gold-standard systems. Full article

StageMix is a video compilation of multiple stage performances of the same song, edited seamlessly together using appropriate editing points. However, generating a StageMix requires specialized editing techniques and is a considerable time-consuming process. To address this challenge, we introduce AutoStageMix, an automated StageMix generation system designed to perform all processes automatically. The system is structured into five principal stages: preprocessing, feature extraction, identifying a transition point, editing path determination, and StageMix generation. The initial stage of the process involves audio analysis to synchronize the sequences across all input videos, followed by frame extraction. After that, the facial features are extracted from each video frame. Next, transition points are identified, which form the basis for face-based transitions, inter-stage cuts, and intra-stage cuts. Subsequently, a cost function is defined to facilitate the creation of cross-edited sequences. The optimal editing path is computed using Dijkstra’s algorithm to minimize the total cost of editing. Finally, the StageMix is generated by applying appropriate editing effects tailored to each transition type, aiming to maximize visual appeal. Experimental results suggest that our method generally achieves lower NME scores than existing StageMix generation approaches across multiple test songs. In a user study with 21 participants, AutoStageMix achieved viewer satisfaction comparable to that of professionally edited StageMixes, with no statistically significant difference between the two. AutoStageMix enables users to produce StageMixes effortlessly and efficiently by eliminating the need for manual editing. Full article

In the context of accelerating digital transformation and growing sustainability imperatives, entrepreneurial ecosystems increasingly rely on open innovation and strategic collaboration to foster resilient, knowledge-driven growth. This study aims to examine how leadership behaviors and strategic alliances interact as enablers of sustainable innovation across macro (systemic), meso (organizational), and micro (individual) levels. To achieve this, this study employs a literature review, supported by bibliometric analysis, as its core methodological approach. Drawing on 86 influential publications from 1992 to 2024, two major thematic streams emerge: leadership dynamics in entrepreneurial settings and the formation and governance of strategic alliances as vehicles for innovation. The findings underscore the pivotal role of transformational and ethical leadership in cultivating trust-based inter-organizational relationships, facilitating digital knowledge sharing, and catalyzing sustainable value creation. Simultaneously, strategic alliances enhance organizational agility and innovation capacity through co-creation mechanisms, digital platforms, and crowdsourcing, especially in small and medium-sized enterprises (SMEs). This paper highlights a mutually reinforcing relationship: effective leadership strategies empower alliances, while alliance participation enhances leadership capabilities through experiential learning in diverse, digitalized environments. By bridging leadership theory, open innovation practices, and digital transformation, this study offers critical insights for entrepreneurs, managers, and policymakers seeking to drive inclusive and sustainable innovation within interconnected global markets. Therefore, this study provides practical guidance for business leaders aiming to strengthen alliance performance through adaptive leadership and for policymakers seeking to foster innovation ecosystems through supportive regulatory and institutional frameworks. Full article