Search Results (458)

Background: Fear of falling (FOF) is a significant concern among older adults, especially after total knee arthroplasty (TKA). FOF can limit daily activities, reduce quality of life, and hinder recovery. This study aimed to investigate the prevalence, severity, and impacts of FOF in patients undergoing TKA and identify factors contributing to increased FOF. Methods: A prospective observational study was conducted at King Abdulaziz Medical City in Riyadh, Saudi Arabia, from April 2024 to December 2024. This study included 52 participants aged 20 to 75 years who had undergone primary TKA. Data were collected at two time points: after TKA and at three months post-surgery. The Short Falls Efficacy Scale-International (SFES-I) was used to assess the severity of FOF, and the Short Form 36 (SF-36) was used to measure the quality of life. Descriptive statistics, t-tests, and logistic regression were used for analysis. Results: This study included 52 participants (mean age: 63.77 ± 6.65 years; 82.7% female). Post-TKA, all participants exhibited high FOF (mean SFES-I score: 56.75 ± 8.30). After three months, the mean SFES-I score decreased significantly to 49.04 ± 12.45 (t = 4.408, p < 0.05). Post-TKA, SF-36 showed significant improvements in the physical function, role of physical limitations, bodily pain, vitality, social function, role of emotional limitations, and mental health subdomains. Bilateral total knee arthroplasty, body mass index, and some SF-36 subcomponents—such as general health, vitality, and role of emotional limitations—were identified as factors leading to increased FOF. Conclusions: FOF remains prevalent and severe in TKA patients, even at three months post-surgery, affecting rehabilitation outcomes. Early identification and tailored interventions for FOF should be considered essential components of comprehensive TKA recovery programs. Full article

Background and Objectives: Adverse clinical outcomes are associated with malnutrition and frailty, which are highly prevalent among hospitalized older patients. This study aimed to evaluate their predictive value for the duration of hospitalization, short-term survival, and rehospitalization of patients admitted to internal medicine wards. Materials and Methods: This prospective cohort study included 134 acutely ill patients aged ≥50 years who were hospitalized in an internal medicine department and evaluated within the first 48 h of admission. Nutritional status was evaluated using the Mini nutritional assessment–short form (MNA-SF), Nutritional Risk Screening 2002 (NRS-2002), and Global Leadership Initiative on Malnutrition (GLIM) criteria. Frailty was evaluated using the FRAIL scale and Clinical Frailty Scale (CFS). The primary outcomes were prolonged hospitalization (>10 days), mortality, and rehospitalization at 3 and 6 months post-discharge. Results: According to MNA-SF, 33.6% of patients were malnourished; 44% had nutritional risk per NRS-2002, and 44.8% were malnourished per GLIM. Frailty prevalence was 53.7% (FRAIL) and 59% (CFS). Malnutrition defined by all three scales (MNA-SF, NRS-2002, GLIM) was significantly associated with prolonged hospitalization (p = 0.043, 0.014, and 0.023, respectively), increased rehospitalization at both 3 months (p < 0.001) and 6 months (p < 0.001). Mortality was also significantly higher among malnourished patients. Higher CFS scores and low handgrip strength were additional predictors of adverse outcomes (p < 0.05). In multivariable analysis, GLIM-defined malnutrition and CFS remained independent predictors of rehospitalization and mortality. Conclusions: Frailty and malnutrition are highly prevalent and independently associated with prolonged hospital stay, short-term rehospitalization and mortality. Routine screening at admission may facilitate early identification and guide timely interventions to improve patient outcomes. These findings might guide hospital protocols in aging health systems and support the development of standardized geriatric care pathways. Full article

Driven by carbon neutrality and peak carbon policies, hydrogen energy, due to its zero-emission and renewable properties, is increasingly being used in hydrogen fuel cell vehicles (H-FCVs). However, the high cost and limited durability of H-FCVs hinder large-scale deployment. Hydrogen internal combustion engine hybrid electric vehicles (H-HEVs) are emerging as a viable alternative. Research on the techno-economics of H-HEVs remains limited, particularly in systematic comparisons with H-FCVs. This paper provides a comprehensive comparison of H-FCVs and H-HEVs in terms of total cost of ownership (TCO) and hydrogen consumption while proposing a multi-objective powertrain parameter optimization model. First, a quantitative model evaluates TCO from vehicle purchase to disposal. Second, a global dynamic programming method optimizes hydrogen consumption by incorporating cumulative energy costs into the TCO model. Finally, a genetic algorithm co-optimizes key design parameters to minimize TCO. Results show that with a battery capacity of 20.5 Ah and an H-FC peak power of 55 kW, H-FCV can achieve optimal fuel economy and hydrogen consumption. However, even with advanced technology, their TCO remains higher than that of H-HEVs. H-FCVs can only become cost-competitive if the unit power price of the fuel cell system is less than 4.6 times that of the hydrogen engine system, assuming negligible fuel cell degradation. In the short term, H-HEVs should be prioritized. Their adoption can also support the long-term development of H-FCVs through a complementary relationship. Full article

Background/Objectives: Despite the psychological benefits of breast reconstruction (BR) after mastectomy, uptake remains limited among women with breast cancer. This study explores psychosocial and personality predictors of BR intentions in the pre-mastectomy phase, aiming to inform strategies for mental health promotion in oncology care. Methods: This cross-sectional analysis used preoperative data from a longitudinal study at a university hospital in Greece. Women with primary breast cancer scheduled for mastectomy completed a battery of validated self-report measures, including the International Personality Item Big-Five Factor Markers (IPIP-BFFM), the Hospital Anxiety and Depression Scale (HADS), and the Short Form-36 Health Survey (SF-36). Demographic, clinical, and psychosocial data were also collected. Binary logistic regression was used to examine predictors of (a) BR information-seeking and (b) BR intention. Results: Seventy-four women participated (mean age = 61.1 years). Older age predicted lower BR intention (Exp(b) = 0.897, 95% CI: 0.829–0.970) and information-seeking (Exp(b) = 0.925, 95% CI: 0.859–0.997). Single/divorced status was associated with reduced BR information-seeking (Exp(b) = 0.053, 95% CI: 0.005–0.549). Openness to experience significantly predicted both outcomes (BR information-seeking: Exp(b) = 1.115, 95% CI: 1.028–1.209); BR intention: Exp(b) = 1.095, 95% CI: 1.016–1.181). Higher physical health-related QoL scores were associated with increased BR intention (Exp(b) = 1.039, 95% CI: 1.007–1.072), whereas higher mental health-related QoL (Exp(b) = 0.952, 95% CI: 0.912–0.994) and higher depression scores (Exp(b) = 0.797, 95% CI: 0.638–0.996) were linked to decreased BR intent. No psychological factor significantly predicted information-seeking. Conclusions: These findings underscore the value of psychosocial screening and personality-informed counseling prior to surgery. By identifying individuals less likely to seek information or consider BR, pre-mastectomy assessments can contribute to tailored, mental health-promoting interventions and support informed, patient-centered surgical decision-making. Full article

Background and Objectives: Congenital heart defects (CHD) affect around 1% of the population, making them the most common congenital disease worldwide. Thanks to advances in treatment, over 90% of affected children are able to reach adulthood, shifting focus to long-term outcomes such as disease-specific quality of life (DsQoL). To date, there has been no validated, standardized instrument for assessing DsQoL in young German CHD patients. This study introduces the Congenital Heart Disease Specific Inventory (CHDSI), the first freely available German-language instrument for measuring DsQoL in children and adolescents with CHD. Materials and Methods: The CHDSI was developed at the German Heart Center Munich in collaboration with affected children and adolescents and validated nationwide via the National Register for Congenital Heart Defects (NRCHD) with 1201 participants (46 kindergarten children, 530 children, 625 adolescents). Two age-specific versions (36/37 items) and a 31-item preschool version were created, alongside a 6-item short form (CHDSI-SF) for rapid screening. Reliability was assessed using Cronbach’s alpha and split-half methods; construct validity via confirmatory factor analysis (CFA) using DWLS; and score interpretation through standardized stanine scales. The small sample size of kindergarten children precluded a model test for this group. The standard values given for this subsample should therefore be interpreted with caution. Results: The CHDSI showed excellent internal consistency (Cronbach’s α = 0.856 to 0.900) and high split-half reliability (>0.95). CFA confirmed a robust six-factor structure with excellent model fit (CFI and TLI ≥ 0.991, RMSEA ≤ 0.05). Subscales showed strong discriminant validity, and significant differences were found by CHD severity and sex. Conclusions: The CHDSI is a psychometrically valid, age-appropriate, and freely available instrument for assessing DsQoL in children and adolescents with CHD. It provides valuable support for clinical decision-making and research. Further studies should explore international validation and cultural adaptation. Full article

Objective: The mother’s birth experience is crucial in identifying her care needs. The “Questionnaire for Assessing the Childbirth Experience” (QACE) consists of four subscales designed to assess a mother’s childbirth experience. However, psychometric evaluations of the QACE have not been conducted in Turkey. This study aims to adapt and assess the validity and reliability of the “Questionnaire for Assessing the Childbirth Experience” short version for the Turkish maternal population. Methods: This methodological study included 205 mothers who gave birth in a public hospital. Data were collected using an Introductory Information Form and the Questionnaire for Assessing the Childbirth Experience (QACE). Results: The content validity index (CVI) for Item 9 was calculated as 0.875, while the remaining 12 items obtained a CVI of 1.00. The internal consistency of the scale, as measured by Cronbach’s alpha coefficient (α = 0.758), indicated an acceptable level of reliability across all items. During the Exploratory Factor Analysis (EFA), one item (Item 13) was excluded due to cross-loading. The remaining 12 items were grouped into four distinct subscales. Conclusions: The short version of the QACE demonstrates acceptable psychometric properties and serves as a valid and reliable instrument for assessing childbirth experiences among Turkish women. Full article

The hydraulic turbine serves as the cornerstone of hydropower generation systems, with the sealing system’s performance critically influencing energy conversion efficiency and operational cost-effectiveness. The sealing ring is a pivotal component, which mitigates leakage and energy loss by regulating flow within the narrow gap between itself and the frame. This study investigates the intricate flow dynamics within the gap between the sealing ring and the upper frame of a super-large-scale Francis turbine, with a specific focus on the rotating wall’s impact on the flow field. Employing theoretical modeling and three-dimensional transient computational fluid dynamics (CFD) simulations grounded in real turbine design parameters, the research reveals that the rotating wall significantly alters shear flow and vortex formation within the gap. Tangential velocity exhibits a nonlinear profile, accompanied by heightened turbulence intensity near the wall. The short flow channel height markedly shapes flow evolution, driving the axial velocity profile away from a conventional parabolic pattern. Further analysis of rotation-induced vortices and flow instabilities, supported by turbulence kinetic energy monitoring and spectral analysis, reveals the periodic nature of vortex shedding and pressure fluctuations. These findings elucidate the internal flow mechanisms of the sealing ring, offering a theoretical framework for analyzing flow in microscale gaps. Moreover, the resulting flow field data establishes a robust foundation for future studies on upper crown gap flow stability and sealing ring dynamics. Full article

Background/Objectives: Menière’s disease (MD) is a debilitating disorder with episodic and variable ear symptoms. Diagnosis can be challenging, and evidence for therapeutic approaches is low. Furthermore, patients show a unique and fluctuating configuration of audiovestibular impairment. As a psychometric instrument to assess hearing-specific disability is currently lacking, we evaluated a short form of the Speech, Spatial, and Qualities of Hearing Scale (SSQ) in a cohort of patients with MD. Methods: Data was collected in the context of a multicenter prospective patient registry intended for the long-term follow up of MD patients. Hearing was assessed by pure tone and speech audiometry. The SSQ was applied in the German language version with 17 items. Results: In total, 97 consecutive patients with unilateral MD with a mean age of 56.2 ± 5.0 years were included. A total of 55 individuals (57.3%) were female, and 72 (75.0%) were categorized as having definite MD. The average total score of the SSQ was 6.0 ± 2.1. Cronbach’s alpha for internal consistency was 0.960 for the total score. We did not observe undue floor or ceiling effects. SSQ values showed a statistically negative correlation with hearing thresholds and a statistically positive correlation with speech recognition scores of affected ears. Conclusions: The short form of the SSQ provides insight into hearing-specific disability in patients with MD. Therefore, it may be informative regarding disease stage and rehabilitation needs. Full article

Background/Objectives: Patellar instability in adolescents is a significant cause of short- and long-term morbidity and disability. Traditionally, patients with first-time patellar dislocation are managed nonoperatively, although most studies are not focusing on the adolescent athletic population. The primary objective of the current study was to compare patient-reported outcomes and complications in adolescent athletes who underwent surgery either after the first patellar dislocation or after the recurrence of the dislocation with a minimum postoperative follow-up of 48 months (48–75 months). Methods: A total of 39 adolescent athletes who underwent medial patellofemoral ligament (MPFL) reconstruction (Group A, after the first dislocation, and Group B, recurrent patella dislocation) were included in this study. In all the patients, the same MPFL reconstruction technique was applied using a semitendinosus autograft. The graft was fixed on the patella using a transverse tunnel and adjustable loop button fixation and, in the femur, using a tunnel and absorbable screw fixation. The tunnel was drilled obliquely to prevent penetration of the distal femoral physis. The preoperative and postoperative clinical and functional evaluations of the patients were conducted via the visual analog scale (VAS), the Lysholm Knee Scoring System, the Kujala Anterior Knee Pain Scale, and the Pediatric International Knee Documentation Committee (Pedi-IKDC), and the return to sports score was assessed via the Tegner Activity Scale (TAS). Results: At the latest follow-up, both groups demonstrated significant improvement in the Lysholm scores, with Group A achieving a mean of 92.57 ± 6.21 and Group B achieving a mean of 90.53 ± 8.21 (p = 0.062). Postoperatively, Group A achieved a mean Kujala score of 94.21 ± 9.23, whereas Group B reached 92.76 ± 12.39, with no statistically significant difference (p = 0.08). The Pedi-IKDC score improved postoperatively in both groups. In Group A, it increased from 67.98 ± 12.29 to 93.65 ± 4.1, and in Group B, from 56.21 ± 13.6 to 91.67 ± 6.21 (p = 0.067). The preoperative visual analog scale (VAS) score for pain was significantly lower in Group A (3.1 ± 1.13) than in Group B (4.2 ± 3.01, p < 0.01). At the latest follow-up, the VAS scores improved in both groups, with Group A reporting a mean score of 0.47 ± 1.01 and Group B 0.97 ± 1.32 (p = 0.083). The Tegner activity scores were similar between the groups preoperatively, with Group A at 7.72 ± 1.65 and Group B at 7.45 ± 2.09 (p = 0.076). Postoperatively, Group A had a mean score of 7.28 ± 2.15, whereas Group B had a mean score of 6.79 ± 3.70 (p = 0.065). The mean time to return to sports was significantly shorter in Group A (5.1 ± 1.3 months) than in Group B (7.6 ± 2.1 months) (p < 0.01). Overall, 84.61% of the patients returned to their previous activity level. Specifically, 95.2% (20/21) of patients in Group A achieved this outcome, whereas 72.22% (13/18) achieved it in Group B. Patient satisfaction was generally high, with 76% (16/21) of patients in Group A reporting being satisfied or very satisfied, compared with 77% (14/18) in Group B. Conclusions: MPFL reconstruction is a safe and effective procedure for both acute and recurrent patellar dislocation in adolescent athletes. While patients who underwent acute reconstruction returned to sport more quickly and showed higher absolute postoperative scores, the greatest overall improvement from preoperative to final follow-up was observed in those treated for recurrent instability. Both surgical approaches demonstrated high satisfaction rates and minimal complications, supporting MPFL reconstruction as a reliable option in both acute and recurrent cases. Full article

Objective: This study aimed to investigate the relationship between social media use (SMU) in children diagnosed with major depression (MD) or attention deficit hyperactivity disorder (ADHD) and various psychosocial factors, including familial functioning, parental SMU, and parent-reported internalizing and externalizing symptoms. A healthy control group was included for comparison. Methods: The study included 121 children and adolescents aged 10–18 years (36 with MD, 41 with ADHD, and 44 healthy controls). The Social Media Addiction Scale—Short Form (SMDS) was administered to all participants, while mothers completed the McMaster Family Assessment Scale (FAS), the Social Media Addiction Scale—Adult Form (SMAS-AF), and the Child Behavior Checklist (CBCL). Psychiatric diagnoses were made using the K-SADS-PL DSM-5-T. Correlation and linear regression analyses were used to assess associations among variables. Results: SMU scores were significantly higher in the ADHD group compared to both the depression and control groups. Parental SMU was also higher in the ADHD group. In the depression group, child SMU was significantly associated with internalizing symptoms and impaired family communication. In the ADHD group, child SMU was predicted by poor family problem-solving and communication. Regression analyses showed that internalizing symptoms and family communication predicted SMU in the depression group (R² = 0.335), while family problem-solving and communication predicted SMU in the ADHD group (R² = 0.709). Conclusion: The findings suggest that social media use in children with depression and ADHD is associated with different psychosocial factors. While internalizing symptoms and family communication are more prominent in depressed children, family functioning—particularly problem-solving and communication—plays a larger role in children with ADHD. These results emphasize the need for targeted family-based interventions to mitigate problematic SMU in clinical populations. Full article

Emotional intelligence is a crucial determinant of socioemotional adaptation, psychological well-being and healthy habits in a population, although it has been barely studied in Generation Z. Therefore, the following research objectives were established: (1) to measure the levels of attention, clarity and emotional repair of Spanish university students in teaching undergraduates and (2) to design predictive models of emotional intelligence considering sex, anthropometric measurements, physical activity and the use of social networks as factors. A cross-sectional study was conducted with the involvement of Spanish teaching undergraduates. An online questionnaire integrating sociodemographic questions, the International Physical Activity Questionnaire Short Form, Trait Meta-State Mood Scale TMMS-24 and Social Network Addiction Scale SNAddS-6S were administered. University students exhibited higher levels of emotional attention (30.32 ± 6.08) than those of emotional clarity (28.18 ± 6.34) and emotional repair (28.51 ± 6.02). Most students use X, Pinterest, TikTok, Instagram, YouTube and WhatsApp most days of the week. There are positive relationships between attention and emotional clarity (r = 0.33; p ≤ 0.001), attention and emotional repair (r = 0.18; p ≤ 0.001) and clarity and emotional repair (r = 0.44; p ≤ 0.001). In conclusion, males have higher levels of emotional clarity and emotional repair, but females show higher levels of emotional attention. The model with the highest explanatory power is the one obtained for men’s emotional attention. Full article

With the availability of more ground-based remote-sensing meteorological equipment at Hong Kong International Airport, many more interesting features of terrain-disrupted airflow have been observed, such as the applications of short-range Doppler LIDAR. This paper documents a number of new features observed at the airport area, such as the hydraulic jump-like feature, vortex, and extensive mountain wake/reverse flow. The technical feasibility of using a numerical resolution weather prediction model to simulate such features is also explored. It is found that the presently available input data and numerical model may not be able to capture the fine features of the atmospheric boundary layer, and thus they are not very successful in reproducing many small-scale terrain-disrupted airflow features downstream of an isolated hill. On the other hand, more larger-scale terrain-disrupted flow features may be better captured, but there are still limitations with the available turbulence parameterization schemes. This paper aims at documenting the newly observed flow features at the Hong Kong International Airport, enhancing the understanding of low-level windshear, and evaluating the outputs of numerical resolution simulations for reproducing such observed features and its technical feasibility on short-term forecasting. Full article

Wind shear at the Hong Kong International Airport (HKIA) poses a significant safety risk due to terrain-induced airflow disruptions near the runways. Accurate assessment is essential for safeguarding aircraft during take-off and landing, as abrupt changes in wind speed or direction can compromise flight stability. This study introduces a hybrid framework for short-term wind shear prediction based on data collected from Doppler LiDAR systems positioned near the central and south runways of the HKIA. These systems provide high-resolution measurements of wind shear magnitude along critical flight paths. To predict wind shear more effectively, the proposed framework integrates a signal processing technique with a deep learning strategy. It begins with optimized variational mode decomposition (OVMD), which decomposes the wind shear time series into intrinsic mode functions (IMFs), each capturing distinct temporal characteristics. These IMFs are then modeled using bidirectional gated recurrent units (BiGRU), with hyperparameters optimized via the Tree-structured Parzen Estimator (TPE). To further enhance prediction accuracy, residual errors are corrected using Extreme Gradient Boosting (XGBoost), which captures discrepancies between the reconstructed signal and actual observations. The resulting OVMD–BiGRU–XGBoost framework exhibits strong predictive performance on testing data, achieving R² values of 0.729 and 0.926, RMSE values of 0.931 and 0.709, and MAE values of 0.624 and 0.521 for the central and south runways, respectively. Compared with GRUs, LSTM, BiLSTM, and ResNet-based baselines, the proposed framework achieves higher accuracy and a more effective representation of multi-scale temporal dynamics. It contributes to improving short-term wind shear prediction and supports operational planning and safety management in airport environments. Full article

Physical activity plays a critical role in health and well-being, particularly during students’ academic development. This study explores the relationship between self-efficacy and physical activity among physiotherapy students, recognizing self-efficacy as a key factor influencing exercise behavior. Despite awareness of physical activity’s benefits, academic demands may hinder participation, reducing confidence in maintaining an active lifestyle. A total of 244 physiotherapy students (mean age 24.44 ± 7.56 years) completed the General Self-Efficacy Scale (GSES) and the International Physical Activity Questionnaire—Short Form (IPAQ-SF). The results showed that the self-efficacy scores ranged from 17 to 40, with a mean of 30.44 (±3.93), indicating moderate to high levels. In terms of activity, 40.3% of students reported sufficient activity (high level), 51.7% reported moderate activity (meeting minimum guidelines), and 8.05% reported insufficient (low) activity. Self-efficacy positively correlated with age (r = 0.199, p < 0.01) and education level (r = 0.191, p < 0.01), and negatively with employment (r = –0.171, p < 0.05). Physical activity was significantly associated with self-efficacy (r = 0.217, p < 0.01). These findings underscore the importance of fostering self-efficacy to promote physical activity, highlighting the need for targeted strategies within academic settings to support student well-being and healthier lifestyle choices. Full article