Search Results (10,758)

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: Medication adherence is a critical determinant of therapeutic outcomes in type 2 diabetes mellitus (T2DM); however, its relationship with glycemic control remains inconsistent, particularly in real-world and socially vulnerable settings. This study aimed to evaluate medication adherence using multiple validated instruments, assess disease-related knowledge, and examine their relationship with glycemic control, with a focus on potential discordance between self-reported adherence and objective metabolic outcomes. Methods: A cross-sectional analytical study was conducted with 237 adults with T2DM receiving care in a primary health care (PHC) unit in the Brazilian Amazon. Medication adherence was assessed using the Almeida Adherence Scale, ARMS-12, and the Haynes–Sackett test, while disease-related knowledge was evaluated using the Batalla–Martínez questionnaire. Glycemic control was determined based on glycated hemoglobin (HbA1c) values obtained from clinical records within the previous three months. Descriptive and comparative analyses were performed. Results: The study population was predominantly female (64.1%) and aged 40–59 years (55.7%), with a high prevalence of socioeconomic vulnerability. Non-adherence was identified in 55.7% of participants using the Almeida Adherence Scale, whereas higher adherence rates were observed with ARMS-12 (91.1%) and the Haynes–Sackett test (72.2%). Inadequate disease-related knowledge was found in 77.2% of participants. Among individuals with available HbA1c data (n = 116), the mean HbA1c was 8.63% (SD = 1.65), and 81.9% presented inadequate glycemic control (HbA1c ≥ 7%). Notably, among participants classified as adherent by the ARMS-12 scale (91.1%), inadequate glycemic control was nonetheless present in 81.9% of those with available HbA1c data, illustrating the magnitude of the observed discordance between self-reported adherence and objective metabolic outcomes. Cross-tabulation of each adherence instrument against glycemic control showed no statistically significant associations (chi-square with Yates correction; ARMS-12: p = 0.631, φ = 0.045; Almeida Adherence Scale: p = 0.301, φ = 0.096; Haynes–Sackett: p = 0.800, φ = 0.024). Multivariable logistic regression (Nagelkerke R² = 0.321; AUC = 0.834) identified older age (aOR = 0.92; 95% CI: 0.87–0.96; p < 0.001) and higher income (aOR = 9.96; 95% CI: 2.05–48.32; p = 0.004) as independent predictors of glycemic outcome, while no adherence measure was independently associated with HbA1c ≥ 7%. A sensitivity analysis using HbA1c ≥ 8.0% revealed poor control in 59.5% of participants (n = 69/116). Conclusions: Despite varying levels of self-reported medication adherence, inadequate glycemic control was highly prevalent. The absence of statistically significant associations between self-reported adherence and HbA1c, combined with the high prevalence of poor glycemic control regardless of adherence status, is consistent with the hypothesis that adherence alone does not fully explain metabolic outcomes in T2DM. Given the cross-sectional design, no causal inferences can be drawn. These findings highlight the need for integrated care strategies in primary health care, including improved health literacy, structured pharmacotherapeutic follow-up, and the use of multiple adherence assessment tools to better inform clinical decision-making. Full article

Background: Implant supply strategy in spine surgery affects operative workflow, resource utilization, and packaging-related material use, yet has received limited systematic investigation. This study evaluates single-sterile implants versus multipack implants using a hospital-based Health Technology Assessment (HB-HTA) framework. Methods: A non-randomized, mixed-methods comparative study was conducted at a tertiary academic spine center. Time measurements were recorded during eight posterior fusion procedures (four per supply type; n = 18 single-pack screws, n = 20 multipack screws) across three process steps: implant retrieval, sterile transfer, and instrument preparation. Time measurements were recorded per packaging unit; per-implant comparisons were additionally derived for operational interpretation. Packaging volume, weight, and packaging-related CO₂-equivalent estimates were calculated per implant. Standardized questionnaires were distributed to operating-room (OR) nurses (n = 14/21; 66.7%) and institutional surgeons (n = 11/11; 100%). Manufacturer-provided descriptive process and cost data were analyzed. Results: Multipack implants were associated with consistently shorter handling times across all measured process steps. Mean retrieval time per packaging unit was 25.4 s (multipack) versus 58.7 s (single-pack); retrieval time was significantly shorter for multipack units on the Mann–Whitney U test (p = 0.004), a result that was robust to supply-related outlier events (p = 0.001 after their post hoc exclusion). Packaging-normalized sterile-transfer burden per implant was reduced by a factor of 4.76. Instrument preparation was faster with multipack systems (15.6 s vs. 25.2 s). Packaging volume per implant was reduced by a factor of 5.6, and packaging weight by a factor of 2. Packaging-related CO₂-equivalent estimates were lower for multipack implants (0.017 kg vs. 0.026 kg per implant). Survey responses indicated predominantly positive evaluations of workflow and handling efficiency. A trade-off was identified regarding the potential disposal of unused implants (noted by 73% of institutional surgeons). Manufacturer-provided descriptive data suggested scale effects in packaging and sterilization processes. Conclusions: Under high-volume academic conditions, multipack implants were associated with shorter implant-handling process times, favorable staff perceptions, and reduced packaging-related material burden while introducing trade-offs that require local evaluation. These exploratory findings suggest that the implant supply strategy is an underexplored but potentially relevant dimension of surgical process optimization in spine surgery. Full article

The Fifth Industrial Revolution (Industry 5.0) requires human-centric mechanisms that preserve the integrity, reproducibility, and interpretability of AI-driven decisions in smart manufacturing. Injection molding generates heterogeneous, imbalanced, and weakly labeled process data, posing reliability and integrity risks to data-driven quality control. This study proposes an integrity-verified and reproducibility-instrumented secure machine learning framework for operating-regime analysis in injection molding that integrates (i) SHA-256-based data-integrity verification at ingestion, (ii) Pearson correlation-based feature selection, and (iii) a Gaussian Mixture Model (GMM) under a passive-adversary threat model with Transport Layer Security (TLS)-secured transmission. Evaluated on real industrial data (n = 6719 cycles, seven process variables), correlation-based feature selection retained four non-redundant variables and improved the GMM Silhouette Score from 0.274 ± 0.075 (all features) to 0.323 ± 0.014 (95% CI [0.318, 0.329]), a +18.2% relative improvement (paired t(29) = 3.39, p = 0.002; Cohen’s d = 0.62; Wilcoxon p = 0.022), while lowering the Davies–Bouldin Index from 1.63 to 1.17. The Silhouette standard deviation of 0.014 over 30 seeds meets the σ ≤ 0.02 reproducibility target. The GMM resolves four interpretable operating regimes—one low-load regime consistent with nominal operation and three elevated-load regimes (left-side, right-side, and bilateral)—with operator-readable per-variable signatures. Relative to hard-partition and projection baselines, the GMM is not Silhouette-optimal but provides an interpretable, generative regime model that meets the σ ≤ 0.02 reproducibility target. The framework operationalizes human-centric manufacturing security as measurable integrity, reproducibility, and interpretability. Full article

Implicit bias, automatic attitudes or stereotypes outside conscious awareness, may influence clinicians’ communication, diagnosis, and treatment decisions, contributing to inequities in care. We conducted a scoping review to map measurement strategies used to assess implicit bias among health professionals and students in healthcare and training settings. Using Joanna Briggs Institute guidance and PRISMA-ScR, we searched PubMed, Embase, BVS, Google Scholar, and institutional repositories for studies to November 2025; two reviewers independently screened and charted data (protocol was developed a priori but submitted internal in organization, and then uploaded in OSF. Of 1864 records, 93 studies from 28 countries were included. We identified 57 bias domains, most often race/ethnicity, weight, and sexual orientation. Across studies, 42 unique instruments were reported; the Implicit Association Test was most common, while psychometric validation and administration details were frequently limited, constraining comparability and interpretation. Evidence gap mapping showed concentration in academic and hospital settings, with fewer studies in primary care or community contexts and limited attention to age, disability, and intersectionality-related biases. The evidence base is growing but fragmented; future work should prioritize standardized administration and reporting, stronger validation, and tools that better capture automatic responding across diverse identities and care settings to support education and equity-oriented interventions. Full article

Introduction: Traditional instruments for measuring lifelong learning of health professionals fail to capture digital-age learning, creating a critical measurement disconnect. To address this gap, we developed a 16-item Self-Pursuits, Aspirations, and Knowledge Endeavors in the Digital Era (SPArKED) instrument. Methods: To gather validity evidence for SPArKED, a cross-sectional survey was deployed to health professional students (n = 558). The survey questionnaire included: SPArKED, Jefferson scale of lifelong learning for students in health professions, basic psychological needs satisfaction scale, and human–computer trust scale assessing students’ trust in generative technology to support lifelong learning. Exploratory factor analysis (EFA) and correlation analysis were performed. Results: The EFA of the SPArKED revealed a three-component structure: networked learning, i-learning (individual mastery), and AI-powered learning, together explaining 55% of the total variance. The SPArKED demonstrated good internal consistency (α = 0.86) and convergent validity with the Jefferson scale of lifelong learning (r = 0.75). The correlations between SPArKED and psychological needs satisfaction scores were moderately high: autonomy (r = 0.50), competence (r = 0.48), and relatedness (r = 0.51). SPArKED had a higher correlation with students’ trust in generative technology to support lifelong learning than the Jefferson scale (r = 0.52 and r = 0.32, respectively). Conclusions: Compared to the Jefferson scale, the SPArKED instrument appears to better capture digital-age learning behaviors among students in health professions. By assessing these evolving behaviors in learners, education programs can better guide future health practitioners in developing desired lifelong learning competencies and digital literacies. Future research should gather validity evidence for SPArKED across diverse learner samples and educational stages, informing a critical re-assessment of established instruments in the rapidly evolving learning landscape. Full article

Background and Objectives: A relationship between cognitive decline (CD) and chronic coronary syndrome (CCS), common among the elderly population, has not yet been clearly established. Our study aims to evaluate the link between severe cognitive impairment and cognitive impairment, as measured by various neuropsychological tests in patients with or without CCS. In addition, we sought to identify cardiovascular risk factors (CVRFs) that influence the severity of CD and severe cognitive impairment. Materials and Methods: This observational study was conducted on 264 people with CVRFs. Of the 264, 132 were classified as patients with CCS and 132 as control subjects without CCS. Neuropsychological assessment tools included the Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL) scales, the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), and the Geriatric Depression Scale (GDS-15). Clinical characteristics, echocardiographic measures, and vascular parameters of all subjects were also evaluated. Results: Patients with CCS had significantly lower cognitive performance (MMSE, p = 0.010; MoCA, p = 0.021), reduced functional status (IADL, p = 0.030; ADL, p = 0.012), and higher depression scores (p = 0.004) compared with controls. They also had worse cardiovascular profiles, including lower left ventricular ejection fraction (LVEF) (p = 0.001), higher NT-proBNP levels (p = 0.005), and increased carotid intima-media thickness (IMT) (p < 0.05). IMT and blood pressure values were negatively correlated with cognitive and functional scores and positively correlated with depression severity (p < 0.001). Multivariate analysis identified systolic and diastolic blood pressure, age, body mass index, heart rate, reduced daily activity, and depression as independent predictors of cognitive decline in patients with CCS. In the GDS-15 score, each unit increase was associated with a 32.1% higher risk of cognitive decline and a 37.1% higher risk of MMSE-defined severe cognitive impairment, while improved ADL scores significantly reduced this risk. Conclusions: CCS is associated with an increased risk of severe cognitive impairment and also with cognitive decline, influenced by hypertension, subclinical atherosclerosis, depression, and reduced functional status. These findings emphasize the importance of early identification and multidisciplinary management of cognitive impairment in patients with CCS to prevent progression to severe cognitive impairment. Full article

The accurate characterization of low-power near-infrared LEDs typically requires costly radiometric equipment, limiting broader accessibility. This study proposes a low-cost indirect method for comparative NIR LED characterization based on the thermal response of black-coated aluminum absorbing targets monitored by a commercial MLX90614 contactless temperature sensor integrated with an ESP32 acquisition system. The absorbed optical power was estimated from a steady-state energy-balance model combining convective and radiative heat transfer, with geometry-dependent effective coefficients derived for 10 mm and 15 mm diameter targets. Experiments were conducted using 850 nm and 940 nm LEDs at drive currents between 30 mA and 100 mA. The absorbed power increased linearly with the drive current and electrical input power across all configurations, with R² values of 0.995–0.997 and 0.996–0.999, respectively. The 15 mm targets exhibited higher capture ratios (10.4–11.9%) compared to the 10 mm targets (8.4–9.4%). The combined measurement uncertainty ranged from 13% at high drive currents to nearly 70% at low drive currents, with the temperature-rise sensitivity being the dominant factor; within the recommended operating range (≥70 mA for 10 mm and ≥80 mA for 15 mm targets), the uncertainty remained below 25%. The proposed platform enables reliable comparative characterization of low-power NIR emitters using exclusively off-the-shelf components. Full article

This article presents a structured spectral-stability assessment of an nJ-class ultrafast fiber laser generating femtosecond pulses with an approximate pulse duration of 115 fs, based on an ensemble of 61 consecutively acquired optical spectra. The study is motivated by the practical need to extract reliable short-sequence stability information from routine compact-spectrometer exports without requiring a separate pulse-diagnostic instrument at the initial assessment stage. For each spectrum, peak wavelength, centroid wavelength, FWHM bandwidth, integrated spectral area, correlation with the ensemble mean spectrum, and RMS deviation were calculated. Principal component analysis (PCA) was then applied to reduce the full spectral ensemble into a compact diagnostic space and to identify the dominant modes of residual spectral variation. The analyzed spectra yielded a peak wavelength of 775.31 ± 0.19 nm, a FWHM bandwidth of 7.95 ± 0.20 nm, an integrated spectral area of 10.43 ± 0.42 a.u.·nm, and a correlation with the mean spectrum of 0.99957 ± 0.00019, confirming a highly repeatable spectral envelope. PCA showed that PC1 and PC2 explained 66.50% and 12.60% of the variance, respectively, while PC3 contributed only 1.90%, indicating that the measured variability was weak and largely low-dimensional. These results demonstrate that consecutively exported optical spectra can provide a defensible and physically interpretable short-sequence stability assessment of ultrafast femtosecond fiber lasers, offering a practical route for routine monitoring, early-stage diagnostics, and future integration with simultaneous temporal and spectral characterization. Full article

Background: Pediatric hematopoietic cell transplantation (HCT) conveys significant risk of mortality, morbidity, impaired quality of life, and multifactorial distress. One potential strategy for improving experience and relieving suffering is proactive specialty palliative care (SPC) utilization. However, SPC is not routinely incorporated into pediatric HCT. One barrier to SPC integration is unknown pediatric HCT provider perceptions of SPC services, particularly among providers with lived experience working within a collaborative HCT-SPC partnership. Objective: This single-institution pilot study aimed to (1) describe an approach to standardized, proactive pediatric HCT-SPC clinical partnership, and (2) quantify acceptability, appropriateness, and satisfaction regarding the program among pediatric HCT providers. Methods: Survey methods were used to assess attitudes among HCT providers who had worked with the SPC clinical partnership for at least three months. Core survey metrics were the validated Acceptability of Intervention Measure and Intervention Appropriateness Measure. Additional survey items were adapted from the Perceptions of Palliative Care Instrument. Results: Respondents reported high mean scores for acceptability (4.96) and appropriateness (4.93) on a 5-point scale. Overall satisfaction with SPC integration averaged 8.72 (SD 1.13) on a 10-point scale. Satisfaction scores for each individual service provided by SPC were similarly high. No significant differences in responses were found based on provider type, prior SPC training, or years in practice. Conclusions: In this single-institution pilot study, pediatric HCT providers with lived experience working in an environment with standardized SPC collaboration view SPC as highly acceptable, appropriate, and beneficial for their patients, supporting the feasibility and value of proactive SPC integration in pediatric HCT care. Full article

This study examines where socioeconomic differences in students’ computational thinking (CT) learning become visible by comparing a diagnostic assessment of conceptual CT knowledge with behavioral indicators derived from interaction data in a digital programming environment. The study involved 444 elementary school students who completed a structured sequence of programming tasks while their activity was recorded. Conceptual CT knowledge was assessed using a validated diagnostic instrument, and four behavioral indicators were derived from learning logs: average first-try stars, attempts per challenge, highest challenge reached, and average solution time. Analyses were conducted at two complementary levels: individual indicators and integrated digital behavioral types identified through clustering. The findings revealed no meaningful socioeconomic differences in diagnostic CT performance and no consistent differences across most individual behavioral indicators, with the exception of average first-try stars. However, socioeconomic differences became visible when students’ interaction patterns were examined as multidimensional configurations of engagement. These results suggest that socioeconomic variation is reflected primarily in students’ engagement with digital problem-solving processes rather than in conceptual knowledge alone. The study highlights the value of combining diagnostic and log-based measures for understanding how educational inequality may become observable in computational thinking development. Full article

Background: Clinical reasoning is a vital competency for safe nursing practice, yet no validated Arabic instrument exists to assess this skill among nursing students in Saudi Arabia. Aim: This study aimed to translate, culturally adapt, and psychometrically evaluate the Arabic version of the Clinical Reasoning Scale (CRS) and to investigate clinical reasoning among Saudi nursing students. Methods: This methodological instrument validation study with a cross-sectional survey component was conducted in Saudi Arabia between January 2024 and May 2025 among nursing students. The Arabic Clinical Reasoning Scale (CRS-A) was translated and culturally adapted in accordance with the WHOQOL Group guidelines for instrument translation. Content validity was assessed by 10 experts, and construct validity was evaluated using exploratory factor analysis (n = 365). The response rate was 98.65%. Internal consistency was evaluated using Cronbach’s alpha (n = 365), and test–retest reliability (n = 30) was measured with the Intraclass Correlation Coefficient (ICC) over a two-week period. Descriptive statistics, one-way analysis of variance (ANOVA), and independent sample t-tests were also performed. Results: The tool’s content validity (S-CVI = 0.98) was confirmed by a panel of experts. The CRS-A demonstrated excellent temporal stability (ICC = 0.95, p < 0.001) and internal consistency (Cronbach’s α = 0.935). The exploratory factor analysis showed that the 16 items’ factor loadings ranged from 0.542 to 0.807, and three factors accounted for 64.33% of the total variance. Students self-reported agreement with clinical reasoning abilities (mean scores: 3.81–4.18). No significant differences in clinical reasoning were found by age (p = 0.102) or gender (p = 0.226), but significant differences were found by Cumulative Grade Point Average (CGPA) (p < 0.001). Conclusions: The Arabic Clinical Reasoning Scale demonstrated preliminary psychometric performance for measuring clinical reasoning among Arabic-speaking student nurses. It provides educators with a valuable tool for identifying learning needs and evaluating educational interventions. Full article

Background/Objectives: Chronic home oxygen therapy—long-term oxygen therapy (LTOT)—improves survival and quality of life in chronic respiratory failure when used ≥15 h/day, but adherence is frequently suboptimal and specific patient-reported outcome measures (PROMs) are scarce. To develop, validate and apply a specific PROM for patients on LTOT. Methods: A prospective observational cohort study was conducted at San Juan de Alicante University Hospital (April 2024–December 2025) following a four-stage process: conceptual framework definition and expert workshop, content validation and item reduction, cognitive interviews with pilot reliability testing (n = 25), and field application to 120 consecutive chronic LTOT users. The LTOT-PROM was designed to capture the patient-perceived impact attributable to LTOT during the previous 4 weeks. Internal consistency was assessed with Cronbach’s α and test–retest reproducibility with the intraclass correlation coefficient (ICC). Results: The final instrument comprises 15 scored items in two dimensions—Daily Activity (9 items) and Adverse Effects (6 items)—plus one ambulatory-only mobility item excluded from the total score. Cronbach’s α was 0.814 (95% CI 0.681–0.906) for Daily Activity, 0.743 (95% CI 0.548–0.872) for Adverse Effects and 0.808 (95% CI 0.677–0.902) for the total scale; total ICC(A,1) was 0.890 (95% CI 0.767–0.950). Among the 120 patients (62 men, 58 women; mean age 78 ± 13 years; mean therapy duration 40 ± 32 months), 68% reported reduced effort for daily activities, 66% reported a reduction in dyspnoea and 67% reported improved self-confidence; 49% reported morning airway dryness and 7% abandoned the equipment due to nasal dryness or rhinitis. Conclusions: The LTOT-PROM is a brief, reliable and reproducible oxygen-specific instrument for assessing the recent patient-perceived impact of LTOT in routine clinical practice. Further studies should evaluate structural validity, external validity and the relationship between LTOT-PROM scores and objective adherence measures. The construct was predefined as the patient-perceived impact attributable to LTOT during a standardised 4-week recall window, and cognitive interviews confirmed that respondents interpreted the items as experienced benefit/burden during that period rather than as week-to-week symptom change. Full article

The article presents selected problems related to the modernization of large-panel buildings in the context of the requirements arising from the EU EPBD (Energy Performance of Buildings Directive). The study has an exploratory character and is based on qualitative case study analyses of selected large-panel residential buildings representing different prefabrication systems and modernization conditions. The characteristic features of prefabricated buildings are outlined, and the main modernization barriers are identified, including structural limitations, insufficient thermal performance of building envelopes, outdated technical systems, and organizational and legal challenges resulting from ownership structures. Particular attention is given to the EPBD requirements concerning energy efficiency improvement, CO₂ emission reduction, and the implementation of the zero-emission building (ZEB) standard. The analysis indicates that the modernization of large-panel buildings requires a systemic approach integrating technical, economic, and organizational measures. The importance of comprehensive thermal retrofitting and the integration of renewable energy sources is emphasized. The findings also suggest that digital tools such as BIM (Building Information Modeling) may support modernization planning and building information management. The conclusions of the article indicate that the effective implementation of the EPBD provisions for large-panel buildings will only be possible with simultaneous systemic support, including financial and regulatory instruments, as well as the development of technical and organizational competencies within the construction sector. Full article

Recent studies have proposed improving Laser Speckle Contrast Imaging (LSCI) by using polarimetric filtering to isolate multiply scattered photons from moving red blood cells (RBCs), an approach referred to as Laser Speckle Orthogonal Contrast Imaging (LSOCI). This reliance on multiple scattering enables the development of a calibration method based on a moving reference sample, chosen to generate dynamic circular Gaussian speckle fields that replicate the statistical properties of RBC scattering in both intensity and the distribution of polarization states. Assuming that multiply scattered photons from both RBCs and the reference sample exhibit a homogeneous distribution of polarization states over the Poincaré sphere, the proposed calibration links in vivo speckle contrast reduction bijectively to an equivalent speed of the reference sample. We demonstrate that this equivalent-velocity metric yields consistent in vivo measurements across distinct instruments despite the use of different laser spectral widths, thereby providing a standardized and transferable means to quantify microcirculatory activity. Full article