Search Results (547)

This study explores water as memory and as method in African thought. It shows how rivers, rain, and oceans act not only as sources of life but also as teachers who carry a story, restore balance, and reveal moral truth. Drawing from Yoruba, Akan, Igbo, southern African, Kenyan and Afro-Atlantic traditions, this paper presents water as archive and as oracle, holding the past while speaking to the present. This article develops the idea of hydro epistemology, understood here as a way of knowing through flow, renewal, and relationship. In this framework, knowledge is created through ritual engagement with water, transmitted through oral memory and ecological observation, tested against environmental response and revised when conditions change. Water is treated as a witness, mediator and guide, rather than a passive resource. By setting these traditions alongside global discussions on water governance, nature-based ecological care and decolonial environmental ethics, this paper argues that African water imagination offers more than symbolism. It proposes a practical philosophy in which caring for water and caring for life are the same act. To listen to water is to remember, to restore and to recover a way of living that renews both people and land. Full article

Background and Clinical Significance: SLIPPERS syndrome (Supratentorial Lymphocytic Inflammation with Parenchymal Perivascular Enhancement Responsive to Steroids) was first described in 2015 as a variant of CLIPPERS restricted to supratentorial regions. Only a few cases have been reported so far, and its distinction from primary angiitis of the central nervous system (PACNS) remains challenging, as both may present with overlapping clinical, radiological, and histopathological features. We report two patients initially diagnosed with SLIPPERS but finally fulfilling the diagnostic criteria for PACNS, highlighting the complexity of the differential diagnosis. Case Presentation: The first patient was a 49-year-old woman who presented with seizures, memory impairment, and facial neuralgia. MRI showed multiple cortico-subcortical and deep nodular lesions in the left hemisphere with gadolinium enhancement. Brain biopsy revealed a T-cell-predominant lymphocytic vascular infiltrate. She responded to corticosteroids but later relapsed, requiring methotrexate for long-term immunosuppression, with no further recurrences during seven years of follow-up. The second patient was a 64-year-old man with hypertension, dyslipidemia, and alcohol use who developed repeated focal-to-generalized seizures. MRI disclosed multifocal nodular gadolinium-enhancing right hemispheric lesions, with SWI microhemorrhages. Biopsy demonstrated transmural T-cell vasculitic infiltrates. He responded to corticosteroids and methotrexate, but radiological progression at 14 months prompted replacement with cyclophosphamide. Conclusions: There is a considerable clinical, radiological, and histological overlap between SLIPPERS and PACNS. Careful analysis of advanced MRI sequences, particularly angiographic and vessel-wall imaging studies, combined with meticulous histopathological analysis, is essential to avoid misdiagnosis. These similarities suggest that some cases attributed to SLIPPERS may, in fact, correspond to variants of PACNS. Full article

This study examines how the sense of home for people with dementia is shaped not only by physical settings but by dynamic atmospheric compositions emerging through memory, sensation, and everyday practices. Building on a preliminary literature mapping that identified three dimensions of home in later-life care environments—safe space, small world, and connection—we developed a multisensory co-design toolkit combining key-element cards and curated olfactory prompts. The study was conducted in a dementia-friendly residential care facility in Italy. Nine residents with mild–moderate dementia (aged 75–84) participated in two group sessions and six individual sessions, facilitated by two design researchers with care staff present. Data consist of audio-recorded and transcribed interviews, guided olfactory sessions, and researcher fieldnotes. Across sessions, participants articulated “small worlds” as micro-environments composed of meaningful objects, bodily comfort, routines, and sensory cues that supported emotional regulation and identity continuity. Olfactory prompts, administered through a low-intensity and participant-controlled protocol, supported scene-based autobiographical recall for some participants, often eliciting memories of domestic rituals, places, and relationships. Rather than treating home-like design as a fixed architectural style, we interpret home as continuously re-made through situated sensory–temporal patterns and relational practices. We translate these findings into atmospheric design directions for dementia care: designing places of self and refuge, staging accessible material memory devices, embedding gentle olfactory micro-worlds within daily routines, and approaching atmosphere as an ongoing process of co-attunement among residents, staff, and environmental conditions. The study contributes a methodological and conceptual framework for multisensory, narrative-driven approaches to designing home-like environments in long-term care. Full article

Despite widespread adoption, Electronic Medical Record (EMR) systems remain limited in providing intelligent clinical decision support, particularly for early detection of patient deterioration. We present MedROAD V2 (Medical Records Organization, Analysis, and Display), an open-source EMR that integrates AI-driven physiological analysis with comprehensive patient management. The system combines continuous vital sign monitoring and laboratory data using an ensemble of the following four complementary machine learning models: gradient boosting for supervised prediction, isolation forests for anomaly detection, autoencoders for pattern recognition, and Long Short-Term Memory networks for temporal modeling. A novel framework couples these predictions with a large language model (Claude AI) to generate explainable differential diagnoses grounded in medical literature. Validation on the MIMIC-IV database demonstrated excellent 12 h deterioration prediction. MedROAD demonstrates that combining quantitative prediction with natural language explanation can enhance clinical decision support while extending quality care to populations that would otherwise lack access. Full article

African American (AA) women often experience earlier onset and more severe menopause symptoms, especially vasomotor symptoms (VMSs) like hot flashes, compared to other groups. However, limited research has examined the effectiveness and acceptability of menopause treatments in this population. This scoping review synthesized evidence on pharmacological (e.g., hormone replacement therapy [HRT], SSRIs, venlafaxine, nitroglycerin) and holistic (e.g., dietary changes, physical activity [PA], supplementation) approaches for managing menopause symptoms in AA women. Using Joanna Briggs Institute and PRISMA-ScR guidelines, a scoping review was conducted, guided by the PCC framework. Four databases (CINAHL, PsycInfo, PubMed, Scopus) were searched for English-language studies (2010–2025) involving AA women aged 40–65. Eligible studies included RCTs and observational designs with ≥10% AA participants. Data were charted and synthesized descriptively. Fourteen U.S.-based studies (11–53% AA representation) were included. Pharmacological treatments—especially HRT and SSRIs—were effective for VMSs and mood symptoms. Holistic approaches showed mixed outcomes; PA and magnesium offered modest benefit, while phytoestrogens sometimes worsened memory. Race-specific results were rarely reported. Effective pharmacological options exist, but evidence tailored to AA women is lacking. Future research must ensure greater AA representation and culturally responsive approaches to menopause care. Full article

Ageing is a dynamic biological process involving interconnected physiological, psychological, and social changes, making the promotion of healthy ageing a global public health priority. The World Health Organization (WHO) defines healthy ageing as the process of developing and maintaining functional ability that enables well-being in older age. The WHO’s Decade of Healthy Aging (2021–2030) outlines four key action areas: changing attitudes toward ageing, creating age-friendly environments, delivering integrated and person-centred care, and ensuring access to long-term care. This Perspective examines yoga, a holistic mind–body practice integrating physical postures, breath regulation, and mindfulness, as a potentially safe, adaptable, and scalable intervention for older adults. Evidence suggests that yoga may improve flexibility, balance, mobility, and cardiovascular function, reduce pain, and support the management of chronic conditions commonly associated with ageing. Psychological and cognitive research further indicates reductions in stress, anxiety, and depressive symptoms, alongside potential benefits for attention, memory, and executive function. Improvements in health-related quality of life (HRQoL) have been reported across physical, psychological, and social domains, with benefits sustained through regular practice. Adaptations such as chair-based practices, restorative postures, and the use of props enhance accessibility and safety, allowing participation across diverse functional levels. Mindfulness and breath-focused components of yoga may additionally support emotional regulation, resilience, and psychological well-being, particularly among older adults experiencing stress or limited mobility. Yoga interventions are generally well tolerated, demonstrate high adherence, and can be delivered through in-person and digital formats, addressing common access barriers. Despite this growing evidence base, yoga remains underintegrated within health policy and care systems in the US, UK, and India. Strengthening its role may require coordinated efforts across research, policy, and implementation to support healthy ageing outcomes. Full article

Environmental time series, such as near-surface air temperature, exhibit strong multi-scale structure and persistent autocorrelation. Accurate forecasting therefore requires careful consideration of both temporal scale separation and serial dependence. In this study, we evaluate a unified framework that integrates Kolmogorov–Zurbenko (KZ) filtering with two classes of models: (i) classical regression with Cochrane–Orcutt autocorrelation correction, and (ii) an autocorrelation-adjusted Long Short-Term Memory (LSTM) network that learns an embedded correlation coefficient ($\rho$). All models are assessed using standardized meteorological predictors of T2M under walk-forward validation. The LSTM trained on raw predictors shows moderate performance (RMSE = 0.73, $R^2=0.46$, DW = 0.79), which improves after KZ filtering (RMSE = 0.59, $R^2=0.63$, DW = 1.84). Classical regression applied to KZ-decomposed predictors and corrected using the Cochrane–Orcutt procedure achieves substantially higher accuracy (RMSE = 0.41, $R^2=0.89$, DW $\approx 2.0$), outperforming the LSTM in both predictive precision and residual behavior. Visual diagnostics further confirm tighter predicted–actual alignment and near-white residuals in the classical models, whereas the LSTM retains small systematic deviations even after filtering. Overall, the results demonstrate that addressing multi-scale structures and autocorrelation had a greater impact than increasing model complexity. Integrating spectral decomposition with autocorrelation correction thus produces more reliable, statistically valid forecasts, demonstrating that classical regression with KZ filtering can surpass LSTM models in both accuracy and interpretability. These findings emphasize the value of combining time series–aware pre-processing with both traditional and neural network approaches for environmental prediction. Full article

Background: Serum lactate is a key biomarker of tissue hypoperfusion and metabolic stress in sepsis. Although lactate clearance is widely recognized, many intensive care units record only a peak lactate within 24 h (pLac-24h). The prognostic value of pLac-24h among patients receiving blood purification therapy remains unclear in Asian intensive care settings. Methods: We retrospectively analyzed the 2018–2020 ICU dataset from MacKay Memorial Hospital, Taiwan. Among 16,693 adult ICU admissions, 2506 patients received continuous renal replacement therapy (CRRT) as blood purification for severe sepsis or septic shock. Of these, 1264 (50.4%) had available pLac-24h data, and 27 (1.1%) also required extracorporeal membrane oxygenation (ECMO). The primary outcome was 28-day all-cause mortality. Multivariate logistic regression adjusted for age, sex, APACHE II score, infection source, and CRRT/ECMO use. Discrimination was evaluated by receiver operating characteristic (ROC) curves and decision-curve analysis. This analysis was conducted as a predefined sub-analysis of an institutional ICU database. Results: The mean age of the cohort was 65.7 ± 13.4 years, and 64.8% were male. Median pLac-24h was 5.1 mmol/L (IQR 3.2–8.6). The overall 28-day mortality among CRRT patients was 47.3%. Mortality rose progressively across pLac-24h quartiles (Q1–Q4: 28.9%, 39.4%, 54.7%, and 68.1%; p < 0.001). Each 1 mmol/L increase in pLac-24h independently predicted higher mortality (adjusted OR 1.18, 95% CI 1.10–1.26, p < 0.001). The area under the ROC curve for pLac-24h predicting 28-day mortality was 0.78 (95% CI 0.74–0.82), outperforming the APACHE II score (AUC 0.69, p = 0.02). Conclusions: In critically ill patients with septic shock undergoing CRRT, peak lactate within 24 h was a strong, independent predictor of 28-day mortality. pLac-24h offers a pragmatic, readily available prognostic indicator when serial lactate measurements are unavailable, supporting its integration into bedside risk assessment in real-world Asian ICU practice. Full article

Stroke often results in lasting cognitive impairments that severely reduce independence and quality of life. Traditional neuropsychological assessments rely on mean scores that provide an average estimate of overall cognitive function but neglect the fluctuations in performance. The variability in performance can be captured as inconsistency, i.e., fluctuations across multiple trials within a single task or as dispersion, i.e., fluctuations across multiple tasks. While inconsistency has been extensively studied, the impact of post-stroke cognitive impairment on cognitive dispersion is unknown. In this study, ninety-five stroke survivors (41 cognitively impaired and 54 cognitively normal) completed a neuropsychological battery that captured performance across five cognitive domains: executive function, attention, memory, language, and processing speed. We compared the stroke groups on across- and within-domain cognitive dispersion. Cognitively impaired stroke individuals showed elevated dispersion within executive function compared to cognitively normal individuals. The two groups did not differ on any other within-domain or across-domain cognitive dispersion. Post-stroke cognitive impairment increased variability within executive functioning. Incorporating cognitive dispersion into routine post-stroke assessment can advance clinical practice by identifying subtle cognitive instability, anticipate supportive needs, and tailor rehabilitation plans for improving stroke care. Full article

This qualitative study explored the experiences of caregivers of people with dementia who received home-based occupational therapy from the Modena Memory Clinic. Five participants were interviewed through semi-structured conversations analyzed using thematic analysis. Results identified three main mechanisms underlying the effectiveness of the intervention: education, empowerment, and collaboration. Therapist-tailored interventions helped caregivers recognize remaining abilities, improve problem-solving, and enhance daily care strategies. The home environment supported comfort and engagement, while collaboration with professionals strengthened continuity of care. These findings highlight occupational therapy as a key component of community-based and person-centered dementia care. Full article

Background: Inadequate nutrition, poor health care, and limited stimulation constrain early childhood development and cognitive potential. Micronutrient deficiencies during pregnancy and early life are prevalent in low- and middle-income countries (LMICs) and may impair cognitive outcomes. Maternal multiple-micronutrient (MMN) and point-of-use micronutrient powder (MNP) supplements improve birth outcomes and iron status, but their long-term cognitive impact remains unclear. This systematic review assessed the long-term impact of maternal MMN and early-childhood MNP supplementation on cognitive development among children aged 4–14 years in LMICs. Method: Following PRISMA guidelines (PROSPERO CRD42023459846), (cluster) randomized controlled trials were identified from six databases and gray literature (October 2023; updated July 2025). Records were managed in EndNote and screened in Covidence, and data were synthesized using Review Manager. Eligible studies examined MMN or MNP interventions during pregnancy, lactation, or early childhood, reporting cognitive, motor, or socio-emotional outcomes in children aged 4–14. Results: Ten studies met the inclusion criteria: six on maternal supplementation, three on early childhood interventions, and one combining both. Most were conducted in Asia, with one in Tanzania and one in Peru. Although most findings were not statistically significant, two large UNIMMAP-based trials indicated modest long-term improvements in procedural memory and intelligence, while one early childhood point-of-use MNP trial suggested enhanced pre-academic skills. Conclusions: Maternal MMN supplementation may modestly enhance specific domains of cognitive development, whereas evidence on the long-term effects of MMN and point-of-use MNPs on cognitive development remain limited, highlighting the necessity for further research. Full article

Background/Objectives: In recent years, Narrative Medicine (NM) has gained prominence in the context of neurodegenerative diseases, such as dementia, offering tools to understand the subjective experience of illness and to improve the care relationship. Methods: This scoping review, conducted following the PRISMA guidelines, analyzed the scientific literature from PubMed, PsycInfo, Web of Science, and Medline, encompassing 10 contributions focused on NM and patients with dementia or Alzheimer’s disease. Results: The analysis identified three main themes: 1) narrative, memory, and personal identity, highlighting the role of narrative in preserving a sense of self; 2) personalization of care, oriented towards person-centeredness; 3) the use of narrative in a formative and reflective function as a tool to promote empathy, clinical awareness, and observation skills in the training of health professionals. Conclusions: NM confirms itself as a relational and reflexive paradigm, capable of humanizing care and promoting therapeutic pathways that are more inclusive and sensitive to the patient’s subjectivity. Full article

The study of cognitive processes in sheep (Ovis aries) has gained interest in recent years, particularly for their potential as a model species in translational medicine. This scoping review aimed to identify, classify, and describe cognitive tasks developed to assess executive functions in sheep. A literature search followed PRISMA guidelines and used CAB Abstracts, PubMed, and Scopus to identify studies on cognitive tasks in sheep from 1 January 2010, to 4 August 2025. The search yielded 2873 records; after removing duplicates and applying inclusion criteria, 20 studies were analyzed. Data on animal categories, test methods, and timing were collected. The selected studies were grouped by cognitive domain: memory and flexibility (13), sensory discrimination (6), and problem-solving (6). All studies describe specific testing apparatuses tailored to assess distinct cognitive functions, detailing materials, apparatus dimensions, and the importance of pre-test periods, as well as the necessity of a reward system. The review emphasizes ethical testing that minimizes animal stress, supporting welfare. Standardizing cognitive tests can improve reliability, and comparability while integrating neurobiology, ethology, and welfare knowledge advances research and livestock care. Full article

We, five co-authors of this paper, came together for a three-day collective biography workshop to reflect on moments of recognition that have impacted our lives. We told our stories from lives lived with disability; we listened to each other’s stories and wrote and read them to each other with careful attention. In the discussions that followed, both during the workshop and during the following months of finalizing this paper, we explored the ways in which disability is made to matter and how. In that process, we each moved beyond our own singularity, our own particular memories of recognition and belonging, to a new, emergent understanding of our shared materiality and response-ability. Full article

This paper explores what heritage conservation might become when it listens differently—when it opens itself to relational, situated, and community-led practices of care. Beginning with the provocation “Museums? I don’t think this is for us. Museums are far too clever for us,” voiced in the context of an ecomuseum, I interrogate the assumptions that underpin conventional heritage conservation: expert authority, linear temporality, and the desire to stabilize. Drawing on new materialism theories, I question the disciplinary logics that produce heritage as a human centred practice that look at objects as static and conservation as a neutral act. In contrast, I present ecomuseums not as policy model but as conceptual disruption—territories of care that emerge from entanglements of memory and place, becoming, therefore, an active force that are engaged in sustainable practices. In thinking with ecomuseum practices, I consider how conservation would look if shifted from colonial to liberative practices, from control to attention, from fixity to fluidity. I explore conservation as a field of relations—affective and unfinished. Finally, I offer a call for heritage practitioners to reimagine conservation not as the act of keeping things the same, but as an ongoing negotiation with change in a pluriversal world. Full article