Search Results (4,196)

Treatment-resistant depression (TRD) remains a significant public-health challenge, with many patients failing to respond to conventional therapies. Ketamine has emerged as a rapid-acting intervention, but quantitative outcomes alone do not capture patients’ lived experiences, which shape engagement, acceptability, and adherence. We conducted a narrative review of qualitative and mixed-methods studies to enable conceptual integration and thematic synthesis of patients’ experiences with ketamine treatment for depression, guided by established narrative review methodology and the SANRA framework. A targeted search of MEDLINE and Scopus (November 2025) identified studies reporting adult patients’ perspectives on therapeutic ketamine or esketamine use, with qualitative data synthesized iteratively in keeping with narrative review principles. Across the literature, patients’ perspectives coalesce around key thematic domains, including motivations and expectations for treatment, the phenomenology of the treatment experience, post-treatment trajectories, side effects and reasons for discontinuation, relational and environmental factors, and information and education needs. By focusing on these thematic groups, the review highlights the experiential dimensions that influence the perceived value and acceptability of ketamine, underscoring the need for patient-centered service design. Integrating these insights can guide the development of ketamine programs that are both evidence-based and aligned with patients’ priorities and perspectives. Full article

We examined the positions of policymakers and businesses on the forest-based bioeconomy (FBE) in Slovenia, focusing on the importance of forest ecosystem services within the FBE. We also explored how businesses perceive their market potential and the role of payments for ecosystem services (PES) schemes in strengthening the FBE. We conducted interviews with 35 policymakers from the fields of forestry, the wood industry, the environment, and tourism, as well as with 24 business representatives from primary wood production, the wood industry, and forest tourism. Respondents identified fragmented land ownership (mean score on a 1–5 scale = 4.19), the lack of a strategic framework (4.12), and inefficient use of woody biomass (4.08) as key challenges to implementing the FBE in Slovenia. They highlighted knowledge transfer (4.54), investment support (4.47), and raising environmental awareness (4.44) as the main forms of state support for the FBE, while unfamiliarity with PES appears to contribute to its neglect. No significant sectoral differences were observed among policymakers regarding PES involvement; however, they viewed their role mainly in the design phase of PES and least in the phases of coordination and establishment. Greater interest in participating in PES was expressed by forest tourism businesses, despite perceiving lower market potential than those in primary wood production and the wood industry. The evident heterogeneity of stakeholder positions on the FBE calls for strong coordination and a transparent policy process involving all stakeholder coalitions to establish a coherent national strategy for the FBE. The results highlighted policymakers’ limited governance capacity and reluctance to fully implement PES as a potential solution for strengthening the FBE. The differing motivations of businesses regarding PES underscore the need for a nuanced, sector-specific approach to foster broader engagement. Full article

Background: In response to the growing emotional support needs of patients in oncology, peer support was introduced into clinical teams in Quebec, Canada, in 2018. These peers, called accompanying patients (APs), are former cancer patients who use their experiential knowledge to provide support to patients during their oncology journey. This paper aims to identify APs’ perceptions of the program by including a diversity of perspectives. We include inexperienced and experienced APs, APs in different facilities, and APs in different cancer programs. Methods: We conducted a qualitative study based on 12 semi-structured interviews of APs between June and August 2024 in Quebec, Canada. We explored four themes, building on the Practice Change Model for qualitative analysis: APs’ sources of motivation, influences and environmental factors, resources available for AP integration, and the program’s effects. Results: 12 APs from 5 facilities participated in an interview. All the APs, both experienced and inexperienced, were highly motivated to participate in the program. Their motivations included a desire to give back to society, to help people and to give meaning to their illness. Both experienced and inexperienced APs were confident in their ability to accompany others. They were aware of their responsibilities and its limits regarding their role as an AP. They pointed out the program’s positive impact on their own emotional well-being and that of the patients. The program also benefited the clinical team, by limiting unhelpful demands from patients and saving time for clinicians. However, experienced APs did not feel well integrated into the healthcare team. Conclusions: We concluded that APs are highly motivated to be in the program. They perceived a need for the program in the current health system. They noted its beneficial effects on patients, on themselves, and on the clinical team. However, more resources need to be directed toward integrating APs into healthcare teams. Full article

It is widely recognized that outdoor and nature-based educational activities can significantly enhance pupils’ learning, increase environmental awareness and improve pupils’ well-being. At the same time, a growing body of literature supports that the extent to which outdoor learning is implemented depends largely on factors, such as the general institutional context of schools, social and geomorphological aspects and the teacher’s own motivation. The current study employs data collected from 507 primary, middle and high schools in Greece, using a structured questionnaire, and investigates the factors that prevent teachers from engaging in outdoor teaching activities in a green space, as well as those that encourage them to be involved in such educational learning approaches. The results identify institutional barriers, such as the demanding school curriculum, lack of financial resources, limited available time, and insufficient external support, as the main constraints preventing teachers from implementing outdoor activities in nature. On the other hand, it appears that altruistic and intrinsically driven factors, such as personal environmental interest, knowledge of the positive outcomes of environmental education, and a sense of social contribution, are the main factors promoting the adoption of outdoor green education approaches. Availability of green spaces and support by leadership also appear to promote teachers’ engagement in outdoor activities. The findings of the current study highlight the need for educational reforms, to include outdoor, nature-based learning in the school curriculum, provide training and financial support and enhance the confidence of teachers in outdoor, nature-based education. Addressing these barriers could enhance education’s role in fostering sustainable development and reconnecting pupils with nature. Full article

Diffractive optical elements (DOEs) are essential components in optical and photonic technologies, motivating the need for rapid mass production with high-precision fabrication methods. Photopolymers are particularly attractive for DOEs production because their optical phase can be modified via both surface and refractive index modulations. In this work, we report the fabrication of DOEs on PVA/AA photopolymers using ultrafast laser direct writing. By combining surface topography measurements with a phase depth model, we extract the surface and bulk phase depth contributions and demonstrate a transition from surface-dominated modulation at 1 kHz to bulk refractive index modification under cumulative conditions at 100 kHz. These outcomes highlight ultrafast laser direct writing as a powerful, rapid and controlled method for the high-quality and rapid fabrication of DOEs. Full article

This study examines lexical and syntactic convergence between Dai Lue and Chinese in the multilingual environment of Sipsongpanna, employing an apparent-time approach across three generational cohorts (N = 90, balanced gender). Through mixed-methods analysis (structured questionnaires and semi-structured interviews), significant diachronic variation was observed. Younger speakers exhibited pronounced convergence, adopting Chinese-derived syntactic patterns (e.g., prenominal quantifiers and preverbal adjunct phrases) and borrowing Chinese lexical elements (e.g., an adverb sɛn⁵⁵ ‘first’ ← Chinese 先 xiān, and a superlative marker tsui³⁵ ‘most/best’ ← Chinese 最 zuì). Middle-aged speakers use transitional hybrid structures, while older speakers more consistently maintain native Dai Lue features. The results conform with Labov’s age-grading model in contact linguistics and refine Thomason’s borrowing hierarchy by revealing two factors: First, the prestige of the Chinese language drives convergence among youth. Second, syntactic compatibility with Chinese is mediated not merely by language structure, but by discourse-pragmatic needs, functional load redistribution, and the social indexicality of borrowed structures. This underscores the interplay between sociolinguistic motivations and structural-adaptive constraints in language change. The findings provide critical insights into language contact mechanisms among ethnic minorities of China, with implications for sociolinguistic theory, language revitalization efforts, and bilingual education policy implementation in linguistically diverse communities. Full article

Climate change and river flow alterations in the Mekong River have significantly exacerbated drought conditions in the Vietnamese Mekong Delta (VMD). Understanding the temporal dynamics and propagation mechanisms of drought, coupled with the compounded impacts of human activities, is crucial. This study analyzed meteorological (1992–2021) and hydrological (2000–2021) drought trends in the Lower Mekong River Basin (LMB) using the Standardized Precipitation Index (SPI) and the Streamflow Drought Index (SDI), respectively, complemented by Mann–Kendall (MK) trend analysis. The results show an increasing trend of meteorological drought in Cambodia and Lao PDR, with mid-Mekong stations exhibiting a strong positive correlation with downstream discharge, particularly Tan Chau (Pearson r ranging from 0.60 to 0.70). A key finding highlights the complexity of flow regulation by the Tonle Sap system, evidenced by a very strong correlation (r = 0.71) between Phnom Penh and the 12-month SDI lagged by one year. Crucially, the comparison revealed a shift in drought severity since 2010: hydrological drought has exhibited greater severity (reaching severe levels in 2020–2021) compared to meteorological drought, which remained moderate. This escalation is substantiated by a statistically significant discharge reduction (95% confidence level) at the Chau Doc station during the wet season, indicating a decline in peak flow due to upstream dam operations. These findings provide a robust database on the altered hydrological regime, underlining the increasing vulnerability of the VMD and motivating the urgent need for comprehensive, adaptive water resource management strategies. Full article

University years represent a period of major transition during which health-related behaviors, such as sleep and physical activity, may influence students’ academic functioning. This cross-sectional, single-center study, conducted at an Italian university, examined the associations between sleep, physical activity, and academic well-being. Students completed an online survey assessing sleep, physical activity, and several indicators of academic functioning (i.e., academic stress, self-efficacy, dropout intention, and motivation). Nonparametric tests (Kruskal–Wallis, Jonckheere–Terpstra) were used to explore differences in these indicators across sleep quality and physical activity categories, while linear regressions tested associations between sleep duration and Metabolic Equivalent of Task–minutes/week with the same academic outcomes. A total of 2192 students (15.55%) accessed the survey, and 1246 (8.84%) completed all questionnaires. Most participants were female (62.7%) and Italian (94.5%). Both sleep and physical activity showed significant but small associations with academic stress, dropout intention, and self-efficacy, whereas associations with academic motivation were weaker. These findings suggest that maintaining regular physical activity and healthy sleep habits may contribute to students’ academic adjustment, although the cross-sectional design limits causal interpretation and underscores the need for integrative models to better understand the underlying psychological mechanisms. Full article

Background/Objectives: The nursing profession is experiencing a global shortage of nurses. Early-Career Nurses (ECNs) assist in addressing the shortage; however, a significant number are leaving their workplaces and the profession. The aim of the review is to explore the factors that impact early-career nurses thriving at work, including their motivation and intention to stay in employment and the profession. Methods: A scoping review was conducted following the Joanna Briggs Institute (JBI) methodology. The objectives, analysis, and inclusion and exclusion criteria were informed by PRISMA for Scoping Reviews (PRISMA-ScR) to ensure accurate and complete reporting of findings. The target population were ECNs who are in the first five years of practice. Databases including CINAHL, PubMed, PsycINFO, Scopus, and Web of Science were searched to identify the literature on ECN thriving between 1985 and 2025. Titles, abstracts, and full texts of the identified studies were screened by two independent reviewers, and thematic analysis was undertaken to analyse the data. Results: A total of 190 studies was initially identified, and after screening and review, a total of 16 articles met the inclusion criteria and explored factors related to thriving and retention. Key themes identified within the literature that contribute to ECNs thriving at work encompass the work environment, work–life balance, and education, where generational differences may also create unique nuances between ECNs. Conclusions: ECNs encounter many challenges in the early stages of their nursing career. Organisational support may be responsive and provide conducive work environments that nurture growth, career development, and thriving for ECNs. However, future research is needed to further confirm drivers of thriving, along with understanding the impact of targeted interventions to better support ECN thriving and retention. Future search will include stakeholders to validate the findings. Full article

Objectives: Traffic accidents cause severe social and economic impacts, demanding fast and reliable detection to minimize secondary collisions and improve emergency response. However, existing cloud-dependent detection systems often suffer from high latency and limited scalability, motivating the need for an edge-centric and consensus-free accident detection framework in IoV environments. Methods: This study presents a real-time accident detection framework tailored for Internet of Vehicles (IoV) environments. The proposed system forms an integrated IoV architecture combining on-vehicle inference, RSU-based validation, and asynchronous cloud reporting. The system integrates a lightweight ensemble of Vision Transformer (ViT) and EfficientNet models deployed on vehicle nodes to classify video frames. Accident alerts are generated only when both models agree (vehicle-level ensemble consensus), ensuring high precision. These alerts are transmitted to nearby Road Side Units (RSUs), which validate the events and broadcast safety messages without requiring inter-vehicle or inter-RSU consensus. Structured reports are also forwarded asynchronously to the cloud for long-term model retraining and risk analysis. Results: Evaluated on the CarCrash and CADP datasets, the framework achieves an F1-score of 0.96 with average decision latency below 60 ms, corresponding to an overall accuracy of 98.65% and demonstrating measurable improvement over single-model baselines. Conclusions: By combining on-vehicle inference, edge-based validation, and optional cloud integration, the proposed architecture offers both immediate responsiveness and adaptability, contrasting with traditional cloud-dependent approaches. Full article

Background: Differentiating true tumor progression (TP) from treatment-related pseudoprogression (PsP) in glioblastoma remains challenging, especially at early follow-up. Methods: We present the first timepoint-specific, cross-sectional benchmarking of deep learning models for follow-up MRI using the Burdenko GBM Progression cohort (n = 180). We analyze different post-RT scans independently to test whether architecture performance depends on timepoint. Eleven representative DL families (CNNs, LSTMs, hybrids, transformers, and selective state-space models) were trained under a unified, QC-driven pipeline with patient-level cross-validation. Across both timepoints, accuracies were comparable (~0.70–0.74), but discrimination improved at the second follow-up, with F1 and AUC increasing for several models, indicating richer separability later in the care pathway. Results: A Mamba+CNN hybrid consistently offered the best accuracy–efficiency trade-off, while transformer variants delivered competitive AUCs at substantially higher computational cost, and lightweight CNNs were efficient but less reliable. Performance also showed sensitivity to batch size, underscoring the need for standardized training protocols. Notably, absolute discrimination remained modest overall, reflecting the intrinsic difficulty of TP vs. PsP and the dataset’s size and imbalance. Conclusions: These results establish a timepoint-aware benchmark and motivate future work incorporating longitudinal modeling, multi-sequence MRI, and larger multi-center cohorts. Full article

The capacity of the Valencian fruit and vegetable sector (i.e., cooperatives) to absorb knowledge has been analysed, as well as the influence of this capacity on the adoption of technological innovations and production processes. This objective is motivated by the multiple challenges currently facing the agricultural sector. The dominance of large distribution chains and competition from products imported from other countries have increased production costs without a proportional increase in income. The study was conducted with a sample of 14 fruit and vegetable companies and cooperatives. This study explored how these organisations acquire and assimilate knowledge from abroad and the barriers they face in this process. The results reveal that the extent of assimilation is fundamental to transforming potential absorption capacity into reality. Acquiring knowledge is not the problem, given the abundance of information available. The challenge lies in discerning which knowledge is relevant and aligning it with the needs of the organisation and its customers. The importance of generational change and team dynamics in knowledge consolidation is evident. The importance of effectively managing knowledge assimilation for the success of innovation in agri-food cooperatives is highlighted. In addition, common barriers to the implementation of innovation are identified. The lack of gender diversity is evident in the leadership profiles of cooperatives, highlighting the need for future research addressing absorptive capacity from a gender perspective. Full article

Background: Rehabilitation technologies, including assistive devices, adaptive software, and robotic systems, are increasingly integral to contemporary rehabilitation practice. Yet, ensuring that training in their use is inclusive and accessible remains a critical challenge. Methods: This study reports findings from patient and public involvement (PPI) activities conducted by the National Institute for Health and Care Research (NIHR) HealthTech Research Centre in Rehabilitation. Fifteen contributors participated, comprising rehabilitation professionals and educators, individuals with lived experience of serious illness, injury, or disability requiring rehabilitation, and technology innovators. The purpose of these activities was to identify the factors necessary to ensure that training in rehabilitation technologies is equitable for people with sensory, cognitive, and physical impairments. Findings: Contributors highlighted a series of priority domains that together capture the breadth of challenges and opportunities in this area. These included the need to address physical, sensory, and cognitive accessibility; to foster participation, motivation, and engagement; to strengthen instructional design and delivery; to ensure technological accessibility and integration; to enhance staff training and competence; and to embed participant-centred and policy approaches. Contributions in these domains were synthesised into thematic categories that provide a structured understanding of the training requirements of rehabilitation technology recipients. Evaluation: The PPI process was evaluated using the Guidance for Reporting Involvement of Patients and the Public (GRIPP2) Short Form, supplemented by an evaluation survey. This dual approach ensured that the contributions were systematically documented and critically appraised. Implications: Guided by implementation science, the principal output of this work was a co-created stakeholder engagement strategy, structured using the Implementation STakeholder Engagement Model (I-STEM). This plan will serve as a foundation for future research exploring the education and training needs of diverse stakeholder groups, thereby contributing to the development of more inclusive and effective rehabilitation technology training practices. Full article

Background/Objectives: Candida biofilms exhibit high resistance to antifungal treatment, motivating investigation of adjunctive physical disinfection methods. To quantitatively assess the effect of Er:YAG laser fluence on growth inhibition and viability of single-species Candida biofilms in vitro using a 7 mm full-beam handpiece. Methods: Biofilms of Candida albicans ATCC 10231, C. glabrata ATCC 90030, C. parapsilosis ATCC 22019, and C. krusei ATCC 6258 were grown on Sabouraud agar. In phase 1, growth inhibition zones (GIZs) were evaluated after non-contact Er:YAG irradiation (2 Hz, 300 µs, 10 mm distance, no air or water spray) at fluences from 0.3 to 3.4 J/cm², with incubation for 24 to 96 h. In phase 2, 96 h mature biofilms were irradiated for 120 s at 0.8, 1.0, 1.5, or 2.0 J/cm², and viability was quantified by colony-forming unit (CFU) imprinting. All experimental conditions were tested in quadruplicate. Results: GIZ diameters increased significantly with fluence for all species (p < 0.05) and remained stable up to 96 h. At the highest fluence, mean GIZs reached approximately 8.0 mm for C. albicans, 7.7 mm for C. parapsilosis, 7.0 mm for C. krusei, and 5.2 mm for C. glaxfbrata. In mature biofilms, CFU counts decreased significantly with increasing fluence (p < 0.05). For C. albicans, CFUs were reduced from 164.0 ± 25.1 at 0.8 J/cm² to 16.5 ± 5.2 at 2.0 J/cm², while C. glabrata decreased from 103.5 ± 5.4 to 20.8 ± 1.7. C. parapsilosis and C. krusei showed maximal reductions at 1.0–1.5 J/cm², followed by partial CFU rebound at 2.0 J/cm². Conclusions: Er:YAG irradiation delivered over a large, uniformly illuminated area induces stable, fluence-dependent inhibition and significant reduction of Candida biofilm viability in vitro. Optimal fluence ranges are species specific, underscoring the need for parameter optimization and further evaluation in more complex biofilm models before clinical extrapolation. Full article

Epilepsy is a prevalent neurological disorder where reliable seizure tracking is essential for patient care. Existing documentation often relies on self-reports, which are unreliable, creating a need for objective, wearable-based solutions. Prior work has shown that Electrocardiography (ECG)-based seizure detection is feasible but limited by small datasets. This study addresses this issue by evaluating Matrix Profile, MADRID, and TimeVQVAE-AD on SeizeIT2, the largest open wearable-ECG dataset with 11,640 recording hours and 886 annotated seizures. Using standardized preprocessing and clinically motivated windows, we benchmarked sensitivity, false-alarm rate (FAR), and a Harmonic Mean Score integrating both metrics. Across methods, TimeVQVAE-AD achieved the highest sensitivity, while MADRID produced the lowest FAR, illustrating the trade-off between detecting seizures and minimizing spurious alerts. Our findings show ECG anomaly detection on SeizeIT2 can reach clinically meaningful sensitivity while highlighting the sensitivity–false alarm trade-off. By releasing reproducible benchmarks and code, this work establishes the first open baseline and enables future research on personalization and clinical applicability. Full article