Search Results (50)

Background: Surgical management of trauma in the maxillofacial complex can result in iatrogenic nerve injuries, particularly involving the infraorbital, inferior alveolar, and mental nerves. Paresthesia is a common postoperative complication, often attributed to the anatomical positioning of these nerve structures, making them vulnerable to injury. Among current therapeutic options for nerve injuries, low-level laser therapy (LLLT) has shown promising results in published studies. Objectives: This prospective observational study evaluated the effects of LLLT on nerve recovery following maxillofacial trauma surgery. Methods: A total of 21 participants, with a median age of 35 years and no gender-based selection criteria, were enrolled. Cases included zygomaticomaxillary complex and mandibular osteosynthesis; analyses were within-subject across time. Postoperative laser therapy was administered to both groups using the DUO MMO device (MMOptics, São Carlos, Brazil), delivering infrared light along the pathways of the inferior alveolar, infraorbital, and mental nerves. Nerve function was assessed regularly using a Visual Analog Scale (VAS) and the Brush Stroke Direction (BSD) test to evaluate sensory recovery. Results: Compared with baseline (15 days post-op, pre-LLLT), VAS scores showed significant reductions at sessions 7 and 10, and BSD responses increased over time. Conclusion: After multiplicity control, only the session 10 comparison remained significant. These observational findings support the feasibility of multi-session LLLT after maxillofacial trauma; controlled trials are warranted to determine efficacy. Full article

Background: Children with autism spectrum disorder (ASD) frequently show postural abnormalities and elevated muscle tone, which can hinder participation in education and rehabilitation. Evidence on the immediate physiological effects of standardized multisensory environments is limited. Objective: To evaluate feasibility, safety and short-term physiological/postural responses to an automated multisensory smart relaxation system in children with severe ASD. Methods: In a single-session pilot across three sites, 30 children (27 boys; 6–16 years) underwent pre–post postural observation and bilateral surface EMG of the upper trapezius, biceps brachii and rectus abdominis. The system delivered parameterized sound, vibration, and mild heat. EMG was normalized to a quiet-sitting baseline. Results: The intervention was well tolerated with no adverse events. Most children sat independently (25/30; 80%) and a majority stood up unaided after the session (24/30; 76.9%). Postural profiles reflected common ASD features (neutral trunk 76%, forward head 52%, rounded/protracted shoulders 46%), while limb behavior was predominantly calm (73%). Normalized EMG amplitudes were low, with no significant pre–post changes and no meaningful left–right asymmetries (all p > 0.05; Cohen’s d < 0.20), indicating physiological calmness rather than tonic co-contraction. Conclusions: A single session with a smart multisensory relaxation system was safe, feasible, and physiologically calming for children with severe ASD, without increasing postural or muscular tension. The platform’s standardization and objective monitoring support its potential as a short-term calming adjunct before therapy or classroom tasks. Larger, gender-balanced, multi-session trials with behavioral outcomes are warranted. Full article

Objectives: Individuals with Autism Spectrum Disorder (ASD) exhibit difficulties in the social use of language, regardless of age, cognitive abilities, and symptom severity. The left Broca’s area and adjacent cortex are crucial for socio-pragmatic language, particularly in retrieving and integrating context-dependent words. Neuroimaging studies in ASD have shown hypoactivation of the Broca’s area and an aberrant pattern of functional connectivity between language-related regions, suggesting their potential involvement in socio-communicative deficits. Given the potential of tDCS to modulate brain activity, its application targeting Broca’s areas in addition to psychological intervention may represent a promising approach for enhancing socio-communicative skills in ASD. Thus, this study aims to investigate the effect of concomitant anodal tDCS and cognitive behavioral-oriented training (CBT) on pragmatic and communicative skills in young adults with ASD. Methods: A sample of 10 ASD individuals (18–25 years) underwent treatment with both active and sham tDCS targeting the left Broca’s area during concomitant CBT. Each condition was delivered for five consecutive days, and the order of the conditions was blindly randomized. Results: Active tDCS significantly improved global communicative and pragmatic abilities compared to sham. A negative correlation was observed between communicative skills improvement and Intelligence Quotient (IQ); no significant association was found between IQ and ASD symptoms’ severity. Conclusions: Multisession tDCS targeting the left Broca’s area, combined with CBT, may enhance social language in terms of both production and comprehension of non-literal meanings, supporting Broca’s area as a central neural hub for social language. Full article

With the proliferation of online learning platforms, selecting appropriate artificial intelligence (AI) courses has become increasingly complex for learners. This study proposes a novel hybrid AI course recommendation framework that integrates Term Frequency–Inverse Document Frequency (TF-IDF) and Bidirectional Encoder Representations from Transformers (BERT) for robust textual feature extraction, enhanced by a Random Forest classifier to improve recommendation precision. A curated dataset of 2238 AI-related courses from Udemy was constructed through multi-session web scraping, followed by comprehensive data preprocessing. The system computes semantic and lexical similarity using cosine similarity and fuzzy matching to handle user input variations. Experimental results demonstrate a high recommendation accuracy = 91.25%, precision = 96.63%, and F1-Score = 90.77%. Compared with baseline models, the proposed framework significantly improves performance in cold-start scenarios and does not rely on historical user interactions. A Flask-based web application was developed for real-time deployment, offering instant, user-friendly recommendations. This work contributes a scalable and metadata-driven AI recommender architecture with practical deployment and promising generalization capabilities. Full article

Background/Objectives: Senior nurses in Taiwan shoulder layered responsibilities shaped by professional roles, gendered expectations, and family duty. Although Taiwan faces a persistent shortage of experienced clinical nurses, limited research has explored how long-serving nurses sustain identity and commitment across decades of caregiving. This study examines how senior staff nurses understand their journeys of becoming—and remaining—nurses within a culturally and emotionally complex landscape. Methods: Interviews were conducted between May 2019 and September 2023 in locations chosen by participants, with most sessions face-to-face and others undertaken via video conferencing during COVID-19. This narrative inquiry involved in-depth, multi-session interviews with five female senior staff nurses born in the 1970s to early 1980s. Each participant reflected on her life and career, supported by co-constructed “nursing life lines.” Thematic narrative analysis was conducted using McCormack’s five-lens framework and Riessman’s model, with ethical rigor ensured through reflexive journaling and participant validation. Results: Three overarching themes emerged: (1) inner strength and endurance, highlighting silent resilience and the ethical weight of caregiving; (2) support and responsibility in relationships, revealing the influence of family, faith, and relational duty; and (3) role navigation and professional identity, showing how nurses revisit meaning, self-understanding, and tensions across time. Participants described emotionally powerful moments, identity re-connection, and cultural values that shaped their paths. Conclusions: These narratives offer a relational and culturally embedded understanding of what it means to sustain a career in nursing. Narrative inquiry created space for reflection, meaning-making, and voice in a system where such voices are often unheard. Identity was not static—it was lived, reshaped, and held in story. Full article

Introduction: Substance use disorders (SUDs) pose a significant public health challenge, with current treatments often exhibiting limited effectiveness and high relapse rates. Transcranial direct current stimulation (tDCS), a noninvasive neuromodulation technique that delivers low-intensity direct current via scalp electrodes, has shown promise in various psychiatric and neurological conditions. In SUDs, tDCS may help to modulate key neurocircuits involved in craving, executive control, and reward processing, potentially mitigating compulsive drug use. However, the precise neurobiological mechanisms by which tDCS exerts its therapeutic effects in SUDs remain only partly understood. This review addresses that gap by synthesizing evidence from clinical studies that used neuroimaging (fMRI, fNIRS, EEG) and blood-based biomarkers to elucidate tDCS’s mechanisms in treating SUDs. Methods: A targeted literature search identified articles published between 2008 and 2024 investigating tDCS interventions in alcohol, nicotine, opioid, and stimulant use disorders, focusing specifically on physiological and neurobiological assessments rather than purely behavioral outcomes. Studies were included if they employed either neuroimaging (fMRI, fNIRS, EEG) or blood tests (neurotrophic and neuroinflammatory markers) to investigate changes induced by single- or multi-session tDCS. Two reviewers screened titles/abstracts, conducted full-text assessments, and extracted key data on participant characteristics, tDCS protocols, neurobiological measures, and clinical outcomes. Results: Twenty-seven studies met the inclusion criteria. Across fMRI studies, tDCS—especially targeting the dorsolateral prefrontal cortex—consistently modulated large-scale network activity and connectivity in the default mode, salience, and executive control networks. Many of these changes correlated with subjective craving, attentional bias, or extended time to relapse. EEG-based investigations found that tDCS can alter event-related potentials (e.g., P3, N2, LPP) linked to inhibitory control and salience processing, often preceding or accompanying changes in craving. One fNIRS study revealed enhanced connectivity in prefrontal regions under active tDCS. At the same time, two blood-based investigations reported the partial normalization of neurotrophic (BDNF) and proinflammatory markers (TNF-α, IL-6) in participants receiving tDCS. Multi-session protocols were more apt to drive clinically meaningful neuroplastic changes than single-session interventions. Conclusions: Although significant questions remain regarding optimal stimulation parameters, sample heterogeneity, and the translation of acute neural shifts into lasting behavioral benefits, this research confirms that tDCS can induce detectable neurobiological effects in SUD populations. By reshaping activity across prefrontal and reward-related circuits, modulating electrophysiological indices, and altering relevant biomarkers, tDCS holds promise as a viable, mechanism-based adjunctive therapy for SUDs. Rigorous, large-scale studies with longer follow-up durations and attention to individual differences will be essential to establish how best to harness these neuromodulatory effects for durable clinical outcomes. Full article

Introduction: Cerebellar transcranial magnetic stimulation (TMS) has emerged as a promising neuromodulatory intervention for addressing motor, cognitive, and socio-affective deficits across a range of clinical populations. Materials and Methods: This systematic review aimed to synthesize recent evidence (2015–2025) on the efficacy, safety, and methodological characteristics of multi-session cerebellar TMS protocols used in rehabilitation settings. Following PRISMA guidelines, a comprehensive search of PubMed and Scopus was conducted to identify peer-reviewed studies applying multi-session cerebellar TMS in clinical populations for motor, cognitive, or affective rehabilitation. A total of 1750 records were screened, and 46 studies met the inclusion criteria. Data extraction included sample characteristics, study design, TMS protocol, targeted symptoms, outcomes, and risk of bias. Results: The results show that repeated sessions of cerebellar TMS are safe, well-tolerated, and associated with functional improvements primarily in motor disorders—such as spinocerebellar ataxia, Parkinson’s disease, multiple system atrophy, essential tremor, and post-stroke deficits—as well as in psychiatric populations, particularly patients with schizophrenia. Discussion: Evidence regarding the effects of cerebellar TMS on cognitive functions remains limited, though promising. Despite overall positive findings, the literature is limited by variability in stimulation parameters, protocol designs, and outcome measures, small sample sizes and potential publication bias. Conclusions: The review highlights the need for further large-scale and well-controlled trials to refine stimulation protocols, explore long-term effects, and clarify the underlying mechanisms of cerebellar TMS across motor, cognitive, and affective domains. This systematic review has been registered on PROSPERO (registration number: CRD420251067308). Full article

Background/Objectives: The COVID-19 pandemic affected frontline workers’ mental health, including healthcare workers, firefighters, and police officers, increasing the need for effective interventions. This study focuses on the pandemic’s psychological impact, perceived stress, depression/anxiety symptoms, and resilience, examining if a brief virtual reality (VR)–based relaxation session could reduce psychological symptoms. Methods: In this preliminary study with data collected in 2025 from frontline workers who had served during the acute phase of the COVID-19 pandemic, 54 frontline workers completed a baseline assessment of the perceived psychological impact of COVID-19 pandemic, general perceived well-being, perceived stress (PSS-4), anxiety/depression (PHQ-4) and resilience (RS-25). Each participant then engaged in a 10-min immersive VR relaxation session featuring a calming 360° nature environment with audio guidance, after which questionnaires were re-administered. Paired samples t-tests and repeated-measures ANOVA evaluated pre-/post-session differences, and a hierarchical multiple linear regression model tested predictors of the change in stress. Results: Pre-session results showed moderate perceived stress and resilience and low depression/anxiety. Occupation groups varied in baseline stress, mostly reporting negative pandemic psychological effects. After VR, significantly perceived well-being increased, and stress decreased, whereas depression/anxiety changes were nonsignificant. Repeated-measures ANOVA revealed a main effect of time on stress (p = 0.003) without occupation-by-time interaction (p = 0.246), indicating all occupational groups benefited similarly from the VR session. Hierarchical regression indicated baseline depression and higher perceived pandemic-related harm independently predicted greater stress reduction, whereas resilience and baseline anxiety showed no statistically significant results. Conclusions: A single VR relaxation session lowered perceived stress among frontline workers, particularly those reporting higher baseline depression or pandemic-related burden. Limitations include the absence of a control group. Results support VR-based interventions as feasible, rapidly deployable tools for high-stress settings. Future research should assess longer-term outcomes, compare VR to alternative interventions, and consider multi-session protocols. Full article

Background/Objectives: Clinical incivility is a persistent issue in nursing education and practice, with negative impacts on students, educators, and clinicians. Uncivil behaviors—such as belittling, exclusion, and dismissiveness—compromise communication, teamwork, and patient safety. Although various interventions have been implemented, their effectiveness remains inconsistent. This systematic review aimed to evaluate the effectiveness of interventions addressing clinical incivility in nursing and to identify common trends, gaps, and implications for future practice and research. Methods: Following PRISMA 2020 guidelines, a systematic search was conducted in PubMed, Web of Science, and EBSCOhost (CINAHL) for peer-reviewed empirical studies published between 2014 and 2024. Search terms included “clinical incivility” and (“intervention” or “program” or “training”) and “nursing”. Studies were eligible if they evaluated interventions aimed at reducing incivility among nursing students, faculty, or practicing nurses. Seventeen studies met the inclusion criteria and were analyzed for intervention types, target populations, delivery methods, and outcomes. Results: The review identified five main intervention types: educational modules (n = 9), cognitive rehearsal (n = 5), simulation and role-play (n = 5), team-based strategies (n = 3), and feedback/communication strategies (n = 2). Many studies used multiple strategies. Fourteen studies reported positive outcomes such as improved awareness, communication, and self-efficacy. Eight studies demonstrated statistically significant reductions in perceived incivility, particularly those with simulation-based, multi-session, or institutionally supported formats. Three studies showed limited or mixed results due to insufficient follow-up or lack of leadership engagement. Conclusions: Experiential and multi-component interventions appear effective in reducing clinical incivility. Long-term success requires leadership engagement, institutional support, and integration into ongoing professional development. Full article

Sleep occupies about one-third of human life and is crucial for health, but traditional sleep staging relies on experts manually performing polysomnography (PSG), a process that is time-consuming, labor-intensive, and susceptible to subjective differences between evaluators. With the development of deep learning technologies, particularly the application of convolutional neural networks and recurrent neural networks, significant progress has been made in automatic sleep staging. However, existing methods still face challenges in feature extraction and cross-modal data fusion. This paper introduces an innovative deep learning architecture, MultiSEss, aimed at solving key issues in automatic sleep stage classification. The MultiSEss architecture utilizes a multi-scale convolution module to capture signal features from different frequency bands and incorporates a Squeeze-and-Excitation attention mechanism to enhance the learning of channel feature weights. Furthermore, the architecture discards complex attention mechanisms or encoder–decoder structures in favor of a state–space sequence coupling module, which more accurately captures and integrates correlations between multi-modal data. Experiments show that MultiSEss achieved accuracy results of 83.84% and 82.30% in five-fold cross-subject testing on the Sleep-EDF-20 and Sleep-EDF-78 datasets. MultiSEss demonstrates its potential in improving sleep stage accuracy, which is significant for enhancing the diagnosis and treatment of sleep disorders. Full article

Meditation interventions have important benefits, including potentially helping those with higher attachment anxiety and avoidance enjoy better personal and relational growth. This preregistered and reproducible systematic map sought to identify the extent and scope of experimental evidence investigating the role of mindfulness, loving-kindness, and compassion-based multi-session meditation interventions in (a) moderating the effects of attachment orientations on outcomes over time and/or (b) changing attachment orientations over time. We conducted a systematic map, as the literature on meditation interventions and attachment is nascent. We searched 5 databases, screening 725 studies. We extracted data from four journal articles and one dissertation (five studies in total) which met our inclusion criteria. Four studies examined the effects of meditation interventions on buffering attachment insecurity and one examined attachment security enhancement. All five studies included a mindfulness meditation intervention, and one included a loving-kindness meditation intervention. All studies were conducted in Western cultures. Studies primarily found evidence for interventions benefitting those with higher attachment anxiety, although some evidence emerged for higher attachment avoidance. Our systematic map highlights a critical need for further application of meditation interventions in an attachment and personal growth context, given the promising nature of early work in this area. Full article

Communication network security has become increasingly vital in an era of rapidly developing technology, and protecting against unauthorized access is essential. This paper introduces a server-aided approach for secure key distribution to users participating in multiple sessions. This paper presents a system model in which each user is assigned a unique private key, enabling them to derive session keys from codewords broadcast by the server. These session keys are essential for facilitating the secure transmission of session messages within their respective sessions. The system model ensures that an eavesdropper cannot derive any session keys, despite having access to broadcast codewords, due to their lack of private keys. Our results show that our coding scheme is optimal by proving the necessary conditions for secure key distribution, indicating that secure key distribution is achievable if and only if the length of a user’s private key is at least equal to the total size of session messages across all the sessions in which they participate. This paper further illustrates the proposed secure key distribution and session message transmission mechanism through examples, emphasizing the necessity of user-specific private keys tailored to the sessions in which users are involved. Full article

Background: A Special Health Care Need (SHCN) is characterized by any type of physical, mental, sensorial, cognitive, emotional, or developmental condition that requires medical treatment, specialized services, or healthcare interventions. These conditions can negatively impact oral health as SHCN children can hardly cooperate or communicate and experience higher levels of dental fear/anxiety, which interfere with regular appointments. The present narrative review aims to analyze the use of audiovisual (AV) tools in dental setting for the management of SHCN children during dental treatment and to evaluate their effectiveness in anxiety/behavior control from the child, dentist, and care-giver perspectives. This analysis leads to the proposal of a new multi-session model for the behavioral management of SHCN pediatric subjects. Methods: An electronic search on the MEDLINE/Pubmed, Scopus, and Web of Science databases was carried out and through this analysis, a new model was proposed, the “UNISA-Virtual Stepwise Distraction model”, a multi-session workflow combining traditional behavior management and the progressive introduction of AV media to familiarize the SHCN child with dental setting and manage behavior. Results: AV tools helped in most cases to manage SHCN behavior and decreased stress in both the dentist and child during dental treatments. Care-givers also welcomed AV distractors, reporting positive feedback in using them during future treatments. Conclusions: The present narrative review found increasing evidence of the use of AV media for SHCN pediatric subjects as distraction tools during dental treatment. In the majority of the studies, AV tools proved to be effective for the management of anxiety, dental fear, and behavior in dental setting. Full article

Personal identification is an important aspect of managing electronic health records (EHRs), ensuring secure access to patient information, and maintaining patient privacy. Traditionally, biometric, signature, username/password, photo identity, etc., are employed for user authentication. However, these methods can be prone to security breaches, identity theft, and user inconvenience. The security of personal information is of paramount importance, particularly in the context of EHR. To address this, our study leverages ResNet1D, a deep learning architecture, to analyze surface electromyography (sEMG) signals for robust identification purposes. The proposed ResNet1D-based personal identification approach using the sEMG signal can offer an alternative and potentially more secure method for personal identification in EHR systems. We collected a multi-session sEMG signal database from individuals, focusing on hand gestures. The ResNet1D model was trained using this database to learn discriminative features for both gesture and personal identification tasks. For personal identification, the model validated an individual’s identity by comparing captured features with their own stored templates in the healthcare EHR system, allowing secure access to sensitive medical information. Data were obtained in two channels when each of the 200 subjects performed 12 motions. There were three sessions, and each motion was repeated 10 times with time intervals of a day or longer between each session. Experiments were conducted on a dataset of 20 randomly sampled subjects out of 200 subjects in the database, achieving exceptional identification accuracy. The experiment was conducted separately for 5, 10, 15, and 20 subjects using the ResNet1D model of a deep neural network, achieving accuracy rates of 97%, 96%, 87%, and 82%, respectively. The proposed model can be integrated with healthcare EHR systems to enable secure and reliable personal identification and the safeguarding of patient information. Full article

Transcranial direct current stimulation (tDCS) is a non-invasive and painless technique of brain neuromodulation that applies a low-intensity galvanic current to the scalp with the aim of stimulating specific areas of the brain. Preliminary investigations have indicated the potential therapeutic efficacy of multisession tDCS applied to the auditory cortex (AC) in the treatment of chronic tinnitus. The aim of this study was to explore the therapeutic effects of repeated sessions of bilateral tDCS targeting the AC on chronic tinnitus. A double-blinded randomized placebo-controlled trial was conducted on patients (n = 48) with chronic intractable tinnitus (>2 years duration). Participants were randomly allocated to two groups: one receiving tDCS (n = 26), with the anode/cathode placed over the left/right AC, and the other receiving a placebo treatment (n = 22). A 20 min daily session of 2 mA current was administered for five consecutive days per week over two consecutive weeks, employing 35 cm² electrodes. Tinnitus handicap inventory (THI) scores, tinnitus loudness, and tinnitus distress were measured using a visual analogue scale (VAS), and were assessed before intervention, immediately after, and at one-month follow-up. Anodal tDCS significantly reduced THI from 72.93 ± 10.11 score to 46.40 ± 15.36 after the last session and 49.68 ± 14.49 at one-month follow-up in 18 out of 25 participants (p < 0.001). The risk ratio (RR) of presenting an improvement of ≥20 points in the THI after the last session was 10.8 in patients treated with tDCS. Statistically significant reductions were observed in distress VAS and loudness VAS (p < 0.001). No statistically significant differences in the control group were observed. Variables such as age, gender, duration of tinnitus, laterality of tinnitus, baseline THI scores, and baseline distress and loudness VAS scores did not demonstrate significant correlations with treatment response. Repeated sessions of bilateral AC tDCS may potentially serve as a therapeutic modality for chronic tinnitus. Full article