Search Results (371)

Background: Live music, understood as real-time musical performance delivered in the physical presence of patients or other participants, is increasingly incorporated into healthcare settings as an arts-based, non-pharmacological practice intended to support well-being and humanize care. While previous reviews have examined a broad range of music-based interventions in healthcare, limited attention has been given specifically to live music, its contextual characteristics, and the values attributed to its use within hospital environments. Objectives: This scoping review aims to map and synthesize the literature on live music in healthcare settings, focusing on clinical contexts, populations involved, and the therapeutic, psychosocial, and environmental values reported. Methods: A scoping review was conducted following the framework of Arksey and O’Malley. Searches were performed in Web of Science, Scopus and Pubmed using terms related to live music and healthcare settings. Studies published in English or Spanish over the past 20 years were considered. After screening titles, abstracts, and full texts, 81 studies met the inclusion criteria. Results: The studies covered diverse hospital units and patient groups, particularly oncology, neonatal and intensive care, palliative care, and haemodialysis. Reported outcomes were mainly psychological and emotional, including reductions in anxiety, stress, and distress, alongside improvements in mood, well-being, and quality of life. Cognitive, physiological, and environmental benefits were also identified, emphasizing the role of live music in creating supportive and humanized care environments. Most studies were conducted in Europe and North America. Conclusions: Live music is widely implemented in healthcare settings and is associated with benefits extending beyond symptom reduction to experiential and humanizing dimensions of care. This scoping review provides an overview of the existing evidence base and identifies directions for future research in arts and health. Full article

Objective: This study was conducted to examine the relationship between ruminative thinking styles and suicide probability in individuals presenting to the emergency department with suspected alcohol and substance intoxication/use, and to investigate whether these variables differ according to various demographic characteristics. Methods: The sample of this descriptive study consisted of 45 cases presenting to the emergency departments of two hospitals in eastern Turkey. Data were collected using a Sociodemographic Data Form, the Rumination Scale, and the Suicide Probability Scale. Descriptive statistics, Pearson correlation, independent samples t-test, and Linear Regression analysis were used for data analysis. Results: Of the participants, 66.7% were male and 44.4% were in the 18–23 age group. A positive and moderately significant relationship was found between rumination and suicide probability (r = 0.441; p = 0.001). Regression analysis revealed that rumination explained 34% of the variance in the suicide probability. Furthermore, suicide probability scores of those using non-alcohol or multiple substances were significantly higher than those using only alcohol (p = 0.025). Conclusions: Ruminative thinking is a significant associated factor of suicide risk in patients with alcohol and substance use disorders presenting to the emergency department. It is recommended that cognitive assessments of these patients be conducted during clinical processes and that multiple-substance users, in particular, should be closely monitored for suicide risk. Full article

(1) Background and Objectives: Parkinson’s disease’s (PD) underlying pathophysiology still remains incompletely understood, with Braak’s hypothesis of ASyn pathology propagation being the most widely accepted. Recently, a novel model has been introduced, proposing two distinct ASyn propagation pathways: a bottom-up trajectory termed Body-first PD, and a central nervous system (CNS)-initiated pathway termed Brain-first PD. This distinction introduces new perspectives in the PD literature landscape regarding diagnosis, prognostic factors and patient management. This study set out to systematically synthesize the current literature comparing Brain-first and Body-first PD, with a focus on clinical characteristics and disease progression, diagnostic biomarkers, and management approaches. (2) Materials and Methods: A systematic literature search was conducted in March 2025 using PubMed, Cochrane Library, DOAJ and Google Scholar. Human observational, diagnostic, and interventional studies published between 2019 and March 2025, including patients with de novo or early PD, were eligible. Pre-motor REM sleep behavioral disorder (RBD) was used as the primary differentiation criterion. Risk of bias was evaluated using the Joanna Briggs Institute (JBI) critical appraisal checklists. Results were synthesized using a narrative approach. (3) Results: Sixteen studies comprising 2107 PD patients met the inclusion criteria. Body-first PD was associated with a higher non-motor symptom (NMS) burden, faster disease progression, and a higher prevalence of cognitive impairment. Additionally, Body-first PD patients exhibited more widespread and symmetrical neurodegeneration, along with electrophysiological and metabolic differences. Distinct biomarker and microbiome profiles were also observed between subtypes. No eligible studies addressing management approaches were identified. (4) Conclusions: In conclusion, the available evidence suggests that Brain-first and Body-first PD may represent two distinct pathophysiological entities, a proposal with great significance for the diagnosis, prognosis and management of PD patients. However, the predominantly cross-sectional nature of the current literature limits causal inference. Future longitudinal and interventional studies are required to clarify the potential clinical implications of this subtype classification theory. Full article

In the highly climate- and ecology-sensitive eastern margin of the Qinghai–Tibet Plateau (QTP), understanding the adaptation behaviors of agro-pastoralists is crucial for reconfiguring human–climate–ecosystem interactions. However, existing studies often overlook the bounded rationality of micro-level decision-makers. Based on behavioral decision theory, this study constructs a “Perception–Capital–Adaptation” analytical framework. Utilizing micro-survey data from 890 agro-pastoralist households and employing Multinomial Logit (MNL) and Ordinary Least Squares (OLS) models, this paper systematically explores how environmental risk perception and livelihood capital are jointly associated with livelihood strategy choices and land-use behaviors. The findings reveal that (1) risk perception exhibits significant heterogeneity: sudden risks show a strong association with risk-avoidance transitions, whereas gradual risks often manifest as traditional livelihood lock-in due to “cognitive lag.” (2) The moderation of capital exhibits non-linear characteristics: physical and natural capital correspond to path dependence on existing production, while financial capital may be associated with expansionary behaviors, reflecting “maladaptation” in specific contexts. (3) Their interaction corresponds to a duality of adaptation pathways: a coordinated pathway (balancing ecological conservation and livestock reduction) and a conflictive pathway (maintaining production scale). Accordingly, a “risk-capital” trade-off matrix is constructed to identify four typical adaptation patterns: risk-avoidance transformation, path-dependent persistence, resilience-driven expansion, and fragile maintenance. This study demonstrates that climate adaptation essentially reflects the dynamic trade-offs made by boundedly rational actors between cognitive constraints and capital structures, providing a novel micro-behavioral perspective for avoiding maladaptation. Full article

Cognitive Digital Twins (CDTs) are regarded as an evolved version of existing Digital Twin (DT) systems and are capable of certain cognitive abilities. However, the various introduced definitions and characteristics of CDTs, and different understandings of “cognition”, create conceptual ambiguity around CDTs. This paper critically reviews key definitions, application domains, capabilities, and proposed architectures of CDTs. Following PRISMA 2020 guidelines, a systematic review methodology is conducted across Scopus and Web of Science to map existing definitions, cognitive capabilities, and application domains of CDTs. Studies that explicitly implement or conceptualise a DT and explicitly mention cognitive, intelligent, autonomous, or AI-driven properties are included. Conversely, conference papers, book chapters, editorial pieces, review articles, and non-English publications are excluded from this review. The results of 59 reviewed studies present bibliometric metadata and a thematic analysis of early and recent definitions and applications of CDTs across various domains, such as manufacturing, which is the most studied discipline in terms of CDT implementation. Findings show that the understanding of cognitive enhancement has shifted toward the semantic enrichment of DT systems, with a significant emphasis on knowledge-driven approaches. The discussion focuses on identifying key differences between DTs and CDTs and synthesising existing definitions. The key contribution of this study is a unified definition of CDT, a mapping of cognitive capabilities and application domains, and a future research agenda. The review is not registered. The review is limited to journal articles, and the enabling CDT technologies, along with their implementations, are not addressed within this paper. Full article

As a non-rivalrous, replicable, and non-consumable production factor, data offers conditions for resource-efficient value creation, and the conversion from scattered data resources into measurable data assets sits at the center of firm competitiveness and sustainable allocation of digital factors. How artificial intelligence supports this conversion, and how executive cognition shapes its strength, are taken up within a framework drawing on the resource-based view, dynamic capability, and upper-echelons theory. Using 24,251 firm-year observations from Chinese A-share listed firms over 2012–2022, panel fixed-effects estimation yields a positive association between AI and data asset formation, stable across instrumental-variable estimation, propensity score matching, Heckman correction, and alternative measures of both variables. AI deepens data mining capability through stronger research and development investment and widens data-carrying capacity through expanded digital infrastructure, with the two channels opening up the relationship. Cognitive flexibility improves the fit between AI and shifting business scenarios, while cognitive complexity supports balanced allocation of technological resources across competing constraints; both characteristics strengthen the main association. The pattern is more pronounced among state-owned enterprises and firms in eastern and central regions, with industry differences less clear-cut. The findings inform differentiated policy design for sustainable digital development in emerging-market settings. Full article

Self-limited focal epilepsies in childhood (SELFEs), formerly referred to as “benign epilepsies in childhood”, constitute a heterogeneous group of epileptic conditions with onset predominantly in the neonatal, infantile, and childhood periods. A defining feature of these syndromes is that seizures arise without underlying structural, metabolic, or other demonstrable cerebral pathology, and the overall clinical trajectory is expected to be favorable, with seizures resolving spontaneously over time. Current nosological frameworks divide SELFEs into two broad categories according to age at onset: (a) neonatal and infantile forms, encompassing self-limited familial and non-familial neonatal, neonatal-infantile, and infantile epilepsies, genetic epilepsy with febrile seizures plus (GEFS+), and myoclonic epilepsy of infancy (MEI); and (b) childhood-onset forms, including self-limited epilepsy with centrotemporal spikes (SeLECTS), self-limited epilepsy with autonomic seizures (SeLEAS), childhood occipital visual epilepsy (COVE), and photosensitive occipital lobe epilepsy (POLE). Despite their historically “benign” label, there is no general agreement to include GEFS + and MEI among the group of SELFEs as both these conditions have been not classified as focal epilepsy in general. Accumulating evidence shows that a subset of affected children subsequently develop additional seizure types, cognitive deterioration, and behavioral or neuropsychiatric difficulties—outcomes that the word “benign” does not adequately communicate. Advances in molecular genetics have identified pathogenic variants affecting ion channels, synaptic transmission, and neuronal excitability, reshaping current understanding of disease mechanisms and phenotypic variability across these syndromes. This review highlights clinically relevant challenges in the diagnosis and management of SELFEs, critically examines emerging genotype–phenotype correlations, and provides evidence-based recommendations for antiseizure medication initiation and withdrawal tailored to individual syndrome characteristics and risk profiles. Full article

Myalgic encephalomyelitis (ME) is characterized by profound fatigue, post-exertional malaise (PEM), and cognitive dysfunction. Despite its clinical significance, the pathophysiology of PEM and disease heterogeneity remain unclear, and no validated biomarkers are available for rapid diagnosis or monitoring. We aimed to develop a screening approach combining label-free Raman spectroscopy (RS) and machine learning modeling (ML) to detect biomolecular changes in blood plasma and differentiate patients with ME from sedentary healthy controls. Blood plasma was collected from 115 patients with ME and 45 controls at rest (T0) and 90 min after a standardized, non-invasive stress test designed to induce PEM. Plasma samples were analyzed by RS, and ML models were developed independently at each time point to differentiate patients with ME and controls. The RS-ML models identified spectral features consistent with contributions from proteins, lipids, and low-molecular-weight metabolites. At T0 and T90, the area under the receiver operating characteristic curve, accuracy, specificity and sensitivity were 0.85 and 0.83, 79% and 84%, 82% and 90%, and 73% and 69%, respectively. RS-ML provides a rapid, low-cost approach to detect ME-associated biomolecular signatures in plasma and capture biochemical alterations associated with standardized stress. Full article

This study examines recent research trends in the use of serious games for science education through a bibliometric analysis of 340 articles and a qualitative content analysis of 56 studies published between 2020 and 2025 in the Web of Science Core Collection. By combining these approaches, the study provides a comprehensive view of both research patterns and how serious games are designed and used in science education. The findings indicate that the field is maturing, with research moving beyond general effectiveness toward understanding how serious games support learning in different contexts. Most studies report positive effects compared to traditional instructional methods. However, results vary across contexts and depend on factors such as design, implementation, and learner characteristics. Research is mainly focused on higher education and is largely driven by leading countries such as the USA and China, although participation from developing countries is increasing. The growing use of immersive technologies, such as augmented and virtual reality, offers new opportunities for interactive and multimodal learning but may also increase cognitive load in certain contexts. There is also growing interest in non-digital games, which have received limited attention despite their effectiveness. Overall, the findings show that more systematic research and clearer design frameworks are needed to better understand how serious games can be used in science education. Full article

Pupil area reflects not only the light reflex but also cognitive activity and arousal, and has been proposed as a non-invasive indicator of stress. However, the temporal characteristics of pupillary responses during cognitive stress tasks and their associations with other physiological and psychological measures remain unclear. This study examined cognitive stress responses during an N-back task using pupil area and changes in salivary alpha-amylase (sAA). Twenty-nine university and graduate students (mean age = 21.07 ± 0.91 years; 4 males, 25 females) participated. Pupil area was continuously recorded during a 2-back task. Salivary alpha-amylase was measured before (pre) and immediately after the task (post), and the change in sAA (post–pre) was calculated. Subjective stress responses and mood states were assessed using the SRS-18 and TDMS. A notable gender imbalance (predominantly female) limits the generalizability of findings, and future studies should aim for more balanced samples. Pupil area significantly decreased in the latter half of the task, consistent with a time-on-task effect. Although sAA showed no significant group-level change (BF₁₀ = 0.25, indicating evidence for the null hypothesis), individual differences in the change in sAA (post–pre) were evident. Task accuracy and the change in sAA were associated with subjective measures of mood and stress. These findings suggest that cognitive stress is reflected differently across pupil area, changes in sAA, and subjective measures, highlighting the value of integrating multiple physiological and psychological indicators. Full article

This study examines the impact of biophilic design in school common areas—specifically corridors, stairwells, and central halls—on users’ perceptual and physiological responses. Biophilic design attributes were categorized into direct experiences (Plants & water) and indirect experiences (Materials & Images), and simulation stimuli for each common area type were generated using generative AI. Thirty university students participated in the experiment, where their hemodynamic responses (fNIRS) and galvanic skin responses (GSRs) were measured during exposure to various biophilic environmental stimuli to quantitatively analyze emotional arousal and cognitive recovery levels. The results indicated that biophilic environments elicited significant physiological stabilization responses in specific spatial and application conditions compared to non-biophilic settings. Distinct physiological responses were observed based on spatial characteristics and application methods; vertical elements facilitated cognitive rest, whereas horizontal elements promoted attention restoration through moderate arousal. Furthermore, significant associations between nature connectedness and selected physiological responses highlighted the importance of considering individual predispositions in spatial design. As an exploratory pilot study, this research contributes preliminary evidence by integrating generative AI-based simulations with fNIRS and GSR measurements to examine vertical and horizontal biophilic applications in school common areas. Full article

Background: Visio-spatial skills (VSS) are essential perceptual-cognitive skills that enable athletes to process visual information, interpret spatial relationships, and execute appropriate motor responses in dynamic sporting environments. In combat sports, athletes must rapidly anticipate and react to an opponent’s actions, making well-developed VSS crucial for optimal performance. Although boxing, karate, and taekwondo share similar competitive characteristics, each discipline presents distinct technical and perceptual demands that may influence the development of specific VSS profiles. This study aimed to investigate whether significant differences exist in VSS profiles among boxing, karate, and taekwondo athletes. Methods: A comparative cross-sectional design was used involving 150 amateur combat sport athletes, 50 boxers, 50 karate athletes, and 50 taekwondo athletes. Participants were assessed using a VSS test battery measuring six variables: accommodation facility (AF), saccadic eye movement (SEM), speed of recognition (SR), (HEC), peripheral awareness (PA), and visual memory (VM). Data was analyzed using one-way ANOVA with η², ω², and Cohen’s f effect sizes, and principal component analysis (PCA). Results: One-way ANOVA revealed statistically significant differences in five of six VSS (all p < 0.001). PA produced the largest sport-specific differentiation (η² = 0.457, Cohen’s f = 0.918), followed by HEC (η² = 0.273, f = 0.612), SR (η² = 0.224, f = 0.537), and SEM (η² = 0.180, f = 0.468). AF yielded a significant moderate effect (η² = 0.108, f = 0.347). VM was the sole non-significant variable (F (2.147) = 0.74, p = 0.479, ω² = 0.000), suggesting domain-general encoding processes insensitive to discipline-specific training at this developmental level. Boxing athletes achieved the highest scores in SEM, SR, and PA, while karate athletes led in AF and HEC. PCA revealed a single dominant component (PC1 = 93.91% of variance), confirming that VSS function as a highly integrated perceptual-motor construct rather than independent sub-skills. Conclusions: Visio-spatial skills in combat sports are governed by a dominant integrated factor, with discipline-specific variations reflecting unique performance requirements. Visio-spatial skills in combat sport athletes are highly interdependent and largely governed by a single perceptual-motor construct, with discipline-specific profiles observed across boxing, karate, and taekwondo. The findings support the integration of sport-specific, ecologically valid visual training programs targeting key perceptual-cognitive skills, alongside routine assessment to inform athlete development and performance optimization. Full article

Objective: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is an aggressive locoregional treatment for selected patients with peritoneal surface malignancies. Although its oncological role has been widely discussed, longitudinal data focusing on postoperative quality-of-life (QoL) trajectories remain limited. This study aimed to describe longitudinal QoL trajectories during the first two years after CRS/HIPEC and to provide exploratory descriptive comparisons according to selected clinical characteristics. Methods: This retrospective single-center cohort study included 144 consecutive adult patients who underwent CRS/HIPEC between January 2018 and July 2022. Patients were evaluated preoperatively and postoperatively at day 14 and at 1, 3, 6, 12, 18, and 24 months. QoL was assessed during routine follow-up primarily using the EORTC QLQ-C30 questionnaire; the EORTC QLQ-CR29 was also administered in institutional practice as a supplementary instrument in selected settings. Repeated QLQ-C30 measurements were analyzed descriptively using the Friedman test with post hoc Nemenyi comparisons. Results: Questionnaire completion rates were 100% at baseline, postoperative day 14, and month 1; 96.5% at months 3 and 6; 91.0% at month 12; 81.9% at month 18; and 75.7% at month 24. Longitudinal analyses demonstrated significant time effects across multiple QoL domains, including global health status, physical functioning, emotional functioning, role functioning, cognitive functioning, social functioning, pain, fatigue, and diarrhea. The most pronounced deterioration was observed in the early postoperative period, particularly at postoperative day 14. Thereafter, several domains improved gradually; however, recovery was domain-specific and did not consistently return to preoperative levels during follow-up. In exploratory descriptive analyses, patients with major postoperative complications showed more pronounced early impairment in global health status, physical functioning, and social functioning, together with greater pain and fatigue burden, particularly at postoperative day 14 and month 1. Exploratory subgroup comparisons also suggested heterogeneity in recovery patterns according to primary tumor origin. Later follow-up findings should be interpreted cautiously in view of attrition over time and the absence of adjusted longitudinal modeling. Conclusions: Quality of life declines substantially during the early postoperative period after CRS/HIPEC, followed by gradual but incomplete recovery over time. This recovery pattern is non-linear and varies across domains. Exploratory descriptive findings suggested that early postoperative QoL impairment may be greater in patients with major complications, but these subgroup patterns require confirmation in prospectively designed studies using adjusted longitudinal models. Longitudinal QoL assessment may provide clinically meaningful insight into postoperative recovery after CRS/HIPEC. Full article

Patients with chronic kidney disease (CKD) frequently experience depressive symptoms, which substantially impair their quality of life. To facilitate the early identification of high-risk individuals, this study aimed to develop a predictive model for assessing depression risk among CKD patients. This study was based on data from the China Health and Retirement Longitudinal Study (CHARLS) 2018 wave, including 1777 middle-aged and elderly participants with self-reported CKD diagnosed by a physician. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D 10). A total of 29 variables were included, covering lifestyle factors, health status, comorbidities, and sociodemographic characteristics. The Elastic Net algorithm was employed to select 11 features with the highest predictive value. Seven machine learning models, including XGBoost and support vector machine (SVM), were compared, with CHARLS 2020 data used as a temporal validation set. In the multi-model comparison, XGBoost demonstrated discrimination performance comparable to logistic regression (LR), SVM, and multilayer perceptron (MLP) (DeLong test, p > 0.05). However, considering its superior calibration performance and ability to capture nonlinear interactions, XGBoost was selected as the final model. In the validation set, the model achieved an area under the curve (AUC) of 0.8017 and an accuracy of 72.39%. SHAP analysis further revealed the nonlinear effects of predictors, with life satisfaction, sleep duration, and self-rated health showing high contributions and negative associations with depression risk, whereas limitations in activities of daily living (ADL), physical pain, and digestive system diseases were significantly associated with an increased risk of depression. Overall, the risk of depression in CKD patients is influenced by multiple dimensions, including psychological cognition, quality of life, physical function, and social environment. The predictive model developed in this study may provide a valuable reference for the early screening of high-risk populations. However, its applicability to non-CKD populations requires further validation. Full article

Children with attention deficit/hyperactivity disorder (ADHD) often exhibit deficits in executive functions (EFs), which are crucial for self-regulation and academic performance. Physical activity (PA) has emerged as a promising non-pharmacological approach to support EF development in this population. This scoping review, guided by the PRISMA-ScR framework, examined PA interventions aimed at improving EFs in children aged 6–12 diagnosed with ADHD. Evidence was synthesized narratively by categorizing interventions according to PA modality, intensity, and the specific EF domains targeted, whilst describing the methodological characteristics of existing studies. A systematic search of PubMed, Cochrane Library, Web of Science, Scopus, and PsycINFO up to the end of 2024 yielded 55 peer-reviewed empirical studies involving 3863 participants. Both acute and chronic PA interventions were associated with improvements in EFs, with inhibitory control most commonly enhanced, followed by working memory and cognitive flexibility. Structured sports such as swimming and football, as well as multimodal interventions including physical–cognitive training and exergames, demonstrated positive effects. Intervention efficacy was influenced by factors such as intensity, duration, cognitive engagement, and context. However, variability in study designs, small sample sizes, and lack of standardization limited comparability. These findings suggest that PA interventions can support EF development in children with ADHD, particularly when activities are cognitively engaging. Future research should address methodological limitations and explore mediators and moderators in ecologically valid and theory-driven designs. Full article