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19 pages, 2642 KiB  
Article
Lipid Nanoparticle-Encapsulated TALEN-Encoding mRNA Inactivates Hepatitis B Virus Replication in Cultured Cells and Transgenic Mice
by Tiffany Smith, Prashika Singh, Ridhwaanah Bhana, Dylan Kairuz, Kristie Bloom, Mohube Betty Maepa, Abdullah Ely and Patrick Arbuthnot
Viruses 2025, 17(8), 1090; https://doi.org/10.3390/v17081090 (registering DOI) - 7 Aug 2025
Abstract
Chronic infection with the hepatitis B virus (HBV) results in over 1 million deaths annually. Although currently licensed treatments, including pegylated interferon-α and nucleoside/nucleotide analogs, can inhibit viral replication, they rarely eradicate covalently closed circular DNA (cccDNA) reservoirs. Moreover, vaccination does not offer [...] Read more.
Chronic infection with the hepatitis B virus (HBV) results in over 1 million deaths annually. Although currently licensed treatments, including pegylated interferon-α and nucleoside/nucleotide analogs, can inhibit viral replication, they rarely eradicate covalently closed circular DNA (cccDNA) reservoirs. Moreover, vaccination does not offer therapeutic benefit to already infected individuals or non-responders. Consequently, chronic infection is maintained by the persistence of cccDNA in infected hepatocytes. For this reason, novel therapeutic strategies that permanently inactivate cccDNA are a priority. Obligate heterodimeric transcription activator-like effector nucleases (TALENs) provide the precise gene-editing needed to disable cccDNA. To develop this strategy using a therapeutically relevant approach, TALEN-encoding mRNA targeting viral core and surface genes was synthesized using in vitro transcription with co-transcriptional capping. TALENs reduced hepatitis B surface antigen (HBsAg) by 80% in a liver-derived mammalian cell culture model of infection. In a stringent HBV transgenic murine model, a single dose of hepatotropic lipid nanoparticle-encapsulated TALEN mRNA lowered HBsAg by 63% and reduced viral particle equivalents by more than 99%, without evidence of toxicity. A surveyor assay demonstrated mean in vivo HBV DNA mutation rates of approximately 16% and 15% for Core and Surface TALENs, respectively. This study presents the first evidence of the therapeutic potential of TALEN-encoding mRNA to inactivate HBV replication permanently. Full article
(This article belongs to the Section Human Virology and Viral Diseases)
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13 pages, 1488 KiB  
Article
Validation of a Quantitative Ultrasound Texture Analysis Model for Early Prediction of Neoadjuvant Chemotherapy Response in Breast Cancer: A Prospective Serial Imaging Study
by Daniel Moore-Palhares, Lakshmanan Sannachi, Adrian Wai Chan, Archya Dasgupta, Daniel DiCenzo, Sonal Gandhi, Rossanna Pezo, Andrea Eisen, Ellen Warner, Frances Wright, Nicole Look Hong, Ali Sadeghi-Naini, Mia Skarpathiotakis, Belinda Curpen, Carrie Betel, Michael C. Kolios, Maureen Trudeau and Gregory J. Czarnota
Cancers 2025, 17(15), 2594; https://doi.org/10.3390/cancers17152594 - 7 Aug 2025
Abstract
Background/Objectives: Patients with breast cancer who do not achieve a complete response to neoadjuvant chemotherapy (NAC) may benefit from intensified adjuvant systemic therapy. However, such treatment escalation is typically delayed until after tumour resection, which occurs several months into the treatment course. Quantitative [...] Read more.
Background/Objectives: Patients with breast cancer who do not achieve a complete response to neoadjuvant chemotherapy (NAC) may benefit from intensified adjuvant systemic therapy. However, such treatment escalation is typically delayed until after tumour resection, which occurs several months into the treatment course. Quantitative ultrasound (QUS) can detect early microstructural changes in tumours and may enable timely identification of non-responders during NAC, allowing for earlier treatment intensification. In our previous prospective observational study, 100 breast cancer patients underwent QUS imaging before and four times during NAC. Machine learning algorithms based on QUS texture features acquired in the first week of treatment were developed and achieved 78% accuracy in predicting treatment response. In the current study, we aimed to validate these algorithms in an independent prospective cohort to assess reproducibility and confirm their clinical utility. Methods: We included breast cancer patients eligible for NAC per standard of care, with tumours larger than 1.5 cm. QUS imaging was acquired at baseline and during the first week of treatment. Tumour response was defined as a ≥30% reduction in target lesion size on the resection specimen compared to baseline imaging. Results: A total of 51 patients treated between 2018 and 2021 were included (median age 49 years; median tumour size 3.6 cm). Most were estrogen receptor–positive (65%) or HER2-positive (33%), and the majority received dose-dense AC-T (n = 34, 67%) or FEC-D (n = 15, 29%) chemotherapy, with or without trastuzumab. The support vector machine algorithm achieved an area under the curve of 0.71, with 86% accuracy, 91% specificity, 50% sensitivity, 93% negative predictive value, and 43% positive predictive value for predicting treatment response. Misclassifications were primarily associated with poorly defined tumours and difficulties in accurately identifying the region of interest. Conclusions: Our findings validate QUS-based machine learning models for early prediction of chemotherapy response and support their potential as non-invasive tools for treatment personalization and clinical trial development focused on early treatment intensification. Full article
(This article belongs to the Special Issue Clinical Applications of Ultrasound in Cancer Imaging and Treatment)
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12 pages, 3874 KiB  
Article
Comparison of the Marginal Integrity of Sectional Non-Invasive Laminate Veneers Versus Sectional Minimally Invasive Laminate Veneers Under Artificial Aging
by Polykarpos Papanagiotou, Phophi Kamposiora, George Papavasiliou and Spiros Zinelis
Dent. J. 2025, 13(8), 358; https://doi.org/10.3390/dj13080358 - 7 Aug 2025
Abstract
Background/Objectives: To compare the marginal integrity of sectional non-invasive laminate veneers versus sectional minimally invasive laminate veneers. Methods: A total of eighty (80) intact maxillary and mandibular frontal teeth (central incisors) were randomly divided into four groups (n = 20). [...] Read more.
Background/Objectives: To compare the marginal integrity of sectional non-invasive laminate veneers versus sectional minimally invasive laminate veneers. Methods: A total of eighty (80) intact maxillary and mandibular frontal teeth (central incisors) were randomly divided into four groups (n = 20). Two groups received non-invasive veneers made of feldspathic porcelain (Feldspathic Non-Invasive—FNI) and lithium disilicate (Lithium Disilicate Non-Invasive—LNI) accordingly. Groups FP and LP received minimally invasive veneers manufactured by feldspathic porcelain and lithium disilicate, respectively. Following cementation, three grooves with mesio-distal orientation on the labial surface of teeth of each sample, at the incisal, middle, and cervical third, were made. Before and after artificial aging, the mesio-distal distance between the end of the groove on the tooth and the edge of each veneer was measured in micrometers (μm) employing an SEM immediately after cementation (T0), after simulated artificial aging equivalent to four months of everyday brushing (T1), and after twelve months of everyday brushing (2 times per day) (T2) to identify the wear of veneers. In the same manner, the horizontal dimension of the cement layer extending from its edge till the margin of the veneer was measured for all the groups at T0, T1, and T2, respectively. The statistical analysis was performed employing non-parametric Kruskal–Wallis ANOVA and Dunn’s test. Results: No significant differences from T0 to T1 and from T1 to T2, as well as from T0 to T2, were identified for all the groups tested. No significant differences were allocated among all groups for the dimensional changes in the cement. Conclusions: All the groups responded similarly to aging factors, regardless of the non-invasive or minimally invasive approach, or the material used to fabricate the veneers. Full article
(This article belongs to the Special Issue Dental Materials Design and Innovative Treatment Approach)
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13 pages, 778 KiB  
Article
Relationship Between Chronic Wasting Disease (CWD) Infection and Pregnancy Probability in Wild Female White-Tailed Deer (Odocoileus virginianus) in Northern Illinois, USA
by Jameson Mori, Nelda A. Rivera, William Brown, Daniel Skinner, Peter Schlichting, Jan Novakofski and Nohra Mateus-Pinilla
Pathogens 2025, 14(8), 786; https://doi.org/10.3390/pathogens14080786 - 7 Aug 2025
Abstract
White-tailed deer (Odocoileus virginianus) are a cervid species native to the Americas with ecological, social, and economic significance. Managers must consider several factors when working to maintain the health and sustainability of these wild herds, including reproduction, particularly pregnancy and recruitment [...] Read more.
White-tailed deer (Odocoileus virginianus) are a cervid species native to the Americas with ecological, social, and economic significance. Managers must consider several factors when working to maintain the health and sustainability of these wild herds, including reproduction, particularly pregnancy and recruitment rates. White-tailed deer have a variable reproductive capacity, with age, health, and habitat influencing this variability. However, it is unknown whether chronic wasting disease (CWD) impacts reproduction and, more specifically, if CWD infection alters a female deer’s probability of pregnancy. Our study addressed this question using data from 9783 female deer culled in northern Illinois between 2003 and 2023 as part of the Illinois Department of Natural Resources’ ongoing CWD management program. Multilevel Bayesian logistic regression was employed to quantify the relationship between pregnancy probability and covariates like maternal age, deer population density, and date of culling. Maternal infection with CWD was found to have no significant effect on pregnancy probability, raising concerns that the equal ability of infected and non-infected females to reproduce could make breeding, which inherently involves close physical contact, an important source of disease transmission between males and females and females and their fawns. The results also identified that female fawns (<1 year old) are sensitive to county-level deer land cover utility (LCU) and deer population density, and that there was no significant difference in how yearlings (1–2 years old) and adult (2+ years old) responded to these variables. Full article
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16 pages, 1169 KiB  
Review
Bispecific Antibodies—A New Hope for Patients with Diffuse Large B-Cell Lymphoma
by Romeo Gabriel Mihaila and Samuel B. Todor
J. Clin. Med. 2025, 14(15), 5534; https://doi.org/10.3390/jcm14155534 - 6 Aug 2025
Abstract
T-cell-engaging antibodies are a promising new type of treatment for patients with refractory or relapsed (R/R) diffuse large B-cell lymphoma, which has changed the prognosis and evolution of these patients in clinical trials. Bispecific antibodies (BsAbs) bind to two different targets (B and [...] Read more.
T-cell-engaging antibodies are a promising new type of treatment for patients with refractory or relapsed (R/R) diffuse large B-cell lymphoma, which has changed the prognosis and evolution of these patients in clinical trials. Bispecific antibodies (BsAbs) bind to two different targets (B and T lymphocytes) at the same time and in this way mimic the action of CAR (chimeric antigen receptor) T-cells. They are the T-cell-engaging antibodies most used in practice and are a solution for patients who do not respond to second- or later-line therapies, including chemoimmunotherapy, followed by salvage chemotherapy and hematopoietic stem cell transplantation. They are a therapeutic option for patients who are ineligible for CAR T-cell therapy and are also active in those with prior exposure to CAR T-cell treatment. A remarkable advantage of BsAbs is their rapid availability, even if the disease progresses rapidly, unlike CAR T-cell treatment, and they avoid the practical and financial challenges raised by autologous CAR T-cell therapies. CAR-T has been proven to have better efficacy compared to BsAbs, but cytokine release syndrome and neurotoxicity have appeared significantly more frequently in patients treated with CAR T-cells. The possibility of combining BsAbs with chemotherapy and their administration for relapses or as a frontline therapy is being studied to increase their efficacy. BsAbs are a life-saving therapy for many patients with diffuse large B-cell malignant non-Hodgkin’s lymphoma (NHL) who have a poor prognosis with classical therapies, but are not without adverse effects and require careful monitoring. Full article
(This article belongs to the Special Issue Immunotherapy of Hematological Malignancies: The State of the Art)
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14 pages, 614 KiB  
Article
Development of Cut Scores for Feigning Spectrum Behavior on the Orebro Musculoskeletal Pain Screening Questionnaire and the Perceived Stress Scale: A Simulation Study
by John Edward McMahon, Ashley Craig and Ian Douglas Cameron
J. Clin. Med. 2025, 14(15), 5504; https://doi.org/10.3390/jcm14155504 - 5 Aug 2025
Abstract
Background/Objectives: Feigning spectrum behavior (FSB) is the exaggeration, fabrication, or false imputation of symptoms. It occurs in compensable injury with great cost to society by way of loss of productivity and excessive costs. The aim of this study is to identify feigning [...] Read more.
Background/Objectives: Feigning spectrum behavior (FSB) is the exaggeration, fabrication, or false imputation of symptoms. It occurs in compensable injury with great cost to society by way of loss of productivity and excessive costs. The aim of this study is to identify feigning by developing cut scores on the long and short forms (SF) of the Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ and OMPSQ-SF) and the Perceived Stress Scale (PSS and PSS-4). Methods: As part of pre-screening for a support program, 40 injured workers who had been certified unfit for work for more than 2 weeks were screened once with the OMPSQ and PSS by telephone by a mental health professional. A control sample comprised of 40 non-injured community members were screened by a mental health professional on four occasions under different aliases, twice responding genuinely and twice simulating an injury. Results: Differences between the workplace injured people and the community sample were compared using ANCOVA with age and gender as covariates, and then receiver operator characteristics (ROCs) were calculated. The OMPSQ and OMPSQ-SF discriminated (ρ < 0.001) between all conditions. All measures discriminated between the simulation condition and workplace injured people (ρ < 0.001). Intraclass correlation demonstrated the PSS, PSS-4, OMPSQ, and OMPSQ-SF were reliable (ρ < 0.001). Area Under the Curve (AUC) was 0.750 for OMPSQ and 0.835 for OMPSQ-SF for work-injured versus simulators. Conclusions: The measures discriminated between injured and non-injured people and non-injured people instructed to simulate injury. Non-injured simulators produced similar scores when they had multiple exposures to the test materials, showing the uniformity of feigning spectrum behavior on these measures. The OMPSQ-SF has adequate discriminant validity and sensitivity to feigning spectrum behavior, making it optimal for telephone screening in clinical practice. Full article
(This article belongs to the Section Clinical Rehabilitation)
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17 pages, 284 KiB  
Article
Exploring the Motivation for Media Consumption and Attitudes Toward Advertisement in Transition to Ad-Supported OTT Plans: Evidence from South Korea
by Sang-Yeon Kim, Jeong-Hyun Kang, Hye-Min Byeon, Yoon-Taek Sung, Young-A Song, Ji-Won Lee and Seung-Chul Yoo
J. Theor. Appl. Electron. Commer. Res. 2025, 20(3), 198; https://doi.org/10.3390/jtaer20030198 - 4 Aug 2025
Viewed by 177
Abstract
As ad-supported subscription models proliferate across over-the-top (OTT) media platforms, understanding the psychological mechanisms and perceptual factors that underlie consumers’ transition decisions becomes increasingly consequential. This study integrates the Uses and Gratifications framework with a contemporary motivation-based perspective to examine how users’ media [...] Read more.
As ad-supported subscription models proliferate across over-the-top (OTT) media platforms, understanding the psychological mechanisms and perceptual factors that underlie consumers’ transition decisions becomes increasingly consequential. This study integrates the Uses and Gratifications framework with a contemporary motivation-based perspective to examine how users’ media consumption motivations and advertising attitudes predict intentions to adopt ad-supported OTT plans. Data were collected via a nationally representative online survey in South Korea (N = 813). The sample included both premium subscribers (n = 708) and non-subscribers (n = 105). The findings reveal distinct segmentation in decision-making patterns. Among premium subscribers, switching intentions were predominantly driven by intrinsic motivations—particularly identity alignment with content—and by the perceived informational value of advertisements. These individuals are more likely to consider ad-supported plans when ad content is personally relevant and cognitively enriching. Conversely, non-subscribers exhibited greater sensitivity to extrinsic cues such as the entertainment value of ads and the presence of tangible incentives (e.g., discounts), suggesting a hedonic-reward orientation. By advancing a dual-pathway explanatory model, this study contributes to the theoretical discourse on digital subscription behavior and offers actionable insights for OTT service providers. The results underscore the necessity of segment-specific advertising strategies: premium subscribers may be engaged through informative and identity-consistent advertising, while non-subscribers respond more favorably to enjoyable and benefit-laden ad experiences. These insights inform platform monetization efforts amid the evolving dynamics of consumer attention and subscription fatigue. Full article
(This article belongs to the Section Digital Marketing and the Connected Consumer)
13 pages, 475 KiB  
Article
Clinical Outcomes of Patients with Achalasia Following Pneumatic Dilation Treatment: A Single Center Experience
by Viktorija Sabljić, Dorotea Božić, Damir Aličić, Žarko Ardalić, Ivna Olić, Damir Bonacin and Ivan Žaja
J. Clin. Med. 2025, 14(15), 5448; https://doi.org/10.3390/jcm14155448 - 2 Aug 2025
Viewed by 168
Abstract
Background/Objectives: Pneumatic dilation (PD) is a widely used treatment modality in the management of achalasia. It is particularly relevant in regions where many centers lack access to advanced therapeutic modalities. Therefore, we aimed to assess the effectiveness and safety of PD in our [...] Read more.
Background/Objectives: Pneumatic dilation (PD) is a widely used treatment modality in the management of achalasia. It is particularly relevant in regions where many centers lack access to advanced therapeutic modalities. Therefore, we aimed to assess the effectiveness and safety of PD in our local region. Methods: This study retrospectively analyzed patients with achalasia that underwent PD from 1/2013 to 12/2019. The diagnosis of achalasia was established on the grounds of clinical symptoms, radiological and endoscopic findings, and esophageal manometry. Data on patient’s clinical characteristics, dilation technique and postprocedural follow-up were collected and statistically analyzed. Procedure effectiveness was defined as the postprocedural Eckardt score ≤ 3. Results: PD significantly reduced frequency of dysphagia, regurgitation, and retrosternal pain (p < 0.001). Body-weight increased significantly one month and one year after the procedure (p < 0.001). The procedural success rate was 100%. No severe complications were reported. Conclusions: PD is an effective and safe treatment modality in the management of achalasia. The study limitations include a single center design with the small number of participants, not all of whom underwent manometry, gender disproportion, absence of non-responders, and a short follow-up. Full article
(This article belongs to the Special Issue Clinical Advances in Gastrointestinal Endoscopy)
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19 pages, 2656 KiB  
Article
Circulating Lipid Profiles Indicate Incomplete Metabolic Recovery After Weight Loss, Suggesting the Need for Additional Interventions in Severe Obesity
by Alina-Iuliana Onoiu, Vicente Cambra-Cortés, Andrea Jiménez-Franco, Anna Hernández-Aguilera, David Parada, Francesc Riu, Antonio Zorzano, Jordi Camps and Jorge Joven
Biomolecules 2025, 15(8), 1112; https://doi.org/10.3390/biom15081112 - 1 Aug 2025
Viewed by 143
Abstract
The effects of long-term adjustments in body weight on the lipid balance in patients with severe obesity are not well understood. This study aimed to evaluate a non-invasive lipidomic approach to identifying biomarkers that could help predict which patients may require additional therapies [...] Read more.
The effects of long-term adjustments in body weight on the lipid balance in patients with severe obesity are not well understood. This study aimed to evaluate a non-invasive lipidomic approach to identifying biomarkers that could help predict which patients may require additional therapies before and after weight loss. Using mass spectrometry, 275 lipid species were analysed in non-obese controls, patients with severe obesity, and patients one year after bariatric surgery. The results showed that severe obesity disrupts lipid pathways, contributing to lipotoxicity, inflammation, mitochondrial stress, and abnormal lipid metabolism. Although weight loss improved these disturbances, surgery did not fully normalise the lipid profiles of all patients. Outcomes varied depending on their baseline liver health and genetic differences. Persistent alterations in cholesterol handling, membrane composition, and mitochondrial function were observed in partial responders. Elevated levels of sterol lipids, glycerophospholipids, and sphingolipids emerged as markers of complete metabolic recovery, identifying candidates for targeted post-surgical interventions. These findings support the use of lipidomics to personalise obesity treatment and follow-up. Full article
(This article belongs to the Section Molecular Biomarkers)
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13 pages, 1293 KiB  
Article
Integration of an OS-Based Machine Learning Score (AS Score) and Immunoscore as Ancillary Tools for Predicting Immunotherapy Response in Sarcomas
by Isidro Machado, Raquel López-Reig, Eduardo Giner, Antonio Fernández-Serra, Celia Requena, Beatriz Llombart, Francisco Giner, Julia Cruz, Victor Traves, Javier Lavernia, Antonio Llombart-Bosch and José Antonio López Guerrero
Cancers 2025, 17(15), 2551; https://doi.org/10.3390/cancers17152551 - 1 Aug 2025
Viewed by 185
Abstract
Background: Angiosarcomas (ASs) represent a heterogeneous and highly aggressive subset of tumors that respond poorly to systemic treatments and are associated with short progression-free survival (PFS) and overall survival (OS). The aim of this study was to develop and validate an immune-related [...] Read more.
Background: Angiosarcomas (ASs) represent a heterogeneous and highly aggressive subset of tumors that respond poorly to systemic treatments and are associated with short progression-free survival (PFS) and overall survival (OS). The aim of this study was to develop and validate an immune-related prognostic model—termed the AS score—using data from two independent sarcoma cohorts. Methods: A prognostic model was developed using a previously characterized cohort of 25 angiosarcoma samples. Candidate genes were identified via the Maxstat algorithm (Maxstat v0.7-25 for R), combined with log-rank testing. The AS score was then computed by weighing normalized gene expression levels according to Cox regression coefficients. For external validation, transcriptomic data from TCGA Sarcoma cohort (n = 253) were analyzed. The Immunoscore—which reflects the tumor immune microenvironment—was inferred using the ESTIMATE package (v1.0.13) in R. All statistical analyses were performed in RStudio (v 4.0.3). Results: Four genes—IGF1R, MAP2K1, SERPINE1, and TCF12—were ultimately selected to construct the prognostic model. The resulting AS score enabled the classification of angiosarcoma cases into two prognostically distinct groups (p = 0.00012). Cases with high AS score values, which included both cutaneous and non-cutaneous forms, exhibited significantly poorer outcomes, whereas cases with low AS scores were predominantly cutaneous. A significant association was observed between the AS score and the Immunoscore (p = 0.025), with higher Immunoscore values found in high-AS score tumors. Validation using TCGA sarcoma cohort confirmed the prognostic value of both the AS score (p = 0.0066) and the Immunoscore (p = 0.0029), with a strong correlation between their continuous values (p = 2.9 × 10−8). Further survival analysis, integrating categorized scores into four groups, demonstrated robust prognostic significance (p = 0.00021). Notably, in tumors with a low Immunoscore, AS score stratification was not prognostic. In contrast, among cases with a high Immunoscore, the AS score effectively distinguished outcomes (p < 0.0001), identifying a subgroup with poor prognosis but potential sensitivity to immunotherapy. Conclusions: This combined classification using the AS score and Immunoscore has prognostic relevance in sarcoma, suggesting that angiosarcomas with an immunologically active microenvironment (high Immunoscore) and poor prognosis (high AS score) may be prime candidates for immunotherapy and this approach warrants prospective validation. Full article
(This article belongs to the Special Issue Genomics and Transcriptomics in Sarcoma)
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12 pages, 501 KiB  
Article
Effect of Sarcopenia on the Outcomes of Radiofrequency Ablation of Medial Branch Nerves for Lumbar Facet Arthropathy in Patients Aged 60 Years and Older: A Retrospective Analysis
by Seung Hee Yoo and Won-Joong Kim
J. Pers. Med. 2025, 15(8), 344; https://doi.org/10.3390/jpm15080344 - 1 Aug 2025
Viewed by 165
Abstract
Background/Objectives: Sarcopenia is defined by the progressive loss of muscle mass, strength, and/or physical performance associated with aging. Radiofrequency ablation (RFA) of the medial branch nerves is a well-established and effective treatment for lumbar facetogenic pain. While sarcopenia is associated with poor [...] Read more.
Background/Objectives: Sarcopenia is defined by the progressive loss of muscle mass, strength, and/or physical performance associated with aging. Radiofrequency ablation (RFA) of the medial branch nerves is a well-established and effective treatment for lumbar facetogenic pain. While sarcopenia is associated with poor outcomes following epidural steroid injections and lumbar spine surgeries, its impact on clinical outcomes in patients undergoing RFA for facetogenic pain remains unexplored. This study aims to evaluate the influence of sarcopenia on treatment outcomes in this patient cohort. Methods: Patients were classified into sarcopenia (n = 35) and non-sarcopenia groups (n = 67) based on predefined psoas muscle index (PMI) thresholds. The primary outcomes included changes in back pain intensity and the proportion of responders at 1, 3, and 6 months following RFA. The secondary outcome was to identify demographic, clinical, and sarcopenia-related factors predictive of treatment response at each follow-up interval. Results: Both groups demonstrated statistically significant improvements in pain scores compared to baseline at all follow-up points. However, the median pain scores at 3 months post-RFA remained significantly higher in the sarcopenia group. Despite this, the proportion of responders did not differ significantly between the two groups at any time point. At 3 months, the absence of prior spinal surgery was identified as a significant predictor of treatment response. At 6 months, favorable outcomes were significantly associated with the absence of diabetes, no history of spinal surgery, and a higher PMI. Conclusions: Sarcopenia may influence the extent of pain improvement following medial branch nerve RFA. Additionally, patient-specific factors, such as diabetes, prior spinal surgery, and PMI, should be considered when predicting treatment outcomes. Full article
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17 pages, 302 KiB  
Article
Validity of PROMIS® Pediatric Physical Activity Parent Proxy Short Form Scale as a Physical Activity Measure for Children with Cerebral Palsy Who Are Non-Ambulatory
by Nia Toomer-Mensah, Margaret O’Neil and Lori Quinn
Behav. Sci. 2025, 15(8), 1042; https://doi.org/10.3390/bs15081042 - 31 Jul 2025
Viewed by 209
Abstract
Background: Self-report physical activity (PA) scales, accelerometry, and heart rate (HR) monitoring are reliable tools for PA measurement for children with cerebral palsy (CP); however, there are limitations for those who are primary wheelchair users. The purpose of our study was to [...] Read more.
Background: Self-report physical activity (PA) scales, accelerometry, and heart rate (HR) monitoring are reliable tools for PA measurement for children with cerebral palsy (CP); however, there are limitations for those who are primary wheelchair users. The purpose of our study was to evaluate face and construct validity of the PROMIS® Pediatric PA parent proxy short form 8a in measuring PA amount and intensity in children with CP who are non-ambulatory. Methods: Face validity: Semi-structured interviews with parents and pediatric physical therapists (PTs) were conducted about the appropriateness of each item on the PROMIS® Pediatric PA short form. Construct validity: Children with CP who were non-ambulatory participated in a one-week observational study. PA amount and intensity were examined using PA monitors (Actigraph GT9X) and HR monitors (Fitbit Charge 4). Activity counts and time in sedentary and non-sedentary intensity zones were derived and compared to the PROMIS® T-scaled score. Results: Twenty-two physical therapists (PTs) and fifteen parents participated in the interviews, and ten children completed 1-week PA observation. Eight and seven participants completed sufficient time of uninterrupted PA and HR monitor wear, respectively. Parents and PTs agreed that several questions were not appropriate for children with CP who were non-ambulatory. PA intensity via activity counts derived from wrist worn monitors showed a strong positive correlation with the PROMIS® PA measure. Conclusions: Construct validity in our small sample was established between PROMIS® scores and accelerometry activity counts when documenting PA amount and intensity; however, there were some differences on PROMIS® face validity per parent and PT respondents. Despite some concerns regarding face validity, the PROMIS® Pediatric PA parent proxy short form 8a shows promise as a valid measure of physical activity amount and intensity in non-ambulatory children with CP, warranting further investigation and refinement. Full article
38 pages, 401 KiB  
Article
The Use of Artificial Intelligence Tools for Religious Purposes: Empirical Research Among Hungarian Religious Communities
by Mónika Andok, Zoltán Rajki and Szilvia Dornics
Religions 2025, 16(8), 999; https://doi.org/10.3390/rel16080999 (registering DOI) - 31 Jul 2025
Viewed by 511
Abstract
This study empirically investigates the use of artificial intelligence (AI) tools within Hungarian religious communities, with a focus on Catholic respondents, to assess their awareness, application, and acceptance of AI in religious contexts. By religious communities, we do not mean monastic or priestly [...] Read more.
This study empirically investigates the use of artificial intelligence (AI) tools within Hungarian religious communities, with a focus on Catholic respondents, to assess their awareness, application, and acceptance of AI in religious contexts. By religious communities, we do not mean monastic or priestly communities, but rather communities of lay religious people. Conducted between 10 February and 11 March 2025, the questionnaire-based research (N = 133) employs Campbell’s Religious Social Shaping of Technology (RSST) framework to analyze attitudes toward AI across 15 religious functions. Six hypotheses explore gender differences, religiosity types (church-based vs. self-defined), and the acceptability, authenticity, and ethicality of AI applications. Findings reveal high acceptance for administrative tasks (e.g., email list updates: 64.7%) and technical functions (e.g., live translation: 65.4%), but low acceptance for spiritual roles (e.g., spiritual leadership: 12.8%). Self-defined religious individuals are significantly more accepting, perceiving AI as more authentic and ethical compared to those adhering to church teachings. No significant gender differences were found. The study contributes to digital religion studies, highlighting the influence of religiosity on AI adoption, though its non-representative sample limits generalizability. Full article
(This article belongs to the Special Issue Religious Communities and Artificial Intelligence)
24 pages, 2070 KiB  
Article
Reinforcement Learning-Based Finite-Time Sliding-Mode Control in a Human-in-the-Loop Framework for Pediatric Gait Exoskeleton
by Matthew Wong Sang and Jyotindra Narayan
Machines 2025, 13(8), 668; https://doi.org/10.3390/machines13080668 - 30 Jul 2025
Viewed by 281
Abstract
Rehabilitation devices such as actuated lower-limb exoskeletons can provide essential mobility assistance for pediatric patients with gait impairments. Enhancing their control systems under conditions of user variability and dynamic disturbances remains a significant challenge, particularly in active-assist modes. This study presents a human-in-the-loop [...] Read more.
Rehabilitation devices such as actuated lower-limb exoskeletons can provide essential mobility assistance for pediatric patients with gait impairments. Enhancing their control systems under conditions of user variability and dynamic disturbances remains a significant challenge, particularly in active-assist modes. This study presents a human-in-the-loop control architecture for a pediatric lower-limb exoskeleton, combining outer-loop admittance control with robust inner-loop trajectory tracking via a non-singular terminal sliding-mode (NSTSM) controller. Designed for active-assist gait rehabilitation in children aged 8–12 years, the exoskeleton dynamically responds to user interaction forces while ensuring finite-time convergence under system uncertainties. To enhance adaptability, we augment the inner-loop control with a twin delayed deep deterministic policy gradient (TD3) reinforcement learning framework. The actor–critic RL agent tunes NSTSM gains in real-time, enabling personalized model-free adaptation to subject-specific gait dynamics and external disturbances. The numerical simulations show improved trajectory tracking, with RMSE reductions of 27.82% (hip) and 5.43% (knee), and IAE improvements of 40.85% and 10.20%, respectively, over the baseline NSTSM controller. The proposed approach also reduced the peak interaction torques across all the joints, suggesting more compliant and comfortable assistance for users. While minor degradation is observed at the ankle joint, the TD3-NSTSM controller demonstrates improved responsiveness and stability, particularly in high-load joints. This research contributes to advancing pediatric gait rehabilitation using RL-enhanced control, offering improved mobility support and adaptive rehabilitation outcomes. Full article
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Article
Building Safe Emergency Medical Teams with Emergency Crisis Resource Management (E-CRM): An Interprofessional Simulation-Based Study
by Juan Manuel Cánovas-Pallarés, Giulio Fenzi, Pablo Fernández-Molina, Lucía López-Ferrándiz, Salvador Espinosa-Ramírez and Vanessa Arizo-Luque
Healthcare 2025, 13(15), 1858; https://doi.org/10.3390/healthcare13151858 - 30 Jul 2025
Viewed by 301
Abstract
Background/Objectives: Effective teamwork is crucial for minimizing human error in healthcare settings. Medical teams, typically composed of physicians and nurses, supported by auxiliary professionals, achieve better outcomes when they possess strong collaborative competencies. High-quality teamwork is associated with fewer adverse events and [...] Read more.
Background/Objectives: Effective teamwork is crucial for minimizing human error in healthcare settings. Medical teams, typically composed of physicians and nurses, supported by auxiliary professionals, achieve better outcomes when they possess strong collaborative competencies. High-quality teamwork is associated with fewer adverse events and complications and lower mortality rates. Based on this background, the objective of this study is to analyze the perception of non-technical skills and immediate learning outcomes in interprofessional simulation settings based on E-CRM items. Methods: A cross-sectional observational study was conducted involving participants from the official postgraduate Medicine and Nursing programs at the Catholic University of Murcia (UCAM) during the 2024–2025 academic year. Four interprofessional E-CRM simulation sessions were planned, involving randomly assigned groups with proportional representation of medical and nursing students. Teams worked consistently throughout the training and participated in clinical scenarios observed via video transmission by their peers. Post-scenario debriefings followed INACSL guidelines and employed the PEARLS method. Results: Findings indicate that 48.3% of participants had no difficulty identifying the team leader, while 51.7% reported minor difficulty. Role assignment posed moderate-to-high difficulty for 24.1% of respondents. Communication, situation awareness, and early help-seeking were generally managed with ease, though mobilizing resources remained a challenge for 27.5% of participants. Conclusions: This study supports the value of interprofessional education in developing essential competencies for handling urgent, emergency, and high-complexity clinical situations. Strengthening interdisciplinary collaboration contributes to safer, more effective patient care. Full article
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