Search Results (494)

Background and Objectives: Depression is a leading cause of disability globally, with treatment challenges including limited access, stigma, and poor adherence. Gamification, which applies game elements such as points, levels, and storytelling into non-game contexts, offers a promising strategy to enhance engagement and augment traditional treatments. Our research is the first study designed to explore the implementation of gamification within the Malaysian context. The objective was to explore the feasibility of implementation of gamification as an adjunctive treatment for adults with depression. Materials and Methods: Focus group discussions were held with five mental health professionals and ten patients diagnosed with moderate depression. The qualitative component assessed perceptions of gamified interventions, while quantitative measures evaluated participants’ depressive and anxiety symptomatology. Results: Three key themes were identified: (1) understanding of gamification as a treatment option, (2) factors influencing its acceptance, and (3) characteristics of a practical and feasible intervention. Clinicians saw potential in gamification to boost motivation, support psychoeducation, and encourage self-paced learning, but they expressed concerns about possible addiction, stigma, and the complexity of gameplay for some patients. Patients spoke of gaming as a source of comfort, escapism, and social connection. Acceptance was shaped by engaging storylines, intuitive design, balanced difficulty, therapist guidance, and clear safety measures. Both groups agreed that gamification should be used in conjunction with standard treatments, be culturally sensitive, and be presented as a meaningful therapeutic approach rather than merely as entertainment. Conclusions: Gamification emerges as an acceptable and feasible supplementary approach for managing depression in Malaysia. Its success depends on culturally sensitive design, robust clinical oversight, and seamless integration with existing care pathways. Future studies should investigate long-term outcomes and establish guidelines for the safe and effective implementation of this approach. We recommend targeted investment into culturally adapted gamified tools, including training, policy development, and collaboration with key stakeholders to realistically implement gamification as a mental health intervention in Malaysia. Full article

Background: Induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) hold transformative potential for cardiovascular regenerative medicine, yet their clinical application is hindered by suboptimal mitochondrial maturation and metabolic inefficiencies. This systematic review evaluates targeted strategies for optimizing mitochondrial function, integrating metabolic preconditioning, substrate selection, and pathway modulation to enhance energy production and cellular resilience. Additionally, we examine the role of extracellular matrix stiffness and mechanical stimulation in mitochondrial adaptation, given their influence on metabolism and maturation. Methods: A comprehensive analysis of recent advancements in iPSC-CM maturation was conducted, focusing on metabolic interventions that enhance mitochondrial structure and function. Studies employing metabolic preconditioning, lipid and amino acid supplementation, and modulation of key signaling pathways, including PGC-1α, AMPK, and mTOR, were reviewed. Computational modeling approaches predicting optimal metabolic shifts were assessed, alongside insights into reactive oxygen species (ROS) signaling, calcium handling, and the impact of electrical pacing on energy metabolism. Results: Evidence indicates that metabolic preconditioning with fatty acids and oxidative phosphorylation enhancers improves mitochondrial architecture, cristae density, and ATP production. Substrate manipulation fosters a shift toward adult-like metabolism, while pathway modulation refines mitochondrial biogenesis. Computational models enhance precision, predicting interventions that best align iPSC-CM metabolism with native cardiomyocytes. The synergy between metabolic and biomechanical cues offers new avenues for accelerating maturation, bridging the gap between in vitro models and functional cardiac tissues. Conclusions: Strategic metabolic optimization is essential for overcoming mitochondrial immaturity in iPSC-CMs. By integrating biochemical engineering, predictive modeling, and biomechanical conditioning, a robust framework emerges for advancing iPSC-CM applications in regenerative therapy and disease modeling. These findings pave the way for more physiologically relevant cell models, addressing key translational challenges in cardiovascular medicine. Full article

Background/Objectives: The integration of AI chatbots in nursing education, particularly in simulation-based learning, is advancing rapidly. However, there is a lack of structured evaluation models, especially to assess AI-generated simulations. This article introduces the AI-Integrated Method for Simulation (AIMS) evaluation framework, a dual-phase evaluation framework adapted from the FAITA model, designed to evaluate both prompt design and chatbot performance in the context of nursing education. Methods: This simulation-based study explored the application of an AI chatbot in an emergency planning course. The AIMS framework was developed and applied, consisting of six prompt-level domains (Phase 1) and eight performance criteria (Phase 2). These domains were selected based on current best practices in instructional design, simulation fidelity, and emerging AI evaluation literature. To assess the chatbots educational utility, the study employed a scoring rubric for each phase and incorporated a structured feedback loop to refine both prompt design and chatbox interaction. To demonstrate the framework’s practical application, the researchers configured an AI tool referred to in this study as “Eval-Bot v1”, built using OpenAI’s GPT-4.0, to apply Phase 1 scoring criteria to a real simulation prompt. Insights from this analysis were then used to anticipate Phase 2 performance and identify areas for improvement. Participants (three individuals)—all experienced healthcare educators and advanced practice nurses with expertise in clinical decision-making and simulation-based teaching—reviewed the prompt and Eval-Bot’s score to triangulate findings. Results: Simulated evaluations revealed clear strengths in the prompt alignment with course objectives and its capacity to foster interactive learning. Participants noted that the AI chatbot supported engagement and maintained appropriate pacing, particularly in scenarios involving emergency planning decision-making. However, challenges emerged in areas related to personalization and inclusivity. While the chatbot responded consistently to general queries, it struggled to adapt tone, complexity and content to reflect diverse learner needs or cultural nuances. To support replication and refinement, a sample scoring rubric and simulation prompt template are provided. When evaluated using the Eval-Bot tool, moderate concerns were flagged regarding safety prompts and inclusive language, particularly in how the chatbot navigated sensitive decision points. These gaps were linked to predicted performance issues in Phase 2 domains such as dialog control, equity, and user reassurance. Based on these findings, revised prompt strategies were developed to improve contextual sensitivity, promote inclusivity, and strengthen ethical guidance within chatbot-led simulations. Conclusions: The AIMS evaluation framework provides a practical and replicable approach for evaluating the use of AI chatbots in simulation-based education. By offering structured criteria for both prompt design and chatbot performance, the model supports instructional designers, simulation specialists, and developers in identifying areas of strength and improvement. The findings underscore the importance of intentional design, safety monitoring, and inclusive language when integrating AI into nursing and health education. As AI tools become more embedded in learning environments, this framework offers a thoughtful starting point for ensuring they are applied ethically, effectively, and with learner diversity in mind. Full article

Operations management personnel emphasize the maintenance of workforce empowerment on the shop floor. This is made possible by implementing effective operations and human resource management practices. However, organizations are adept at controlling the workforce empowerment domain within operational scenarios. In the current industry revolution scenario, industry personnel often face failure due to a laggard mindset in the face of industry revolutions. There are higher possibilities of failure because of standardized operations controlling the shop floor. Organizations utilize well-established human resource concepts, including McClelland’s acquired needs theory, Herzberg’s two-factor theory, and Maslow’s hierarchy of needs, in order to enhance the workforce’s performance on the shop floor. Current SME individuals require fast-paced approaches for tracking the performance and idleness of a workforce in order to control them more efficiently in both flexible and transformational stages. The present study focuses on investigating the parameters and factors that contribute to workforce empowerment in an industrial revolution scenario. The present research is used to develop a framework utilizing operations and human resource management approaches in order to identify and address the issues responsible for deteriorating workforce contributions. The framework includes HRM and operations management practices, including Herzberg’s two-factor theory, Maslow’s theory, and lean and smart approaches. The developed framework contains four phases for achieving desired outcomes on the shop floor. The developed framework is validated by implementing it in a real-life electric vehicle manufacturing organization, where the human resources and operations team were exhausted and looking to resolve employee-related issues instantly and establish a sustainable work environment. The current industry is transforming from Industry 3.0 to Industry 4.0, and seeks future-ready innovations in operations, control, and monitoring of shop floor setups. The operations management and human resource management practices teams reviewed the results over the next three months after the implementation of the developed framework. The results revealed an improvement in workforce empowerment within the existing work environment, as evidenced by reductions in the number of absentees, resignations, transfer requests, and medical issues, by 30.35%, 94.44%, 95.65%, and 93.33%, respectively. A few studies have been conducted on workforce empowerment by controlling shop floor scenarios through modifications in operations and human resource management strategies. The results of this study can be used to fulfil manufacturers’ needs within confined constraints and provide guidelines for efficiently controlling workforce performance on the shop floor. Constraints refer to barriers that have been decided, including production time, working time, asset availability, resource availability, and organizational policy. The study proposes a decision-making plan for enhancing shop floor performance by providing suitable guidelines and an action plan, taking into account both workforce and operational performance. Full article

Cardiac devices have transformed the management of heart failure, ventricular arrhythmias, ischemic cardiomyopathy, and valvular heart disease. Technologies such as cardiac resynchronization therapy (CRT), conduction system pacing, left ventricular assist devices (LVADs), and implantable cardioverter-defibrillators have contributed to abated global cardiovascular risk through action onto pathophysiological processes such as mechanical unloading, electrical resynchronization, or hemodynamic optimization, respectively. While their clinical benefits are well established, their long-term molecular and structural effects on the myocardium remain under investigation. Cardiac devices dynamically interact with myocardial and vascular biology, inducing molecular and extracellular matrix adaptations that vary by pathology. CRT enhances calcium cycling and reduces fibrosis, but chronic pacing may lead to pacing-induced cardiomyopathy. LVADs and Impella relieve ventricular workload yet alter sarcomeric integrity and mitochondrial function. Transcatheter valve therapies influence ventricular remodeling, conduction, and coronary flow. Understanding these remodeling processes is crucial for optimizing patient selection, device programming, and therapeutic strategies. This narrative review integrates the current knowledge on the molecular and structural effects of cardiac devices, highlighting their impact across different disease settings. Full article

Rowing is a cyclic sport that consists of repetitive biomechanical actions, with performance being influenced by the balance between propulsive and resistive forces. The current study aimed to assess the relationships between intracycle velocity variation (IVV) and key biomechanical and performance variables in male and female single scullers. Twenty-three experienced rowers (10 females) completed a 2000 m rowing competition, during which boat position and velocity were measured using a 15 Hz GPS, while cycle rate was derived from the integrated triaxial accelerometer sampling at 100 Hz. From these data, it was possible to calculate distance per cycle, IVV, the coefficient of velocity variation (CVV), and technical index values. Males presented higher mean, maximum and minimum velocity, distance per cycle, CVV, and technical index values than females (15.40 ± 0.81 vs. 13.36 ± 0.88 km/h, d = 0.84; 21.39 ± 1.68 vs. 18.77 ± 1.52 km/h, d = 1.61; 11.15 ± 1.81 vs. 9.03 ± 0.85 km/h, d = 1.45; 7.68 ± 0.32 vs. 6.89 ± 0.97 m, d = 0.69; 14.13 ± 2.02 vs. 11.64 ± 1.93%, d = 2.06; and 34.25 ± 4.82 vs. 26.30 ± 4.23 (m²/s·cycle), d = 4.56, respectively). An association between mean velocity and intracycle IVV, CVV, and cycle rate (r = 0.68, 0.74 and 0.65, respectively) was observed in males but not in female single scullers (which may be attributed to anthropometric specificities). In female single scullers, mean velocity was related with distance per cycle and was associated with technical index in both males and females (r = 0.76 and 0.66, respectively). Despite these differences, male and female single scullers adopted similar pacing strategies and CVV remained constant throughout the 2000 m race (indicating that this variable might not be affected by fatigue). Differences were also observed in the velocity–time profile, with men reaching peak velocity first and having a faster propulsive phase. Data provided new information on how IVV and CVV relate to commonly used biomechanical variables in rowing. Technical index (r = 0.87): distance per cycle was associated with technical index in both males and females (r = 0.76 and 0.66, respectively). Future studies should include other boat classes and other performance variables such as the power output and arc length. Full article

Peanut (Arachis hypogaea L.) is a globally important oilseed cash crop, yet its limited genetic diversity and unique reproductive biology present persistent challenges for conventional crossbreeding. Traditional breeding approaches are often time-consuming and inadequate, mitigating the pace of cultivar development. Essential for double fertilization and programmed cell death (PCD), DUF679 membrane proteins (DMPs) represent a membrane protein family unique to plants. In the present study, a comprehensive analysis of the DMP gene family in peanuts was conducted, which included the identification of 21 family members. Based on phylogenetic analysis, these genes were segregated into five distinct clades (I–V), with AhDMP8A, AhDMP8B, AhDMP9A, and AhDMP9B in clade IV exhibiting high homology with known haploid induction genes. These four candidates also displayed significantly elevated expression in floral tissues compared to other organs, supporting their candidacy for haploid induction in peanuts. Subcellular localization prediction, confirmed through co-localization assays, demonstrated that AhDMPs primarily localize to the plasma membrane, consistent with their proposed roles in the reproductive signaling process. Furthermore, chromosomal mapping and synteny analyses revealed that the expansion of the AhDMP gene family is largely driven by whole-genome duplication (WGD) and segmental duplication events, reflecting the evolutionary dynamics of the tetraploid peanut genome. Collectively, these findings establish a foundational understanding of the AhDMP gene family and highlight promising targets for future applications in haploid induction-based breeding strategies in peanuts. Full article

Right ventricular apex (RVA) pacing has historically been the default approach for cardiac pacing; however, it is associated with the development of progressive left ventricular dysfunction and heart failure (HF), particularly in patients with high pacing burdens. While advances in device programming and modern algorithms have sought to mitigate these effects, preserving physiological activation has proven to be more critical than reducing ventricular pacing. Conduction system pacing (CSP) techniques—namely, His-bundle pacing (HBP) and particularly left bundle branch area pacing (LBBAP)—have emerged as superior alternatives, enabling improved left ventricular function and reduced rates of pacing-induced cardiomyopathy (PICM). Nevertheless, despite the clinical advantages of these procedures over RVA, they face limitations including variable implantation success rates, increased pacing thresholds and lead revision rates, technical challenges, and occasional procedure prolongation. Thus, while CSP approaches represent the future of physiological pacing, RVA pacing continues to provide a necessary and reliable option in the current clinical practice. Full article

Although measurements of urban shrinkage in China have received much attention, most have relied on statistical yearbook data based on political–administrative city boundaries, and remote-sensing-based quantification is mainly one-dimensional. This has caused problems in incorporating rural areas and spatiotemporal inconsistencies, as well as an inadequate understanding, which has subsequently resulted in an inaccurate shrinkage identification. This study merely utilized the latest multisensory and time-series remote sensing data, including nighttime light, land use, and population grids, to quantify the spatiotemporal patterns of multidimensional shrinkage based on the county-level urban entity mapping of Yangtze River Delta urban agglomerations (YRD-UAs) from 2003 to 2023. County-level urban entities were acquired from a pioneering mapping effort that utilized city-specific commuting distance and land use maps. The results demonstrated that urban entities in 215 counties grew at a generally slowing pace. The degree of economic, population, and space shrinkage was mainly slight, and the shrinking trajectory was dominated by temporary shrinkage. Most counties experienced population shrinkage in their coastal-oriented distribution, whereas economic shrinkage affected the fewest counties, with the lowest spatial clustering occurring northward. Population shrinkage also displayed the highest spatial autocorrelation, but its agglomeration weakened against space shrinkage clustering. This study concluded that the exclusive utilization of remote sensing products to measure urban-entity-based multidimensional shrinkage reduced the uncertainty associated with rural area inclusion and resulted in satisfactory assessment accuracy. The spatiotemporal patterns of multidimensional shrinkage suggested strengthening ecological land allocation within urban entities across the entire region, implementing polycentric development strategies in the north, as well as enhancing county-level economic governance in the northwest. This study presents a spatiotemporally comparable methodology for quantifying the multidimensional shrinking of county-level urban entities at a large scale and contributes to further optimizing the developments of YRD-UAs. Full article

This research aims to explore the role of architecture in creating an identifiable brand for Amman. It seeks to put forward a vision through which Amman’s city can formulate a clear model for implementing a successful branding strategy. In doing so, this research studies the concepts associated with the ideas of branding, city image and identity, and the extent to which such ideas are to be implemented in Amman. The study adopted an inductive approach using in-depth, semi-structured interviews with 35 experts with central roles in stating the city’s key values that best reflect the city’s identity. A thematic analysis was conducted in line with theoretical aspects, including the city’s message, strategies for formulating the brand, and communication via architecture. The image of Amman shows an obvious distinction between its historical character and modern global styles as it suffers from disorder within its architectural landscape. Amman needs to rethink its identity in order to create a new brand that keeps pace with time without losing the originality of the place. This calls for re-evaluating the role of the iconic buildings and their associations with the surroundings, enabling them to become of significant presence, both symbolically and operationally, in expressing the city’s personality and promoting its message. Full article

The aging process is a complex and dynamic phenomenon influenced by genetic, environmental, and biochemical factors. One of the key contributors to aging and age-related diseases is oxidative stress, resulting from an imbalance between the generation of reactive oxygen species (ROS) and the efficiency of antioxidant defense systems. In this review, we introduce the concept of the oxidative stress complexity—a network encompassing ROS-generating systems, enzymatic and non-enzymatic antioxidants, and genetic determinants that collectively shape redox homeostasis. Emerging research highlights the significant influence of genetic variability on the activity and expression of selected and most examined antioxidant enzymes, including superoxide dismutase (SOD), paraoxonase 1 (PON1), catalase (CAT), and glutathione peroxidase (GPX), thereby modulating individual susceptibility to oxidative damage, disease onset, and the pace of aging. Particular attention is paid to the interplay among oxidative stress, chronic inflammation, and metabolic dysfunction in the pathogenesis of various age-related disorders. By integrating findings from molecular studies, clinical research, and population genetics, we discuss the diagnostic and prognostic potential of antioxidant enzymes as biomarkers of aging and explore strategies for redox-modulating interventions. Understanding these interrelations is essential for identifying biomarkers of biological aging and developing personalized strategies aimed at promoting healthy aging and reducing the risk of chronic disease. Full article

Background: Optimal nutrition and training regimens are essential for athletes to maximize performance and recovery. Probiotic supplementation, through the modulation of the gut microbiota, and omega-3 fatty acids, known for their anti-inflammatory properties, may enhance physiological adaptations when combined with targeted training. This study evaluated the effects of probiotics and omega-3 supplementation, alongside ultra-short race pace training (USRPT), on performance metrics in competitive sprint swimmers. Methods: In this double-blind, placebo-controlled study, 60 male sprint swimmers (age: 19.2 ± 3.6 years; height: 182.2 ± 5.2 cm; weight: 81.6 ± 4.4 kg) with a minimum of five years of training experience, were randomly assigned to six groups (n = 10 per group): (1) Control (CON), (2) USRPT only, (3) Placebo + USRPT (PLA + USRPT), (4) Probiotics + USRPT (PRO + USRPT), (5) Omega-3 + USRPT (OMEGA + USRPT), and (6) Probiotics + Omega-3 + USRPT (PRO + OMEGA + USRPT). Over the eight-week intervention, the participants in PRO + USRPT consumed one multi-strain probiotic capsule daily (4.5 × 10¹¹ CFU) and a placebo capsule. Those in OMEGA + USRPT ingested 1000 mg of fish oil after lunch (500 mg EPA and 180 mg DHA per capsule) paired with a placebo capsule. The combined supplementation group (PRO + OMEGA + USRPT) received both probiotic and omega-3 capsules. The PLA + USRPT group consumed two starch capsules daily. The USRPT protocol was implemented across all the training groups, where the swimmers performed 17 sets of 25 m and 12.5 m sprints based on weekly recorded race times. Performance assessments included pre- and post-test measurements of sprint times (50 m and 100 m freestyle), vertical jump tests (both in water and on dry land), and other strength and endurance metrics (reaction time, agility T-test, sprint index, fatigue index, and velocity). Results: The combined intervention of probiotics and omega-3 with USRPT produced the greatest improvements in performance. The PRO + OMEGA + USRPT group reduced 50 m freestyle time by 1.92% (p = 0.002, pEta² = 0.286) and 100 m freestyle time by 2.48% (p = 0.041, pEta² = 0.229), demonstrating significant Time × Group interactions consistent with a synergistic effect. Additionally, the sprint index improved (pEta² = 0.139, p = 0.013) and reaction time decreased (pEta² = 0.241, p = 0.009) in the combined group, indicating enhanced anaerobic capacity and neuromuscular responsiveness compared to single interventions. Conclusions: This study suggests that combining probiotics and omega-3 supplementation with USRPT leads to synergistic improvements in sprint swimming performance, enhancing anaerobic power and recovery beyond what is achieved with individual interventions. This integrated approach may provide a practical strategy for competitive swimmers seeking to optimize their performance. Future studies should incorporate mechanistic markers, longer intervention durations, and diverse athlete populations to clarify further and extend these findings. Full article

Objectives: This review aims to systematically evaluate the clinical outcomes of left ventricle-only fusion pacing (LV-only fCRTp) and identify evidence-based selection criteria that may optimize patient response and long-term therapeutic benefit. Background: Cardiac resynchronization therapy (CRT) is traditionally associated with biventricular pacing (BiVp). However, approximately 20–40% of patients seem to remain non-responders to this therapy. LV-only fCRTp offers a more physiological alternative by combining left ventricular epicardial pacing with the intrinsic ventricular activation wavefront. Beyond optimization strategies, the observed variability in response highlights the need for better patient selection in order to fully unlock its therapeutic potential. Methods: A systematic literature search was conducted in PubMed and Cochrane Library for original articles published up to April 2025, following PRISMA 2020 guidelines. The search focused on LV-only fCRTp performed either through standard RA/LV/RV biventricular devices or RA/LV dual-chamber systems. Results: Twenty-seven studies met the inclusion criteria. Among these, 17 studies obtained LV-only fCRTp using biventricular devices, and 10 were considered true LV-only fCRTp using RA/LV dual-chamber devices. Standard and specific selection criteria were used to qualify patients for LV-only fCRTp. Preserved atrioventricular conduction, ischemic cardiomyopathy, arrhythmic risk stratification, and the management of supraventricular arrhythmias were common overlapping parameters among studies with high variability, highlighting their potential role in response. RA/LV devices yielded consistent clinical benefits and low complication rates, particularly in nonischemic patients with stable AV conduction and low arrhythmic risk, while having a lower financial burden. Conclusions: Beyond guideline recommendations for CRT, this review identifies supplementary selection criteria that could further influence the effectiveness and stability of fusion pacing. Full article

Background: Parental burnout is one of today’s significant challenges, increasingly manifesting as a problem in our fast-paced world. The aim of this review is to create an exploratory, descriptive summary of parental burnout through the analysis of available international publications, providing a clearer and more accurate understanding of the psychological condition, severity, manifestations, and treatment options. Methods: Our narrative literature review includes publications from 2010 onwards, focusing on those that directly address the topic of parental burnout syndrome and contain epidemiological data, risk factors, symptoms, diagnostic possibilities, and treatment strategies. We excluded publications that examined the condition within narrow societal groups, such as parents caring for children with somatic mental disorders. Results: Based on our review, it appears that parental burnout may potentially affect both women and men. Factors such as low emotional intelligence, workplace stress, and lack of supportive family background render parents vulnerable to this condition. Significant differences in the prevalence of parental burnout can be measured between countries, due to cultural differences. Parental burnout has extremely detrimental effects on family dynamics and the emotional development of children, and it can negatively impact the willingness to have more children at the family level, which has dire consequences considering the low birth rates characteristic of European countries. Full article

This article reviews and discusses the behaviours and patterns associated with panic evacuations, as documented in the literature, which must be considered when analysing and modelling such events. This article does not take the form of a typical research article but, rather, a review of previous studies alongside its own commentary. The studies analysed in this article were selected according their ability to provide a new perspective. Where possible, diverse perspectives from existing research have been contrasted with the author’s own observations and reflections. Structured as an overview, this article introduces subsequent analyses and highlights several non-intuitive questions that arose during the investigation. This study examines the relationship between movement velocity and crowd density, comparing experimental data with simulations conducted to date. It also explores the connections between flow rate, crowd density, and velocity and suggests potential directions for further research in this field. Additionally, this article addresses the loss of evacuation coordination under crowding conditions and presents studies that demonstrate optimal evacuation at speeds that differ from the so-called comfortable pace. The positive effects of strategically placed obstacles in reducing congestion and improving evacuation times are also analysed. This literature review is conducted from a practical perspective, with the primary aim of deepening our understanding of panic evacuation phenomena. Furthermore, this article categorises the impact of various phenomena associated with stampedes and panic evacuations on the requirements for safe evacuation. A tabular summary of the technical and structural measures for evacuation is provided, which may prove useful in designing effective evacuation strategies when dealing with heightened emotional states among evacuees. Full article