Search Results (80)

Background: Chronic pain affects nearly one in five adults worldwide and is increasingly recognized not only as a disease but as a potential risk factor for neurocognitive decline and dementia. While some evidence supports this association, existing systematic reviews are static and rapidly outdated, and none have leveraged advanced methods for continuous updating and robust uncertainty modeling. Objective: This protocol describes a living systematic review with dose–response Bayesian meta-analysis, enhanced by artificial intelligence (AI) tools, to synthesize and maintain up-to-date evidence on the prospective association between any type of chronic pain and subsequent cognitive decline. Methods: We will systematically search PubMed, Embase, Web of Science, and preprint servers for prospective cohort studies evaluating chronic pain as an exposure and cognitive decline as an outcome. Screening will be semi-automated using natural language processing models (ASReview), with human oversight for quality control. Bayesian hierarchical meta-analysis will estimate pooled effect sizes and accommodate between-study heterogeneity. Meta-regression will explore study-level moderators such as pain type, severity, and cognitive domain assessed. If data permit, a dose–response meta-analysis will be conducted. Living updates will occur biannually using AI-enhanced workflows, with results transparently disseminated through preprints and peer-reviewed updates. Results: This is a protocol; results will be disseminated in future reports. Conclusions: This living Bayesian systematic review aims to provide continuously updated, methodologically rigorous evidence on the link between chronic pain and cognitive decline. The approach integrates innovative AI tools and advanced meta-analytic methods, offering a template for future living evidence syntheses in neurology and pain research. Full article

Streptococcus pneumoniae remains a leading cause of invasive diseases, particularly affecting young children and the elderly. Currently, two main types of pneumococcal vaccines are commercially available: polysaccharide vaccine (PPSV23) and conjugate vaccines (e.g., PCV20). Of over 100 identified pneumococcal serotypes, vaccines targeting 24 serotypes covered by PPSV23 and PCV20 (19 serotypes overlap between the two vaccines) have been developed, with serotype distribution varying by geography, age, and time. The immune response to pneumococcal vaccines differs across serotypes, vaccine types (polysaccharide vs. conjugate), and host factors. Quantitative methods for antibody assessment—particularly newer high-throughput assays—have emerged since 2000 to address limitations in conventional approaches. However, these methods have not been comprehensively reviewed. This scoping review aimed to systematically map the existing literature on quantitative methods used to assess antibody responses to pneumococcal vaccines. Specific objectives included the following: 1. summarizing conventional and novel quantitative immunoassays; 2. evaluating the current state of validation and application of these methods; 3. identifying knowledge gaps and methodological challenges. We followed the PRISMA-ScR guidelines. We included the following: 1. peer-reviewed, open-access papers related to immunoassays used for pneumococcal antibody assessment; 2. articles written in English; 3. Studies published between 2000 and 2023. We excluded the following: 4. studies focusing on other pathogens, employing different analytical methods, or using animal models. Articles meeting the eligibility criteria were primarily retrieved from PubMed and Scopus. If free full-text versions were unavailable there, Google Scholar or the original journal databases were consulted. All references were exported to EndNote 20 for further management. At the beginning of the review, a data-charting form was developed based on prior studies and commonly addressed themes. Additional charts were created to accommodate newly identified variables during the review. All charting tools were reviewed and finalized through discussion among all research team members. The included studies were classified into five thematic groups: 1. general descriptions of quantitative assessment methods, 2. assay development and validation, 3. comparative studies, 4. technical details of assay development, 5. interpretation of assay application findings. Of 1469 articles from PubMed and 2946 articles from Scopus initially identified, 55 articles met the inclusion criteria. The earliest methods included radioimmunoassays, later replaced by WHO-standardized ELISA. While ELISA remains the gold standard, it is limited by labor, cost, and throughput. Multiplex immunoassays (MIAs), including Luminex-based platforms, have demonstrated advantages in efficiency and scalability. However, many MIAs did not initially meet WHO validation criteria. More recent assays show an improved performance, yet interlaboratory variability and lack of standardized protective thresholds remain major limitations. This review provides the first comprehensive mapping of quantitative antibody assessment methods for pneumococcal vaccines. Although ELISA continues to serve as the benchmark, MIAs represent a promising next-generation approach. Continued efforts are needed to harmonize assay validation protocols and establish global standards for protective thresholds, which will enhance the reliability of vaccine efficacy monitoring across diverse populations. Full article

Pregnancy induces substantial anatomical, hormonal, and biomechanical changes in the spine and pelvis to accommodate fetal growth and maintain postural adaptation. This narrative review synthesizes peer-reviewed evidence regarding pregnancy-related spinal biomechanics, with a particular focus on low back pain, spinopelvic alignment, sacroiliac joint dysfunction, and potential contributions to degenerative spinal conditions. A systematic search of PubMed, Embase, and Google Scholar was conducted using Boolean operators and relevant terms, yielding 1050 unique records, with 53 peer-reviewed articles ultimately cited. The review reveals that increased lumbar lordosis, ligamentous laxity, altered gait mechanics, and muscular deconditioning elevate mechanical load on the lumbar spine, predisposing up to 56% of pregnant individuals to low back pain. These changes are often associated with sacroiliac joint laxity, anterior pelvic tilt, and multiparity. Long-term risks may include degenerative disc disease and spondylolisthesis. Conservative interventions such as pelvic floor muscle training, prenatal exercise, and surface topography monitoring offer symptom relief and support early rehabilitation, although standardized protocols and longitudinal outcome data remain limited. Pregnancy-related spinal changes are multifactorial and clinically relevant; an interdisciplinary approach involving spinal biomechanics, physical therapy, and obstetric care is critical for optimizing maternal musculoskeletal health. Full article

The construction industry is undergoing a significant transformation due to the increasing influence of digital technology, sustainability requirements, and diverse stakeholder expectations, which highlights the need to update the existing service quality models accordingly. However, the traditional service quality models often fail to address these evolving demands comprehensively. This study systematically reviews 44 peer-reviewed articles to identify the key service quality dimensions and offer clear guidance for future research that can address the complexities of modern construction. The findings reveal that reliability, tangibles, and communication remain the most emphasized dimensions across the reviewed literature, whereas critical areas, such as digital integration, sustainability indicators, and service recovery, are significantly underexplored. This contrast explicitly links the limitations of the classic frameworks to these emerging demands, highlighting their difficulty in accommodating the industry’s growing reliance on real-time data, an environmentally friendly performance, and multi-stakeholder collaboration. Because the construction industry typically contributes 6–10 per cent of the national GDP and underpins wider economic development, inadequate service quality models can propagate cost overruns, productivity losses, and reputational damage across the economy; conversely, improved models enhance project efficiency, and thus support sustained economic growth. This review is limited by its reliance on the Scopus and Web of Science databases, which may exclude relevant regional or non-English studies. Furthermore, many reviewed articles are context-specific, potentially reducing the generalizability of the findings. Despite these limitations, this review offers an evidence-based framework that integrates advanced digital tools, sustainability measures, and diverse stakeholder perspectives. Future studies should demonstrate this framework’s efficacy and applicability in different circumstances. Full article

Background: Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder that continues into adulthood and is linked to significant academic, occupational, and psychological challenges. Medical students may be at heightened risk due to the cognitive and emotional demands of their training. However, regional data on adult ADHD symptoms in this population, particularly in northern Saudi Arabia, remain limited. Objective: to estimate the prevalence of probable adult ADHD symptoms among medical students at the University of Tabuk and to examine the associated sociodemographic, academic, and health-related factors. Methods: A cross-sectional, web-based survey was conducted between 15 May and 5 June 2025 among randomly selected Saudi medical students (years 2–6) at the University of Tabuk. The validated Arabic version of the WHO Adult ADHD Self-Report Scale (ASRS-v1.1) was used to screen for probable ADHD. A positive screen was defined as ≥4 flagged items. Descriptive and bivariate analyses were performed using SPSS v29. Results: Of the 219 respondents (60.3% male; mean age: 21.6 years), 23.3% screened positive for probable adult ADHD. Symptom frequency peaked in the third (40.0%) and fourth (35.6%) academic years and was lowest among sixth-year students (11.4%) (p = 0.012). A strong association was observed between positive ADHD screening and self-reported psychiatric disorders (p < 0.001). No statistically significant associations were found for gender, income, GPA, marital status, or academic phase. Conclusions: Nearly one in four medical students at the University of Tabuk exhibited symptoms suggestive of adult ADHD, a prevalence markedly higher than global estimates and consistent with regional trends. The association with psychiatric morbidity and the mid-programme peak suggests a need for proactive screening, mental health support, and academic accommodations. Universities can translate these findings into practice by instituting routine ADHD screening, offering flexible assessment accommodations, embedding peer-mentoring programmes, and strengthening on-campus mental-health referral pathways. Full article

Business Continuity Management (BCM) is critical for organizations to mitigate disruptions and maintain operations, yet many struggle with fragmented and non-standardized self-assessment tools. Existing frameworks often lack holistic integration, focusing narrowly on isolated components like cyber resilience or risk management, which limits their ability to evaluate BCM maturity comprehensively. This research addresses this gap by proposing a structured Self-Assessment System designed to unify BCM components into an adaptable, standards-aligned methodology. Grounded in Design Science Research, the system integrates a BCM Model comprising eight components and 118 activities, each evaluated through weighted questions to quantify organizational preparedness. The methodology enables organizations to conduct rapid as-is assessments using a 0–100 scoring mechanism with visual indicators (red/yellow/green), benchmark progress over time and against peers, and align with international standards (e.g., ISO 22301, ITIL) while accommodating unique organizational constraints. Demonstrated via focus groups and semi-structured interviews with 10 organizations, the system proved effective in enhancing top management commitment, prioritizing resource allocation, and streamlining BCM implementation—particularly for SMEs with limited resources. Key contributions include a reusable self-assessment tool adaptable to any BCM framework, empirical validation of its utility in identifying weaknesses and guiding continuous improvement, and a pathway from initial assessment to advanced measurement via the Plan-Do-Check-Act cycle. By bridging the gap between theoretical standards and practical application, this research offers a scalable solution for organizations to systematically evaluate and improve BCM resilience. Full article

(1) Background: Traumatic brain injury (TBI) is caused from rapid head acceleration/deceleration, focal blows, blasts, penetrating forces, and/or shearing forces, whereas hypoxic–anoxic injury (HAI) is caused through oxygen deprivation events, including strangulation. Most service-seeking domestic violence (DV) survivors have prior mechanistic exposures that can lead to both injuries. At the time of our study, some evidence existed about the exposure to both injuries over the course of a survivor’s lifetime from abuse sources, yet little was known about their co-occurrence to the same survivor within the same episode of physical intimate partner violence (IPV). To better understand the lived experience of service-seeking DV survivors and the context in which partner-inflicted brain injury (PIBI) is sustained, we sought to understand intentional brain injury (BI) exposures that may need to be addressed and accommodated in services. Our aims were to 1. characterize the lifetime co-occurrence of strangulation and intentional head trauma exposures from all abuse sources to the same survivor and within select physical episodes of IPV and 2. establish the lifetime prevalence of PIBI. (2) Methods: Survivors seeking DV services in the state of Ohio in the United States of America (U.S.) completed interview-administered surveys in 2019 (n = 47). Community-based participatory action approaches guided all aspects of the study development, implementation, and interpretation. (3) Results: The sample was primarily women. Over 40% reported having Medicaid, the government-provided health insurance for the poor. Half had less than a postsecondary education. Over 80% of participants presented to DV services with both intentional head trauma and strangulation exposures across their lifetime from intimate partners and other abuse sources (i.e., child abuse, family violence, peer violence, sexual assault, etc.), though not always experienced at the same time. Nearly 50% reported an experience of concurrent head trauma and strangulation in either the first or last physical IPV episode. Following a partner’s attack, just over 60% reported ever having blacked out or lost consciousness—44% experienced a loss of consciousness (LOC) more than once—indicating a conservative estimate of a probable brain injury by an intimate partner. Over 80% of service-seeking DV survivors reported either a LOC or two or more alterations in consciousness (AICs) following an IPV attack and were classified as ever having a partner-inflicted brain injury. (4) Conclusions: Most service-seeking IPV survivors experience repetitive and concurrent exposures to abusive strangulation and head trauma through the life course and by intimate partners within the same violent event resulting in brain injury. We propose the use of the term partner-inflicted brain injury (PIBI) to describe the physiological disruption of normal brain functions caused by intentional, often concurrent and repeated, traumatic and hypoxic neurologic insults by an intimate partner within the context of ongoing psychological trauma, coercive control, and often past abuse exposures that could also result in chronic brain injury. We discuss CARE (Connect, Acknowledge, Respond, Evaluate), a brain-injury-aware enhancement to service delivery. CARE improved trauma-informed practices at organizations serving DV survivors because staff felt knowledgeable to address and accommodate brain injuries. Survivor behavior was then interpreted by staff as a “can’t” not a “won’t”, and social and functional supports were offered. Full article

The competitiveness of tourism destinations is a multidimensional concept encompassing natural and cultural resources, infrastructure, accessibility, and services that cater to an increasingly discerning tourism market. Business ecosystems enhance these competitive conditions by adapting to consumers seeking high-value, differentiated experiences. This study examined the relationship between accommodation supply and tourist expenditure in the Canary Islands based on a sample of 38,071 visitors from the 2024 Tourist Expenditure Survey (EGT) of the Canary Islands Statistics Institute. Using Python and R for statistical processing, the findings revealed distinct spending patterns across accommodation types, from five-star hotels to peer-to-peer rentals, demonstrating how supply diversification influences competitiveness. The results reinforce prior research on the significance of investing in infrastructure, technology, and human capital to optimise the tourist experience. Tourist expenditure serves as an indicator of competitiveness, reflecting visitor preferences and the destination’s capacity to meet them. Accommodation choice is identified as a key determinant of spending patterns and their distribution within the local economy. This study provides an analytical basis for evaluating tourism strategies, emphasising the strategic importance of accommodation heterogeneity. It advances methodological understanding of tourist spending behaviour, offering a practical framework for destination development and strategic planning. Full article

Background: Over the past decade, Italy has made progress in adopting recovery-oriented approaches in mental health care, though full alignment with international guidelines remains incomplete. This study investigates the feasibility, acceptability, and impact of integrating recovery-oriented practices in an Italian Community Mental Health Service (CMHS), focusing on both user and professional perspectives to identify strengths and areas for improvement. Methods: A longitudinal pilot study was conducted at the South Verona CMHS. Data on users’ socio-demographic and clinical characteristics, symptoms, functioning, needs, and autonomy were collected at baseline and six-month follow-up. Participants included individuals in supported accommodation and outpatient care. The Mental Health Recovery Star (MHRS) assessed recovery progress. Qualitative data from focus groups and interviews captured users’ and professionals’ experiences. Results: Nineteen professionals completed the MHRS with 25 users, who demonstrated significant improvements in MHRS scores (p = 0.003), romantic relationships (p < 0.001), employment (p < 0.001), functioning (p = 0.015), psychopathology (p = 0.001), functional autonomy (p = 0.003), and unmet needs (p = 0.026). Qualitative findings emphasized the value of a personalized, holistic approach but noted gaps in follow-up and shared decision-making. Focus groups (30 participants) highlighted recovery as a process of hope, meaning, and empowerment. Participants called for ongoing education, structural changes, and peer-support initiatives. Professionals reported increased motivation. Conclusions: Integrating recovery-oriented practices within the South Verona CMHS was both feasible and acceptable. The MHRS positively impacted service users’ personal recovery and professionals’ motivation. The study underscores the need for continued training, structural reforms, and peer-support initiatives to foster lasting changes and enhance CMHS practices. Full article

Caregivers of children with chronic conditions face daily challenges and a lower quality of life, which may be improved through peer support. This scoping review explored the literature on formal caregiver-to-caregiver mentorship programs, identifying strategies to inform future programs. Using Arskey and O’Malley’s framework, we searched five databases for peer-reviewed literature on caregiver-to-caregiver mentorship programs for adult caregivers caring for children (≤18 years) with chronic conditions. Thematic analysis was performed on relevant articles. Of the 10 064 search hits, 109 were included after full-text screening. Theme 1, “Mentorship adds to medical support”, reflected how mentorship can complement medical care provided by healthcare teams. Theme 2, “Successful mentorship requires the right mentors”, highlighted the qualities of mentors crucial for effective mentorship, mentor-matching practices, and training areas for mentors. Theme 3, “Mentorship programs should balance structure and flexibility”, emphasized the importance of allowing for flexibility to accommodate diverse family needs. Theme 4, “Mentorship programs face common challenges”, summarized the challenges frequently faced when implementing mentorship programs. The study findings suggest that the success of mentorship programs hinge on factors including a flexible program structure, knowledgeable and dedicated mentors, and an infrastructure in place for supporting both the mentors and the financial needs of the program. Full article

Background: Ableism obstructs employment equity for disabled individuals. However, research lacks a comprehensive understanding of how ableism multidimensionally manifests across job types, disability types, stages of employment, and intersecting identities. Objectives: This scoping review examines how ableism affects disabled workers and jobseekers, as well as its impacts on employment outcomes, variations across disabilities and identities, and the best practices for addressing these. Eligibility Criteria: The included articles were 109 peer-reviewed empirical studies conducted in the US, Canada, Australia, New Zealand, the UK, Ireland, Denmark, Sweden, Iceland, Norway, and Finland between 2018 and 2023. Sources of Evidence: Using terms related to disability, ableism, and employment, the databases searched included Sociology Collection, CINAHL, PsycInfo, Web of Science, SCOPUS, Education Source, Academic Search Complete, and ERIC. Charting Methods: Data were extracted in tabular form and analyzed through thematic narrative synthesis to identify study characteristics, ableist barriers within employment, intersectional factors, and best practices. Results: Ableism negatively impacts employment outcomes through barriers within the work environment, challenges in disclosing disabilities, insufficient accommodations, and workplace discrimination. Intersectional factors intensify inequities, particularly for BIPOC, women, and those with invisible disabilities. Conclusions: Systemic, intersectional strategies are needed to address ableism, improve policies, and foster inclusive workplace practices. Full article

The ability to communicate effectively in writing and produce clear and cohesive text is a necessary skill in both educational settings and the workplace, yet many young students struggle to organize their thoughts and engage in deep thinking. To address these challenges, an augmented reality (AR) application titled “Explore Wild Animals” has been used to help students organize information; however, it may not accommodate different cognitive styles. Integrating formative peer assessment (FPA) strategy into AR-based instruction can enhance knowledge construction and address diverse cognitive needs. This study, conducted from May to June 2023, empirically investigates the effects of FPA in an AR environment on the writing performance of learners with field-independent (FI) and field-dependent (FD) cognitive styles. A total of 89 fifth-grade pupils from China were randomly assigned to two groups: one group adopting FPA in an AR environment (AR-FPA), and the other group adopting FPA in a conventional PowerPoint (PPT) version 2410 environment (FPA). The results of a two-way analysis of covariance (ANCOVA) indicate that the AR-FPA group outperformed the FPA group in writing performance. Specifically, FI learners benefitted more from the AR-FPA approach, while FD learners performed better with the FPA approach. However, multiple linear regression analysis reveals that the peer feedback quality and features showed little to no significant correlation with feedback providers’ writing performance, regardless of cognitive style. These results highlight the effectiveness of integrating AR and FPA in enhancing educational outcomes, providing practical insights for promoting the sustainability of technology-enhanced learning and teaching practices. Full article

The case of Hellen Keller presents a great example of what a learner who is deafblind can achieve if provided with the appropriate educational accommodation in terms of content, environment, learning approach, instructional strategies, and teaching methodologies. However, access to education is not the reality for most learners who are deafblind due to their unique educational needs, owing to their dual sensory impairment. There has been an assertion that learners who are deafblind may not thrive in inclusive educational spaces, but there is a paucity of research to support or dispute this assertion. This scoping review explored what is documented in the literature on the barriers and facilitators to inclusive education for learners who are deafblind. A scoping review methodology using Arksey and O’Malley’s framework was employed. A search was conducted using six databases, including Science Direct, PubMed, Scopus Medline, ProQuest and gray literature, to identify publications focusing on the barriers and facilitators to inclusive education for learners who are deafblind. The findings from the scoping review suggest that the factors that influence the inclusion of learners who are deafblind in inclusive educational settings include the availability of educational settings; accessibility to the physical and social environment, and assistive devices; acceptability by peers and educators and the preparedness of educators; and the adaptability of classroom strategies. For learners who are deafblind to thrive in inclusive educational settings, transformational attitudes and intentional and specific strategies from multiple stakeholders are necessary. Therefore, the educational system, schools, peers and communities should be deliberate in putting in place specialized support and resources to accommodate the diverse needs of learners who are deafblind in all phases of their schooling life. Full article

The rapid proliferation of peer-to-peer short-term vacation rentals has sparked a debate regarding their impact on housing markets. This study further investigates this issue by examining the effect of Airbnb on relative rent costs in San Francisco. The research addresses a critical gap in understanding whether Airbnb financially burdens local renters within different income groups. The authors also differentiated the effect of Airbnb accommodations with different levels of commercialization by categorizing Airbnb listings based on their level of commercialization. Using the multiscale geographically weighted regression technique, this study also considered spatial variations in the relationship between short- and long-term rental markets. The findings indicate that the density of Airbnb only affects the relative rent of renters with a yearly household income between USD 50,000 and USD 75,000. Furthermore, the density of Airbnb listings from more commercialized hosts that own between three and eleven showed a positive relationship with the relative rent cost. This study highlighted the variability in the impact of Airbnb on the local community by income group, listing characteristic, and geographic region. This finding underscores the need for differentiated regulation toward peer-to-peer accommodations, as the impact on rent affordability varies by host commercialization level and renter income group. Full article

Students at 2-year colleges who wish to enter the mental health professions, particularly students of color in urban community college environments, often lack opportunities for internships and experience-building programming relevant to their field. Some programs targeting such students do exist, but little research has been performed on these models. In addition, while pipeline programs in 2-year college settings often focus on successful transitions to senior colleges, many students in such programs also seek to eventually enter graduate school. The purpose of this case study is to bridge this research gap by focusing on a community college-based peer support and psychoeducational outreach program in the northeastern United States, serving as a career development internship for aspiring mental health professionals. Qualitative data in the form of student participant feedback was analyzed to determine the impact of the program on their experiences later in their educational careers. Results from this qualitative analysis indicate the substantial importance of such a program to the successful academic progress of its student participants, providing insights into how pipeline programs can accommodate student preparation and support, not only toward successful senior college transition, but also specific to graduate school program entry. Full article