Search Results (17,423)

Background/Objectives: Chronic heart failure (CHF) is a leading cause of global morbidity and mortality, particularly among older adults, significantly impacting their quality of life and imposing a substantial economic burden. While pharmacological and surgical treatments remain essential, non-pharmacological interventions led by nurses are gaining prominence due to their comprehensive approach and biopsychosocial impact. The objective of this study was to synthesise and integrate such interventions for community-dwelling older adults with CHF. Methods: An integrative review was conducted in accordance with the Joanna Briggs Institute protocols and the PRISMA statement, utilising a systematic search across databases including PubMed and Cochrane. Qualitative, quantitative, and mixed-methods studies evaluating non-pharmacological interventions in the home setting were included, whilst those targeting non-specific populations were excluded. Following a rigorous screening process, 12 studies were selected, and their methodological quality was appraised based on study design. Results: The 12 included studies involved a total of 2466 participants and addressed interventions across the domains of education, physical activity, telehealth, and nutrition, with programme durations ranging from 4 weeks to 16 months. Notable improvements were observed in physical capacity, cognitive function, quality of life, and self-care capabilities, alongside potential reductions in hospitalisations reported in some studies. However, considerable methodological variability was identified across the literature. Conclusions: This review synthesises non-pharmacological nursing interventions for older adults with CHF, demonstrating varied benefits across multiple biopsychosocial domains. The findings emphasise the critical need for further research to evaluate the economic viability of these programmes and to adapt interventions to enhance the delivery of community-based care. Full article

Despite the growing use of acceleration–speed (AS) profiling in elite football, the number and composition of sessions required to generate stable in situ profiles remain unclear. AS profiling provides estimates of maximal theoretical acceleration (A0) and maximal theoretical velocity (S0), which may offer practically relevant information for monitoring player sprint-related qualities. This study examined the influence of profiling-window length and match exposure on in situ AS profile outcomes in 19 professional football players competing in the 2023–2024 English Football League Championship. Profiles were generated using two non-overlapping conditions comprising five consecutive sessions (5SS) and ten consecutive sessions (10SS). Mean A0 values were 6.91 ± 0.36 m/s² for 5SS and 7.12 ± 0.40 m/s² for 10SS, while mean S0 values were 9.52 ± 0.29 m/s and 9.89 ± 0.28 m/s, respectively. Reliability was assessed using intraclass correlation coefficients (ICCs), standard error of measurement (SEM), and smallest worthwhile change (SWC). The match count within each profiling window was associated with A0 and S0 outcomes in both 5SS and 10SS conditions (all p ≤ 0.004). However, ICC values were low, particularly for S0, and SEM exceeded SWC across conditions, indicating limited sensitivity for detecting small meaningful changes. These findings suggest that longer profiling windows may provide slightly more stable A0 estimates, whereas S0 appears more sensitive to match exposure and contextual variability. The results highlight the importance of interpreting AS profiles at an individual level and accounting for match exposure when comparing profile outcomes across monitoring windows. Full article

We report the use of our group’s hierarchical Bayesian implementation of the multi-dimensional nominal categories model followed by standard factor rotations of the principal dimensions to obtain 28 curated sparse dimensions from a set of 203,564 (104,998 pre- and 98,566 post-) administrations of a multiple-choice concept test in mechanics. We emphasize our careful attention to issues common to fitting such multi-parameter models to large datasets: a novel set of filters to remove administrations of questionable validity, the use of Bayesian methods to avoid overfitting, selecting the best transformations to find easily identifiable sparse dimensions, and verification and pruning of these using bootstrap samples. We demonstrate that these dimensions are invariant across demographically different samples of students as well as between pre-instruction and post-instruction samples. Most sparse dimensions correspond to well-known misconceptions in mechanics. Full article

Background/Objectives: The increasing prevalence of antimicrobial resistance has become a major challenge in the management of Helicobacter pylori infection and is a leading cause of eradication failure. Resistance to clarithromycin and fluoroquinolones is primarily mediated by mutations in the 23S rRNA and gyrA genes, respectively. This study aimed to evaluate the prevalence of resistance-associated mutations in the 23S rRNA and gyrA genes, investigate their relationship with phenotypic antimicrobial resistance, assess their impact on eradication outcomes, and develop a prediction model for treatment failure. Methods: This retrospective real-world cohort study included 294 adult patients with confirmed H. pylori infection evaluated at the Oradea County Emergency Clinical Hospital, Romania, between November 2022 and November 2025. Clinical, endoscopic, histopathological, microbiological, molecular, and treatment outcome data were collected from medical records. Resistance-associated mutations in the 23S rRNA (A2143G, A2142G, and A2142C) and gyrA (N87K, D91G, and D91N) genes were analyzed and correlated with phenotypic antimicrobial resistance and eradication outcomes. Independent predictors of eradication failure were identified using multivariable logistic regression, and a prediction model was subsequently developed. Results: Overall, 101 patients (34.4%) harbored 23S rRNA mutations and 64 (21.8%) carried gyrA mutations, while 27 patients (9.2%) exhibited mutations in both genes. A2143G was the most frequent mutation (25.2%). Resistance-associated mutations showed strong concordance with phenotypic antimicrobial resistance. Patients with wild-type strains achieved eradication rates exceeding 90%, whereas significantly lower success rates were observed among patients carrying A2143G, A2142G, or gyrA mutations. Multivariable analysis identified previous eradication attempts (aOR 3.12, 95% CI 1.71–5.68), A2143G mutation (aOR 4.86, 95% CI 2.43–9.72), gyrA mutation (aOR 2.91, 95% CI 1.45–5.84), increasing age (aOR 1.03, 95% CI 1.01–1.05), and treatment with clarithromycin-based triple therapy (aOR 2.18, 95% CI 1.02–4.63) as independent predictors of eradication failure. The prediction model demonstrated excellent discriminatory performance (AUC 0.88, 95% CI 0.84–0.92), with a sensitivity of 82.5%, specificity of 80.1%, and satisfactory calibration (Hosmer–Lemeshow p = 0.68). Conclusions: Resistance-associated mutations in the 23S rRNA and gyrA genes are strongly associated with phenotypic antimicrobial resistance and reduced H. pylori eradication success. Molecular resistance testing may facilitate individualized treatment selection and improve clinical outcomes. The proposed prediction model, integrating clinical characteristics, treatment regimen, and molecular resistance markers, demonstrated excellent performance and may represent a useful tool for identifying patients at increased risk of eradication failure. Full article

In professional water polo, understanding the effects of ball wettability on game dynamics is essential but remains insufficiently investigated. This research aims to evaluate how the surface wettability of various professional water polo balls could influence their behavior during play. The study employed a combination of laboratory measurements to assess the wettability of multiple ball brands using the sessile drop method under standardized conditions. FTIR spectroscopy was also performed to characterize the surface chemical composition and support the interpretation of wettability differences observed in contact angle measurements. Performance-related parameters, including static contact angle values and droplet behavior during measurement, were analyzed in relation to surface chemistry and material composition. Significant variability in wettability was observed across different ball brands. These differences indicate that surface properties may play an important role in modulating ball–water interaction mechanisms, which are influenced by both chemical composition and surface morphology. Based on these results, we propose including wettability-related parameters in the official water polo equipment guidelines, which currently cover only size, weight, and material composition. This adjustment could help standardize ball behavior across competitive play, leading to more consistent and fair conditions. This study extends current knowledge of the physical factors influencing sports performance and suggests practical improvements to enhance fairness and quality in water polo competitions. Full article

Background: Currently, expected goal models are tools that enable quantitative analysis in the study of conventional sports, although they have seen very little application in the Paralympic context. Objective: To present a trained expected goals model for 5-a-side blind soccer games based on an analysis of 164 offensive plays by the national team that won first place at the 2022 IBSA Copa América. The novelty of this work lies in being, to our knowledge, the first expected goals (xG) model developed for Paralympic blind football (B1): conventional xG weights cannot be transferred directly because shooting in F5 is governed by auditory orientation, the absence of an offside rule, a smaller rebound-walled pitch, and fully blind executors, so a sport-specific, reproducible and SHAP-interpretable benchmark is required where none previously existed. Materials and Methods: The SHapley Additive exPlanations library was used to analyze the data via partial dependency plots, dependency scatter plots, waterfall plots, decision plots, and SHAP heatmaps. Additionally, ten machine learning algorithms were compared, including logistic regression, random forest, extra trees, gradient boosting, XGBoost, LightGBM, CatBoost, support vector machine, k-nearest neighbors, and multilayer perceptron, using a 70/30 stratification process with fivefold stratified cross-validation to define the main hyperparameters. Results: The most consistent model was CatBoost (F1 = 0.778; AUC-ROC = 0.913; AUC-PR = 0.828; MCC = 0.729; Brier = 0.072), which allowed for independent analysis and evaluation of the dataset. The five main offensive variables were determined to be (i) distance to the goal before the shot; (ii) lateral coordinate; (iii) absolute magnitude of the shooting angle; (iv) magnitude of the progression vector; (v) proximity to the side kickboard. However, none of these variables proved to be decisive in the tournament (n = 24), a characteristic that the model captured as a significant negative contribution from the opponent variable. Conclusions: The expected goals model considered for this study serves as a starting point for further analysis of tactical variables in 5-a-side soccer for the blind. Because the model was trained on a single team in a single tournament with few positive cases, these results should be read as preliminary, hypothesis-generating tactical insights rather than validated performance estimates, and require external validation before transfer to other teams or competitions. Full article

Background: Problematic smartphone use may threaten student well-being, especially among nursing students who rely on smartphones for academic and clinical activities. This study estimated potential problematic smartphone use among Greek nursing students, examined its association with quality of life (QoL), and explored whether contextual factors modified these associations. Methods: A cross-sectional study was conducted among 331 nursing students in Greece from September to November 2025. Participants completed an anonymous online questionnaire including sociodemographic data, the Smartphone Addiction Scale–Short Version (SAS-SV), and the World Health Organization Quality of Life–BREF (WHOQOL-BREF). Results: The mean SAS-SV score was 29.30 ± 9.69, and 18.9% of students screened positive for potential problematic smartphone use. Mean overall QoL and general health satisfaction were 3.80 ± 0.78 and 3.97 ± 0.88, respectively. Higher SAS-SV scores were associated with lower physical, psychological, and environmental QoL, but not with social QoL. Years of study moderated only the association with environmental QoL. Conclusions: Problematic smartphone use was associated with poorer physical, psychological, and environmental QoL among Greek nursing students. These domain-specific findings extend existing evidence and support integrating digital well-being, self-regulation, and sleep-hygiene strategies into nursing education and student-support services. Full article

The accumulation of training and competition loads represents a critical determinant of musculoskeletal injury risk in professional team sports, yet contemporary monitoring systems remain limited by their reliance on single-domain temporal analysis that overlooks the multi-scale rhythmic patterns inherent in athletic workload signals. This study introduces FDTM (frequency-aware dual-stream temporal model), a deep learning framework that jointly encodes time-domain dependencies and frequency-domain spectral signatures from digital athlete monitoring streams to predict individual injury risk over a forward-looking seven-game horizon. The framework integrates a stacked bidirectional long short-term memory branch augmented with temporal self-attention pooling, a spectral encoding branch employing discrete Fourier transform decomposition across high-frequency (weekly), mid-frequency (bi-weekly), and low-frequency (seasonal) bands, and a cross-modal gated attention fusion module that adaptively balances temporal and spectral representations conditioned on player context. We evaluate FDTM on three heterogeneous public sports datasets spanning basketball (NBA game-log corpus 2013–2023), Australian rules football (AFL Player Workload Dataset), and soccer (SoccerMon open monitoring corpus), comprising 612 athletes and 247,830 player-game observations across ten competitive seasons. FDTM achieves AUC-ROC values of 0.858, 0.833, and 0.821 on the three datasets respectively, outperforming the strongest deep-learning baseline (FEDformer) by 2.0 to 3.3 percentage points and the strongest non-spectral baseline (TCN) by 3.2 to 4.5 percentage points while maintaining a Brier score below 0.04. Ablation studies confirm that the spectral branch contributes 5.1 percent to overall discriminative performance. SHAP attribution analyses identify high-frequency weekly components as the dominant injury-relevant signal, followed by low-frequency seasonal trends and the cumulative acute-to-chronic workload temporal feature, with gating-weight visualizations revealing dynamic modality contributions consistent with established sports science theory. Direct spectral analysis of the raw workload signal confirms that injury-preceding windows exhibit significantly elevated weekly-band power across all three datasets (Mann–Whitney U test, p < 1 × 10⁻⁷), and the architectural advantage is shown to be robust across 30 independent training seeds. These findings suggest that frequency-aware modeling may serve as a transferable methodology for sports engineering applications in injury prevention, return-to-play planning, and individualized rehabilitation, pending further external validation in female athletes and additional team sports. Full article

Running is a widely practiced exercise modality in which central and peripheral fatigue can influence performance and pacing strategy. This study investigated the influence of cognitive–emotional factors, based on the psychobiological model of fatigue, on 5 km time trial performance using a randomized crossover design. Twenty-two recreational male runners (23.0 ± 3.05 years) completed four laboratory visits. During the first visit, participants underwent body composition assessment and an incremental test to determine maximal oxygen uptake (VO₂max) and the velocity associated with VO₂max. In the subsequent three visits, participants performed a 5 km treadmill time trial as fast as possible under three conditions: no feedback (5k-NF), distance-only feedback (5k-Dist), and full feedback (5k-FF). No significant differences in performance were observed between conditions (5k-FF: 24.3 ± 1.8 min; 5k-NF: 24.8 ± 2.1 min; 5k-Dist: 24.7 ± 2.7 min). Regardless of the condition, ratings of perceived exertion and heart rate increased progressively throughout the trials. Other physiological variables showed similar responses across conditions. These findings indicate that manipulating feedback availability during a 5 km time trial did not significantly alter performance or physiological responses under the specific laboratory conditions examined, despite that the true absolute absence of effect should be interpreted with appropriate caution. Full article

Objective: This study examined the prospective association between self-reported physical exercise and depressive symptoms among older adults, and further tested whether loneliness statistically accounted for this association and whether baseline cognitive emotion regulation strategies moderated the exercise–loneliness pathway. Methods: A two-wave prospective survey with a six-month interval was conducted among 980 community-dwelling older adults in Zhengzhou, China. Baseline data were collected in September 2024, and follow-up data were collected in March 2025. Physical exercise was assessed using the Physical Activity Rating Scale-3, depressive symptoms using the 10-item Center for Epidemiologic Studies Depression Scale, loneliness using the 8-item UCLA Loneliness Scale, and cognitive emotion regulation strategies using the short version of the Cognitive Emotion Regulation Questionnaire. Cross-lagged models were used to examine the residual prospective association between physical exercise and depressive symptoms. A two-wave prospective explanatory model was then tested to examine the role of follow-up loneliness, and moderated explanatory (half-longitudinal) analyses were conducted using baseline adaptive and maladaptive cognitive emotion regulation strategies as moderators. Results: Baseline physical exercise was significantly associated with lower depressive symptoms at follow-up after controlling for baseline depressive symptoms and covariates (β = −0.182, p < 0.001). In contrast, baseline depressive symptoms were not significantly associated with follow-up physical exercise (β = −0.016, p = 0.633). Baseline physical exercise was negatively associated with follow-up loneliness (β = −0.267, p < 0.001), and follow-up loneliness was positively associated with follow-up depressive symptoms (β = 0.324, p < 0.001). The indirect association through follow-up loneliness was significant (indirect effect = −0.087, 95% CI [−0.112, −0.065]). Baseline adaptive cognitive emotion regulation strategies strengthened the association between physical exercise and lower loneliness (interaction β = −0.076, p < 0.001), whereas baseline maladaptive strategies weakened this association (interaction β = 0.059, p = 0.004). Conclusions: Self-reported physical exercise was prospectively associated with fewer depressive symptoms among older adults six months later. This association was statistically accounted for, in part, by lower follow-up loneliness, and baseline cognitive emotion regulation strategies were associated with the strength of the exercise–loneliness association. Because this study used a two-wave observational design with the explanatory variable and outcome measured at the same follow-up wave, the findings should be interpreted as prospective associations rather than evidence of causal or temporal mediation. Full article

Hypoxic training is widely used to enhance endurance performance, yet its application in combat sports such as judo is poorly understood. This study explored (1) hypoxic training practices, (2) perceptions, and (3) educational pathways among judo athletes and performance staff (coaches/practitioners). A total of 173 judo athletes and 39 performance staff completed an online questionnaire covering participant characteristics, hypoxic practices, education, and perceptions. Closed-ended responses were analysed using frequency statistics, and open-ended responses using thematic analysis. Hypoxic training was not widely used, with most respondents reporting no engagement. Among participants currently using hypoxic training, the primary aim was to enhance sea-level performance (13.7%), with limited use for altitude competition (8.5%). Natural altitude was the most common modality, with 7.1% respondents currently using it, typically at ≤1500 m. Only 20.8% of participants reported receiving or delivering education on hypoxic training. Perceptions were mixed, with 38.7% agreeing it benefits judo performance, although agreement was higher among performance staff than athletes. Thematic analysis identified perceived benefits (e.g., time-efficient fitness gains) and drawbacks (e.g., cost, access, and scheduling constraints). Hypoxic training is not a common practice in judo, but amongst some respondents it is perceived as potentially beneficial; these perceptions should not be interpreted as evidence of effectiveness. Its use is primarily oriented towards improving sea-level performance, and current knowledge appears largely informal. Greater sport-specific guidance and education may support more informed application in practice. Full article

(1) Background: The aim of the present study was to assess changes in body composition following a water lifeguard training course and to examine the relationship between body composition parameters and the effectiveness of mannequin towing using different towing techniques. (2) Methods: Thirty-one male participants (22.69 ± 3.35 years) completed pre- and post-course assessments, including body composition analysis and 50-m mannequin towing tests performed using three techniques: Two-handed back tow, Chin tow, and Sailor’s tow. Body composition variables included body fat percentage (BF%), fat mass, fat-free mass (FFM), and total body water (TBW). Linear mixed-effects models were used to evaluate differences in towing performance and associations between body fat and towing time. (3) Results: No significant changes in body composition parameters were observed after the course (all pFDR ≥ 0.29). Towing performance improved significantly across all techniques (p < 0.001). A significant main effect of towing technique was detected by the mixed-effects model (p = 0.04), indicating overall differences among techniques. However, none of the post hoc pairwise comparisons remained significant after correction for multiple testing. Body fat percentage was not significantly associated with towing performance (p = 0.55), and no consistent relationships were found across techniques or timepoints. (4) Conclusions: Short-term lifeguard training improves mannequin towing performance primarily through functional and technical adaptations rather than changes in body composition. Technical proficiency and motor coordination may therefore play a greater role than somatic characteristics in young, trained lifeguards. Full article

Background/Objectives: Childhood and adolescence are critical periods for bone mineral accrual and future skeletal reserve. Milk intake, sun exposure and caffeinated energy drink consumption are familiar lifestyle concepts, but they differ substantially in biological proximity and evidential strength. This structured narrative review critically evaluates these exposures in relation to peak bone mass accrual in youth. Methods: PubMed/MEDLINE, Scopus, Web of Science, the Cochrane Library and Google Scholar were searched from database inception to 23 June 2026. Search terms combined pediatric population terms with bone outcomes and exposure terms related to milk/dairy, calcium, vitamin D, sun exposure, physical activity, sleep, caffeine and energy drinks. A literature collection flowchart and a GRADE-informed evidence appraisal table are provided to improve transparency and clinical interpretability. Results: Evidence is strongest for adequate calcium intake, calcium-rich foods and weight-bearing physical activity as modifiable contributors to skeletal accrual. Vitamin D is essential for mineral homeostasis, but supplementation effects on bone density in otherwise healthy children are context-dependent and appear most relevant for deficiency prevention or treatment. Milk intake is best interpreted as a practical marker of calcium-rich dietary patterns rather than as the only route to calcium adequacy. Sun exposure is an indirect determinant of vitamin D status and is modified by season, latitude, skin pigmentation, clothing, sunscreen, adiposity and outdoor behavior. Direct evidence linking caffeinated energy drinks to impaired pediatric bone accrual is very limited. The relevance of caffeinated energy drink intake is better framed as indirect and hypothesis-generating, through possible displacement of calcium-rich beverages, sleep disruption and clustering with poorer lifestyle patterns. Conclusions: A prevention framework for pediatric bone health should emphasize calcium adequacy, avoidance of vitamin D deficiency, mechanical loading and correct pediatric DXA interpretation using Z-scores. Energy drinks can be included as a lifestyle concern, but conclusions should remain cautious because direct skeletal evidence is limited. Full article

Quantifying metabolic cost during short transitional movements is challenging because conventional metabolic measurements have limited temporal resolution. This proof-of-concept study examined whether model-derived metabolic cost during the sit-to-walk (STW) transition could be exploratorily stratified using interpretable ensemble learning. Forty-nine healthy adults completed the STW phase of the Timed Up and Go task with synchronized three-dimensional kinematics, ground reaction forces, and eight-channel surface electromyography. Individually scaled OpenSim gait2392 models and the Umberger metabolic model were used to estimate metabolic power from seat-off to the end of the first complete gait cycle. Window-averaged metabolic power was stratified into low-, medium-, and high-cost levels. Window-level biomechanical features were extracted from kinematic, kinetic, and muscle-state time series. Seven classifiers were trained using a subject-level 7:3 train–test split and stratified five-fold cross-validation within the training set, and their probability outputs were integrated through TOPSIS-weighted classifier fusion. SHapley Additive exPlanations were used for class-specific feature attribution. The fused ensemble achieved an AUC of 0.870, F1 score of 0.703, accuracy of 0.705, and specificity of 0.853 on the independent test set. Discrimination was stronger for the low- and high-cost levels than for the medium-cost level. SHAP-based attribution highlighted force-related changes and knee-angle variability and amplitude measures as prediction-relevant biomechanical features. These findings support a model-derived, interpretable workflow for extending STW assessment from task performance to task cost, while indicating the need for further validation in larger and clinical datasets. Full article

This study aimed to describe the upper-body bilateral deficit (BD) in recreational climbers and to examine its relationship with specific performance. Fifteen recreational climbers (11 men, 4 women; 25–45 years; ≥3 years of experience) performed unilateral and bilateral maximal isometric handgrip strength test (HGT), and unilateral and bilateral maximal isometric strength test using a climbing-specific fingerboard test (CSFT). The fatigue resistance index test (FRI) and the endurance capacity test (ECT) were used as performance tests. Paired Student’s T-tests were used to compare bilateral deficit results between CSFT and HGT. Pearson’s correlation was used to assess relationships between these variables with the level at 5%. The results showed a significant (p < 0.05) bilateral deficit in the CSFT (−2.53 ± 4.49%) and the HGT (−2.05 ± 3.29%), with no difference between methods. A positive correlation was found between bilateral deficit in the CSFT and the ECT (r = 0.53; p = 0.044), while no correlation was observed with the FRI. Relative bilateral strength to body mass was strongly associated with ECT (r = 0.92; p < 0.001). Greater bilateral deficit was associated with endurance capacity in climbers. In addition, the CSFT demonstrated good predictive accuracy and may be considered a specific and reliable tool for assessing BD in climbers. Full article