Search Results (15,319)

Physical activity (PA) integration in special education has gained recognition as a neuroeducational intervention supporting emotional and social development in students with special educational needs and disabilities (SEND), yet teacher perceptions remain underexplored. This cross-sectional study examined how Israeli special education teachers perceive physical activity’s benefits and how teaching experience and educational setting influence these perceptions. A structured questionnaire was administered to 45 female special education teachers from northern Israel. The instrument assessed perceptions of physical activity’s emotional benefits, social outcomes, and implementation practices using Likert-type scales. Teachers strongly endorsed PA as a means to foster emotional resilience and coping, with most preferring group-based activities. Mixed activities were the most preferred approach, followed by movement games. Experienced teachers reported significantly stronger perceptions of emotional benefits compared to less experienced colleagues. Secondary teachers demonstrated higher extracurricular promotion and perceived greater social benefits than elementary teachers. Despite positive attitudes, implementation barriers, including infrastructure limitations and training gaps, were evident. These findings highlight physical activity’s potential as a neuroeducational tool for fostering regulation and inclusion while revealing the need for differentiated professional development, infrastructure investment, and policy integration. Full article

Background/Objectives: Swallowing disorder(s), or oropharyngeal dysphagia (OPD), are very common in children with cerebral palsy (CP) and pose a significant risk to their health. Behavioural interventions are frequently recommended when targeting OPD in children with CP; however, their efficacy has yet to be determined. This systematic review aimed to synthesise the current evidence for behavioural interventions in the treatment of OPD in children with CP. Methods: A comprehensive search in six databases in October 2024 sought studies that (1) included participants aged 0–18 years with a diagnosis of CP and OPD; (2) utilised and described a behavioural intervention for OPD; and (3) used a randomised controlled trial (RCT) experimental design. Three reviewers independently extracted the data, and results were tabulated. The Revised Cochrane Risk of Bias (ROB-2) tool was used to determine the methodological quality of eligible articles. Results: From an initial yield of 2083 papers, 99 full-text studies were screened for eligibility. Seven RCTs involving 329 participants aged 9.5 months (SD = 2.03) to 10.6 yrs were included. CP description varied. Most studies used a combination of behavioural interventions to treat OPD (n = 6), and oral sensorimotor treatment was the most frequently utilised treatment (n = 4). Positive outcomes were reported in all (n = 7); however, there was high risk of bias in five studies. Conclusions: The use of behavioural interventions to treat OPD in children with CP continues to be supported by low-level evidence. Rigorously designed RCTs with larger samples of children with CP and OPD are needed to evaluate the true effects of behavioural interventions across the developmental phase of childhood. Importantly, consistency in describing and reporting baseline analysis of swallowing and OPD; together with treatment-component data, is a priority in future research. Full article

This study investigates the certification outcomes of intermediate-level ICs in The National Fire Service Academy in South Korea through a comprehensive quantitative analysis of their evaluated competencies. Using assessment data from 141 candidates collected from 2022 to 2024, we examine how scores on six higher-order competencies—comprising 35 sub-competencies—influence pass or fail results. Descriptive statistics, correlation analysis, logistic regression (a statistical model for binary outcomes), random forest modeling (an ensemble decision-tree machine-learning method), and principal component analysis (PCA; a dimensionality reduction technique) were applied to identify significant predictors of certification success. Visualization techniques, including heatmaps, box plots, and importance bar charts, were used to illustrate performance gaps between successful and unsuccessful candidates. Results indicate that competencies related to decision-making under pressure and crisis leadership most strongly correlate with positive outcomes. Furthermore, unsupervised clustering analysis (a data-driven grouping method) revealed distinctive performance patterns among candidates. These findings suggest that current evaluation frameworks effectively differentiate command readiness but also highlight specific skill domains that may require enhanced instructional focus. The study offers practical implications for fire training academies, policymakers, and certification bodies, particularly in refining curriculum design, competency benchmarks, and evaluation criteria to improve fireground leadership training and assessment standards. Full article

Sierra Leone possesses distinct educational, economic, and social characteristics. Public universities in the country, funded by the government, are mandated to promote sustainable development, ethical conduct, and social welfare, aligning with national development strategies such as the Midterm National Development Plan and the Education Sector Plan, which emphasize leadership, diversity, and ethical standards to advance sustainable development practices. This study applies Transformational Leadership Theory to investigate the influence of transformational leadership on corporate social responsibility, exploring the mediating role of innovative work behavior and the moderating effect of organizational culture on this relationship. Using a stratified sampling technique, data were collected from 367 employees across six public universities in Sierra Leone and analyzed with SMART PLS software 4.1.1.2. The findings revealed that transformational leadership positively and significantly impacts corporate social responsibility and innovative work behavior, with innovative work behavior partially mediating the relationship between transformational leadership and corporate social responsibility, while organizational culture positively and significantly moderates this relationship. Based on these findings, the study recommends that public universities in Sierra Leone integrate transformational leadership principles into their institutional frameworks to improve organizational outcomes and leadership effectiveness. This can be achieved through leadership development programs emphasizing transformational attributes such as inspirational motivation, individualized consideration, and vision-sharing, alongside mentorship programs for leaders at all levels to strengthen leadership skills and foster an organizational culture aligned with institutional goals. Full article

Background/Objectives: Children with neurodevelopmental disorders (NDDs) frequently present with feeding challenges that can lead to inadequate fruit and vegetable consumption, which can increase their risk of nutritional deficiencies and related health issues. The aim of this scoping review was to describe the main interventions focused on promoting fruit and vegetable consumption in children with NDDs. Methods: Two authors carried out a search strategy in PubMed, Scopus, EMBASE, Web of Science, and PsycINFO using the following terms: “autism OR autistic OR asperger OR rett OR pervasive OR disintegrative OR ‘neurodevelopmental disorder’ OR ‘attention deficit disorder with hyperactivity’”; and the outcome (O): “fruit OR vegetable”. We included all randomized or non-randomized studies, published in English or Spanish, which assessed children’s fruit and vegetable consumption. Results: We included seven articles that applied different interventions, such as a mobile health and behavioral modification program (n = 1), repeated food exposure programs (n = 2), a play-based program with parental training (n = 1); the implementation of Dietary Approaches to Stop Hypertension diet (n = 1); an intensive interdisciplinary mealtime behavioral treatment (n = 1); and restrictive diets (n = 1). Conclusions: Parent-led behavior changes supported by multidisciplinary teams using play, positive reinforcement, and food modification strategies were the main interventions used to increase fruit and vegetable consumption in children with NDDs. This review supports designing evidence-based approaches to improve feeding challenges in this population. Full article

Background and Objectives: Anhedonia, a core symptom of major depressive disorder (MDD), is a known predictor of treatment response. It has been linked to heart rate variability (HRV), a physiological marker implicated in both MDD and cardiovascular disease. Agomelatine, a melatonergic antidepressant, has shown positive effects on both anhedonia and HRV. But little is known about the relationship between anhedonia improvement and HRV changes. This study aimed to investigate whether early changes in HRV predict anhedonia improvement following 8 weeks of agomelatine monotherapy. Materials and Methods: We enrolled 84 unmedicated patients with MDD and 143 age- and sex-matched healthy controls (HCs). Resting-state HRV, indexed by the standard deviation of NN intervals (SDNN), was recorded at baseline for all participants and after 1, 4, and 8 weeks of agomelatine treatment in patients. Anhedonia was assessed using the Snaith–Hamilton Pleasure Scale (SHAPS). Results: At baseline, patients exhibited significantly lower SDNN than HCs. After 8 weeks, SDNN levels in patients no longer differed significantly from HCs. SDNN decreased after one week of treatment but increased by week eight. Notably, a smaller reduction in SDNN after one week predicted greater improvement in anhedonia at week eight, filling the gap in the literature needed to facilitate treatment outcome prediction by integrating HRV assessment. Conclusions: Here we demonstrate that early reductions in HRV may serve as a predictive biomarker for anhedonia response to agomelatine in MDD. These findings support the potential utility of HRV monitoring to guide personalized treatment strategies. Full article

Background/Objectives: Commonly known as clubfoot, congenital talipes equinovarus (CTEV) is a structural deformity characterized by cavus, adductus, varus, and equinus (CAVE) positioning of the foot. Idiopathic clubfoot requires prompt treatment to achieve functional, pain-free, and aesthetically normal feet. The Ponseti method is a conservative treatment involving serial manipulation, casting, and Achilles tenotomy, which has demonstrated high success rates. The purpose of this study is to report 10 years of experience using the Ponseti method. Methods: A retrospective and follow-up analysis were conducted with 72 patients (118 feet) with idiopathic clubfoot were treated between 2011 and 2023 who met the minimum follow-up requirement of 12 months (mean follow-up: 54.15 months). The severity of deformities was assessed using the Pirani score. Data collection included demographic details, number of casts, tenotomy procedures, adherence to the Denis Browne brace protocol, and complications. Results: Initial correction of deformities was achieved in all 91 patients (100%). Outcomes were measured using the Ponseti functional scoring system. The average number of casts applied was 9.51 per patient. Percutaneous Achilles tenotomy was performed in 91.21% of cases. Relapse occurred in 22.2% of patients, which required additional treatments. The outcomes were excellent in 77.7% of cases, good in 13.88%, fair in 6.94%, and poor in 1.38%. Discussion: The Ponseti method is effective for idiopathic clubfoot treatment and achieves high rates of initial correction, favorable mid-term outcomes, and minimal complications. These results confirm its reliability and align with previously reported success rates. Full article

Background/Objectives: This scoping review aims to map existing AI applications in dental education, in student learning, assessment, and diagnostic training, identifying key limitations and challenges. Methods: Following the Arksey and O’Malley framework and PRISMA-ScR guidelines, six databases were searched in March 2025 using combinations of the following search words: “dental education,” “artificial intelligence,” “machine learning,” and “student assessment”. Inclusion was limited to English-language empirical studies focused on dental student education. Of 547 identified studies, 17 met the inclusion criteria. They were categorized into four domains: (1) Preclinical Training, (2) AI in Clinical, Diagnostic Training, and Radiographic Interpretation, (3) AI as an Assessment Tool and Feedback System, and (4) AI in Content Generation for Dental Education. Results: AI has positively influenced various domains, enhancing procedural accuracy, diagnostic confidence, assessment efficiency, and content delivery. However, it struggles to assess nuanced competencies like dexterity and clinical judgment. The challenges faced include disparate definitions of AI, ethical and privacy concerns, model variability, and a deficiency of dental leadership in AI development. At present, most tools are engineered by computer scientists and may not align effectively with the priorities of dental education. Conclusions: AI holds significant potential to enhance dental education outcomes. However, to guarantee its relevance and reliability, it requires standard frameworks, ethical oversight, and clinician-led development. Future research should concentrate on implementing real-time AI-driven feedback systems during preclinical training and advocate for more precise definitions to support consistent AI application and evaluation in dental education. Full article

Introduction: Major depressive disorder (MDD) is more prevalent in women, but men with MDD may experience higher suicide risk and a different symptom profile. This study investigates the subjective impact of MDD on health-related quality of life (HR-QoL) in males and females. Methods: A cross-sectional analysis was conducted on a representative sample from six Italian regions. MDD diagnoses were determined through semi-structured clinical interviews, and HR-QoL was assessed using the SF-12 questionnaire. Mania, hypomania, and subthreshold hypomanic symptoms were evaluated using the Mood Disorder Questionnaire (MDQ). Results: Women had a higher prevalence of MDD (6.2%) than men (3.5%). However, men with MDD showed significantly lower HR-QoL scores compared to non-depressed males, with a greater difference than that observed in women. No significant sex differences emerged in psychiatric comorbidities, but men showed a trend toward higher MDQ positivity, possibly indicating a different depressive phenotype. Conclusions: Although less frequently diagnosed in men, MDD appears to have a stronger perceived impact on quality of life in males. This finding may reflect under-recognized symptoms such as irritability, hyperactivity, and social rhythm dysregulation. Gender-sensitive screening and intervention strategies are essential to improve early detection and reduce the untreated burden of depression in men, ultimately supporting more equitable mental health outcomes. Full article

Background/Objectives: Patients with non-small cell lung cancer (NSCLC) being evaluated for stereotactic body radiation therapy (SBRT) are frequently staged non-invasively with positron emission tomography/computed tomography (PET/CT). Performing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in addition to PET/CT scanning may increase clinical certainty in lymph node staging, but the magnitude of added benefit of EBUS-TBNA over non-invasive staging methods is unclear. Methods: A single-center prospective cohort study involving patients with suspected or confirmed Stage I or IIa NSCLC referred for EBUS-TBNA prior to SBRT was performed. The primary outcome was concordance between PET/CT and EBUS-TBNA for nodal metastases. Secondary endpoints included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PET/CT, and clinical outcomes based on staging results. Results: Among 115 patients, the concordance between PET/CT and EBUS-TBNA was 84.3% (95% CI: 0.76 0.90). EBUS-TBNA led to a stage shift in 15.7% of cases: 4 of 98 PET/CT N0 patients (4.1%) had nodal metastases, while 14 of 17 PET/CT N1 patients (82.4%) were downstaged to N0. PET/CT sensitivity was 42.9% (95% CI: 0.09–0.81), specificity 87% (95% CI: 0.79–0.93), PPV 17.6% (95% CI: 0.04–0.43), and NPV 95.9% (95% CI: 0.90–0.99). PET/CT-positive, EBUS-TBNA-negative patients had worse survival (HR 4.25, 95% CI: 1.24–14.53, p = 0.021) compared with double-negative patients. Conclusions: EBUS-TBNA improves staging accuracy over PET/CT in early-stage NSCLC, impacting SBRT candidacy. However, PET/CT-positive, EBUS-TBNA-negative patients had worse outcomes in comparison to double-negative patients, suggesting a need for additional therapy or surveillance in that population. Full article

Afforestation substantially promotes vegetation restoration and modifies soil physical, chemical, and biological properties. The integrated effects of soil properties on soil quality, expressed via a composite soil quality index (SQI), remain unclear despite variations among individual properties. Here, five vegetation restoration treatments were selected as follows: (1) barren land (BL, control), (2) disturbed short-rotation Eucalyptus plantation (REP); (3) undisturbed long-term Eucalyptus plantation (UEP); (4) mixed native-species plantation (MF); and (5) natural forest (NF) following >50 years of restoration. Soil physicochemical properties and microbial community compositions were investigated, and soil quality was evaluated by an integrated SQI. Our results showed that vegetation restoration had strong effects on soil physicochemical properties, soil quality, and microbial communities. Most of the soil physicochemical properties exhibited significant differences among treatments. Soil dissolved organic carbon, total nitrogen, and ammonium nitrogen were the three key soil quality indicators. The SQI increased significantly with vegetation recovery intensity. In both UEP and MF, it reached levels comparable to NF, and was higher in UEP than in REP, implying that short-rotation practices impede soil restoration. In addition, microbial biomass (bacteria, fungi, arbuscular mycorrhizal fungi, actinomycetes, and total microbe PLFAs) increased from BL to NF. All plantations exhibited lower microbial biomass than NF, revealing incomplete recovery and a greater sensitivity to soil physicochemical properties. Conversely, the fungi-to-bacteria biomass ratio decreased sequentially (REP > BL > UEP > MF > NF). Strong positive correlations between microbial biomass and the SQI were observed. These results collectively indicate that afforestation with mixed tree species is optimal for rapid soil restoration, and undisturbed long-term monocultures can achieve similar outcomes. These findings highlight that tree species mixtures and reducing disturbance should be taken into consideration when restoring degraded ecosystems in the tropics. Full article

In this perspective article, we introduce Ecocebo as a novel concept describing the modulatory effects of physical environments, whether natural or built, on drug effect. Positioned as a spatial component of the placebo effect, Ecocebo is grounded in evidence-based design principles and proposes that environmental features such as natural light, greenery, spatial geometry, and calming esthetics can significantly influence sensory, emotional, and cognitive processes. These environmental factors may enhance or modify pharmacological responses, especially for analgesics, anxiolytics, and antidepressants. We highlighted how exposure to restorative spaces can reduce pain perception, stress, and the need for medication, paralleling findings in placebo research where contextual and sensory cues influence brain regions linked to emotion and pain regulation. We propose virtual reality (VR) as the most suitable methodological tool to study Ecocebo in controlled and ecologically valid settings. VR allows for the precise manipulation of spatial features and real-time monitoring of physiological and psychological responses. We also propose integrating VR with neuromodulation techniques to investigate brain–environment–drug interactions. Finally, we addressed key methodological challenges such as defining control conditions and standardizing the measurement of presence. This perspective opens new directions for the integration of non-pharmacological and pharmacological interventions and personalized therapeutic environments to optimize clinical outcomes. Full article

Objectives: The need for routine brain magnetic resonance imaging (MRI) for patients presenting with unilateral facial palsy in the emergency department (ED) is a subject of ongoing debate. This study aimed to evaluate the diagnostic yield of MRI in this population and to identify clinical risk factors associated with non-idiopathic causes, to inform selective imaging strategies. Methods: This single-center, retrospective study was conducted in the ED of a tertiary-care center in Korea. We analyzed adult patients (aged ≥ 18 years) who presented with facial palsy as the primary symptom between 1 January 2020 and 31 December 2022. Patients with other neurological abnormalities detected during the initial examination or those who did not undergo brain MRI were excluded. The primary outcome was the identification of positive MRI findings, defined as brain lesions (e.g., ischemic stroke, tumor, and hemorrhage) considered causally related to the facial palsy based on anatomical correlation and radiological interpretation. Patients were categorized into positive or negative MRI groups accordingly, and baseline characteristics were compared between the groups. Results: Among the 436 patients who underwent brain MRI, 13 (3.0%) showed positive findings such as brain tumors or stroke that led to diagnoses other than Bell’s palsy, while the remaining 423 (97.0%) were ultimately diagnosed with Bell’s palsy. The proportion of patients with a history of transient ischemic attack/stroke and malignancy was significantly higher in the group with non-idiopathic facial palsy (p = 0.02 and p < 0.001, respectively). Conclusions: In adults presenting to the ED with clinically isolated unilateral facial palsy and no other neurological signs, routine brain MRI had a low diagnostic yield (3%). A history of malignancy or prior TIA/stroke was associated with alternative diagnoses. A selective imaging strategy based on risk factors may improve diagnostic efficiency without compromising safety. Full article

Background: Sentinel lymph node biopsy (SLNB) has traditionally been used to stage the axilla in early-stage breast cancer. However, its utility in women over 70 with hormone receptor-positive tumors and negative axillary imaging is increasingly questioned due to limited therapeutic benefit and potential complications. Objectives. To assess the feasibility of omitting SLNB in women aged 70 and older with clinically node-negative, luminal-type breast cancer. Methods: A retrospective analysis was conducted on women aged 70 and above with histologically confirmed invasive breast cancer, negative axillary imaging, and surgery between January 2021 and December 2024. Eligible patients were selected based on normal axillary ultrasound findings. All underwent SLNB. We examined demographics, clinical characteristics, surgical outcomes, and oncological variables such as recurrence and mortality. Results: A total of 149 women underwent surgery, with a mean age of 77.2 (5.24) years. SLNB was positive in 23.5% of cases, but only 6.7% required axillary dissection. Sensitivity and specificity of SLNB declined notably after age 76. No axillary or breast recurrences were reported. Most patients (89.9%) received hormonal therapy, while 11.4% had chemotherapy and 17.5% axillary radiotherapy. Outpatient management was feasible in 87.9% of cases, and no clinically significant lymphedema was observed. Conclusions: Omitting SLNB in women ≥70 years with luminal breast cancer and negative axillary imaging appears safe and does not compromise oncological outcomes. This strategy minimizes surgical risks and enhances quality of life, supporting a more tailored and less invasive approach to axillary management in older patients. Full article

Background/objectives: Prostate cancer (PCa) is the most common cancer among males. Approximately 20–40% of patients with clinically localized PCa will present with a biochemical recurrence after a radical prostatectomy (RP), while some will present with recurrent metastasis. Monitoring the disease post-treatment is crucial for detecting a potential cancer recurrence early. Urinary volatile organic compounds (VOCs) have shown potential to detect PCa. However, their application in disease monitoring remains unexplored. Methods: A total of 165 urine samples were collected from male adults with biopsy-designated PCa-positive results before (n = 55) and after a RP (n = 55), and with biopsy-designated PCa-negative diagnosis (n = 55). The post-RP cohort was subdivided into three groups based on their health status after surgery as recovered healthy, biochemical recurrence, and recurrent metastasis. VOCs in the urine samples were extracted by stir bar sorptive extraction and analyzed using gas chromatography and mass spectrometry. We explored the use of metabolomics and a machine learning algorithm tool to investigate the potential of using VOCs for differentiating PCa diagnoses before and after the RP procedure with different outcomes. Results: Over 100 potential VOCs were identified to differentiate PCa patients before and after a RP, and those with biochemical recurrence and recurrent metastasis. Conclusions: Urinary VOCs are promising biomarkers that could be used to differentiate PCa patients pre- and post-RP. The findings from this research provide preliminary insights and could aid future investigations in developing tools for PCa patients after treatment. The absence of a validation cohort limits the reproducibility and translational impact of these findings; therefore, the results should be considered exploratory and require confirmation in larger, independent cohorts. Full article