Search Results (285)

Background: Falls are a leading cause of injury and disability among older adults. Conventional clinical tests typically do not challenge reactive postural responses to unexpected perturbations, which limits their ability to comprehensively assess fall risk. Objective: To examine the test–retest reliability of five pragmatic, low-cost, perturbation-based tests designed to identify compensatory stepping strategies in older adults, and to explore their concurrent validity against established clinical assessments. Methods: Fifty-seven older adults (44 community-dwelling and 13 institutionalized) completed five compensatory stepping tests (obstacle crossing, forward push, backward pull, and lateral pulls to the right and left) and conventional functional tests [Timed Up and Go (TUG), 30 s Chair Stand, and the Short Physical Performance Battery (SPPB)] on two separate days, ten days apart. Cohen’s weighted kappa (Kw) quantified test–retest reliability, and Pearson’s correlation coefficients assessed relationships with conventional tests. Results: Obstacle (Kw = 0.443), forward push (Kw = 0.518), and backward pull (Kw = 0.438) demonstrated moderate agreement overall. Lateral pull tests showed poor reliability. Nevertheless, moderate correlations were observed between some perturbation tests (particularly obstacle and backward pull) and standard clinical measures, especially TUG and SPPB. Conclusions: Although reliability was limited—most notably for lateral perturbations—specific tests showed meaningful associations with validated functional assessments. Pending methodological refinements, these low-cost tools may offer useful insights for initial fall-risk screening. Full article

Cancer-related pain remains one of the most frequent and burdensome symptoms in oncology, significantly impairing patients’ quality of life and functional status. Despite advances in treatment and the availability of evidence-based guidelines, pain continues to be undertreated worldwide. In Italy, legislative efforts such as Law 38/2010 have not fully translated into consistent clinical practice. On 28 March 2025, a national roundtable held in Rome, Italy, brought together experts from medical oncology, radiation oncology, palliative care, anesthesiology, and pain medicine, representing the main Italian scientific societies involved in oncology and supportive care, to examine the current status of cancer pain management and develop a consensus on actionable priorities. Four key gaps were identified: insufficient education and training of healthcare providers in pain management; fragmented care pathways and limited interdisciplinary integration; lack of clarity regarding professional roles; and challenges in implementing shared diagnostic and therapeutic care pathways (Percorsi Diagnostico Terapeutici Assistenziali). The roundtable proposed coordinated strategies to address these gaps, including expanding interdisciplinary educational initiatives and integrating pain management into undergraduate and specialty curricula; establishing local oncology orientation centers to provide joint, patient-centered assessments; promoting cross-specialty collaboration through congress sessions, educational activities, and practical workshops; and developing adaptable therapeutic frameworks to ensure standardized yet context-sensitive care delivery. This congress report formalizes a joint framework aimed at embedding pain management within comprehensive cancer care. Its implementation will require sustained advocacy, structured education, and alignment of clinical practice with policy support. By addressing these barriers through pragmatic, evidence-informed actions, the proposed strategies aim to optimize timely, integrated, and effective pain care, ultimately improving outcomes for patients with cancer. Full article

This paper investigates the speech variety of the English–Spanish community of Miami, which features a high degree of English–Spanish bilingualism. Specifically, it explores intensification, a site of analytic–synthetic conflict between English and Spanish grammars. English predominantly uses lexical-analytic strategies (e.g., very beautiful, a big house) for intensification, whereas Spanish employs more morphological-synthetic markers (e.g., guapísimo ‘very beautiful’, un casón ‘a big house’). Concretely, the current study aims to investigate whether Miami bilinguals have preferences in terms of the language or strategy of choice to express intensification and whether these preferences are influenced by intralinguistic (e.g., semantic-pragmatic function of the intensifier) or extralinguistic factors (e.g., speakers’ proficiency in, acquisition of, and attitudes toward both languages). To this end, an empirical study is conducted on three corpora, one bilingual and two monolingual ones. In this study, a wide variety of both analytic and synthetic intensifiers is found. The qualitative and quantitative findings reveal that Miami bilinguals use more English than Spanish intensifiers and favor analytic intensifiers over synthetic ones. However, among the Spanish intensifiers, the proportion of synthetic forms is significantly higher than among the English intensifiers. Full article

Background: Intravenous vancomycin is a mainstay for prosthetic joint infections, osteomyelitis, and implant-associated infections, yet real-world dosing frequently misses PK/PD targets. We assessed whether a ward-embedded standard operating procedure (SOP) improves target attainment and dosing efficiency. Methods: Single-centre, non-randomized pre-post study in an orthopedic service. SOP mandated weight-adapted loading dose, renal function-adjusted maintenance dosing, a 15–20 mg/L trough target, and scheduled TDM. Adults receiving ≥72 h IV vancomycin were included; major renal failure and incomplete TDM were excluded. Pre-SOP data were retrospective; post-SOP data were prospective (03/2024–06/2025). Primary outcome: proportion of troughs within 15–20 mg/L (first and repeated). Repeated measures were modeled with GEE. Time to first in-range trough used Kaplan–Meier (indexed by measurement number). Results: We included 154 patients (pre-SOP n = 58; post-SOP n = 96); baseline characteristics were broadly similar. Use of a weight-based loading dose rose from 31.0% pre-SOP to 100% post-SOP (p < 0.001). At the first trough, 17.2% vs. 26.0% were within 15–20 mg/L (p = 0.238). Across 847 troughs (pre = 319; post = 528), the in-range proportion increased from 28.2% to 41.7%, with subtherapeutic values declining from 38.2% to 26.3% and supratherapeutic values remaining nearly similar (33.5% → 32.0%). Time to first in-range trough shortened from a median of 4 to 2 measurements (log-rank p < 0.001). Post-SOP measurements had higher odds of being in range (aOR 1.68, 95% CI 1.29–2.20; p < 0.001), with marginal predicted probabilities of 33.4% (pre) vs. 47.8% (post). Dose adjustments per patient decreased from a mean 4.0 to 2.48 (p < 0.001). Conclusions: A pragmatic, orthopedic ward–embedded SOP for intravenous vancomycin improved pharmacologic precision: more measurements within target, fewer subtherapeutic exposures, faster target attainment, and fewer dose changes. These data support protocol-first implementation as an immediately actionable step toward more consistent vancomycin exposure in orthopedic care. Future work should integrate AUC-guided, model-informed precision dosing and evaluate clinical endpoints and generalizability across centres. Full article

Ovarian cancer’s high mortality is primarily due to late-stage diagnosis, underscoring the critical need for improved early detection tools. This study develops and validates explainable artificial intelligence (XAI) models to discriminate malignant from benign ovarian masses using readily available demographic and laboratory data. A dataset of 309 patients (140 malignant, 169 benign) with 47 clinical parameters was analyzed. The Boruta algorithm selected 19 significant features, including tumor markers (CA125, HE4, CEA, CA19-9, AFP), hematological indices, liver function tests, and electrolytes. Five ensemble machine learning algorithms were optimized and evaluated using repeated stratified 5-fold cross-validation. The Gradient Boosting model achieved the highest performance with 88.99% (±3.2%) accuracy, 0.934 AUC-ROC, and 0.782 Matthews correlation coefficient. SHAP analysis identified HE4, CEA, globulin, CA125, and age as the most globally important features. Unlike black-box approaches, our XAI framework provides clinically interpretable decision pathways through LIME and SHAP visualizations, revealing how feature values push predictions toward malignancy or benignity. Partial dependence plots illustrated non-linear risk relationships, such as a sharp increase in malignancy probability with CA125 > 35 U/mL. This explainable approach demonstrates that ensemble models can achieve high diagnostic accuracy using routine lab data alone, performing comparably to established clinical indices while ensuring transparency and clinical plausibility. The integration of state-of-the-art XAI techniques highlights established biomarkers and reveals potential novel contributors like inflammatory and hepatic indices, offering a pragmatic, scalable triage tool to augment existing diagnostic pathways, particularly in resource-constrained settings. Full article

Introduction: Botulinum toxin-A (BTX-A) injections are regularly used to treat temporomandibular disorders (TMD). However, consensus regarding the long-term efficacy of BTX-A for TMD-related myalgia remains lacking. This pragmatic, practice-based clinical study aimed to evaluate the Patient-Reported Outcome Measures of pain, health status, quality of life, and function after BTX-A injections in patients with TMD-related myalgia. Methods: This prospective cohort study included 35 patients with TMD-related myalgia who received BTX-A injections in the masseter and temporalis muscles. The Visual Analogue Scale for pain, the EQ-5D-3L for health status, the Oral Health Impact Profile-14 for oral health-related quality of life, the Mandibular Function Impairment Questionnaire for function and the maximum interincisal opening were assessed before treatment and at one, three and six months follow-up. Results: Patients reported a statistically significant and clinically relevant reduction in pain (p < 0.001), improvement of health status (p ≤ 0.003), and oral health-related quality of life (p < 0.001) at one-month follow-up, which remained present at three and six months post-treatment. Self-reported mandibular function and active and passive mouth opening showed no significant change over all time points. Conclusions: In this pragmatic cohort, BTX-A injections in the masseter and temporalis muscles seem to improve pain and oral health-related quality of life in patients with TMD-related myalgia within one month and show effects lasting up to six months, while mandibular function did not improve. Full article

Background: Diabetic ketoacidosis (DKA) in patients with kidney failure receiving dialysis presents a formidable clinical challenge. Standard DKA protocols, designed for patients with preserved renal function, often fail in this cohort and can be unsafe when applied without modification. Patients are at risk of iatrogenic fluid overload, dyskalaemia, and hypoglycaemia due to altered insulin kinetics, impaired gluconeogenesis, and the absence of osmotic diuresis. Purpose: This narrative review aims to synthesise current understanding of DKA pathophysiology in dialysis patients, delineate distinct clinical phenotypes, and propose individualised management strategies grounded in physiology-based reasoning, comparative guideline insights, and consensus-supported literature. Methods: We searched PubMed/MEDLINE, Embase, and Google Scholar (January 2004–June 2024) for adult dialysis populations, using terms spanning DKA, kidney failure, insulin kinetics, fluid balance, and cerebral oedema. Reviews, observational cohorts, guidelines, consensus statements, and physiology papers were prioritised; case reports were used selectively for illustration. Evidence was weighted by physiological plausibility and practice relevance. Nephrology-led authors aimed for a pragmatic, safety-first synthesis, seeking and integrating contradictory recommendations. Conclusions: Our findings highlight the critical need for a nuanced approach to fluid management, a tailored insulin strategy that accounts for glucose-insulin decoupling and prolonged insulin half-life, and careful consideration of potassium and acidosis correction. We emphasise the importance of recognising specific volume phenotypes (hypovolaemic, euvolaemic, hypervolaemic) to guide fluid therapy, and advocating the judicious use of variable-rate insulin infusions (‘dry insulin’) to mitigate fluid overload. We also show that service-level factors are critical. Dialysis-specific pathways, interdisciplinary training, and quality improvement metrics can reduce iatrogenic harm. By linking physiology with workflow adaptations, this review provides a physiologically sound, bedside-oriented map for navigating this complex emergency safely and effectively. In doing so, it advances an individualised model of DKA care for dialysis-dependent patients. Full article

Periodontitis is a biofilm-driven inflammatory disease in which conventional indices (probing depth, clinical attachment level, and radiographs) quantify tissue destruction without capturing the biology of infection. In this review, we synthesized microbiological diagnostics, from chairside tools to omics. We outline sampling strategies and emphasize the quantitative monitoring of bacterial load. Enzymatic assays (e.g., N-benzoyl-DL-arginine-2-naphthylamide hydrolysis assay test) measure functional activity at the point of care. Immunological methods include rapid immunochromatography for Porphyromonas gingivalis and enzyme-linked immunosorbent assay for the high-throughput measurement of bacterial antigens. Molecular platforms encompass quantitative polymerase chain reaction (qPCR) (TaqMan, SYBR, multiplex panels; propidium monoazide quantitative-qPCR for viable cells), checkerboard DNA–DNA hybridization for semi-quantitative community profiling, loop-mediated isothermal amplification (LAMP)/molecular beacon-LAMP for portable isothermal detection, and microarrays. Complementary modalities such as fluorescent in situ hybridization, next-generation sequencing, and Fourier transform infrared spectroscopy provide spatial, ecological, and biochemical resolutions. We discuss the limitations of current approaches, including sampling bias, presence–activity discordance, semi-quantitation, method biases, limited strain/function resolution, low-biomass artifacts, and lack of validated cutoffs. To address these challenges, we propose a pragmatic hybrid strategy: site-specific quantitative panels combined with activity and host-response markers interpreted alongside clinical metrics under standardized quality assurance/quality control. Priorities include outcome-linked thresholds, strain-aware/functional panels, robust point-of-care chemistry, and harmonized protocols to enable personalized periodontal care. Full article

Polypharmacy is typically seen as an unavoidable consequence of multimorbidity and aging, with clinicians addressing complex medication lists unsystematically. In this perspective, we argue that polypharmacy should be managed as a chronic condition. Like diabetes or hypertension, for example, the medication burden shows persistence, progression in its absence despite active management, predictable complications (such as falls, delirium, renal injury, functional decline), and a need for structured surveillance. We introduce a pragmatic diagnostic framework that moves beyond pill counts to modality-agnostic, regimen-level risk across prescribed and non-prescribed medicines. Diagnosis rests on prolonged exposure, composite burden indices (e.g., anticholinergic/sedative load), medication-related complications or prescribing cascades, and the need for a planned review. As biologics, gene therapies and long-acting formulations can lower tablet numbers while increasing monitoring, administration, and interaction complexity. We treat polypharmacy as cumulative pharmacodynamic and operational burden. We advocate stage matched care with unique, functional aims—decreasing the harmful burden instead of mass deprescribing—and position a structured medication review as the standard for polypharmacy with support from pharmacists, shared decision making, and safety netted taper plans. The framework fosters patient-centred care, embedding continuity and equity, and outlines a concise outcome set that integrates pharmacometric measures with patient-reported function and treatment burden. At the systems level, the framework enables registries, recall systems, decision support, and audit/feedback mechanisms to shift from sporadic medication list clean-up to a structured, measurable long-term program. Redefining polypharmacy in this way aligns clinical practice, education, and policy with real-world evidence, fostering a cohesive pathway to safer, streamlined, and more patient-centred care in community settings. Full article

Humans form deep attachments to some nonhuman animals, yet these attachments are unequally distributed across the tree of life. Drawing on evolutionary biology, comparative cognition, neuroscience, and cultural anthropology, this narrative review explains why empathy and affective preference are typically stronger for phylogenetically closer species—especially mammals—than for distant taxa such as reptiles, fish, or arthropods. We synthesize evidence that signal recognizability (faces, gaze, vocal formants, biological motion) and predictive social cognition facilitate mind attribution to mammals; conserved neuroendocrine systems (e.g., oxytocin) further amplify affiliative exchange, particularly in domesticated dyads (e.g., dog–human). Ontogenetic learning and media narratives magnify these effects, while fear modules and disgust shape responses to some distant taxa. Notwithstanding this average gradient, boundary cases—cephalopods, cetaceans, parrots—show that perceived agency, sociality, and communicative transparency can overcome phylogenetic distance. We discuss measurement (behavioral, psychophysiological, neuroimaging), computational accounts in predictive-processing terms, and implications for animal welfare and conservation. Pragmatically, calibrated anthropomorphism, hands-on education, and messaging that highlights agency, parental care, or ecological function reliably broaden concern for under-represented taxa. Recognizing both evolved priors and cultural plasticity enables more equitable and effective science communication and policy. Expanding empathy beyond its ancestral anchors is not only an ethical imperative but a One Health necessity: safeguarding all species means safeguarding the integrity of our shared planetary life. Full article

In response to the challenges of electric mobility in off-grid contexts, this study introduces a novel and pragmatic solution: an intelligent, embedded EV charging system capable of anticipating energy availability using external weather forecasts. An embedded Model Predictive Control (MPC) scheme was implemented on an ESP32 microcontroller, incorporating real-time solar and wind forecasts transmitted via LoRa. Unlike conventional approaches that are often centralized or resource-intensive, the proposed architecture enables localized, forecast-aware decision making, while respecting physical constraints (SOC, power limits, system stability) within the limits of embedded hardware. The proposed system was fully validated through functional simulations (data acquisition, processing, display, and physical actuation). Results confirm the feasibility of real-time, stable, and proactive energy management, laying the foundation for smart, resilient, and autonomous renewable-based EV charging stations tailored to remote areas and decentralized microgrids. Full article

This study examines the use and functions of discourse markers (DMs) in nonnative English speech produced by Arab English speakers. Four DMs (and, but, so, y’know) are analysed based on two theoretical frameworks: Schiffrin’s (1987) framework of functions of DMs and Schourup’s (1999) characterisation of DMs. Semi-structured interviews were conducted with 10 Arab English speakers. The findings show clear patterns in the participants’ use of DMs. The marker and is mainly used for its ideational function, that is, for connecting ideas, events, and positions to keep the discourse together, while pragmatic functions, such as continuing an action or turn organisation, are less represented. But is mainly used for its ideational function, indicating contrastive ideas; less frequently, it is used for such pragmatic functions as returning to a topic, making disclaimers, reclaims, or showing functional contrasts. In contrast, so demonstrates a broader range of functions; while it occasionally marks results at the ideational level, it is extensively utilised pragmatically for marking claims, compliance, requests, and topic transitions, as well as managing turn initiation and adjacency pairs. y’know is used for such pragmatic functions as organising shared knowledge, signalling significant information or disapproval in stories, and appealing. Overall, the findings in the study suggest that, in the narrative register, when using DMs, Arab English speakers rely chiefly on their ideational functions. In contrast, their pragmatic functions are used much less, except for so and y’know, which also show more diversified functions. Full article

This review synthesizes recent research on alternative fuels for piston-engine aircraft and related propulsion technologies. Biofuels show substantial promise but face technological, economic, and regulatory barriers to widespread adoption. Among liquid options, biodiesel offers a high cetane number and strong lubricity yet suffers from poor low-temperature flow and reduced combustion efficiency. Alcohol fuels (bioethanol, biomethanol) provide high octane numbers suited to high-compression engines but are limited by hygroscopicity and phase-separation risks. Higher-alcohols (biobutanol, biopropanol) combine favorable heating values with stable combustion and emerge as particularly promising candidates. Biokerosene closely matches conventional aviation kerosene and can function as a drop-in fuel with minimal engine modifications. Emissions outcomes are mixed across studies: certain biofuels reduce NO_x or CO, while others elevate CO₂ and HC, underscoring the need to optimize combustion and advance second- to fourth-generation biofuel production pathways. Beyond biofuels, hydrogen engines and hybrid-electric systems offer compelling routes to lower emissions and improved efficiency, though they require new infrastructure, certification frameworks, and cost reductions. Demonstrated test flights with biofuels, synthetic fuels, and hydrogen confirm technical feasibility. Overall, no single option fully replaces aviation gasoline today; instead, a combined trajectory—biofuels alongside hydrogen and hybrid-electric propulsion—defines a pragmatic medium- to long-term pathway for decarbonizing general aviation. Full article

Northern Thailand experiences annual haze events with fine particulate matter (PM2.5) exceeding standards, posing risks to schoolchildren. This cross-sectional study (Chiang Mai, 2024) evaluated respiratory impacts among primary school children aged 8–12 years. Daily mean PM2.5 concentrations were obtained from a single fixed-site monitoring station (36T) located within 2 km of the spirometry site. Among 93 children with acceptable spirometry, 52% exhibited restrictive, 18% obstructive, and 30% had normal function. After adjustment for BMI, males had significantly lower odds of any pulmonary abnormality than females (AOR = 0.084; 95% CI 0.017–0.417; p = 0.002). The mean FEV₁/FVC ratio was normal (86.30 ± 13.07%), whereas mean FVC, FEV₁, and PEF were significantly below predicted values, indicating a predominantly restrictive pattern. This predominance likely reflects cumulative exposure to biomass-burning related PM2.5 during the haze season, infiltration of outdoor PM2.5 into indoor environments alongside indoor sources, and the vulnerability of developing lungs in children’s factors that reduce lung volumes while largely preserving the FEV₁/FVC ratio. The exposure assessment provides pragmatic, proximity-based estimates but is limited by reliance on one station and one season, which may not capture spatial or temporal variability. These findings highlight sex-based susceptibility and support stronger air quality protections for children. Full article

Background/Objectives: We aimed to test whether home-based low-intensity interval training (LIIT) could be equally or more effective than traditional continuous walking advice (TWA) in a population hospitalized and healed from severe COVID-19. Methods: This pragmatic nonrandomized controlled trial (NCT04615390) enrolled patients admitted to intensive care units due to COVID-19 who at discharge from the hospital were given a choice between either a home-based LIIT program or TWA. The former received a structured LIIT walking (1:1 walk:rest ratio per 10 times) to be performed at a prescribed progressively increasing speed maintained with a metronome. The latter received TWA according to the guidelines (30 min or moderate intensity activity, 5 days/week). Outcome measures, collected at baseline, at the end of the 3-month training and at the 6-month follow-up, included 6 min walking distance (primary), lower limb strength, quality of life, depression and cognitive status. Results: From a total of 85 enrolled patients, 69 of them (LIIT n = 32; TWA n = 37) completed the study. Home exercise was safely executed with an 82% adherence for the LIIT group and 64% adherence for TWA. After the 3-month program, both groups significantly improved the 6MWD (LIIT: +87 m vs. TWA +42 m; p < 0.001) with a significant difference that was also maintained at follow-up (LIIT: +138 m vs. TWA +69 m; p < 0.001). No other significant between-group differences were noted. However, patients in the LIIT group significantly improved in the majority of the outcomes, while patients of TWA improved in only the primary outcome and the physical component of quality of life. Conclusions: Compared with TWA, LIIT walking was feasible, safe and associated with more favorable multidimensional recovery in COVID-19 survivors after hospitalization for severe pneumonitis. Full article