Search Results (4,078)

Background/Objectives: Chronic primary pain (CPP) is a new diagnostic category including chronic pain conditions lacking clinical signs or a clear etiopathogenetic origin. These disorders may share a common neural mechanism known as central sensitization, where nociceptive neurons become hyper-responsive to standard or subthreshold pain stimuli, resulting in pain hyper-sensitivity. In this context, non-invasive brain stimulation (NIBS) appears to be a promising tool for improving CPP symptoms by targeting maladaptive brain activity and connectivity. To date, the effects of NIBS on CPP symptoms remain unexplored. To fill this gap, we conducted a meta-analysis, investigating the effect of NIBS in improving the three core symptoms of CPP, namely pain intensity, emotional distress, and functional disability. Methods: Following PRISMA guidelines, we screened four databases up to February 2025 for English-language, peer-reviewed randomized clinical trials that included CPP patients treated with NIBS and reported pre/post or follow-up scores on validated measures of at least one core symptom. Quality of life was examined as an additional outcome. Results: Fifty-four studies were included, with 1371 participants receiving real stimulation and 1103 sham. Findings highlighted that real stimulation improved CPP symptoms immediately after treatment and at one-month follow-up. Meta-regressions showed that longer CPP duration reduced short-term effects on emotional distress and diminished all outcomes at one-month follow-up. Conclusions: Further research is needed to establish standardized NIBS protocols for CPP management, to investigate the effectiveness at longer follow-up periods, and to test whether combining NIBS with other interventions enhances treatment effectiveness and durability. Full article

Redevelopment precincts are often assessed through price uplift, although price appreciation alone does not show whether a local housing market becomes more active or liquid. This study examines whether residential turnover and property valuation diverged around the Etihad Campus redevelopment precinct in East Manchester after the 2014Q4 consolidation of the wider campus setting. Using Office for National Statistics House Price Statistics for Small Areas, the analysis applies a neighborhood-scale synthetic control design to a compact Core-4 treatment precinct, using a filtered within-Manchester donor pool to construct the synthetic benchmark. Residential turnover is measured as the mean residential sales count per Lower Layer Super Output Area (LSOA), and valuation is measured as the average of LSOA-level median house-price trajectories. Robustness is assessed using alternative treatment definitions and pre-intervention calibration windows. The results show a persistent post-2014 turnover shortfall relative to the synthetic benchmark, supported by rank-based placebo diagnostics and retained across all valid turnover specifications. By contrast, valuation evidence is weaker, mixed, and more sensitive to design choice. These findings indicate selective housing-market reconfiguration rather than generalized uplift. Redevelopment evaluation should therefore distinguish transaction circulation from price-based valuation, particularly in cumulative precinct-scale redevelopment settings. Full article

Background: Electroencephalographic (EEG) functional connectivity analysis requires multiple signal-processing, source-modelling, and statistical steps that can limit its adoption in clinician-led randomised controlled trials (RCTs). NeuroStat was developed as a prototype research tool to integrate this workflow; formal usability validation with clinician end-users has not yet been conducted. Methods: NeuroStat is an open-source Python/PyQt6 desktop application that integrates automated artefact removal (a Generalised Eigenvalue Decomposition for Artefact Identification [GEDAI] pathway and a traditional Artefact Subspace Reconstruction (ASR)/Independent Component Analysis (ICA)/ICLabel pathway), boundary element model (BEM) source localisation using the Desikan–Killiany atlas (68 cortical regions), Phase Lag Index (PLI) connectivity estimation across five canonical frequency bands, and RCT-oriented statistical analysis. Evaluation separated sensor-space and source-space claims: a sensor-level simulation (repeated across five independent random seeds) tested preprocessing robustness, a repeated source-space simulation tested recovery of a known cortical parcel-pair contrast after forward projection and inverse reconstruction, a PhysioNet benchmark tested posterior Desikan–Killiany alpha PLI in 20 healthy adults, and an illustrative application to 20 sessions from a published chiropractic RCT demonstrated real-world workflow applicability. Results: In the sensor-level simulation benchmark, the Traditional pathway achieved a mean absolute error of $0.168\pm 0.017$ PLI units and root mean squared error of $0.219\pm 0.045$ (mean ± SD across five independent random seeds) across all artefact conditions. In the source-space simulation, reconstructed alpha PLI for the known bilateral lateral-occipital parcel pair exceeded anterior control edges across 60 repeated condition runs (mean known-control difference = 0.105 PLI units, 95% CI 0.096–0.114; $t\left(59\right)=22.61$, $p<0.001$). In the PhysioNet source-space benchmark, posterior Desikan–Killiany alpha PLI was higher during eyes-closed than eyes-open rest (Cohen’s $d=0.85$, $p=0.001$; 16/20 subjects showing the expected direction) after ICLabel-enabled preprocessing. In the pilot RCT application, all 20 sessions completed processing without manual intervention, with default-mode network alpha PLI showing a pre-to-post change of +0.071 in the intervention group versus +0.015 in the active control group. Conclusions: NeuroStat integrates preprocessing, source-space construction, connectivity estimation, and statistical reporting within a parameter-logged desktop workflow for EEG functional connectivity studies. Current evidence supports initial technical feasibility, sensor-level preprocessing robustness for one pathway in controlled simulations, source-space recovery of a known parcel-level contrast, source-space sensitivity to an expected posterior alpha resting-state contrast, and error-free processing across 20 real RCT sessions in a pilot workflow demonstration. Formal usability testing, test–retest reliability analysis, participant-specific source-model validation, and clinical-population validation remain necessary before clinician-facing or trial-deployment claims can be made. Full article

Background/Objectives: Invasive coronary physiology has evolved from a tool for assessing intermediate stenoses to a comprehensive framework for guiding diagnosis and treatment across the spectrum of coronary artery disease (CAD). This review aims to provide an updated, catheterization laboratory-centered overview of contemporary invasive coronary physiology, emphasizing its role in optimizing percutaneous coronary intervention (PCI) and in evaluating patients with angina and non-obstructive coronary arteries (ANOCA/INOCA). Methods: A narrative review of contemporary evidence, including randomized trials, consensus documents, and guideline recommendations, was conducted. Key physiological indices—fractional flow reserve (FFR), non-hyperemic pressure ratios (NHPRs), coronary flow reserve (CFR), and index of microcirculatory resistance (IMR)—were examined alongside emerging tools such as longitudinal vessel analysis and the pullback pressure gradient (PPG). Applications in pre- and post-PCI assessment, physiology–imaging integration, and comprehensive functional testing in ANOCA/INOCA were evaluated. Results: Physiology-guided PCI improves clinical outcomes and resource utilization compared with angiography-guided strategies. Longitudinal vessel assessment and PPG enable characterization of focal versus diffuse CAD, improving procedural planning and prediction of post-PCI physiological results. Post-PCI physiological assessment identifies residual ischemia and guides optimization strategies. In patients without obstructive CAD, combined assessment of microvascular function and vasomotor reactivity allows identification of distinct pathophysiological endotypes, supporting mechanism-based, individualized therapy. Integration with intracoronary imaging further enhances procedural precision. Conclusions: Contemporary invasive coronary physiology provides a multidimensional approach integrating epicardial, microvascular, and vasomotor domains. This framework supports personalized decision-making, optimizes revascularization, and reduces unnecessary interventions, representing a cornerstone of modern coronary care. Full article

Indian metropolitan cities such as Mumbai grapple with rapid urbanisation, extreme urban density, high built-up areas, loss of green cover, and shrinking open spaces, resulting in increased impermeable surfaces, urban heat island effects, and frequent flooding occurrences. Modern stormwater management has increasingly been characterised by integrated grey-green approaches; however, cities in the Global North benefit from established policies, technical expertise, and financial resources that enable the systematic and large-scale integration of Blue-Green Infrastructure (BGI) through district-wide geospatial assessment frameworks, unlike many cities in the Global South. Despite growing interest in nature-based stormwater solutions, there remains a dearth of geospatial empirical research from India examining the placement, distribution, performance, and functionality of BGI integrated with existing stormwater management systems in cities such as Mumbai. Furthermore, hydrological modelling using tools such as the Storm Water Management Model (SWMM) for the design, planning, and implementation of BGI in Indian cities remains largely unexplored. This study explores the role of BGI strategies in improving urban stormwater management within high-density Indian cities under a 25-year return period extreme rainfall scenario. Using an integrated approach that combines QGIS-based spatial analysis with EPA-SWMM hydrologic-hydraulic modelling, the research examines runoff behaviour, identifies flooding hotspots, and evaluates the effectiveness of Low Impact Development (LID)-based BGI measures such as permeable pavements, infiltration trenches, and green roofs applied at the ward level in Mumbai’s F/North and G/North Wards. Detailed land use classification, spatial mapping, and rainfall simulation corresponding specifically to a 25-year return period rainfall event was used to assess pre- and post-intervention conditions. The findings indicate that the applied BGI measures led to a 12.6% reduction in peak runoff (137.6 m³/s to 120.2 m³/s) and a 5.5% decrease in total runoff volume (783,510 m³ to 740,410 m³). More importantly, the peak flooding flow rate decreased by 45% (94.1 m³/s to 51.7 m³/s), demonstrating that BGI measures can efficiently reduce peak flooding flows by extending runoff hydrographs during extreme rainfall events. These findings are specifically applicable to the simulated 25-year return period extreme rainfall scenario and may vary under different rainfall intensities or return periods. Less extreme events could potentially experience even greater relative reductions or prevent flooding altogether, while also easing downstream hydraulic loads. Overall, strategically placed BGI interventions can significantly reduce surface runoff and peak flow, thereby enhancing stormwater resilience within spatially constrained urban environments. This study provides a replicable, data-driven framework for catchment-scale stormwater planning in dense Indian cities under extreme rainfall conditions, offering practical insights into methods, local contextual considerations, and spatial planning strategies for policymakers and urban planners seeking to retrofit and adapt existing infrastructure under increasing hydrologic stress and climate variability. Full article

Background/Objectives: Chronic diseases account for 74% of global deaths, with multimorbidity (existence of more than one chronic condition) increasing disability risk and treatment burden, leading to poor adherence, disease progression, and reduced quality of life. Nursing-led proactive care models that focus on patient engagement, education, and self-care can help mitigate these challenges. The study aims to evaluate the effectiveness of a nurse-led proactive health intervention in improving care for individuals with chronic diseases in general practice. Methods: A quasi-experimental pre–post study will be conducted in a Community Health Home in Northern Italy. Family and community nurses will deliver the intervention, which includes assessments, educational sessions, and follow-ups for patients aged 65+ with at least one chronic condition. Recruitment will occur over three months. Results: Primary outcomes include emergency department visits and hospitalizations, while secondary outcomes focus on medication adherence, self-care, and service utilization. Data will be collected at 6 and 12 months, and statistical analysis will use descriptive methods and generalized estimating equations (GEEs). Conclusions: This study will improve the understanding of the value of nurse-led proactive intervention, filling the gap in the literature by testing evidence-based approaches on a realistic frail population. Moreover, delivering a complex but structured intervention will provide evidence for future interventions to reduce treatment burden and improve health outcomes. Full article

Engineering computer graphics education frequently exhibits a gap between procedural CAD software (e.g. CATIA 2022) training and the strategic engineering reasoning required by industrial practice. This paper documents a holistic redesign of two advanced CAD courses. The study is framed within the Scholarship of Teaching and Learning (SoTL) tradition as a practitioner-led reflective case study. The redesign integrates four pedagogical mechanisms within an enterprise-CAD context: authentic problem-based learning, dual-layered asynchronous video scaffolding, software-agnostic heuristics (including pre-modelling cognitive mapping), and cognitive apprenticeship. The analysis triangulates three institutional data sources: quantitative Course Experience Survey indicators, qualitative student response themes, and twelve consecutive years of cohort-level academic performance records (2013–2024). The 2022 intervention iteration coincided with a marked elevation in academic performance. Grades reached approximately two standard deviations above the historical baseline. Concurrently, qualitative themes highlighted perceived industrial relevance and platform-portable confidence. However, performance in the post-intervention iterations (2023 and 2024) partially regressed. While scores remained above the historical mean, they did not sustain the 2022 peak. This pattern indicates partial sustainment, rather than evidence of a stable or definitive sustained pedagogical effect. This case is reported as descriptive rather than inferential. While the observed patterns align strongly with theoretical predictions, they do not establish definitive causal effects. Ultimately, the primary contribution of this study lies in documenting the integrated operationalization of these four mechanisms. Furthermore, it highlights longitudinal pedagogical sustainability as a critical, under-examined dimension that single-iteration evidence systematically obscures. Full article

Low health literacy is associated with risky alcohol use among young people, particularly those exposed to social and environmental factors that normalize drinking. In digital contexts, innovative and engaging interventions are needed to strengthen alcohol-preventive competencies among hazardous drinkers. This study evaluated the effectiveness of an online health literacy promotion program integrating artificial intelligence (AI) and gamification in improving health literacy and alcohol-preventive behaviors among hazardous-drinking vocational students. A quasi-experimental two-group pre-test–post-test design with a 1-month follow-up was conducted among 114 first-year Higher Vocational Certificate students aged 18–20 years in Bangkok, Thailand. Participants were assigned to an intervention group (n = 57) or a comparison group (n = 57). The intervention group received the ALC Literacy Program, while the comparison group received standard educational materials on alcohol prevention. Data were analyzed using descriptive statistics, chi-square tests, independent t-tests, and two-way mixed-design repeated-measures ANOVA with Bonferroni post hoc comparisons. At baseline, no significant between-group differences were observed. After the intervention and at 1-month follow-up, the intervention group showed significantly greater improvements in both health literacy and alcohol-preventive behaviors than the comparison group (p < 0.001). Large interaction effect sizes were observed for health literacy (partial η² = 0.623) and alcohol-preventive behaviors (partial η² = 0.622). These findings indicate that the ALC Literacy Program was effective in enhancing health literacy and strengthening alcohol-preventive behaviors among hazardous-drinking vocational students. This intervention may represent a potentially useful digital health promotion approach for alcohol prevention in educational settings. Full article

Cancer incidence among adolescents is increasing, yet cancer risk reduction education remains largely absent from school-based curricula. This pilot study assessed whether a small-scale early, developmentally appropriate intervention could improve cancer literacy to support long-term risk reduction. This pilot study used a convergent parallel mixed-methods pre–post design to evaluate two separate, 45 min, school-based cancer education interventions delivered to 24 middle-school students in Pennsylvania. The intervention delivered developmentally appropriate content on cancer biology, modifiable risk factors, genetics, HPV vaccination, and self-advocacy using a low-resource, low-investment model easy for schools to implement. Pre- and post-intervention surveys assessed student knowledge, awareness, and health-related perceptions. Survey data were analyzed both descriptively using frequencies and percentages and thematically. Post-intervention results demonstrated substantial improvements across all domains. Correct definition of cancer increased from 16% to 100%. Awareness of modifiable risk factors increased to 96%, sunscreen knowledge to 90%, genetic testing awareness to 83%, and HPV vaccine understanding from 21% to 57%. Students also reported increased confidence in recognizing symptoms and engaging in health-seeking behaviors. Findings suggest that small-scale, school-based cancer education interventions are feasible and effective in improving adolescent cancer literacy. These results support the need for larger, controlled studies to evaluate long-term knowledge retention and behavioral outcomes. Full article

Rural adolescents face persistent health inequities driven by limited access to preventive health education, intergenerational engagement, and resources that support lifelong wellness. This study evaluated the effectiveness of Active Aging for L.I.F.E., a school-based intergenerational health literacy program, in improving adolescents’ attitudes toward aging and health. The four-session program, delivered through a train-the-trainer model involving older adults and undergraduate students, was implemented in three rural schools during the 2024–2025 academic year. A total of 86 junior high and high school students participated, with 77 completing pre- and post-program surveys assessing attitudes toward aging, health consciousness, and intergenerational engagement. Paired t-tests and multiple regression analyses examined overall program effects and differences by sex/gender and age group. Students demonstrated significant improvements in aging attitudes, perceived relevance of aging topics, enjoyment of intergenerational interaction, and awareness of health-promoting behaviors across the lifespan. Several baseline sex/gender and age-based gaps in health-related perceptions were reduced following participation, with stronger future-oriented attitude shifts observed among younger adolescents. These findings suggest that brief, scalable intergenerational interventions embedded in rural school settings can support early prevention, health literacy, and community capacity building, offering a promising strategy for advancing rural public health outcomes across the life course. Full article

Background: Needle-related procedures such as venipuncture can be distressing for children and may trigger severe fear and behavioral dysregulation, particularly in those with previous traumatic experiences. Trauma-informed care (TIC) is a framework that recognizes the widespread impact of trauma and integrates this knowledge into clinical practice to prevent re-traumatization and support emotional regulation during medical procedures. Methods: This before-and-after study included 135 children aged 4–8 years who had previously shown severe distress during venipuncture, including escape attempts, shouting, or self/other-directed aggressive behaviors. Before venipuncture, children and their families received a TIC-based intervention delivered by a psychological counselor in a dedicated preparation room. Fear, behavioral responses during venipuncture, procedural pain, and heart rate were evaluated before and after the intervention using parent reports, the Children’s Fear Scale, the Wong–Baker FACES Pain Rating Scale, and pulse oximetry. Results: Following the TIC intervention, significant pre–post reduction were observed in distress-related behaviors during venipuncture, including escape attempts, shouting/crying, and self-/other-directed harmful behaviors. The proportion of children rated as experiencing high levels of fear decreased from 96.2% before the intervention to 15.5% after. Among the 85 children with complete heart-rate measurements available, mean heart rate decreased from 113.6 ± 10.1 beats/min to 87.3 ± 8.43 beats/min. Many families reported a more positive venipuncture experience compared with previous procedures. Conclusions: A trauma-informed care intervention delivered before venipuncture is associated with meaningful reductions in behavioral distress, fear, and physiological arousal in children with prior needle-related traumatic experiences. These pre–post associations support the feasibility and potential value of the TIC model, though controlled studies are needed to confirm these findings without confounding clinical effects. Full article

This study investigated undergraduates’ conceptualization of systems thinking (ST). An open-ended question was administered pre- and post-course. Pre-test findings revealed limited conceptualization, with most students unable to articulate core ST attributes. Post-course responses showed reasonable improvement, with seven key attributes—interconnectedness, feedback, causality, systems boundary, mapping, emergent behaviour, and synthesis—emerging to varying extents in their responses. While nearly all students indicated interconnectedness and mapping, fewer mentioned feedback and systems boundary, indicating these as higher-order cognitive skills. A continuum was also developed to categorize students’ conceptualization from inadequate to canonical; this also indicated that only a few students demonstrated engagement with the key attributes of ST. Novel analytical approaches such as attributes prevalence tables, attributes continuum, and evolution of threshold concepts have contributed to different modes for exploring ST in the responses. Findings underscore the complexity of ST and the challenges in fostering holistic conceptualization. Overall, the study highlights a nuanced engagement with the attributes of ST from the intervention and suggests that further work is necessary to better foster these among the students. Full article

Crafting STEM teaching into meaningful experiences can transform facts into knowledge. Immersive virtual reality (IVR) represents a significant pedagogical disruption, offering novel modalities of engagement with science content, extending beyond passive reception towards enhanced critical inquiry, reflective evaluation, and the cultivation of higher-order thinking skills. This study investigated how 20 Maltese students (mean age 12) adjusted their perceptions and acceptance of IVR when encountering it for the first time in formal STEM education. A quasi-experimental design was employed over six weeks, with data collected through pre- and post-intervention questionnaires. The analytical framework combined the Technological Frames of Reference (TFR) and Technology Acceptance Model (TAM) to capture perceptual snapshots and attitudinal shifts. While IVR initially stimulated enthusiasm, sustained exposure prompted critical reflections on its potential and limitations, particularly in relation to subject relevance, peer communication, and ease of use. Such deliberations are themselves suggestive indicators of reflective engagement. Rather than being demonstrated evidence of cognitive skill development, they are consistent with the early exercise of analytical and evaluative reasoning. These insights underscore the recursive dialog between technology-in-use and user contextualization, revealing how perceptions mature through experience. By examining how young learners engage with emergent technologies, this research highlights education’s role in cultivating adaptability, reflective judgment, and critical thinking capacities—central to innovative pedagogy and support for uncertain futures. Full article

This study proposes a barrier-oriented application of conventional failure mode and effects analysis (FMEA) and fuzzy weighted geometric mean (FWGM)-based fuzzy-FMEA for laboratory-scale solvent-based electrospinning. The process was decomposed into 14 sequential steps, and one representative failure mode was defined for each step. Severity, occurrence, and detection were rated by a five-member expert panel, and hazard-type-specific weights were assigned to chemical-dominant, electrical-dominant, fire/static-dominant, and combined-dominant hazards. Conventional FMEA identified material review/approval, equipment setup, pre-start inspection, and response to abnormalities as the highest-risk steps (RPN = 60). FWGM-based fuzzy-FMEA re-ranked tied RPN groups and identified response to abnormalities and equipment setup as the joint highest-FRPN failure modes (FRPN = 79.35), followed by pre-start inspection (77.39) and material review/approval (75.89). Barrier-oriented interpretation revealed four dominant mechanisms: upstream information-based hazards, direct high-voltage access, pre-start combined hazards, and intervention under abnormal or residual-energy states. Scenario-based post-control analysis showed that grounded enclosures, interlocks, de-energize-discharge-verify procedures, pre-start checklists, and bonding/grounding measures reduced FRPN by 25.88–43.79% for prioritized failure modes. The proposed framework supports SOP development, equipment improvement, training prioritization, and laboratory risk-assessment documentation for solvent-based nanofiber manufacturing. Full article

Background and Objectives: Chronic nonspecific neck pain (NSNP) is among the most common musculoskeletal disorders. Global postural re-education (GPR) might be effective in decreasing neck pain (NP) and dysfunction and improving forward head posture (FHP) by recovering muscle chains and reducing postural alteration. Deep neck flexor activation (DNF) might also decrease NP and improve FHP by improving DNF endurance. This study aimed to compare the effects of GPR versus DNF activation on pain, dysfunction, FHP, and DNF endurance. Materials and Methods: Forty-six physiotherapy students with chronic NSNP participated in this non-randomized comparative study and were allocated into two equal groups based on their availability and preference regarding session duration. Group A underwent GPR exercises combined with active neck exercises, whereas group B received DNF activation in addition to active neck exercises. All participants were assessed pre- and post-intervention for pain intensity using a visual analog scale (VAS), neck disability using the Arabic version of the neck disability index (NDI), FHP via a photometric method with Kinovea software, and DNF endurance using pressure biofeedback. Results: A significant effect of both treatments was reported on reducing pain intensity, improving the FHP and enhancing the neck functional status with no substantial differences between both groups. A significant improvement in DNF endurance was observed in both groups, with substantially higher values between groups in favor of the DNF group. Conclusions: Both GPR and DNF activation exercises were associated with reductions in pain and improvements in neck disability among physiotherapy students with chronic NSNP and FHP. Also, both CVA and DNF endurance improved, with more improvement observed in DNF endurance in the DNF group compared with the GPR group. Full article