Search Results (2,265)

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

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

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

Engineering design education is an effective instructional approach for enhancing students’ motivation, interest, and creativity while introducing them to the engineering design process (EDP). However, there is limited knowledge on how to integrate the EDP into robotics education, particularly AI-robotics, and how students experience AI-enabled robotics project-based learning grounded in an EDP. This pre-/posttest embedded mixed-methods study adds to the scarce body of literature on interdisciplinary education in engineering design, robotics, and AI. This project developed, implemented, and evaluated a project-based engineering design AI-robotics curriculum that introduced novice Computer Science (CS) high school students to robotics, machine learning, and AI. Students’ collaborative robotics projects were grounded in an EDP to introduce the students to engineering practices and promote engagement and interest through design-based, hands-on learning. An analysis of quantitative and qualitative data revealed an improvement in students’ CS attitudes, collaboration, and social interactions after participating in the curriculum. Recommendations for designing AI-robotics projects grounded in an EDP are discussed. Full article

Background/Objectives: Spontaneous intracranial hypotension (SIH) is caused by spinal cerebrospinal fluid (CSF) leakage and is typically diagnosed by clinical presentation and characteristic MRI signs; however, objective tools for monitoring physiological changes and treatment response remain limited. Cine phase-contrast MRI (PC-MRI) enables noninvasive quantification of aqueductal CSF dynamics, yet reliable analysis is challenging since the cerebral aqueduct is extremely small and susceptible to low contrast, partial volume effects, and ROI-dependent measurement variability—particularly in SIH where CSF pulsatility is often reduced. Methods: We propose an end-to-end automated framework that integrates (1) a cascade localization–segmentation strategy, consisting of Tiny YOLOv4 detection followed by MultiResUNet segmentation on a YOLOv4-derived cropped ROI; (2) physiology-informed pulsatility-based segmentation (PUBS) to refine anatomical masks into functional flow ROIs; and (3) one-dimensional convolutional neural networks (1D-CNNs) to extract exploratory waveform morphology features from 32-phase cardiac-cycle velocity waveforms. The study includes 39 participants, yielding 59 cine PC-MRI examinations: 11 controls, 28 Pre-treatment SIH scans and 20 Post-treatment Recovery scans. Results: The cascade model significantly improves segmentation robustness compared with a full-image baseline, achieving higher Dice scores and markedly lower boundary errors across cohorts (e.g., Pre-treatment SIH HD95: 1.66 ± 0.74 px vs. 15.37 ± 44.98 px). PUBS refinement reduces quantification deviation from expert manual references in SIH (mean relative error: 7.4% to 5.6%) and improves diagnostic performance for multiple hemodynamic parameters (e.g., downward mean flow AUC: 0.747 to 0.792). For waveform morphology analysis, the end-to-end 1D-CNN classifier was evaluated using repeated-seed participant-level grouped LOOCV. The repeated-seed ensemble prediction showed modest out-of-sample discrimination between Normal controls and Pre-treatment SIH scans, with an AUC of 0.646, a bootstrap 95% confidence interval of 0.455–0.826, and a permutation-test p-value of 0.072. Separately, exploratory analysis of the final baseline-trained 1D-CNN latent space showed marked, apparent Normal-versus-SIH separability and an intermediate recovery distribution in PCA space, suggesting that aqueductal waveform morphology may encode SIH-related physiological information. Conclusions: These findings suggest that SIH-related information may be reflected not only in flow magnitude but also in aqueductal CSF waveform morphology. However, the modest and statistically non-significant out-of-sample performance of the end-to-end 1D-CNN classifier indicates that morphology-based AI features should currently be regarded as exploratory biomarker candidates rather than validated stand-alone diagnostic tools. Larger independent cohorts are required to confirm their reproducibility, physiological meaning, and clinical utility. Full article

Background: Patients undergoing open-heart surgery (OHS) are at risk of postoperative morbidity and mortality. Physical performance has been increasingly recognized as an important factor influencing postoperative outcomes. Therefore, the study aimed to investigate the associations and predictive value of physical performance on postoperative complications and duration of hospital stay. Methods: A prospective cohort study was conducted in 116 patients who were admitted to OHS. Preoperative assessment of physical performance, i.e., Short Physical Performance Battery (SPPB), Five Times Sit to Stand Test (5STS), gait speed (5 m walk test: 5MWT), Timed Up and Go (TUG), and handgrip strength. Duration of hospital stay and incidence of post-operative complications were recorded. Differences between participants with and without postoperative complications were analyzed using independent samples t-tests for continuous variables and chi-square tests for categorical variables. The associations between physical performance and postoperative outcomes were assessed using Spearman’s rank correlation coefficient. Hierarchical regression analysis was conducted to determine the predictive contribution of physical performance. Results: A total of 116 participants were submitted for OHS in two medical school hospitals; however, 108 individuals completed the pre-operative physical performance. The most common procedures were coronary artery bypass grafting and valve surgery. Fifty-one participants (47.22%) experienced postoperative complications, including five deaths, corresponding to 4.63% mortality. For the length of hospital stay analysis, five participants who died postoperatively were excluded, resulting in a final sample of 103 participants. Physical performance was significantly associated with the length of hospital stay (p < 0.05). Hierarchical regression analysis showed that the final prediction model explained 13.4% of the variance in length of hospital stay, with SPPB independently contributing an additional 6.0% to the model, followed by 5STS, 5MWT, handgrip strength, and TUG, which accounted for an additional 5.1%, 4.6%, 4.4%, and 3.7%, respectively. Conclusions: Preoperative physical performance was associated with length of hospital stay. While each measure explained a relatively small proportion of the variance in hospital stay, these assessments offer a simple, non-invasive, and clinically feasible approach to evaluating functional reserve before surgery. These findings highlight the importance of incorporating functional assessment into perioperative care to support risk stratification and guide rehabilitation strategies. Full article

Background/Objectives: Weight loss achieved through lifestyle interventions has been demonstrated to improve the clinical prognosis of female hyperandrogenism. However, the interplay between such interventions, androgens, and glucose–lipid metabolism remains heterogeneous. This study evaluated the effects of lifestyle-induced weight loss on glucose and lipid metabolism and androgen levels in Chinese women of reproductive age with hyperandrogenism and examined the association between the degree of weight loss and changes in androgen levels, glucose and lipid metabolism, exercise capacity, and dietary patterns. Methods: This observational study, based on real-world clinical settings, collected medical records of women of reproductive age with hyperandrogenism who underwent weight-loss interventions between July 2023 and September 2025. Correlation analysis employed Spearman’s rank correlation coefficient, whilst pre- and post-weight-loss comparisons utilised paired t-tests or Wilcoxon signed-rank tests. Results: After a follow-up of 6 to 7 months, a total of 66 participants achieved a mean weight loss of 5.67 ± 4.27 kg. Statistically significant reductions were observed in testosterone (0.40 ± 0.10 vs. 0.30 ± 0.10 ng/mL, p < 0.001), androstenedione (p < 0.001), and the free androgen index (p < 0.001). Glucose metabolism showed statistically significant improvement, with decreases in HOMA-IR (p = 0.040), fasting glucose (p = 0.001), and fasting/2 h postprandial insulin (p < 0.001). However, lipid profiles showed no statistically significant changes. Multiple linear regression revealed that change in testosterone was independently and inversely associated with change in apolipoprotein A1 (β = −0.496, p = 0.008), while change in dehydroepiandrosterone sulfate was inversely associated with change in fasting insulin (β = −0.357, p = 0.032). A non-linear, inverted U-shaped relationship was found between weight loss magnitude and change in sex hormone-binding globulin, with moderate weight loss (5–10%) yielding the greatest increase (p = 0.044). Marked weight loss (≥10%) was associated with the lowest follow-up fasting insulin levels (p = 0.039). Conclusions: Weight loss achieved through lifestyle interventions is associated with improvements in androgen levels and glucose metabolism, though its impact on lipid metabolism remains limited. The degree of improvement in insulin sensitivity correlates more strongly with the magnitude of weight reduction. Full article

Background/Objective: Caffeine has demonstrated ergogenic effects across various doses (2–9 mg·kg⁻¹). However, aerobic responses to caffeine vary substantially, with time-trial performance ranging from ~–3% to +16%. Given that higher doses may increase adverse effects without clear additional benefits, this review examined the effects of low (≤3 mg·kg⁻¹), moderate (4–6 mg·kg⁻¹), and high (>6 mg·kg⁻¹) caffeine doses on time-trial performance. Methods: A systematic review and meta-analysis of randomized, placebo-controlled trials was conducted using PubMed, Embase, and Virtual Health Library databases. Eligible studies included healthy adults (18–59 years) acutely ingesting oral anhydrous caffeine before aerobic time-trial tests, with performance outcomes measured exclusively as time-to-completion variables. Data were pooled using standardized mean differences (SMDs) and 95% confidence intervals under random-effects models, and risk of bias was assessed using the Cochrane Risk of Bias tool. Results: Forty-eight studies (689 participants) met the inclusion criteria. Both low and moderate caffeine doses significantly reduced time-trial completion time relative to placebo. Low doses produced a standardized mean difference of −0.27 (95% CI: −0.44 to −0.11; p = 0.001), whereas moderate doses resulted in an SMD of −0.52 (95% CI: −0.77 to −0.28; p < 0.0001). No studies evaluating high caffeine doses (>6 mg·kg⁻¹) and reporting time-to-completion outcomes met the inclusion criteria. Subgroup analyses demonstrated similar ergogenic effects in both trained and highly trained individuals consuming moderate caffeine doses. Conclusions: This is the first meta-analysis specifically focused on aerobic time-trial performance to suggest that pre-exercise ingestion of low caffeine doses (1.3–3 mg·kg⁻¹) may enhance endurance performance by reducing time-trial completion time. Notably, the use of moderate caffeine doses (4–6 mg·kg⁻¹) appears to produce a more consistent ergogenic effect. Full article

Falls among older adults remain a major public health concern, yet scalable and interpretable sensing approaches for functional fall-risk stratification remain limited. This study presents a lightweight contactless framework for five-level Short Physical Performance Battery (SPPB)-aligned functional fall-risk stratification using monocular RGB video. A total of 688 community-dwelling older adults completed SPPB-aligned assessments, including balance, five-times sit-to-stand, and 3 m gait tasks. Because prospective fall-event outcomes were unavailable, supervised labels were constructed from a pre-specified SPPB-aligned functional risk index rather than observed future falls. BlazePose-based two-dimensional keypoints were extracted, normalized using pelvis-centered and height-scaled transformations, and represented as temporal skeletal trajectories. Biomechanical descriptors were fused with embeddings from the proposed Temporal Convolutional Artificial Intelligence Fall-Risk Network (TCAI-FallNet). Participant-level data partitioning was used to reduce data leakage. TCAI-FallNet achieved a macro-averaged area under the curve of 0.91 and an overall accuracy of 81.3%. The trained model had a footprint under 3 MB, and TCN inference latency was below 20 ms per sequence under workstation-based evaluation. These findings suggest that TCAI-FallNet may support contactless SPPB-aligned functional mobility risk stratification, while prospective fall-event validation remains necessary. Full article

Aquatic recreation significantly enhances well-being; however, individuals experiencing functional limitations remain frequently marginalized from this form of tourism due to infrastructural and environmental barriers. This study investigates the perceived operational risks and apprehensions encountered by users with specific accessibility needs during yacht sailing, aiming to inform inclusive vessel design aligned with the social dimension of sustainable development. A survey of 277 participants with diverse, officially certified functional limitations was conducted to evaluate their maritime experiences and safety concerns. Participants identified a mean of 11 pre-voyage apprehensions out of 19 distinct risk categories. The most prevalent concerns included stumbling, slipping, or falling on board (79%), the risk of falling overboard (73%), and seasickness (70%), with an overall moderate severity ($\overline{X}$ = 2.2 on a 4-point scale). Crucially, severe safety concerns (e.g., vessel sinking or falling overboard) were significantly mitigated following practical sailing experience. Conversely, everyday functional and ergonomic challenges—such as moving between the deck and crew quarters ($\overline{X}$ = 2.6), operating rigging ($\overline{X}$ = 2.7), embarkation ($\overline{X}$ = 2.6), and utilizing sanitary facilities ($\overline{X}$ = 2.1)—persisted irrespective of experience level. Statistical analysis revealed that gender and age had negligible effects on concern levels. Extensive maritime experience reduced apprehensions regarding balance and swimming competencies, while concurrently increasing awareness of communication and comfort-related operational challenges. This study highlights a distinct divergence between initial psychological anxiety—which is largely mitigated by experience—and persistent architectural barriers inherent in standard yacht design. The results underscore that achieving meaningful inclusivity in water tourism requires prioritizing interior spatial layouts, accessible sanitary facilities, and barrier-free vertical circulation in naval architecture, rather than focusing exclusively on emergency safety systems. These insights directly support the advancement of Sustainable Development Goal 10 and the integration of universal and human-centered design principles within the maritime recreation sector. Full article

Background: Frailty is associated with adverse postoperative outcomes and functional decline in older adults undergoing colorectal cancer (CRC) surgery. The long-term course of frailty and functional outcomes among patients undergoing prehabilitation before CRC surgery remains insufficiently investigated. Methods: This prospective observational cohort study evaluated long-term functional and physiological outcomes in older adults with frailty syndrome undergoing colorectal cancer (CRC) surgery who participated in a structured prehabilitation program. Forty-one patients aged >70 years were assessed before prehabilitation and at one-year follow-up. Frailty (the Clinical Frailty Scale [CFS] and the 5-item Frailty Index [5-FI]), physical activity, postural function, respiratory parameters, and functional performance (the 6 min walk test [6MWT] and the Timed Up and Go [TUG] test) were evaluated. Results: Of the 93 eligible patients, 41 completed the one-year follow-up and were therefore included in the final analysis. A small but statistically significant increase in frailty was observed using 5-FI (mean difference = 0.029, p = 0.012), with no significant change in CFS. Postural function improved (p = 0.031), while physical activity and functional performance remained stable (6MWT: 392.71 vs. 384.36 m, p = 0.885; TUG: 12.36 vs. 10.42 s, p = 0.051). A significant reduction in pre- and post-exercise oxygen saturation was observed; however, the magnitude of change (before: −1.25%, p = 0.006; after: −0.91%, p < 0.001) was small and of uncertain relevance. Conclusions: Over a one-year follow-up of prehabilitated CRC patients with frailty, their functional performance remained stable despite a subtle progression of frailty. These findings suggest a dissociation between physiological vulnerability and functional status. Due to the observational design of the study and the lack of a control group, the results should be interpreted as descriptive rather than causal. Full article

Contemporary youth mental health challenges necessitate collaborative approaches to prevention and support. The Mental Health Ambassador (MHA) program was developed to equip youth and adults in mentoring programs with the skills and confidence to discuss and support youth mental health, with the broader goal of creating meaningful impact within their local communities. The 8-session MHA program involves group-based learning and a local youth-led advocacy project. This mixed-method pre-post pilot evaluation examined program acceptability, implementation experiences, and potential for effectiveness. Participants included youth aged 14–18 years (n = 9) and adult mentors (n = 11) from mentoring organizations across five counties in Minnesota. Quantitative surveys assessed mental health resource awareness, preparedness to address youth mental health concerns, confidence in engaging in mental health conversations, and confidence in providing resources and referrals. Post-program focus groups explored participants’ experiences, perceived benefits, and implementation challenges. Findings indicated that both youth and adult participants reported positive experiences with the program and demonstrated increases in resource awareness, preparedness to address youth mental health concerns, confidence in discussing mental health, and confidence in providing resources and referrals. Qualitative findings further highlighted the value of youth-led advocacy activities and identified key considerations for implementation within mentoring settings. Mentoring programs may represent an ideal context for equipping youth and adults to provide early, community-based support for youth mental health concerns. Full article

Spanish–English bilingual learners in U.S. dual language and bilingual education programs develop Spanish orthographic competence while receiving literacy instruction across two writing systems that differ in phonological transparency, orthographic depth, and grammatical marking. This study examined experts’ perceptions of the clarity, instructional coherence, pedagogical relevance, applicability, and refinement priorities of a pedagogical framework for Spanish orthographic development in contexts where Spanish is used as a language of instruction and literacy. The framework conceptualizes Spanish orthographic decision-making as the coordinated activation of phonological mapping, orthographic–grammatical reasoning, and visual–lexical retrieval within biliteracy development. Using a qualitative evaluative design, the study analyzed open-ended questionnaire and interview data from 44 experts in bilingual education and Spanish literacy-related fields. Findings show broad convergence regarding the framework’s clarity, instructional coherence, and relevance for bilingual contexts. Participants emphasized pre-dictation preparation, explicit metalinguistic analysis, visual-memory activation and retrieval routines, and cross-linguistic comparison between Spanish and English. They also identified refinement priorities, including classroom-ready examples, clearer articulation of error and autocorrection, and stronger integration with reading, writing, and oracy practices. This study positions Spanish orthographic instruction as a cognitively guided biliteracy practice and identifies design principles for strengthening orthographic, metalinguistic, and cross-linguistic instruction in bilingual programs. Full article

Objective: This study aims to investigate the acute effects of transcutaneous auricular vagus nerve stimulation (taVNS) on autonomic nervous system (ANS) regulation and spasticity in children with spastic cerebral palsy (SCP). Methods: This preliminary study includes 20 children aged 2–15 years diagnosed with SCP. Participants undergo a single session of taVNS. Spasticity is assessed using the Modified Ashworth Scale, and autonomic regulation is evaluated through heart rate variability (HRV) parameters measured before and immediately after stimulation. Results: Following taVNS, spasticity scores decrease significantly (Modified Ashworth Scale: pre 2.00 ± 0.64 vs. post 1.60 ± 0.52; p = 0.004). Significant reductions are also observed in mean heart rate (pre 98.60 ± 16.32 bpm vs. post 91.25 ± 20.22 bpm; p = 0.022), LF/HF ratio (pre 2.22 ± 2.22 vs. post 1.12 ± 0.84; p = 0.006), and LF power (p = 0.009). No significant changes are detected in RMSSD, pNN50, or HF power (all p > 0.05). No adverse events are reported. Conclusions: This preliminary study suggests that a single session of taVNS may be associated with acute changes in autonomic regulation and reductions in spasticity in children with SCP. The observed shifts in HRV parameters indicate a modulation of sympathovagal balance. These findings support the feasibility of taVNS as a non-invasive neuromodulatory approach and warrant further large-scale, controlled studies with longer follow-up. Because of the small sample size, the absence of a control or sham group, and the short (1-min) HRV recording window, these results should be regarded as preliminary and hypothesis-generating, and they require confirmation in larger, randomised, sham-controlled studies. Clinical Trial Registration: This study was registered at ClinicalTrials.gov (Identifier: NCT06880887) on 10 March 2025. The study was conducted between January 2025 and March 2025; registration on 10 March 2025 therefore occurred during the enrolment and data-collection period rather than prior to it. This retrospective registration is acknowledged as a limitation. Full article

Background: Type II workplace violence by patients, relatives, or visitors is an occupational health and patient-safety concern in primary care. Cranston Ridge Medical Clinic (CRMC), a single urban family medicine and walk-in primary care clinic in Calgary, Alberta, plans to implement a universal, risk-informed workplace-safety bundle that is based on observable behaviour, situational risk, and documented safety concerns rather than demographic profiling. Methods: This article describes a single-site internal quality improvement and workplace-safety evaluation protocol. The comparison is CRMC usual practice during the pre-implementation baseline period; there is no concurrent external control group. The planned evaluation will use aggregate, de-identified operational data from a 12-month pre-implementation baseline, a four-week implementation period, and 12 months of post-implementation monitoring. All clinic staff will receive workplace-safety training as part of routine implementation. No staff, patients, or visitors will be recruited as research participants, and the evaluation will not use individual-level staff survey, interview, or focus-group data. Patient/visitor information will be used only as aggregate operational monitoring data when needed to assess safety, access, patient flow, and complaints. Intervention and analysis: The bundle includes worksite analysis, staff training, a brief arrival safety screen, a response algorithm, standardized reporting, monthly safety huddles, and post-incident support. The primary metric will be the Type II workplace-violence incident rate per 1000 clinic visits. Planned analyses include run charts, pre–post rate ratios, and Poisson or negative binomial segmented regression if monthly counts are sufficient. Implementation learning will be summarized from routine training records, safety-huddle summaries, post-incident debrief themes, and other aggregate de-identified operational indicators. Expected contribution: The protocol contributes a transparent, equity-sensitive, and operationally feasible model for balancing staff safety with patient access in primary care. Full article