Search Results (521)

Background: Adult females with Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) are frequently underdiagnosed due to gender bias, overlapping symptoms, and limited awareness among healthcare professionals. The scarcity of research on this subject—particularly in the UK context—underscores the need for further investigation. Accordingly, the aim of this study was to explore the lived experiences of adult females receiving a late diagnosis of ASD and/or ADHD and to identify key barriers within the UK diagnostic pathway. This study addresses a critical knowledge gap by examining the factors contributing to delayed diagnosis within the United Kingdom. Study Design and Method: The study employed a qualitative approach, utilising an anonymous online questionnaire survey comprising nine open-ended questions. Responses were obtained from 52 UK-based females aged 35–65 years who had either received or were awaiting a diagnosis of ASD and/or ADHD. Data were analysed thematically within a constructivist framework. Findings: The analysis revealed three overarching themes: (i) limited understanding and lack of empathy among healthcare professionals, (ii) insufficient post-diagnostic support, with most participants reporting no follow-up care, and (iii) a complex, protracted diagnostic process, often involving waiting periods exceeding three years. Gender bias and frequent misdiagnosis were recurrent issues, contributing to significant psychological distress. These findings underscore the need for systemic reforms and align closely with gaps identified in the existing literature. Conclusions: The findings emphasise the urgent need for gender-sensitive diagnostic frameworks, enhanced professional training, and a person-centred approach to care. Key recommendations include shortening diagnostic waiting times, strengthening healthcare professionals’ knowledge base, and ensuring equitable and consistent post-diagnostic support. Full article

The technological triangle is a non-mathematical representation of the relationship between the characteristics of transport infrastructure, modes of transport, and the operational concept in a specific region. It is only through the synergistic effect of these three vertices that the railway undertaking, infrastructure manager, and authority can achieve optimal resource utilisation. Concurrently, it is imperative to exert pressure on the authorities to implement conceptual, systematic, and predictable measures. The process of implementing changes to transport infrastructure is a protracted one, typically spanning several years from the initial stages of preparation through to the project’s execution. The application of the technological triangle is possible on various parts of the infrastructure. Based on previous research, the authors prepared this Article to address intermediate stations, which were identified as the key focus of this article. Therefore, the authors in this article answer the question of what typical solutions exist for intermediate station configurations in relation to the operational concept and financial costs. Twenty different configurations were selected, and each was examined from the perspectives of financial, operational, planning, automation, and user pillars. The weights of the individual pillars were then assessed from the perspective of the infrastructure manager, the carrier, and the customer. The result is a comprehensive assessment of all wayside station configurations from different perspectives. Each user of this workflow can determine the weights of the individual pillars according to their needs and financial capabilities. This also gives the article a general use. The final part of the article presents specific examples of existing structures in the Czech Republic, which were not built with the perspective of this article in mind. The authors point out that if our method were applied, not only would large platform stations be built, which is the case for many intermediate stations in the Czech Republic; instead, more efficient solutions would be developed and adapted to the specific case. Full article

Russia’s 2022 invasion precipitated one of Europe’s largest episodes of forced academic mobility, compelling universities to shift from emergency access to durable inclusion. This article investigates how Ukrainian students are integrated into Romanian higher education through a qualitative case study at Ovidius University of Constanta, undertaken within the Erasmus+ EIUS project. We analysed a participatory focus-group workshop (“Building Bridges,” May 2024) involving 72 participants (15 Ukrainian students, 31 Romanian students, 26 academic staff). Transcripts were coded via reflexive thematic analysis and interpreted through a SWOT lens to connect lived experience with institutional strategy. Findings indicate that integration generates tangible pedagogical and social value—diversity enriches coursework, empathy strengthens peer collaboration, and exposure to multilingual classrooms catalyses instructional innovation. Yet systemic fragilities persist: language anxiety (“translation silence”), fragmented support pathways, and limited access to counselling shift emotional labour onto faculty and peers. Opportunities cluster around Erasmus+ infrastructures, bilingual materials, and co-created projects that transform access into participation; threats include latent prejudice, social isolation, compassion fatigue, and policy discontinuity as crisis attention wanes. We advance the concept of institutionalised solidarity—a multi-level inclusion model that couples emotional infrastructures (mentoring, trauma-informed pedagogy, counselling) with organizational infrastructures (integration offices, linguistic scaffolding, adaptive assessment). The study contributes an empirically grounded framework for moving from humanitarian reaction to sustainable academic inclusion and offers actionable guidance for European universities seeking resilience under protracted disruption. Full article

Objectives: This study aimed to comprehensively evaluate and compare the therapeutic effects of Right Angle Maxillary Protraction Appliance (RAMPA) therapy on nasal airway volume in pediatric patients, specifically differentiated by their baseline radiological paranasal sinus status. The objective was to quantify airway volume changes (absolute and percentage) in clear and opacified sinus groups, investigate the influence of age, sex, and treatment duration on these changes, and elucidate potential differences in the underlying mechanisms of airway expansion between groups. Study Design: A retrospective comparative cohort study design was employed. This study includes a “clear sinus group” of 26 patients (mean age: 6.6 years) with radiologically clear sinuses at baseline and an “opacified sinus group” of 20 patients (mean age: 6.8 years) diagnosed with rhinosinusitis and exhibiting significant sinus opacification on baseline CBCT scans. Upper airway volumetric measurements were performed using CBCT scans acquired pre- (T1) and post-treatment (T2), with data analyzed using Invivo 5 software. Results: RAMPA therapy significantly increased upper airway volume in both cohorts. The clear sinus group showed an approximate 18% mean increase (4886.9 mm³ absolute), while the opacified sinus group demonstrated a remarkably greater 61% mean increase (11,192.8 mm³ absolute). This difference was statistically significant. In the clear sinus group, airway volume gain positively correlated with treatment duration (p = 0.0303). Conversely, no significant correlation was found in the opacified sinus group (p = 0.288), suggesting rapid obstruction relief as a dominant mechanism. Sex did not significantly influence outcomes, and age was not a strong independent predictor of volume change magnitude. Conclusions: RAMPA therapy effectively increases upper airway volume in pediatric patients, with a substantially greater effect in those with baseline sinus opacification due to rapid obstruction resolution complementing skeletal changes. The mechanism of action differs by sinus status, with clear sinus patients showing gradual, duration-dependent skeletal adaptation and opacified sinus patients exhibiting immediate, duration-independent gains primarily from sinus clearance. These findings provide crucial insights for tailored clinical decision-making. Full article

Photobiomodulation (PBM) therapy has been effectively used to relieve pain and inflammation and promote tissue healing and regeneration in a broad range of ailments. Prior work has focused on intracellular mitochondrial cytochrome c oxidase, while extracellular latent TGF-β1 activation had been noted. This work investigated the role of PBM-generated redox signaling and integration in normal oral keratinocytes, using Western blots and pathway-specific small molecule inhibitors. We observed that PBM primarily generates ROS intracellularly within mitochondria, which then diffuse extracellularly to activate latent TGF-β1. This activation triggers ATF-4 expression through both canonical (Smad3) and non-canonical (p38, ERK) TGF-β signaling pathways. We observed a critical role for NFκB as an essential integrator, coordinating these responses as evidenced by the loss of ATF-4 expression following NFκB inhibition (BAY II) after both PBM and TGF-β1 treatments. Proteomic pathway analysis revealed that PBM downregulates inflammatory and apoptotic pathways while activating stress-adaptive responses in the NFκB pathway. A core set of PBM-induced redox, NFκB, and TGF-β signaling targets was identified. These findings suggest that optimal PBM treatment responses require a coordinated action of multiple signaling pathways that optimize cellular adaptation to stress and promote tissue repair rather than protracted inflammation and cell death. Full article

Limb amputations are a growing global challenge. Electrically powered prosthetic hands are heavy, expensive, and battery dependent. Body-powered prostheses offer a simpler and lighter alternative; however, existing designs require high body forces to operate, exhibit poor aesthetics, and have limited dexterity. This study aims to present a design of a hydraulically actuated soft bending finger with a simple and scalable manufacturing process. This is then realised into a five-fingered body-powered prosthetic hand that is lightweight, comfortable, and representative of a human hand. The actuator was formed from two silicone materials of different stiffness (Stiff Smooth-Sil 950 and flexible Ecoflex 00-30) and reinforced with double-helix fibres to generate bending under internal hydraulic pressure. A shoulder-mounted hydraulic system has been designed to convert scapular elevation and protraction into actuator pressure. Finite element analysis and physical tests were performed to examine the bending and blocking force performance of the actuators. The physical actuators achieved bending angles up to 230 degrees at 60 kPa and blocking forces of 5.9 N at 100 kPa. The prosthetic system was able to grasp and hold a 320-g water bottle. The results demonstrate a soft actuator design that provides simple and scalable manufacturing and shows how these actuators can be incorporated into a body-powered prosthesis. This study provides a preliminary demonstration of the feasibility of human-powered prosthetics and necessitates continued research. This work makes progress towards an affordable and functional body-powered prosthetic hand that can improve the lives of transradial amputees. Full article

Compound drought and heatwave (CDHW) events pose a rising threat to global water security and ecosystem stability. While their increased frequency under global warming is recognized, their spatiotemporal evolution and subsequent cascading impacts on hydrological processes in monsoonal lake basins remain poorly quantified. This study investigates the characteristics and hydrological impacts of CDHW in the Poyang Lake Basin, China’s largest freshwater lake, from 1981 to 2016. Using a daily rolling-window approach with the Standardized Precipitation Index (SPI) and Standardized Temperature Index (STI), we identified CDHW events and characterized them with metrics of frequency, severity, and intensity. Event coincidence analysis (ECA) was employed to quantify the trigger relationship between CDHW and subsequent hydrological droughts (streamflow and lake water level). Our results reveal a paradigmatic shift in the CDHW regime post-2000, marked by statistically significant increases in all three metrics and a fundamental alteration in their statistical distributions. ECA demonstrated that intensified CDHW events significantly enhance hydrological drought risk, primarily through a robust and increasing lagged influence at seasonal timescales (peaking at 40–90 days). Decomposition of compound events attributes this protracted impact predominantly to the heatwave component, which imposes prolonged hydrological stress, in contrast to the more immediate but rapidly decaying influence of drought alone. This study highlights the necessity of integrating compound extremes and their non-stationary, lagged impacts into water resource management and climate adaptation strategies for monsoonal basins. Full article

Chronic diseases, characterized by their high prevalence and protracted course, represent a paramount challenge to global public health, necessitating effective, evidence-based preventive strategies. While functional foods are widely recognized for their potential, a comprehensive synthesis elucidating their multitargeted mechanisms within a “food-medicine homology” framework and a clear trajectory from broad-spectrum health promotion to targeted intervention remains lacking. This review bridges this critical gap by systematically evaluating the scientific evidence and application potential of functional foods, with a specific focus on key bioactive compounds—β-glucan, omega-3 polyunsaturated fatty acids (PUFAs), dietary fiber, and catechins. We provide a critical analysis of how these components orchestrate synergistic effects at molecular, cellular, and systemic levels to counteract core pathological processes, including oxidative stress, chronic inflammation, metabolic dysregulation, and gut microbiota imbalance. Our unique contribution lies in integrating the ancient wisdom of food-medicine homology with modern multi-omics and evidence-based research, thereby proposing a refined nutritional intervention paradigm. The review offers critical insights into the convergent actions of these bioactives, their dose-response relationships substantiated by clinical meta-analyses, and the emerging role of gut microbiota-derived metabolites. Furthermore, this review also explores the emerging evidence for synergistic interactions among these key bioactives, proposing that their combined use may yield amplified and more network-based protective effects against chronic diseases through complementary mechanisms, aims to develop integrated prevention strategies targeting both cardiometabolic and neurodegenerative diseases. The integrated prevention strategies systematically connect mechanistic insights into bioactive compounds, evaluates the strength of clinical evidence, and examines the implications for regulatory standards and societal acceptance, thereby bridging the gap between basic science, clinical application, and public health policy. The “mechanism-to-evidence-to-regulation” framework in this review links molecular insights with clinical validation and regulatory implications, offering a holistic perspective rarely addressed in existing literature. Full article

Background: Impaired mucus drainage from the paranasal sinuses is often associated with nasal obstruction and reduced airway function in growing patients. Orthopedic maxillary protraction and expansion techniques can enhance airway dynamics, but their underlying fluid–structure mechanisms remain insufficiently understood. Objective: To validate that the Right Angle Maxillary Protraction Appliance (RAMPA), combined with a semi-rapid maxillary expansion (sRME) intraoral device gHu-1, improves mucus drainage by enhancing nasal airflow through nasal cavity expansion. Methods: The effects of RAMPA therapy were analyzed using computational fluid dynamics (CFD) for single-phase (air) and two-phase (air–mucus) flows within the nasal cavity, employing the unsteady RANS turbulence model. Finite element method (FEM) results from prior studies were synthesized to assess changes in the center and radius of maxillary rotation induced by RAMPA-assisted sRME. A male patient (aged 8 years 7 months to 11 years 7 months) treated with extraoral RAMPA and the intraoral appliance (gHu-1) underwent pre- and post-treatment cone-beam computed tomography (CBCT) and ear, nose, and throat (ENT) evaluation. Results: FEM analysis revealed an increased radius and elevated center of maxillary rotation, producing expansion that was more parallel to the palatal plane. CFD simulations showed that nasal cavity expansion increased airflow velocity and pressure drop, enhancing the suction effect that promotes mucus clearance from the frontal sinus. Clinically, nasal passages widened, paranasal opacities resolved, and occlusal and intermolar widths improved. Conclusions: RAMPA combined with sRME improves nasal airflow and maxillary skeletal expansion, facilitating paranasal mucus clearance and offering a promising adjunctive approach for enhancing upper airway function in growing patients. Full article

On 7 October 2023, Israel experienced a large-scale attack, initiating the Iron Swords War (also known internationally as the 2023 Israel–Hamas War). This protracted armed conflict profoundly disrupted social and economic life in Israel and the region. This study investigates the psychological distress of small business owners in the aftermath of this terrorist assault and during the ensuing conflict. Drawing on a nationwide survey of 363 entrepreneurs, we applied a two-stage higher-order PLS-SEM model to examine how economic stressors, psychological and institutional resources, and demographic factors shaped distress. The findings reveal that uncertainty and revenue loss intensified distress, while resilience, hope, and trust in government operated as protective resources, with notable gender differences also observed. Beyond its economic and psychological relevance, the study situates entrepreneurial distress within a broader public health perspective, viewing the mental health and well-being of small business owners as integral to community resilience, social stability, and national recovery during crises. By framing entrepreneurial distress and resilience as key determinants of population mental health and collective well-being, this research underscores how supporting entrepreneurs contributes to wider health promotion and psychosocial recovery efforts. Overall, the study offers a novel multidimensional empirical analysis of entrepreneurial distress during armed conflict, underscoring the psychological mechanisms through which terrorism and its aftermath affect small business owners, and highlighting the need for resilience-building and institutional support to mitigate mental health burdens. Full article

Tuberculosis (TB) remains a public health threat in low- and middle-income countries (LMICs) of the World Health Organization (WHO) Eastern Mediterranean Region (EMR), driven by a combination of social determinants including undernutrition, fragile health systems, conflict-related disruptions, human mobility and displacement, sub-optimal programmatic implementation, and insufficient domestic investment. These programmatic and governance constraints operate within a broader geopolitical context marked by conflict, sanctions, protracted crises, and large-scale displacement, which further limit countries’ ability to deliver uninterrupted TB services. In 2023, the region’s TB incidence was estimated at 116 per 100,000 population, with Pakistan alone accounting for about 73% of the regional burden. Despite a multitude of efforts, progress in reducing the TB burden in the EMR remains slow, with high case detection and treatment coverage gaps, low uptake of TB preventive treatment (TPT), underutilization of WHO-recommended rapid diagnostics, and only 25% of drug-resistant TB (DR-TB) cases initiated on treatment. Vulnerable populations, including internally displaced persons, migrants, refugees, prisoners, and returnees, continue to face major access barriers, and cross-border TB collaboration remains limited. This commentary reasons that the slow pace of TB burden reduction in the region is not only a biomedical or resource issue but also a reflection of structural and governance shortcomings. It proposes a ten-point strategic vision focused on building a sustainable ecosystem, enhancing primary healthcare systems, adopting people-centered and rights-based approaches, leveraging artificial intelligence, and gradually reducing dependency on external donors where feasible. However, in highly fragile settings such as Yemen or Somalia, domestic financing remains limited, and sustained external support will continue to be indispensable. The commentary calls for stronger national leadership, inclusive stakeholder engagement, and increased domestic financing to deliver integrated and resilient TB services. Ending TB in the EMR is within reach, but it requires boldly committed, coordinated, and country-led action. Full article

Challenges to the health and wellbeing of youth refugees in Kenya are well documented, particularly in refugee camps. However, amid protracted crises in the region, changes in refugee camp legislation and reduced funding are driving the further urbanization of refugees, necessitating a greater focus on understanding the hardships, movements, and challenges young urban refugees face. The focus of this paper is to document research on mapping the food supply chains, including points of intersection for young South Sudanese urban refugees in Kenya, and to identify barriers, constraints, and opportunities for procuring, growing, and selling food. This youth-led study, a follow-up to previous findings, included 40 participants aged 19 to 32. Youth food-resilience stories highlight critical areas for strategic intervention and provide insights into the design of spatially just and economically inclusive urban spaces. Applying a multimethod approach, including food diaries, food maps, and survey tools embedded in a learning platform, the paper weaves a narrative that highlights youth ingenuity in food security and provides insights for governments, policymakers, community leaders, and donors to support responsive, economically inclusive community design in addressing social challenges. Our findings indicate that improving the quality of life and food security of refugee youth is complex and requires a holistic approach. Without education and improvements in livelihoods, including urban agricultural opportunities, refugee youth’s health and wellbeing will continue to be affected. Full article

The application of alizarin dye for the marking of fish is a widely adopted practice in post-stocking monitoring programmes. Nevertheless, concerns regarding the welfare implications of alizarin staining persist. The present study conclusively demonstrated that ARS dye exerts instantaneous and protracted deleterious effects on the physiological parameters (gill ventilation frequency, homeostasis in the gut microbiota, total number of erythrocytes and leukocytes) and body fitness (total length, weight and Fulton’s condition factor) of S. trutta fry. The validity of the dye-marked fish stocking effectiveness studies is called into question by these findings. Full article

Persons with disabilities (PWDs) face disproportionate risks during humanitarian crises, yet their inclusion in aid delivery remains limited. To address this, the Inter-Agency Standing Committee (IASC) introduced the Guidelines on the Inclusion of Persons with Disabilities in Humanitarian Action in 2019. The IASC guidelines provide a global framework for mainstreaming disability inclusion. This exploratory study examines how these guidelines are applied in Borno State, Northeastern Nigeria, a region marked by protracted conflict, displacement and insecurity. Using a qualitative phenomenological approach, data were gathered through in-depth interviews from 20 humanitarian practitioners and supplemented with secondary sources. Thematic analysis revealed that while organisations adopted strategies such as data disaggregation, door-to-door outreach and local committee representation, implementation was inconsistent and constrained by cultural beliefs about disability, political interference, population displacement and weak monitoring standards. The findings also highlighted that although the IASC Guidelines are good in principle, the guidelines require context-specific adaptation, stronger organisational commitment and active inclusive engagement with PWDs and their representative organisations. The study recommends incorporating disability inclusion through mandatory organisational policies, dedicated funding, community-based advocacy and improved data systems to ensure that humanitarian responses are both inclusive and sustainable. Full article