Search Results (2,005)

Within the framework of a discrete-time chronon model, we consider a dual description of physical time. In this description, macroscopic time is a continuous parameter, while a microscopic integer chronon index labels elementary updates of the system. On this basis, a hierarchy of temporal layers ${\mathrm{Ch}}_N$ (Chronon) is introduced. The simple layers $\mathrm{Ch}2$, $\mathrm{Ch}3$ and $\mathrm{Ch}4$ are analysed, and it is shown that they naturally support $U\left(1\right)$ (Unitary group), $SU\left(3\right)$ (Special Unitary group) and a pair-locked $SU\left(2\right)$ (Special Unitary group) symmetry, respectively. Special attention is paid to the twelve-slot layer $\mathrm{Ch}12$. This layer is the minimal one which simultaneously separates partitions into four triads and three quartets. For $\mathrm{Ch}12$, we demonstrate that the intersection of the corresponding commutants in ${\mathbb{C}}^3\otimes {\mathbb{C}}^4$ reproduces the Standard Model gauge algebra $SU{\left(3\right)}_C\times SU{\left(2\right)}_L\times U{\left(1\right)}_Y$ and the pattern of hypercharges and anomaly cancellation. The appearance of three fermion generations is interpreted in terms of three inequivalent embeddings of a triad into the dodecad which preserve the quartet structure. Possible connections of the chronon dynamics with the hierarchy of masses (via Floquet-type quasi-energies), with dark sectors associated with misaligned layers, and with a temporal interpretation of entanglement are briefly discussed on a qualitative level. These questions are formulated as open problems for further study. Full article

Background/Objectives: The 2024 Noto Peninsula earthquake in Japan severely affected community care for persons with psychiatric disabilities. This study analyzed the difficulties and adaptive coping strategies of psychiatric visiting nurses (PVN) to inform disaster mental health practice. Methods: A qualitative, descriptive design was used. Semi-structured interviews were conducted with six PVN, and the data were analyzed thematically. Results: Key findings indicated two main challenges: a system-level paralysis of care owing to infrastructure collapse and the ethical dilemmas experienced by the role of PVN as “dual victims.” In response, nurses leveraged pre-existing therapeutic relationships to ensure care continuity and acted as essential liaisons to external teams. The study also documented substantial and unexpected patient resilience. Conclusions: Based on the findings, this study’s primary contribution is a recommendation to reframe disaster policy by shifting focus from merely deploying external aid to empowering existing, trusted community care networks and adopting a strengths-based model for mental health support. Full article

Background: Patellofemoral pain (PFP) is a prevalent overuse injury among recreational cyclists worldwide. Despite its ubiquity, little is known about the lived experiences of people with PFP, especially in Saudi Arabia, where healthcare and cultural factors may have a specific impact on how the condition is managed. The aim of this study was to explore the lived experiences of recreational cyclists with patellofemoral pain in Al Madinah, Saudi Arabia. Method: A qualitative, descriptive design using reflexive thematic analysis was employed. Eleven male recreational cyclists aged 28–44 years diagnosed with PFP were purposely recruited from Al Madinah Physical Therapy Centre. Female participants were excluded due to cultural constraints regarding sports participation. The participants consented to participate in the study and to be audio recorded. Data were collected through semi-structured interviews using an interview guide. The interview data were transcribed verbatim and thematically analysed using Atlas.ti, version 24. Results: The thematic analysis revealed six themes highlighting the multidimensional impact of PFP. The participants described localised mechanical impairment with rapid onset during activity and persistent symptoms lasting up to two weeks. Pain was exacerbated by eccentric loading and cycling-specific stressors, such as uphill riding, leading to significant anxiety and avoidance behaviours. To maintain activity, these cyclists employed adaptive strategies, including bike modifications and self-management. Notably, PFP imposed substantial cultural and social burdens, hindering spiritual practices, specifically Salah (prayer) postures, professional duties, and family caregiving. While the participants demonstrated resourcefulness through a hybrid of physiotherapy and independent research, pharmacological relief was viewed as a transient solution. Conclusions: Patellofemoral pain imposes significant multidimensional burdens on recreational cyclists in Al Madinah, which are exacerbated by cultural practices. Physiotherapy offers targeted interventions for pain relief, functional restoration, and participation enhancement, necessitating the need for culturally sensitive management programmes. Full article

Background: Neonatal mortality remains a significant public health challenge in Ethiopia. Despite efforts to implement key evidence-based interventions, their coverage and utilization remain low. The Saving Little Lives (SLL) program aims to scale-up a Minimum Care Package (MCP) of synergistic, life-saving interventions for all liveborn neonates, with a focus on preterm and low birth weight (LBW) infants, across 290 hospitals in Ethiopia (206 primary, 69 general, and 15 referral hospitals), representing 82% of all hospitals in the country at the time of the study, and evaluate the impact on neonatal mortality. Methods: A non-randomized stepped-wedge trial will be conducted to evaluate the impact of implementing the SLL MCP interventions. Quantitative evaluation data will be collected from 36 primary hospitals, selected from 206 primary hospitals across four regions, receiving the interventions. An independent evaluation research assistant will be deployed in each of the hospitals to collect data using Open Data Kit (ODK) through interviewing mothers before discharge, on the 29th day of life if discharged, and reviewing medical records. A mixed-method, cross-sectional formative assessment will be conducted prior to implementation, employing quantitative facility assessment and qualitative interviews with mothers, healthcare providers, and facility managers. This will be followed by continuous program learning assessment once implementation begins. Descriptive data will be presented using numbers, percentages, tables, and graphs. Regression modeling and generalized estimating equations (GEEs) will be used to estimate the impact of the SLL MCP interventions. Qualitative data will be gathered through in-depth interviews, digitally recorded, transcribed, and thematically analyzed using ATLAS.ti Version 7.5 software to assess facility readiness, barriers, and enablers of implementing the SLL MCP interventions. Expected Outcome: We hypothesize that achieving 80% coverage of the SLL MCP interventions among eligible neonates will result in a 35% reduction in neonatal mortality at implementation facilities. Full article

Background/Objectives: Tinnitus affects various aspects of health, yet its impact on occupational functioning remains less well explored. This study investigated the impact of tinnitus on work productivity, the role of comorbidities of anxiety, depression, and quality of life, and explored whether an evidence-based intervention may potentially influence workplace functioning. Methods: The study used cross-sectional and longitudinal data and employed mixed methods design to enable comparing work productivity before and after undertaking ICBT for tinnitus. Data were collected from 449 participants (64% employed; mean age of 54.4 years) who were seeking to enroll in an internet-based psychological intervention. Of these, 200 also completed an internet-based cognitive behavioral therapy intervention (ICBT). Data were analyzed using descriptive statistics, analysis of variance, qualitative content analysis and comparisons made between those whose work was unaffected due to tinnitus and those who worked less. Results: Pre-intervention, 81% reported no change in work patterns. Because of tinnitus 11% worked fewer hours, 7% had stopped working, and 1% received disability allowance. Participants were significantly less effective in their work capacity prior to undertaking the intervention compared to post-intervention and at follow-up; for the overall sample and post-intervention improvements were observed in tinnitus distress, anxiety, depression, and insomnia. There was significant time difference between group interactions for tinnitus, anxiety and insomnia but not for depression and quality of life when comparing those working and not working. Qualitative findings highlighted challenges related to attention, fatigue, and communication, as well as coping strategies and role modifications. Conclusions: Further studies are required to build on this exploratory research. The present findings underscore the need for workplace policies recognizing tinnitus as a potential disability and providing reasonable accommodation and options to access tinnitus interventions. Clinical interventions should also consider how to improve workplace functioning in individuals with bothersome tinnitus. Future research should explore ways to address cognitive load and enhance productivity. Full article

Background: Digital transformation in healthcare has advanced rapidly in hospitals and primary care, while long-term care facilities have often lagged behind. In nursing homes, nurses play a central role in coordinating care and accessing medical expertise, yet digital tools to support these tasks remain inconsistently implemented. The CareConnect study, funded under the German Model Program for Telecare (§ 125a SGB XI), aimed to develop and implement a multiprofessional telecare system tailored to nursing home care. Objective: This implementation study examined the feasibility, acceptability, and early adoption of a multiprofessional telecare system in nursing homes, focusing on implementation processes, contextual influences, and facilitators and barriers to integration into routine nursing workflows. Methods: A participatory implementation design was employed over 15 months (June 2024–August 2025), involving a university hospital, two nursing homes (NHs), and four medical practices in an urban region in Germany. The telecare intervention consisted of scheduled video-based teleconsultations and interdisciplinary case discussions supported by diagnostic devices (e.g., otoscopes, dermatoscopes, ECGs). The implementation strategy followed the Standards for Reporting Implementation Studies (StaRI) and was informed by the Consolidated Framework for Implementation Research (CFIR). Data sources included telecare documentation, nurse surveys, researcher observations, and structured feedback discussions. Quantitative and qualitative data were analyzed descriptively and triangulated to assess implementation outcomes and mechanisms. Results: A total of 152 documented telecare contacts were conducted with 69 participating residents. Most interactions occurred with general practitioners (48.7%) and dermatologists (23%). Across all contacts, in 79% of cases, there was no need for an in-person visit or transportation. Physicians rated most cases as suitable for digital management, as indicated by a mean of 4.09 (SD = 1.00) on a 5-point Likert scale. Nurses reported improved communication, time savings, and enhanced technical and diagnostic skills. Key challenges included delayed technical integration, interoperability issues, and varying interpretations of data protection requirements across facilities. Conclusions: This pilot study suggests that telecare can be feasibly introduced and accepted in nursing home settings when implemented through context-sensitive, participatory strategies. Implementation science approaches are essential for understanding how telecare can be sustainably embedded into routine nursing home practice. Full article

Intelligent Tutoring Systems are increasingly used in higher education to support personalized learning and academic monitoring in large-scale digital environments. However, existing systems are predominantly based on static architecture and rigid rule-based mechanisms, which limit scalability and hinder effective adaptation to heterogeneous learners, evolving learning behaviors, and real-world educational contexts. This paper presents a self-adaptive multi-agent architecture based on Reinforcement Learning for autonomous decision-making in intelligent systems deployed in real environments. The proposal integrates an RL Meta-Agent that dynamically optimizes the selection of specialized agents through an intelligent switching mechanism, considering the user’s state, behavior, and interaction patterns. The architecture was implemented in Moodle using flows orchestrated in n8n, LLMs, databases, APIs developed in Django, and real academic data. For the empirical evaluation, a real and a simulated case study were designed. A questionnaire was administered to university students, considering dimensions of usability, satisfaction and usefulness, and accessibility and interaction, to understand the perception of the system and improvements. The quantitative data were analyzed using descriptive statistics and nonparametric tests (Mann–Whitney U and Kruskal–Wallis), while the qualitative data were examined using thematic categorization. A simulated case study was conducted to analyze the behavior of the system. The results show that the RL Meta-Agent significantly improves system efficiency, response relevance, and adaptive agent selection, demonstrating that self-adaptive RL-based MAS architectures are a viable solution for intelligent systems applied in real-world contexts, providing empirical evidence of their performance and adaptability in complex scenarios such as higher education. Full article

The informal street food sector serves as a vital component of urban economies in South Africa, providing affordable nutrition and employment. However, this industry struggles to comply with required health and safety practices and standards. This study protocol outlines a mixed-methods investigation into hygiene practices, regulatory compliance, and the intersection with business sustainability among informal food vendors in Johannesburg’s inner city. This study aims to investigate how vendors’ perceptions of health risks and benefits influence compliance behaviours and, in turn, how these behaviours impact operational efficiency, financial stability, and customer trust. Grounded in the Health Belief Model (HBM) and the Balanced Scorecard (BSC) framework, the research seeks to explore both behavioural drivers and performance outcomes associated with hygiene adherence. The study will employ structured stall observations, semi-structured vendor interviews, and customer surveys across high-density vending zones. Quantitative data will be analysed using descriptive and inferential statistics, while qualitative data will be thematically analysed and triangulated with observed practices. The expected outcome is to identify key barriers and enablers of hygiene compliance and demonstrate how improved food safety practices contribute to business resilience, customer trust, and urban public health. The findings aim to inform inclusive policy and innovative business support strategies that integrate informal vendors into safer and more sustainable food systems. Full article

Unless the psychosocial challenges experienced by widows in low-resourced communities are unpacked and understood, efforts to offer them proper and befitting interventions for their experiences will remain scant in South Africa. This paper explores the psychosocial challenges faced by widows in Ngaka Modiri Molema, a district in South Africa’s North West Province with limited resources. Using a qualitative approach and an exploratory descriptive design, this study employed homogeneous purposive sampling to ensure inclusion of widows who have experienced the psychosocial challenges of widowhood in Ngaka Modiri Molema. In-depth interviews conducted with twelve widows provided data saturation. The data were analysed thematically using predetermined and emerging themes, critically discussed and compared to the existing literature. The findings revealed that there were endemic and unexplored psychological issues such as anxiety, stress and depression, whilst some social challenges such as property disputes, eviction from the land and stigma were experienced by widows in the district since the death of their husbands. This paper recommends relevant holistic interventions to ameliorate the psychosocial challenges experienced by the widows in the district. Full article

This study utilises mobile augmented reality (AR) to enhance our understanding of multiword expressions (MWEs) and emphasise that linguistic diversity is part of cultural heritage. The main objective was to implement and evaluate the impact of a multilingual AR resource (in Moldovan, English, Russian, and Spanish) in educational settings and to identify a corpus of MWEs located in Spain. The research was conducted by applying a marker-based AR system in five academic subjects involving N = 220 undergraduate students enrolled in education degrees. Data were collected through two surveys, using both qualitative and quantitative methods that combined descriptive statistics with content analysis. Large Language Models (LLMs) were used to assist with data coding, complemented by iterative human validation. The findings revealed that the application was highly positively received, with 94% of participants acknowledging its usefulness and 83% expressing satisfaction. Furthermore, this study identified a teaching–learning procedure to enhance linguistic diversity in classrooms. Overall, the results suggest that mobile AR constitutes an effective and inclusive pedagogical tool that fosters active learning as a multimodal learning process and provides valuable localised MWE data to support future developments in corpus annotation. Full article

Public schools often operate with shared devices, unstable connectivity, and limited support for digital tools, which can make feature-heavy platforms difficult to adopt and sustain. This study reports the first formal design iteration and formative evaluation of VLEPIC, a school-centred virtual learning environment (VLE) developed to support secondary English as a Foreign Language in a low-resource Ecuadorian public school. Using a design-based research approach with a convergent mixed-methods design, one Grade 10 cohort (n = 42; two intact classes) used VLEPIC for one month as a complement to regular lessons. Data were collected through questionnaires on perceived usability and motivation, platform usage logs, and open-ended feedback from students and the teacher; results were analysed descriptively and thematically and then integrated to inform design decisions. Students reported high perceived usability and strong motivational responses in attention, relevance, and satisfaction, while confidence was more heterogeneous. Usage logs indicated recurrent but uneven engagement, with distinct low-, medium-, and high-activity profiles. Qualitative feedback highlighted enjoyment and clarity alongside issues with progress tracking between missions, navigation on mobile devices, and task submission reliability. The main contribution is a set of empirically grounded, context-sensitive design principles linking concrete interface and task-design decisions to perceived usability, motivation, and real-world usage patterns in constrained school settings. Full article

Background/Objectives: Children in paediatric palliative care often face school attendance barriers due to complex health needs. This study describes post-training perceptions of a training program by a pediatric hospice team to prepare school care assistants to safely include children with complex conditions, focusing on procedural skills, knowledge of the child, and family partnership. Methods: Care assistants who completed a structured course at the Paediatric Palliative Care Centre, University Hospital of Padua (2023–2024), were surveyed immediately after training. The program combined classroom instruction with hands-on simulation using high-fidelity mannequins and standard devices, including suction, pulse oximetry, ventilation, enteral feeding, and tracheostomy care. It also covered modules on urgent and emergency management, as well as family communication. An anonymous online questionnaire gathered socio-demographic data, prior training, clinical tasks performed, self-efficacy levels, and open-ended feedback. Quantitative results were analyzed descriptively, while qualitative comments were subjected to thematic analysis. Results: Of 130 invited assistants, 105 participated (81%). Participants reported strong perceived confidence: 85% selected the upper end of the 5-point scale (“very” or “extremely”) for routine-management ability, and 60% selected these same response options for emergency-management ability. In the most severe events recalled, 60.5% of incidents were resolved autonomously, 7.6% involved contacting emergency services, and 3.8% involved community or hospice nurses. Seventy-five percent judged the course comprehensive; thematic analysis of 102 comments identified satisfaction, requests for regular refreshers, stronger practical components, and requests for targeted topics. Conclusions: Immediately after the session, participants tended to select the upper end of the self-assurance item for both routine and emergency tasks. Combining core emergency procedures with personalized, child-specific modules and family-partnership training may support safety, trust, and inclusion. Regular refreshers and skills checks are advised. Full article

The increasing share of heavy and high-sulfur crude oils in refinery feed slates worldwide highlights the need for models of delayed coking units (DCUs) that are both physically meaningful and computationally efficient. In this study, we develop and calibrate a simplified yet dynamic one-dimensional model of an industrial coke drum intended for integration into digital twin frameworks. The model includes a three-phase representation of the drum contents, a temperature-dependent global kinetic scheme for vacuum residue cracking, and lumped descriptions of heat transfer and phase holdups. Only three physically interpretable parameters—the kinetic scaling factors for distillate and coke formation and an effective wall temperature—were calibrated using routinely measured plant data, namely the overhead vapor and drum head temperatures and the final coke bed height. The calibrated model reproduces the temporal evolution of the top head and overhead temperatures and the final bed height with mean relative errors of a few percent, while capturing the more complex bottom-head temperature dynamics qualitatively. Scenario simulations illustrate how the coking severity (represented here by the effective wall temperature) affects the coke yield, bed growth, and cycle duration. Overall, the results indicate that low-order dynamic models can provide a practical balance between physical fidelity and computational speed, making them suitable as mechanistic cores for digital twins and optimization tools in delayed coking operations. Full article

Objectives: This study aims to explore the facilitators and barriers in the process of using AI agents for disease management in older COPD patients. Methods: Based on the normalization process theory, a descriptive qualitative study was used to conduct semi-structured interviews with 28 older patients with COPD recruited from June to August 2025 in a Class A tertiary hospital in Wuxi, Jiangsu Province. Results: A total of 28 interviews were conducted. Four themes (Coherence, Cognitive Participation, Collective Action, Reflexive Monitoring), nine subthemes (recognition of intelligent technology;supported by policy discourse and the background of national-level projects; the creation of a family atmosphere; recommendations from HCPs; relief and social connection; new “doctor”–patient relationship and communication; eliminate the burden and return to life; benefit and value perception; right self-decision by AI) in facilitators and nine subthemes (privacy conflicts and trust deficiency; blurred boundaries of human–machine responsibility and authority; non-high-quality services are chosen reluctantly; technical anxiety; lack of motivation for continued engagement; extra burden; limitations of the physical environment; human–machine dialogue frustration; a sense of uncertainty about the future of AI) in barriers were extracted. Conclusions: This study identified key factors influencing the use of AI agents in chronic disease management in older patients with COPD. The results provide directions for improving the implementation and sustainable use of AI health technologies. Full article

Public health restrictions during COVID-19 disproportionately affected older adults, especially those in long-term care (LTC) and their families. Family caregivers (FCs) are essential care partners in LTC settings, yet pandemic policies largely excluded them, creating emotional and systemic consequences. This study explored FCs’ experiences of visitation restrictions in British Columbia, Canada, using an arts-based qualitative approach within a larger mixed-methods project. Eight FCs participated in completing a total of twelve artworks, including photographs, collages, and creative writing that reflected their experiences. Virtual talking circles were used to facilitate the sharing and description of their experiences. Findings revealed three interconnected theme categories with eleven sub-themes. These themes suggest a plausible pathway: infection-control rules may lead to caregiver exclusion, disrupting relational continuity and oversight and contributing to distress and task-centered care. While context-specific and exploratory, results underscore the need for trauma-informed, family-inclusive policies and cultural safety in LTC. Arts-based research methods provided a powerful lens for capturing emotional realities often missed by conventional research. Full article