Search Results (1,075)

Introduction: Death anxiety is a salient psychological construct across the adult lifespan; however, few studies have examined the psychometric properties of the Spanish version of the Death Anxiety Scale (DAS) in university populations spanning diverse age ranges. Objectives: To evaluate the factorial structure, model fit, and reliability of the Spanish DAS in a heterogeneous academic cohort comprising traditional (younger) and non-traditional (older) adult learners. Methods: A total of 928 participants (aged 18–93 years) from a Spanish university completed the DAS. We conducted an exploratory factor analysis (EFA; principal axis factoring with oblique rotation) to identify latent dimensions, followed by a confirmatory factor analysis (CFA) to evaluate model fit. Internal consistency was assessed using Cronbach’s alpha and McDonald’s omega, and associations with sociodemographic variables (age, religious belief) were explored. Results: EFA supported a two-factor solution comprising Fear of Death and Peacefulness/Serenity towards Death. Factor reliability was acceptable (α = 0.818 and 0.734; total α = 0.789; ω_total ≈ 0.81). CFA indicated good fit to the two-factor model (χ²(89) = 401.19, RMSEA = 0.064, 90% CI [0.058–0.071], CFI = 0.940, TLI = 0.912, SRMR = 0.063), with information criteria (AIC = 17,018.33; BIC = 17,236.77) supporting model parsimony. Age and religious belief showed small-to-moderate associations with response patterns. Conclusions: The Spanish DAS demonstrates adequate factorial validity and reliability in a university sample spanning a wide age range. The identification of a Peacefulness/Serenity dimension may enrich interpretation, although its distinctiveness should be considered provisional and warrants replication. Future research should examine measurement invariance across age groups and assess applicability in clinical and longitudinal contexts. Full article

Background/Objectives: Individuals with autism spectrum disorder (ASD) often experience high anxiety and low physical activity (PA). While the influence of parenting styles on these outcomes is well-documented in typically developing children, their role in autistic youth remains underexplored. The study examines how parenting style and parental encouragement of physical activity relate to anxiety and activity levels in ASD youth. Methods: The sample consisted of 76 parents of school-aged children diagnosed with ASD, including 54 parents of boys and 22 parents of girls (Aged 6–18; Mage = 10.75, SD = 3.67). The parents’ ages ranged from 23 to 65 years (M = 42.96, SD = 7.01). Results: Using a path model analysis, we found that authoritarian and permissive parenting were directly associated with elevated child anxiety. Authoritative and permissive parenting were inversely associated with child anxiety indirectly via parental encouragement of PA. Furthermore, authoritative and permissive parenting were inversely associated with the child’s PA score via encouragement of PA. Conclusions: The study establishes links between parenting styles and anxiety and physical activity in ASD children and adolescents, while identifying a specific mechanism that partially explains these associations. Full article

Previous research has shown that Two-Spirit Indigenous people may experience more trauma, interracial violence, and violent crimes than youth from other cultural backgrounds. This study aims to examine how identifying as Two-Spirit, an identity that integrates both non-cisgender and non-heterosexual identities, as well as Indigenous identities simultaneously and congruently, may allow one to feel more resilient and empowered. The sample consisted of Indigenous, sexual gender minority emerging adults (N = 91) with ages ranging from 18 to 29 with an average age of 24.78 (SD = 2.35). This sample reported perceived discrimination for being Indigenous, for their gender identity, and for their sexual orientation. The amount of discrimination for each of these categories was not significantly different, but the source was, and the predominant source for all three types was White individuals. The combined effects were related to lower self-esteem; more psychological symptoms of anxiety, depression, and somatization; and greater identity distress and higher scores on disturbed identity and lack of identity. In this study, Two-Spirit identification did not reduce the negative effects of discrimination by connecting with historical memory through this identity, but that does not necessarily mean that it cannot, only that its potential has yet to be fulfilled. Many participants did not have a full understanding of the label and its history. Further research into this idea is another area of study that might be fruitful. Full article

While battery-powered propulsion represents a promising pathway for inland waterway freight, its widespread adoption is hindered by range anxiety and high investment costs. Strategic energy replenishment has emerged as a critical and cost-effective solution to extend voyage endurance and mitigate these barriers. This paper introduces a novel approach to optimize energy replenishment strategies for inland electric ships that considers the possibility of adopting multiple technologies (charging and battery swapping) and partial replenishment. The proposed approach not only identifies optimal replenishment ports but also determines the technology to employ and the corresponding amount of energy to replenish for each operation, aimed at minimizing total replenishment costs. This problem is formulated as a mixed-integer linear programming model. A case study of a 700-TEU electric container ship operating on two routes along the Yangtze River validates the effectiveness of the proposed approach. The methodology demonstrates superior performance over existing approaches by significantly reducing replenishment costs and improving solution feasibility, particularly in scenarios with tight schedules and limited technology availability. Furthermore, a sensitivity analysis examines the impacts of key parameters, offering valuable strategic insights for industry stakeholders. Full article

Accurate understanding of a mental disorder’s symptomatology is essential for valid diagnosis, differential assessment, and treatment planning. It is therefore remarkable that failure to speak is defined as the only symptom in the diagnostic criteria of selective mutism (SM) in current classification systems. This narrow definition may not reflect the full range of difficulties experienced by affected children. This systematic review aimed to synthesize empirical findings on the broader symptomatology of SM across diverse study designs, informants, and assessment methods. Following PRISMA guidelines, we searched PubMed, Web of Science, and APA PsycNet, leading to 82 studies with participant samples (beyond single case reports) included in the final analysis. Results indicated that social and unspecific anxiety were the most frequently assessed and consistently identified symptoms. However, additional features—including withdrawal, depressive symptoms, social skill deficits, and, in qualitative accounts, externalizing and oppositional behaviors—were also documented. The observed symptom diversity varied notably across assessment methods and informants. Our findings support a multisymptomatic understanding of SM and suggest that failure to speak alone do not fully account for its clinical presentation. A more differentiated conceptualization may enhance diagnostic precision, inform individualized intervention strategies, and contribute to discussions on refining diagnostic frameworks. Full article

Acne is a multifactorial skin condition characterized by an infection in the pilosebaceous units in the skin. Patients with acne suffer from comedones, papules, pustules and nodules or cysts in severe cases. These clinical features might cause disfigurmentation, depression, anxiety and significantly impact the quality of life of patients. Systemic and continuous exposure of antibiotics put patients at risk of developing systemic toxicity, bacterial resistance and gut dysbiosis. Microneedles offer an innovative approach of providing targeted topical delivery of minocycline while insuring efficient permeation through skin layers. Methods: minocycline microneedles were formulated using casting method and characterized for insertion ability, mechanical strength, drug content, antibacterial activities, deposition and dissolution behavior using ex vivo full-thickness rat skin. Results: Insertion tests confirmed effective skin penetration and mechanical integrity with only 9.5% height reduction. Drug content was 673.06 ± 5.34 µg/array. Dissolution occurred within 2 min in skin, indicating user-friendly wear time. Ex vivo Franz diffusion studies showed 26% of the drug deposited into the skin, significantly higher (p = 0.0068) than the 18.3% that permeated through it. Antibacterial testing revealed strong activity against S. aureus, S. epidermidis, and C. acnes, with MIC values < 0.146 µg/mL and MBC values ranging from 9.375–18.75 µg/mL. Conclusions: The result of this research demonstrate that minocycline microneedles effectively deliver minocycline into the skin highlighting their potential as a safer and more efficient alternative for acne therapy. Full article

Background: Stroke represents a leading cause of disability worldwide and is frequently associated with cognitive impairment, anxiety, and post-stroke depression (PSD), all of which can hinder rehabilitation and reduce quality of life. This study aimed to evaluate the correlations between cognitive function, depression, and anxiety in stroke survivors. Methods: A total of 71 patients (41 female, 30 male; mean age 68.1 years, range 42–88) were assessed during rehabilitation using the Mini-Mental State Examination (MMSE), the Hospital Anxiety and Depression Scale (HADS), and the Patient Health Questionnaire-9 (PHQ-9). Stroke type and comorbidities, including hypertension, chronic ischemic heart disease, atrial fibrillation, and type II diabetes, were also recorded. Results: As expected, most patients experienced ischemic strokes (73.1%), while 16.9% had hemorrhagic strokes. Comorbidities were highly prevalent, particularly hypertension (63 patients) and chronic ischemic heart disease (60 patients). Cognitive impairment (MMSE < 24) was observed in 28.2% of participants. Emotional assessment showed a mean HADS score of 11.55, with 36.6% of patients classified as having moderate to severe depression (PHQ-9 ≥ 10). Hemorrhagic stroke patients reported slightly higher PHQ-9 scores (8.4 compared to 8.2), while ischemic patients had higher HADS scores (11.8 compared to 9.8). A strong correlation was found between PHQ-9 and HADS (r = 0.90), while MMSE scores showed weak associations with emotional outcomes. Conclusions: Cognitive and affective disturbances are common during stroke rehabilitation, with depression and anxiety strongly interrelated but only weakly linked to cognitive decline. These findings emphasize the need for integrated screening and mental health support in rehabilitation programs. Future studies may explore technology-assisted tools, including virtual reality, to enhance patient engagement and recovery. Full article

Electric vehicles (EVs) are emerging as cost-effective and eco-friendly alternatives to gasoline cars, but widespread adoption still faces hurdles, notably the scarcity of public fast-charging stations. This paper proposes an optimal method to locate and size a fast-charging station in Barcelona, integrating solar photovoltaics (PV) and a battery energy storage system (BESS). The goal is to reduce range anxiety, cut investment costs, and minimize environmental impact. We introduce a modular, scalable station design compatible with second-life batteries and PV panels. Our methodology is twofold: first, determining the optimal charging infrastructure configuration; second, calculating financial viability via net present value (NPV) and internal rate of return (IRR). Results indicate that PV and BESS installation represents the largest cost component, yet energy independence enables rapid capital recovery, with payback in around four years. Selling surplus energy can generate an additional ~4% profit. NPV and IRR values confirm feasibility for scenarios using PV, BESS, or both. Particularly in the highway deployment scenario, combining PV and BESS yields a 72% reduction in greenhouse gas emissions. Overall, our study demonstrates that integrating renewable generation and storage into fast-charging infrastructure in Barcelona is both economically viable and environmentally beneficial. Full article

Accurately predicting the trip-level energy consumption of battery electric vehicles (BEVs) can alleviate range anxiety of drivers and improve intelligent route planning. However, although data-driven methods excel in predicting with multi-feature inputs, each vehicle often requires a dedicated model due to potential inconsistencies in feature spaces of collected data. Consequently, the necessity of sufficient trip data challenges newly registered vehicles. To address the challenges, this study proposed a transformer-based pre-trained model for BEV energy consumption prediction adapting to inconsistent feature spaces, referred to as IFS-Former. By innovatively introducing trainable missing-feature embeddings and placeholder masks, the IFS-Former can tolerate new or missing features of downstream tasks after pre-training. The IFS-Former was pre-trained on a dataset comprising 837 vehicles from 8 different cities, containing 492 thousand trips, and validated on 13 vehicles with inconsistent feature spaces. After applying transfer learning to the 13 vehicles, the pre-trained IFS-Former attains high prediction accuracy (R² = 0.97, mean absolute error (MAE) = 1.19). Even under extremely inconsistent feature spaces, the IFS-Former maintains robust performance (R² = 0.96, MAE = 1.31) leveraging its pre-trained knowledge. Furthermore, the IFS-Former is well-suited for on-board deployment with a size of only 32 MB. This study facilitates on-board artificial intelligence for accurate and practical energy consumption prediction. Full article

Electric vehicles (EVs) are widely recognized as a critical component of strategies for a more sustainable transportation sector. However, adoption remains uneven across communities, in part due to the concern that limited charging availability and long commutes discourage EV use. This paper evaluates the following two hypotheses: (H1) census tracts with longer average commute durations exhibit lower levels of EV adoption, and (H2) greater availability of local charging infrastructure is associated with higher levels of adoption. Using a cross-sectional dataset of 2024 EV registrations in Washington State merged with census tract demographic characteristics, we estimate ordinary least squares models of per capita adoption. The results show that longer average commutes are negatively associated with adoption, while greater charger density is positively associated with adoption. Demographic factors such as income, education, and race also shape adoption patterns. While the cross-sectional design does not permit causal inference, the analysis highlights how behavioral constraints related to range anxiety and infrastructural provision jointly influence EV uptake, providing evidence to guide more equitable and effective EV policies for sustainable transportation. Full article

The state of charge (SOC) serves as a critical indicator for evaluating the remaining driving range of electric vehicles (EVs), and its prediction is of significance for alleviating range anxiety and promoting the development of the EVs industry. This study addresses two key challenges in current SOC prediction technologies: (1) the scarcity of multi-step prediction research based on real driving conditions and (2) the poor performance in multi-scale temporal feature extraction. We innovatively propose the Wavelet-Guided Temporal Feature Enhanced Informer (WG-TFE-Informer) prediction model with two core innovations: a wavelet-guided convolutional embedding layer that significantly enhances anti-interference capability through joint time-frequency analysis and a temporal edge enhancement (TEE) module that achieves the collaborative modeling of local microscopic features and macroscopic temporal evolution patterns based on sparse attention mechanisms. Building upon this model, we establish a multidimensional SOC energy consumption prediction system incorporating battery characteristics, driving behavior, and environmental terrain factors. Experimental validation with real-world operating data demonstrates outstanding performance: 1-min SOC prediction accuracy achieves a mean relative error (MRE) of 0.21% and 20-min SOC prediction exhibits merely 0.62% error fluctuation. Ablation experiments confirm model effectiveness with a 72.1% performance improvement over baseline (MRE of 3.06%) at 20-min SOC prediction, achieving a final MRE of 0.89%. Full article

Introduction: Urinary and fecal incontinence, as well as the presence of an ostomy, are globally prevalent conditions with substantial implications for individuals’ daily lives. Among the psychological consequences, social isolation is a frequently reported experience but remains poorly explored in the existing literature. The aim of this scoping review is to explore how social isolation has been conceptualized and operationalized in research on individuals with incontinence and to synthesize evidence on its antecedents and outcomes. Methods: This review was conducted in accordance with the Joanna Briggs Institute guidelines and reported following the PRISMA-ScR checklist. Data were thematically synthesized and interpreted according to the Middle Range Theory of Social Isolation in Chronic Illness. Results: Twenty-three studies met the inclusion criteria. Findings indicate that social isolation among individuals with incontinence is a complex, multifactorial phenomenon. Predisposing factors included individual needs for social interaction and desire for approval, psychological resilience, toilet accessibility, education, income, gender, and age. Precipitating factors were related to illness trajectory and adaptation processes, including ostomy acceptance, time since ostomy creation or oncological treatment, sense of belonging, perceived social support, stigma, self-esteem, clinical severity, illness-related conditions, and loss of autonomy. Reported outcomes were consistently adverse, encompassing depression, anxiety, and reduced quality of life. Conclusions: Social isolation represents a core dimension of the lived experience of incontinence and should be recognized as a key clinical outcome. Systematic screening and targeted interventions should be integrated into continence care pathways. Future research should adopt longitudinal and interventional designs to clarify causal mechanisms and evaluate strategies to prevent and mitigate isolation. Full article

Background/Objective: Few treatment options improve symptoms and the quality of life of Parkinson’s disease (PD); more treatment choices are needed. This study examined the effectiveness of photobiomodulation therapy (PBMt) combined with exercise to improve PD symptoms and quality of life. Methods: Participants were randomised into Active (n = 32) or Sham (n = 31) PBMt groups. Stage 1 was an 8-week double-blind, randomised, placebo-controlled trial using either active or sham PBMt to the head, back of the neck and abdomen three times weekly at home, followed by a 4-week washout. Stage 2 was 8 weeks of active PBMt for all participants. In Stage 3, participants chose to continue active PBMt treatment (‘continuers’) or receive no PBMt treatment (‘non-continuers’) for up to 48 weeks. Participants continued vigorous exercise throughout the study. Participants were assessed on enrolment and after each stage. The primary outcome measure was timed up-and-go, with a range of secondary motor and non-motor outcomes, including UPDRS. Results: There was no significant difference between the Active and Sham Groups after Stages 1 or 2, apart from minimal increase in MoCA score/cognition (Sham Group) in Stage 1. After Stage 3, continuers showed a significant improvement in the primary outcome measure compared to non-continuers. Anxiety and the motor experiences of daily living (MDS-UPDRS Part II) were also significantly improved, while other outcomes approached significance, including MDS-UPDRS Total score (p = 0.062). Conclusions: As the largest study to date, results add increasing weight to previous clinical trials and highlight potential for at-home, scalable treatment as adjunctive therapy alongside medication and exercise. Full article

Background/Objectives: To determine long-term patient-reported outcomes for patients undergoing hyperbaric oxygen therapy (HBO2) following external beam radiotherapy. Methods: A retrospective cohort study of all consecutive patients who underwent HBO2 for radiation cystitis in South Australia from September 2017 to March 2023 was performed. Patient-reported symptom severity, anxiety, healthcare use and transfusion requirements pre- and post-treatment were collected through telephone interview. Readmission data and procedural data was collected through both telephone interview and a state-wide electronic medical record. Jamovi was used to perform paired sample t-tests for statistical analysis. Results: There were 89 patients who underwent HBO2 for radiation cystitis with 54 completing the questionnaire. There were 85% of patients alive at the time of follow-up, with 61% of the total cohort and 74% of survivors completing the questionnaire. For those completing the questionnaire, 96% were male with all of them having prostate cancer. Median age was 74 (interquartile range [IQR] 69–78). The mean reduction in patients’ perceived symptom severity after HBO2 on a scale out of 10 was 7.9 to 2 with a difference of 5.9 (95% confidence interval [CI] 5.1–6.7, p < 0.001) and the mean reduction in perceived anxiety was 6.9 to 2.1 with a difference of 4.7 (95% CI 3.6–5.8 p < 0.001). Patients reported a reduction in family doctor visits from 2.7 to 0.76 with a mean reduction of 2 (95% CI 0.8 to 3.2, p = 0.003), emergency department presentations from 3.3 to 0.57 with a mean reduction of 2.7 (95% CI 1.4–4.1, p ≤ 0.001) and blood transfusions from 0.67 to 0.31 with a mean reduction of 0.34 (95% CI −0.44 to 1.1, p = 0.017). Ongoing haematuria was reported in 21 of the 54 patients (39%). Further treatment was required for 20 patients (25%). No patients reported any severe or ongoing adverse effects from HBO2 via the questionnaire. Conclusions: HBO2 is a safe option for recurrent haematuria due to radiation cystitis with high patient satisfaction and reduction in patient-perceived symptom severity, anxiety and healthcare utilisation. Level of evidence: 4. Full article

Background/Objectives: Families of ICU patients endure intense psychological strain. While anxiety and depression are well documented, less attention has been given to hostility—expressed both outwardly as anger and inwardly as guilt or self-criticism. Hostility, however, often shapes the climate of the ICU waiting room and the collaboration between families and staff. This study examined the levels and forms of hostility among ICU relatives, focusing on demographic predictors that may influence extrapunitive and intropunitive reactions. Methods: A cross-sectional study was conducted between June 2018 and December 2019 with 215 family members of ICU patients. Hostility was assessed using the Hostility and Direction of Hostility Questionnaire (HDHQ). Descriptive statistics, t-tests, ANOVAs, and multivariate regression analyses were performed to examine the effects of age, gender, and education on hostility subscales. Results: Male relatives exhibited higher acting-out hostility (M = 4.80, SD = 2.63) compared with female relatives (M = 4.12, SD = 2.21; t(216) = 1.96, p = 0.05, Cohen’s d = 0.28). Relatives with lower educational attainment showed significantly higher total hostility (β = −1.23, 95% CI [−1.78, −0.67], p < 0.001) and greater self-criticism (β = −0.44, 95% CI [−0.84, −0.03], p = 0.037). Younger age was associated with increased acting-out hostility (β = −0.029, 95% CI [−0.055, −0.002], p = 0.035). The regression models explained 12–26% of the variance across subscales (R² range = 0.12–0.26). These findings suggest two vulnerability trajectories: an externalized (extrapunitive) pattern in younger men and a broad internalized (intropunitive) pattern in relatives with lower education. Conclusions: Hostility in ICU families emerges in two distinct trajectories: externalized anger among young men and broad hostility in relatives with lower education. Recognizing these patterns is vital for preventing conflict, addressing hidden guilt and self-blame, and developing subgroup-sensitive interventions. The ICU waiting room is a space not only of fear and uncertainty but also of anger, guilt, and fragile attempts at psychological survival—dimensions that deserve systematic attention in both clinical practice and research. Full article