Search Results (1,183)

Background: Patients with pancreatic cancer (PC) commonly present with reduced aerobic fitness, sarcopenia, and malnutrition, which may increase perioperative risk and compromise access to chemotherapy treatments. Although exercise-based prehabilitation can improve physical fitness, its implementation is often limited by short diagnostic-to-surgery intervals and treatment-related toxicity. Methods: We conducted a pilot prospective pretest–posttest feasibility study in Torino, Italy. Patients with PC undergoing neoadjuvant chemotherapy prior to surgery were offered a 4-week, partially supervised, home-based bimodal exercise prehabilitation program (single-arm design) combining remotely monitored high-intensity interval training (HIIT) on a cycle ergometer with functional and resistance exercises. The primary outcome was adherence to prescribed exercise frequency, intensity, and duration, objectively assessed via remote monitoring. Secondary outcomes included cardiorespiratory fitness (CPET), muscle function, body composition, fatigue, quality of life, and circulating inflammatory markers. Results: From July 2022 to February 2024, 23 patients were screened; 15 were eligible and 10 enrolled. Four participants discontinued the intervention (two due to asthenia/fatigue, one due to chemotherapy-related adverse events, and one for organizational reasons), leaving six participants who completed the program. Among completers, fatigue and quality of life did not change meaningfully. Aerobic capacity and muscle function outcomes were generally stable, with few pre–post changes exceeding the minimum clinically important difference (MCID) thresholds used. Body composition markers and the assessed circulating cytokines/chemokines remained unchanged except for IL-6 levels, which decreased significantly (p < 0.05). Conclusions: A partially supervised, home-based HIIT-based prehabilitation program is feasible for a subset of PC patients undergoing neoadjuvant therapy, but a substantial attrition rate suggests the need for more flexible symptom-adapted prescriptions and enhanced supportive strategies. Full article

Background/Objectives: Patients with myeloproliferative neoplasms (MPNs) experience chronic inflammation, elevated cardiovascular risk, and substantial symptom burden. Dietary patterns with anti-inflammatory and cardioprotective effects may represent a modifiable strategy to address these overlapping risks, yet dietary intervention has not been systematically studied in MPN. We evaluated the feasibility, engagement, and preliminary clinical signals of a fully remote dietary counseling intervention in adults with MPN. Methods: In this single-center, randomized, open-label pilot study, 28 adults with polycythemia vera, essential thrombocythemia, or primary myelofibrosis were randomized 1:1 to Mediterranean (MED) or Dietary Approaches to Stop Hypertension (DASH) dietary counseling over 10 weeks. The protocol included a 2-week baseline run-in period, 10-week active intervention with four telehealth dietitian visits, and 4-week postintervention follow-up. Prespecified feasibility endpoints were the completion of dietitian visits, daily MPN Symptom Assessment Form Total Symptom Score (MPN-SAF TSS) surveys, Mediterranean Diet Adherence Screener (MEDAS) questionnaires, and Automated Self-Administered 24-Hour Dietary Recall (ASA24) assessments. Exploratory endpoints included the change in Healthy Eating Index 2015 (HEI-2015) and symptom burden. Results: Twenty-seven participants provided data and were analyzed (14 MED, 13 DASH). Dietitian visit attendance was 96% (MED) and 85% (DASH). Daily symptom survey completion averaged 93% (MED) and 58% (DASH). MEDAS completion was 81% (MED) and 51% (DASH); ASA24 completion was 55% (MED) and 38% (DASH). HEI-2015 increased from 55 to 63 in MED during active intervention. At week 12, 23% of MED and 13% of DASH participants achieved ≥50% TSS reduction. Symptom reductions were observed across multiple domains. Conclusions: A fully remote dietary intervention is feasible in adults with MPN, with strong engagement in the Mediterranean arm. These findings support adequately powered trials incorporating biomarker endpoints to evaluate dietary modification as a strategy for inflammation-driven symptoms and cardiovascular risk in MPN. Full article

Sustainable groundwater management in hyper-arid regions requires accurate water quality assessments, yet remote desert environments present major challenges due to data scarcity, high sampling costs, and limited laboratory infrastructure. This study proposes a framework integrating the Water Quality Index (WQI) with Inverse Distance Weighting (IDW)-based spatial data augmentation and machine learning classification for groundwater quality assessment in the Tabelbala region, southwestern Algeria. Three classifiers were evaluated, Random Forest (RF), Support Vector Machines (SVMs), and Artificial Neural Networks (ANNs), and trained on an augmented dataset generated from 178 original groundwater samples using IDW interpolation with a sensitivity-optimized 150 m radius, producing 2779 augmented training points. RF achieved the highest predictive accuracy (85.9%), followed by ANNs (84.7%) and SVMs (83.1%), with all models demonstrating excellent discriminative performances (area under the receiver operating characteristic curve > 0.96). Permutation Feature Importance analysis identified total dissolved solids (TDS), sulfates (SO₄²⁻), total hardness (TH), and chlorides (Cl⁻) as the most influential parameters, consistent with World Health Organization (WHO) guidelines. Spatial distribution maps revealed that the majority of groundwater sources exhibited poor to very poor quality, highlighting the urgent need for local water management interventions. The proposed framework offers a replicable decision-support tool for water resource managers in data-scarce arid environments, supporting SDG 6 (Clean Water and Sanitation) and SDG 13 (Climate Action). Full article

Background: Aging is associated with increased adiposity, sarcopenia risk, and metabolic vulnerability. Digital tools may enhance adherence to nutritional strategies, but their impact on detailed body composition remains insufficiently explored. Methods: This 6-month prospective controlled longitudinal intervention study included 60 middle-aged and older adults. All participants received a smart watch and smart scale for self-monitoring. The control group attended evaluations only at baseline and study completion, while the intervention group received monthly follow-up and remote feedback. Body composition was assessed using multi-frequency BIA. Statistical analyses included paired tests, effect sizes, correlations, and linear mixed-effects models. Results: Significant reductions were observed in BMI (p < 0.001), fat mass (p = 0.003), and visceral fat (p = 0.003; Cohen’s d = 0.41). The sarcopenic index improved (p = 0.001), while skeletal muscle mass remained stable. ECW increased significantly (p = 0.010). Age was inversely associated with the magnitude of improvement. Mixed-effects modeling confirmed a time-dependent reduction in visceral fat independent of age and sex. Conclusions: A 6-month digitally assisted nutritional monitoring program was associated with favorable changes in adiposity, muscle quality, and hydration status. Multi-frequency BIA provides valuable integrative markers for monitoring nutritional interventions in aging populations. Full article

Portugal’s demographic ageing calls for effective strategies to address mild cognitive impairment (MCI) and Alzheimer’s Disease (AD). However, fragmented evidence on digital tools limits their clinical application. This review aimed to map the landscape of validated digital cognitive rehabilitation platforms in Portugal for older adults with MCI and AD and to analyze their effectiveness, usability, and implementation barriers. Following PRISMA 2020 guidelines, seven studies published between 2015 and 2025 were identified from PubMed, Scopus, and ScienceDirect, complemented by manual searches and platform website analysis. Methodological quality, assessed using the Joanna Briggs Institute (JBI) tools, ranged from 69% to 100%. The included studies evaluated platforms such as the Systemic Lisbon Battery (SLB), Digi&Mind, NeuroVRehab.PT, and the Fit4Alz project. Findings indicate improvements in global cognition, executive functioning, and attention. Multimodal interventions combining digital cognitive training and physical exercise produced more consistent cognitive benefits than isolated approaches. Despite initially low digital literacy among older adults, high adherence and motivation were reported, supported by gamification, user-centred design, and cultural adaptation. Although Portuguese digital platforms show strong potential for cognitive rehabilitation, the evidence base is constrained by methodological heterogeneity, small sample sizes, and short intervention durations. Future research should prioritize long-term follow-up and remote monitoring through telerehabilitation. Full article

Artificial intelligence (AI) is rapidly reshaping cardiovascular (CV) medicine, driving a paradigm shift toward truly personalized and data-driven care. This comprehensive review examines the conceptual foundations, clinical applications, and future implications of AI across the CV continuum, spanning prevention, diagnosis, risk stratification, and therapy. Core AI methodologies (including machine learning, deep learning, natural language processing, and computer vision) are discussed in the context of cardiology’s uniquely data-rich environment, encompassing imaging, electrocardiography, electronic health records, wearable devices, and multi-omics data. This systematic review highlights major clinical domains where AI has demonstrated a substantial impact, including CV imaging, ECG interpretation, hypertension and heart failure management, coronary artery disease, acute coronary syndromes, interventional cardiology, and cardiac surgery. AI-driven predictive analytics enable early detection of subclinical disease, improved prognostication, and individualized prevention strategies, while wearable technologies and remote monitoring platforms facilitate continuous, real-world patient surveillance. Emerging applications in pharmacotherapy, drug repurposing, and genomics further reinforce AI’s role in advancing precision cardiology. Equally emphasized are the ethical, legal, and social challenges accompanying AI adoption, such as algorithmic bias, data privacy, cybersecurity, interpretability, and regulatory oversight. Our review underscores the necessity of rigorous clinical validation, transparent model design, and seamless integration into clinical workflows to ensure safety, equity, and physician trust. Ultimately, AI is best positioned as an augmentative tool that complements (but does not replace!) clinical expertise. By fostering hybrid intelligence that integrates human judgment with computational power, AI has the potential to redefine CV care delivery, improve outcomes, and support a more proactive, patient-centered healthcare model. Full article

This exploratory study examines how journalists in/coordinating investigations use a chatbot designed to reduce power asymmetries during remote work. Twelve freelancers across Africa, Europe, and India tested Obruche, a chatbot advisor covering risk mitigation, pay equality, tension de-escalation, and intellectual property protection. Drawing on the Unified Theory of Acceptance and Use of Technology, semi-structured interviews were coded for Performance Expectancy, Effort Expectancy, Facilitating Conditions, and Social Influence. Results show journalists gravitate towards chatbots that are cognisant of their location-specific challenges and able to provide information that facilitates access to media outlets or peers for future collaborations. Next-best-action responses that expanded user queries or offered role-play scenarios also left journalists feeling supported, less lonely, and not judged. However, the chatbot’s female persona, scepticism of artificial intelligence, and chatbot novelty may reduce user acceptance. Obruche’s potential areas of intervention are linked to eight types of organisational power. The chatbot mainly assisted journalists to confront or rebalance Control of Knowledge and Information, and Control of Scarce Resources, aiding users’ Ability to Cope with Uncertainty. This research contributes to recent qualitative studies on journalists’ well-being by demonstrating how chatbots can mitigate power imbalances between dispersed teams of journalists. The benefits and concerns presented may inform future designs of similar team-mediation chatbots. Full article

Background: The Patient–Reported Outcomes in Parkinson’s Disease (PRO-PD) scale is a 35-item visual analog measure designed to quantify symptom severity across motor and non-motor domains. Developed as a continuous, patient-centered outcome, PRO-PD captures patient-perceived change over time and is suitable for remote longitudinal assessment. This study evaluated the psychometric properties of PRO-PD across two independent datasets, including reliability, validity, factor structure, and minimal clinically important difference (MCID), and assessed its relevance to nutrition- and lifestyle-focused research. Methods: Convergent validity was evaluated in a cross-sectional clinical dataset (n = 46) using established clinician-rated and patient–reported instruments, including Hoehn and Yahr, Unified Parkinson’s Disease Rating Scale (UPDRS), Parkinson’s Disease Questionnaire-39 (PDQ-39), Montreal Cognitive Assessment (MoCA), and PROMIS measures. Internal consistency, temporal stability, factor structure, and known-groups validity were assessed in a large remote-monitoring cohort (n = 2612). MCID thresholds were estimated in a longitudinal subsample (n = 390) using anchor-based methods, multinomial regression, and receiver operating characteristic analyses. Results: PRO-PD demonstrated strong convergent validity with established clinical measures, excellent internal consistency (Cronbach’s α = 0.93 (95% CI: 0.90–0.96) for Small Data and 0.95 (95% CI: 0.947–0.951) for Big Data”), and good test–retest reliability (ICC = 0.78 overall; 0.89 at 6 months). Confirmatory testing of a previously proposed eight-factor structure showed suboptimal fit, leading to a parsimonious four-factor solution (Neurobehavioral, Autonomic, Motor, Mood/Motivation) explaining 47.6% of variance. PRO-PD scores increased significantly with advancing disease duration and stage. MCID thresholds were +53.5 points for worsening and −78.5 points for improvement (AUC = 0.64 for worsened vs. not worsened; AUC = 0.71 for improved vs. worsened), with greater sensitivity for detecting deterioration than improvement. PRO-PD scores demonstrated sensitivity to patient-perceived symptom change over time, supporting its utility for longitudinal monitoring and potential application in lifestyle-focused intervention research. Conclusions: These findings support PRO-PD as a psychometrically robust outcome measure that can be completed remotely without trained administrators. Full article

Background: Frailty is highly prevalent among older adults with cardiovascular disease (CVD) and strongly predicts disability and mortality after cardiac events. Although cardiac rehabilitation (CR) improves prognosis, frail older patients often face barriers to participating in in-person programs. eHealth-based, home-delivered CR programs incorporating tele-rehabilitation and remote monitoring may improve accessibility, yet evidence regarding their effectiveness on frailty status remains limited. Methods: We designed a multicenter, randomized, parallel-group trial enrolling people ≥65 years recently hospitalized for acute heart failure (AHF) and/or acute coronary syndrome (ACS). Participants were randomized 1:1 to an eHealth home-based tele-rehabilitation program or the usual care. The primary endpoint is frailty prevalence at follow-up, defined by an Essential Frailty Toolset (EFT) score ≥3, with co-primary outcomes being between-group differences in the mean levels of EFT and Short Physical Performance Battery (SPPB) scores after 3–6 months. Secondary endpoints include mortality and hospitalization, among others. Results: The full protocol and study procedures are reported. Between May 2024 and December 2025, 589 patients were screened at the two Italian centers involved; 442 met eligibility criteria and 209 were enrolled and randomized. Baseline characteristics were largely comparable between groups. The mean age was 77 ± 9 years, 70% were male, and 55% had ACS. Lower-than-expected enrollment was mainly attributable to refusal related to difficulties in using digital devices. Conclusions: This randomized trial will evaluate whether a multidomain, eHealth-based CR intervention can reduce the prevalence or degree of frailty in older people after AHF or ACS. We report the study protocol and baseline characteristics of the enrolled cohort, highlighting the challenge of digital illiteracy in contemporary older populations. Full article

Background: Home-based digital healthcare interventions are increasingly used to support people living with dementia (PLWD) and their family caregivers. However, evidence regarding their effectiveness across patient and caregiver outcomes remains heterogeneous. Methods: This systematic review followed PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD420261302166). Six databases (PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Scopus) were searched from January 2000 to October 2025. Randomized and quasi-experimental quantitative studies evaluating home-based or remotely delivered digital interventions for PLWD and/or informal caregivers were included. Risk of bias was assessed using RoB 2 and ROBINS-I. Due to heterogeneity, findings were synthesized narratively. Results: Fourteen studies met the inclusion criteria. Interventions included web-based psychoeducation, telecoaching, digital cognitive training, assistive technologies, and multicomponent programs. Caregiver outcomes demonstrated the most consistent benefits, including reduced burden and stress, improved self-efficacy, and improved sleep efficiency in technology-supported trials. For PLWD, small-to-moderate improvements were observed in global cognition and selected neuropsychiatric symptoms, particularly in interactive and personalized programs. Multicomponent interventions combining caregiver education with patient activation and professional feedback showed more durable effects. Conclusions: Home-based digital interventions appear feasible and beneficial, particularly for caregiver outcomes. Future large-scale trials with longer follow-up and standardized outcome measures are needed to confirm durability, equity, and cost-effectiveness. Full article

Chieng Hac in northern Vietnam is expanding maize cultivation, intensifying water competition and soil erosion. This study mapped regional water balance and erosion using remote sensing and GISs by coupling the Thornthwaite–Mather (TM) water balance model with the Revised Universal Soil Loss Equation (RUSLE) at 12.5 m resolution. Land cover was classified into maize, tree crops, paddy, forest, and other types using Random Forest. The TM model used 2021 precipitation and temperature measurements to estimate evapotranspiration, surplus, and deficit, while the RUSLE quantified soil loss. Two scenarios were evaluated: a baseline reflecting existing land use and an adjusted case applying strip cropping on 10–20° maize slopes and converting maize to tree crops on slopes > 20°. Tree crop conversion increased evapotranspiration and prolonged seasonal deficits relative to maize, increasing water deficit from 1013.6 to 1022.2 mm/year. In contrast, the interventions reduced mean soil loss from 15.52 to 11.51 t/ha/year, with the largest decline in the 5–25 t/ha/year class. Residual hotspots persisted on steep slopes and near drainage lines. The integrated framework highlights trade-offs between erosion control and seasonal water availability, supporting slope-based land-use planning in upland agricultural systems. These findings offer guidance for slope-based land-use planning by indicating that intervention priorities should vary depending on slope conditions and local water availability. Full article

Effective Parkinson’s disease (PD) management is hindered by the intermittent nature of clinical snapshots and the discomfort of rigid monitoring hardware. This review critically evaluates the synergy between flexible bioelectronics and artificial intelligence (AI) for continuous remote monitoring. Our analysis reveals that while material innovations have achieved milligram-level sensitivity, a significant ‘translational gap’ persists due to limited validation in real-world environments and small cohort sizes. We conclude that multimodal fusion architectures are essential for accurately mapping digital biomarkers to clinical gold standards such as MDS-UPDRS. By leveraging edge AI for privacy and closed-loop feedback for intervention, this integration facilitates the transition from reactive clinical visits to proactive, personalized digital home-care ecosystems. Full article

Background: Urticaria, particularly chronic urticaria (CU), is a highly prevalent inflammatory skin disorder characterized by recurrent wheals and/or angioedema with a fluctuating and unpredictable course that significantly impairs quality of life and requires long-term monitoring. Despite established therapeutic guidelines, disease control remains suboptimal in a considerable proportion of patients. Telemedicine has emerged as a promising adjunctive strategy for chronic disease management. This review aims to critically evaluate the role, applications, benefits, and limitations of telemedicine and digital health interventions in urticaria management. Methods: A scoping review of the literature was conducted focusing on studies addressing telemedicine, digital patient-reported outcomes, mobile health applications, and remote monitoring strategies in urticaria. Evidence from pandemic and post-pandemic telemedicine models was also analyzed to identify transferable approaches. Results: Telemedicine demonstrates significant potential in urticaria management by enabling structured symptom monitoring, facilitating remote follow-up during therapeutic escalation (including biologic therapies), improving patient empowerment and adherence, and reducing healthcare utilization and indirect costs. Digital tools such as electronic diaries and validated PRO-based applications support continuous disease assessment. However, telemedicine cannot replace direct clinical examination, and limitations include diagnostic uncertainty, digital inequalities, data privacy concerns, and lack of large disease specific trials. Conclusions: Telemedicine represents a valuable complementary and integrative model for urticaria care, particularly suited for chronic disease monitoring. Hybrid care pathways combining remote and in-person management appear to be the most effective and sustainable strategy. Further high-quality urticaria-specific studies and standardized digital frameworks are required to optimize its clinical implementation. Full article

Background: The Cystic Fibrosis Foundation (CFF) recognizes exercise as a critical part of managing cystic fibrosis (CF). This becomes even more important in the era of highly effective modulator therapy (HEMT) due to many people with cystic fibrosis (pwCF) having decreased symptom burden and a newfound ability to tolerate exercise better. Our single-center pilot study was designed to assess the implementation of a remotely delivered, individualized, and comprehensive exercise program for pwCF. We aimed to determine the feasibility, safety and acceptance of this intervention. Methods: PwCF ≥ 18 years old were recruited and consented at the University of Alabama in Birmingham in 2022 and 2023. Basic fitness was assessed for each participant, and an individualized exercise prescription was prepared for each participant, who was expected to exercise three times weekly on a remote basis with the exercise physiologist for 12 consecutive weeks. Subjects were reassessed at 4 and 7 months for post-exercise evaluation. Patient demographics and clinical parameters, including exacerbation rate, FEV₁ percent predicted, 6-min walk test (6MWT), and modified shuttle test (MST) were collected. Questionnaire data from the CFQ-R, PRAISE, and IPAQ were also recorded. The study was registered with ClinicalTrials.gov (NCT04680403) and was submitted on 17 December 2020. Results: Our goal was to enroll 12 participants over the 2-year study period. We were able to recruit nine people for the study, with four participants finishing the program. From the 36 sessions offered over the 12-week program, participants completed an average of 15 sessions. Clinical outcome data was observed, including lung function and exacerbation frequency, but not statistically analyzed due to the small sample size. Conclusions: Implementation of an individualized telehealth-based exercise program for pwCF was well received by participants, safe, and appreciated by the participants. Recruitment and adherence were challenging, which was partially due to the ongoing pandemic. Follow-up studies are needed to assess whether improvements in reducing the amount or supervision of weekly exercise sessions and/or extending the total time might help with adherence. Full article

Ensuring the safety and effectiveness of first responder teams during critical missions requires real-time health monitoring and responsive intervention systems. This study presents a novel system comprising a multimodal wearable device integrated with a remote command centre, designed to support the physiological monitoring and guidance of first responders in the field. The wearable device includes three main components: a physiological and biochemical signal acquisition unit, an electrotactile stimulation unit and a powerful communication interface. The acquisition unit continuously samples heart rate, body temperature, and biochemical markers from sweat, transmitting this data wirelessly to the remote command centre. The transmitted physiological data could be analyzed at the command centre and, based on the inferred first responder condition, appropriate feedback commands could be issued back to the corresponding wearer. The commands are then executed by the electrotactile stimulation unit on the wearable device. Initial testing in laboratory settings confirmed the system’s ability to generate accurate electrochemical readings and dehydration assessment through changes in bulk ionic conductivity. Electrochemical impedance spectroscopy showed good agreement with a commercial potentiostat. Heart rate and temperature readings demonstrated satisfying accuracy with minor removable artifacts. Field trials with first responders validated continuous signal transmission and electrotactile feedback with over 80% success. These results confirm the system’s robustness and modularity, supporting its application in operational environments. Full article