Search Results (4,087)

This paper examines an optimal investment–consumption problem in a setting where the financial environment is influenced by both stochastic factors and delayed effects. The investor, endowed with Constant Relative Risk Aversion (CRRA) preferences, allocates wealth between a risk-free asset and a single risky asset. The short rate follows a Vas$\check{\mathrm{i}}$ček-type term structure model, while the risky asset price dynamics are driven by a delayed Heston specification whose variance process evolves according to a Cox–Ingersoll–Ross (CIR) diffusion. Delayed dependence in the wealth dynamics is incorporated through two auxiliary variables that summarize past wealth trajectories, enabling us to recast the naturally infinite-dimensional delay problem into a finite-dimensional Markovian framework. Using Bellman’s dynamic programming principle, we derive the associated Hamilton–Jacobi–Bellman (HJB) partial differential equation and demonstrate that it generalizes the classical Merton formulation to simultaneously accommodate delay, stochastic interest rates, stochastic volatility, and consumption. Under CRRA utility, we obtain closed-form expressions for the value function and the optimal feedback controls. Numerical illustrations highlight how delay and market parameters impact optimal portfolio allocation and consumption policies. Full article

Backgrounds/Objectives: Mindfulness-based stress reduction (MBSR) programs may have applications for adults with cerebral palsy (CP), particularly as this population is at increased risk of mental health challenges relative to the general population. However, little is known about the experiences of adults with CP participating in these programs. The aim of this study was to explore the experiences of adults with CP, and a facilitator, who participated in a 9-week MBSR telehealth program. Methods: Adults who attended an MBSR telehealth program were invited to participate in focus groups. If a participant was unable to attend a focus group, they were offered a semi-structured interview. The facilitator participated in a semi-structured interview. Focus groups and interviews were recorded, transcribed verbatim, and inductively thematically analyzed using Framework Analysis. Results: Ten adults with CP and one facilitator participated. Feedback on the program spanned across three themes: (i) learning and creating my mindfulness toolbox; (ii) applying mindfulness to everyday life; and (iii) online together with expert facilitation. Participants appreciated having access to a variety of mindfulness techniques to accommodate individual preferences. Peer-learning in a facilitated, online group context was also valued. Participants recalled implementing mindfulness strategies in everyday life and provided recommendations of how to improve the program. These included incorporating a group orientation, shortening group sessions to reduce fatigue, and follow-up sessions to maintain mindfulness skills after program completion. Conclusions: This study provides new knowledge about the perspectives of adults with CP regarding MBSR delivered via telehealth. Participant recommendations should inform future implementation of group mindfulness telehealth programs for adults with CP. Full article

Atlantoaxial instability (AAI) in toy- and small-breed dogs remains a significant clinical challenge, as the restricted anatomical space and risk of complications complicate the selection of implants. This study aimed to compare three patient-specific Ti-6Al-4V stabilizers for the C1–C2 region: a clinically used ventral C1–C3 plate, a shortened ventral C1–C2 plate, and a dorsal C1–C2 implant. Computed tomography, segmentation, virtual reduction, CAD/CAM design, and finite element analysis were employed to evaluate the linear-static mechanical behavior of each construct under loading ranging from 5 to 25 N, with a focus on displacements, von Mises stresses, and peri-screw bone strains. Additionally, cadaver procedures were performed in nine small-breed dogs using custom drill guides and additively manufactured implants to evaluate procedural feasibility and implantation time. Finite element models demonstrated that all stabilizers operated within material and biological safety limits. The C1–C3 plate exhibited the highest implant stresses, while the C1–C2 plate demonstrated an intermediate response, and the dorsal implant minimized implant stresses, albeit by increasing bone stresses. Cadaver experiments revealed that dorsal fixation required less implantation time than ventral fixation. Collectively, the findings indicate that all evaluated constructs represent safe stabilization options, and the choice of implant should reflect the preferred load-transfer pathway as well as anatomical or surgical constraints that may limit ventral access. Full article

Psychosis is a frequent and disabling non-motor complication of Parkinson’s disease (PD). Clozapine and quetiapine are widely used in the treatment of Parkinson’s disease psychosis (PDP). We conducted an exploratory study to compare patient experiences with physician prescribing practices. Patients with PDP hospitalized at a university center completed semi-structured interviews on perceived efficacy, adverse effects, and daily functioning. Neurologists and geriatricians attending training sessions completed a structured questionnaire on prescribing patterns, attitudes toward clozapine, and perceived treatment burden. Data were analyzed thematically and triangulated across cohorts. Eleven patients (mean age 81 years; nine treated with quetiapine, two with clozapine) were included. Most quetiapine-treated patients reported persistent hallucinations, sedation, dizziness, and reduced autonomy. Fourteen physicians completed the survey and most preferred quetiapine, citing monitoring logistics and agranulocytosis risk as barriers to clozapine. Overall, patient priorities centered on symptom control and independence, whereas physician decisions emphasized feasibility and safety. Facilitating clozapine monitoring and incorporating patient-reported outcomes into routine care may improve patient-centered PDP management. Full article

Background and Objectives: Vaginal natural orifice transluminal endoscopic surgery, vNOTES, has become an increasingly preferred minimally invasive option for benign hysterectomy. General anesthesia is still the routine choice, yet regional methods such as combined spinal epidural anesthesia may support a smoother postoperative course. Although the use of vNOTES is expanding, comparative information on anesthetic approaches remains limited, and its unique physiologic setting requires dedicated evaluation. To compare combined spinal epidural anesthesia with general anesthesia for benign vNOTES hysterectomy, focusing on postoperative nausea and vomiting, recovery quality, and intraoperative physiologic safety. Materials and Methods: This retrospective cohort study was conducted in a single center and identified women who underwent benign vNOTES hysterectomy between March 2024 and August 2025 from electronic medical records. Participants received either combined spinal epidural anesthesia or general anesthesia according to routine clinical practice. All patients were managed within an enhanced recovery pathway that incorporated standardized analgesia and prophylaxis for postoperative nausea and vomiting. The primary outcome was the incidence of postoperative nausea and vomiting during the first day after surgery. Secondary outcomes included time to discharge from the recovery unit, pain scores at set postoperative intervals, early functional recovery, patient satisfaction and physiologic parameters extracted from intraoperative monitoring records. Analyses were performed according to the anesthesia group documented in the medical files. Results: One hundred forty patients met inclusion criteria and were included in the analysis. Combined spinal epidural anesthesia was linked to a lower incidence of postoperative nausea and vomiting, a shorter stay in the post-anesthesia care unit, and reduced pain scores in the first 24 h (adjusted odds ratio 0.32, ninety five percent confidence interval 0.15 to 0.68). Early ambulation and oral intake were reached sooner in the combined spinal epidural group, with higher overall satisfaction also noted. Adherence to ERAS elements was similar between groups, with no meaningful differences in early feeding, mobilization, analgesia protocols or PONV prophylaxis. During the procedure, combined spinal epidural anesthesia produced more episodes of hypotension and bradycardia, while general anesthesia was linked to higher airway pressures and lower oxygen saturation. Complication rates within the first month were low in both groups. Conclusions: In this observational cohort study, combined spinal epidural anesthesia was associated with lower postoperative nausea, earlier recovery milestones and greater patient comfort compared with general anesthesia. Hemodynamic instability occurred more often with neuraxial anesthesia but was transient and manageable. While these findings point to potential recovery benefits for some patients, the observational nature of the study and the modest scale of the differences necessitate a cautious interpretation. They should be considered exploratory rather than definitive. The choice of anesthesia should therefore be individualized, weighing potential recovery benefits against the risk of transient hemodynamic effects. Larger and more diverse studies are needed to better define patient selection and clarify the overall risk benefit balance. These findings should be interpreted cautiously and viewed as hypothesis-generating rather than definitive evidence supporting one anesthetic strategy over another. Full article

Predicting energy consumption in battery electric vehicles (BEVs) is a complex task due to the large number of influencing factors and their interdependencies. Nevertheless, reliable energy consumption estimation is essential to reduce range anxiety, facilitate route planning, manage charging infrastructure, and support more effective travel decisions that lower operational risks in transportation, thereby fostering wider BEV adoption. In this context, the present study examines the existing literature on methodologies for predicting BEV energy consumption through a systematic literature review (SLR) following the Denyer and Tranfield protocol and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The analysis covers modelling approaches, computational tools, model accuracy metrics, variable topology, sampling frequency and analysis period, modelling scale, and data sources. In addition, this review incorporates a structured assessment of the methodological quality of the included studies and a systematic evaluation of risk of bias, enabling a critical appraisal of the reliability and generalisability of reported findings. A comprehensive classification of modelling methodologies and variables is proposed, providing an integrative reference framework for future research. Overall, this study addresses existing research gaps, identifies current methodological limitations, and outlines directions for future work on BEV energy consumption prediction. Full article

Climate change and sea-level change (SLC) are intensifying flooding in U.S. coastal communities, with disproportionate impacts on Black and minority neighborhoods that face displacement, economic hardship, and heightened health risks. In Norfolk, Virginia, sea levels are projected to rise by at least 0.91 m (3 ft) by 2100, placing underserved neighborhoods such as Oakleaf Forest at particular risk. This study investigates the compounded impacts of flooding at both the building and urban scales, situating the work within the framework of the UN Sustainable Development Goals (UN SDGs). A mixed-method, community-based approach was employed, integrating literature review, field observations, and community engagement to identify flooding hotspots, document lived experiences, and determine preferences for adaptation strategies. Community participants contributed actively through mapping sessions and meetings, providing feedback on adaptation strategies to ensure that the process was collaborative, place-based, and context-specific. Preliminary findings highlight recurring flood-related vulnerabilities and the need for interventions that address both environmental and social dimensions of resilience. The study proposes multi-scale, nature-based solutions (NbS) to mitigate flooding, restore ecological functions, and enhance community capacity for adaptation. Ultimately, this work underscores the importance of coupling technical strategies with participatory processes to strengthen resilience and advance climate justice in vulnerable coastal neighborhoods. Full article

Music therapy is a non-pharmacological psychosocial intervention that is increasingly recognised for its role in supporting older adults in acute hospital settings. Engagement with music, whether through passive listening, preferred recorded music, live music, or creative music therapy, has been linked to improvements in behavioural, cognitive, and emotional outcomes during episodes of delirium. Although there are reviews on non-pharmacological approaches to delirium, few have focused specifically on music therapy within acute hospital environments. This scoping review examined the evidence relating to music-based interventions for older adults who are experiencing delirium or who are at risk of delirium in acute care settings. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA ScR). Four electronic databases were searched systematically, namely, CINAHL, Medline, PsycINFO and Embase. Seven primary research studies published between 2004 and 2024 met the inclusion criteria. A narrative synthesis approach was used to summarise the data. Three themes were identified. The first relates to the extent to which music therapy may reduce the incidence or severity of delirium or other related behaviours in acute hospital settings. The second relates to the potential for music-based interventions to support clinical practice by improving interaction between patients and staff and reducing distress during recovery and enhancing physical recovery. The third relates to the impact of music therapy on emotional regulation, engagement, cooperation with care, and overall patient experience. Music therapy shows promise as a person-centred, safe, and low-cost intervention that may enhance wellbeing and support delirium care for older adults in acute hospital settings. Further high-quality studies are needed to strengthen the evidence base and guide practice. Full article

Background: Dysglycemia remains a persistent challenge in hospital care. Despite advances in outpatient diabetes technology, inpatient insulin management largely depends on intermittent point-of-care glucose testing, static insulin dosing protocols and rule-based decision support systems. Artificial intelligence (AI) offers potential to transform this care through predictive modeling and adaptive insulin control. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, a scoping review was conducted to characterize AI algorithms for insulin dosing and glycemic management in hospitalized patients. An interdisciplinary team of clinicians and engineers reached consensus on AI definitions to ensure inclusion of machine learning, deep learning, and reinforcement learning approaches. A librarian-assisted search of five databases identified 13,768 citations. After screening and consensus review, 26 studies (2006–2025) met the inclusion criteria. Data were extracted on study design, population, AI methods, data inputs, outcomes, and implementation findings. Results: Studies included ICU (N = 13) and general ward (N = 9) patients, including patients with diabetes and stress hyperglycemia. Early randomized trials of model predictive control demonstrated improved mean glucose (5.7–6.2 mmol/L) and time in target range compared with standard care. Later machine learning models achieved strong predictive accuracy (AUROC 0.80–0.96) for glucose forecasting or hypoglycemia risk. Most algorithms used data from Medical Information Mart for Intensive Care (MIMIC) databases; few incorporated continuous glucose monitoring (CGM). Implementation and usability outcomes were seldom reported. Conclusions: Hospital AI-driven models showed strong algorithmic performance but limited clinical validation. Future co-designed, interpretable systems integrating CGM and real-time workflow testing are essential to advance safe, adaptive insulin management in hospital settings. Full article

Objective: Cosmetic products are widely used, yet public awareness of their potential health risks and of cosmetovigilance remains limited. Given that studies increasingly highlight chemical exposure associated with cosmetics, this study aimed to assess public knowledge, attitudes, and behaviours regarding cosmetic use, toxicity, and cosmetovigilance in Türkiye. Methods: A cross-sectional study was conducted among the general population living in Türkiye, consisting of 700 people between January and May 2024. The study was conducted using a Google survey form. Results: Among 700 participants, 91.6% reported regular cosmetic use and 47.6% experienced at least one adverse effect, most commonly redness, itching, and burning. Adverse effects were more frequently associated with products purchased from shopping malls/cosmetic stores. Education level was significantly linked to awareness of cosmetovigilance and product preferences, with university graduates showing higher awareness and favoring both local and international brands. Conclusion: The study revealed that although cosmetic use is common in Türkiye, awareness of cosmetovigilance remains low, even among well-educated consumers. Many participants reported adverse effects but did not seek professional consultation, indicating gaps in safety practices and reporting. Strengthening public awareness and establishing effective cosmetovigilance systems are essential to ensure safer cosmetic use and protect public health. Full article

Protein-bound uremic toxins (PBUT), particularly indoxyl sulphate (IS) and p-cresyl sulphate (pCS), are poorly removed by conventional haemodialysis because of their strong albumin binding. These toxins are associated with cardiovascular morbidity and mortality in haemodialysis patients. Displacer molecules such as ibuprofen enhance PBUT clearance by competing for albumin-binding sites, but the optimal dose and route of administration remain unclear. The aim of this study was to evaluate the effect of different ibuprofen doses, infusion durations, and routes of administration on the removal of IS and pCS during on-line hemodiafiltration (OL-HDF). In this prospective, single-centre, crossover study, 21 chronic haemodialysis patients receiving intradialytic analgesia underwent nine OL-HDF sessions. Ibuprofen was administered at two doses (400 or 800 mg) either in the arterial pre-filter line (infusion over 1 h, 2 h, or 3 h) or in the venous post-filter line (30 min). Reduction ratios (RR) of total IS and pCS were determined by LC-MS and corrected for haemoconcentration. Statistical analysis included repeated-measures ANOVA with post-hoc testing. Baseline RR for IS and pCS were 53.7 ± 9.9% and 47.1 ± 10.9%, respectively. The highest RR was achieved with 800 mg ibuprofen infused via the arterial line over 2 h (IS: 60.8 ± 8.6%; pCS: 57.8 ± 9.7%). All arterial-line 800 mg regimens and the 3-h 400 mg infusion significantly improved pCS clearance versus baseline; IS clearance improved significantly only with arterial-line 800 mg regimens and with the 400 mg 3-h infusion. Infusion rate (1–3 h) had no significant effect on RR within the same dose group. Pain scores decreased significantly after dialysis regardless of ibuprofen regimen. Arterial-line administration of ibuprofen enhances total IS and pCS removal during OL-HDF, with higher doses yielding greater clearance. Prolonged low-dose infusion appears similarly effective for pCS and may reduce systemic exposure, potentially lowering toxicity risk. These findings support the arterial line as the preferred route for displacer administration in clinical practice. Full article

Traditional surgical techniques are based on the manual application of force using mallets and osteotomes, which often result in uncontrolled impact forces, procedural inconsistencies, and patient discomfort. Magnetic mallets (MMs), magnetodynamic devices, provide a controlled application of force using electromagnetism, aiming to achieve greater precision, reduced operating time, and improved surgical outcomes. The aim of the present systematic review was to evaluate the effectiveness of MMs compared to conventional surgical techniques in oral and implant surgery. The focused question was as follows: “Do magnetic mallets improve clinical outcomes in oral and implant surgery compared to traditional instruments?” Only clinical studies comparing the use of MMs with traditional techniques in oral surgery were included. The following databases were searched up to 27 November 2025: Pubmed, Scopus, Web of Science. For quality assessment, the Cochrane Risk of Bias 2 (RoB 2) tool was applied for randomized controlled trials (RCTs), while the Newcastle–Ottawa Scale (NOS) was used for non-randomized studies. Data were screened and synthesized by two reviewers. The systematic review was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. In total, 347 studies were initially found and 6 matched the inclusion criteria and were included in the review, for a total of 282 patients. Five RCTs were included, as well as one retrospective study. The studies investigated were as follows: implant site preparation (two studies with a total of 86 patients), sinus lift and contextual implant insertion (three studies, total: 102 patients), dental extraction (two studies, total: 70 patients), and split-crest (one study with 46 patients). The outcomes suggest that MMs may serve as a potential alternative to traditional techniques, exhibiting promising although preliminary outcomes. The studies included reported a lower incidence of benign paroxysmal positional vertigo with the use of MMs compared to hand osteotomes. Regarding quality assessment, RCTs raised some concerns, while the retrospective study had a moderate risk of bias. Despite the promising results, the paucity of high-quality controlled trials limits definitive conclusions on the superiority of MM over conventional techniques. Further well-designed comparative trials are needed to confirm the clinical benefits, optimize protocols across different indications, and evaluate MMs’ potential role in the management of critical bone conditions and complex surgery. Full article

Objective—Partial do-not-resuscitate (DNR) orders, directives specifying limited resuscitative efforts, are intended to align medical interventions with patient preferences. However, their complexity may introduce ambiguity, inconsistent care, and ethical challenges. Design—A retrospective review was conducted of inpatient partial code order entries over a three-year period at a single institution with a pediatric oncology and immunology cohort. Partial DNR orders were identified and categorized based on included or excluded interventions (chest compressions, defibrillation, intubation, mechanical ventilation, medications). Data was analyzed to assess the frequency, variation, and internal consistency of documented preferences as well as alignment with institutional definitions and clinical feasibility. Results—Partial DNR orders represented a small (n = 15, 7%) but notable proportion of total code status entries. Wide variability was observed in the combinations of permitted and withheld interventions, with orders containing internally conflicting instructions. Documentation of inconsistencies and unclear terminology were common, raising concerns about interpretability during emergent situations. Conclusions—Partial DNR orders demonstrate heterogeneity and potential for miscommunication. These findings suggest that while partial codes may reflect nuanced patient preferences, they pose operational and ethical risks that could compromise care clarity. Clinical implications are reviewed. These findings will guide institutional deliberations regarding whether to refine, restrict, or eliminate partial code order options to enhance patient safety and decision-making transparency. Full article

Background: Traumatic injuries of the duodenum are generally rare but when they occur, they can result in serious complications. Inaccurate injury classification, delayed diagnosis, or late treatment can significantly raise morbidity and mortality. A multidisciplinary approach is often necessary. Mechanisms of injury: Isolated duodenal injuries are relatively uncommon due to the duodenum’s proximity to pancreas and major vascular structures. Duodenal injuries can result from blunt or penetrating trauma. Classification: The 2019 World Society of Emergency Surgery (WSES)-American Association for the Surgery of Trauma (AAST) guidelines recommend incorporating both the AAST-OIS grading and the patient’s hemodynamic status to stratify duodenal injuries into four categories: Minor injuries WSES class I, Moderate injuries WSES class II, Severe injuries WSES class III, and WSES class IV. Diagnosis: The diagnostic approach involves a combination of clinical assessment, laboratory investigations, radiological imaging and, in particular situations, surgery. Prompt diagnosis is critical because delays exceeding 24 h are associated with a higher incidence of postoperative complications and a significant rise in mortality. Contrast-enhanced abdominal computed tomography (CT) represents the gold standard for diagnosis in patients who are hemodynamically stable. Management: Duodenal trauma requires a multimodal approach that considers hemodynamic stability, the severity of the injury and the presence of associated lesions. Non-operative management (NOM) is reserved for hemodynamically stable patients with minor duodenal injuries without perforation (AAST I/WSES I), as well as all duodenal hematomas (WSES I–II/AAST I–II) in the absence of associated abdominal organ injuries requiring surgical intervention. All hemodynamically unstable patients, those with peritonitis, or with CT findings consistent with duodenal perforations or AAST grade III or higher injuries are candidates for emergency surgery. If intervention is required, primary repair should be the preferred option whenever feasible, while damage control surgery is the best choice in cases of hemodynamic instability, severe associated injuries, or complex duodenal lesions. Definitive reconstructive surgery should be postponed until the patient has been adequately resuscitated. The role of endoscopic techniques in the treatment of duodenal injuries and their complications is expanding. Conclusions: Duodenal trauma is burdened by potentially high mortality. Among the possible complications, duodenal fistula is the most common, followed by duodenal obstruction, bile duct fistula, abscess, and pancreatitis. The overall mortality rate for duodenal trauma persists to be significant with an average rate of 17%. Future prospective research needed to reduce the risk of complications following duodenal trauma. Full article

Chronotype, an individual’s preferred timing of sleep and activity within a 24 h cycle, significantly influences metabolic health, muscle function, and body composition. This review explores the interplay between circadian rhythms, hormonal fluctuations, and behavioral patterns—such as nutrition timing, physical activity and sleep quality—and their impact on muscle mass, strength, and quality. Evening chronotypes (ETs) are consistently associated with poorer sleep, irregular eating habits, reduced physical activity, and increased risk of obesity, sarcopenia and metabolic disorders compared to morning types (MTs). At the molecular level, disruptions in circadian clock gene expression (e.g., BMAL1, PER2, CRY1) affect protein synthesis, insulin sensitivity, and energy metabolism, contributing to muscle degradation and impaired recovery. The review highlights critical components—targeting chrono-nutrition, sleep quality, and exercise timing—to align lifestyle behaviors with circadian biology, thereby preserving muscle health and improving overall metabolic outcomes. Full article