Search Results (355)

The retina offers a unique window into both ocular and systemic health, motivating the development of AI-based tools for disease screening and risk assessment. In this study, we present a comprehensive evaluation of six state-of-the-art deep neural networks, including convolutional neural networks and vision transformer architectures, on the Brazilian Multilabel Ophthalmological Dataset (BRSET), comprising 16,266 fundus images annotated for multiple clinical and demographic labels. We explored seven classification tasks: Diabetes, Diabetic Retinopathy (2-class), Diabetic Retinopathy (3-class), Hypertension, Hypertensive Retinopathy, Drusen, and Sex classification. Models were evaluated using precision, recall, F1-score, accuracy, and AUC. Among all models, the Swin-L generally delivered the best performance across scenarios for Diabetes (AUC = 0.88, weighted F1-score = 0.86), Diabetic Retinopathy (2-class) (AUC = 0.98, weighted F1-score = 0.95), Diabetic Retinopathy (3-class) (macro AUC = 0.98, weighted F1-score = 0.95), Hypertension (AUC = 0.85, weighted F1-score = 0.79), Hypertensive Retinopathy (AUC = 0.81, weighted F1-score = 0.97), Drusen detection (AUC = 0.93, weighted F1-score = 0.90), and Sex classification (AUC = 0.87, weighted F1-score = 0.80). These results reflect excellent to outstanding diagnostic performance. We also employed gradient-based saliency maps to enhance explainability and visualize decision-relevant retinal features. Our findings underscore the potential of deep learning, particularly vision transformer models, to deliver accurate, interpretable, and clinically meaningful screening tools for retinal and systemic disease detection. Full article

Background: Bulgaria carries a high burden of colorectal cancer (CRC) but, at the start of this study, lacked a nationwide organized screening program. Understanding specialist views (particularly on mail-based fecal testing) is essential for effective policy development. Objective: The objective is to assess the attitudes towards, practices of, and perceived barriers to CRC screening among Bulgarian gastroenterologists, with a focus on the feasibility of mail-based fecal occult blood testing (FOBT). Methods: A cross-sectional survey of 38 gastroenterologists examined clinical use of FOBT, screening method preferences, and perceived systemic and patient-level barriers to CRC screening. Results: Among respondents, 57.89% reported using FOBT in clinical practice, and 71.05% indicated they would undergo the test themselves and recommend it to relatives. Colonoscopy was the preferred diagnostic tool for 84.21% of participants; however, the existing literature raises concerns about its feasibility for large-scale population screening. Key systemic barriers, rated on a 5-point Likert scale, included financial constraints (mean = 3.08), inadequate infrastructure (2.89), and healthcare workforce shortages (2.71). Patient-level barriers were led by low health literacy (4.13), lack of motivation (3.95), and procedural fears (3.26). A majority (84.38%) believed that mail-based FOBT would increase screening uptake, and 57.89% supported annual distribution of test kits. Nearly all respondents (97.37%) favored initiating screening at age 50. Conclusions: This study highlights strong support among Bulgarian gastroenterologists for a national CRC screening program, with particular endorsement of mail-based FOBT. Despite acknowledged systemic and population-level barriers, the findings suggest that such an approach could increase screening coverage, promote early detection, and support the strategic rollout of Bulgaria’s emerging cancer control initiatives. Full article

Background: This review explores the influence of eco-anxiety on sustainable consumption, with a specific focus on the urban context. While the literature on green consumerism continues to expand, the role of emotional and psychological factors, especially eco-anxiety, in shaping sustainable consumption decisions remains underexplored. Most existing studies emphasize cognitive, social, or contextual drivers, often overlooking affective dimensions that may significantly influence consumer behavior. Addressing this gap, the review examines how emotional responses to climate change, such as eco-anxiety, inform and potentially motivate eco-friendly consumption patterns. Understanding these affective pathways offers valuable insights on how individuals and urban communities can effectively adapt to climate change and establish a sustainable consumption culture. Methods: A systematic literature search was conducted in Scopus and Web of Sciences databases, following a predefined keyword strategy, resulting in 56 initial records. We further implemented a supplementary search of gray literature on Google Scholar to search for additional reports. The full-text screening process identified 12 eligible studies based on the following inclusion criteria: quantitative or mixed-methods studies focusing on adult and young adult individuals, including both measures of eco-anxiety and green consumption and assessing their direct or indirect relationship. Results: Findings suggest that eco-anxiety functions as a cognitive–affective motivator for sustainable consumer choices; however, the strength and direction of this influence appear contingent on moderating emotional and psychological variables and cross-cultural and demographic moderators. Discussion: This review highlights the need for urban-focused intervention tailored communication, marketing, and business strategies that address the emotional dimensions of climate change. Policymakers and businesses are encouraged to consider affective drivers as eco-anxiety to promote sustainable consumption stewardship within urban communities. By addressing these psychological responses, urban societies can become more resilient and proactive in confronting climate change challenges. Full article

Genetic factors play an important role in the risk of developing lung cancer, a disease that disproportionately affects African American (AA) individuals who smoke. Accumulating evidence suggests that specific ancestry-informative genetic markers are predictive of lung cancer risk in AA individuals who smoke. Although testing for, and communication of, genetic risk to patients should impact health and screening, results are mixed. The goal of this study was to evaluate the effects of genetic risk communication that also included ancestry-specific risk information among African American individuals who smoke. Using an experimental design, African American individuals who smoke (n = 166) were assigned randomly to receive hypothetical genetic test results that indicated (1) low vs. high genetic risk for lung cancer (“Risk”) and (2) European vs. African Ancestry (“Ancestry”). We hypothesized that participants who had been told that they were both at high risk for lung cancer based on genetic markers prominent in African persons at risk of lung cancer, and that they have African ancestry, would exhibit increases in cognitive (perceived lung cancer risk), emotional (cancer worry and psychological distress), and motivational (motivation to quit smoking) factors shown to predict longer-term health behavior change. Results revealed significant and moderate-to-large effects of Risk for all outcomes. There was also a significant Ancestry effect on perceived lung cancer risk: increased risk perceptions among participants who learned that they have high African genetic heritage. Path analytic modeling revealed that cognitive and emotional factors mediated the effects of both Risk and Ancestry feedback on motivation to quit smoking. Findings further highlight the importance of incorporating ancestry-specific genetic risk information into genetic counseling sessions, especially in underserved populations, as doing so may impact key cognitive, emotional, and motivational factors critical to behavior change. Full article

As mental health has gained prominence in recent years, elite ice hockey players have shared their experience of psychological problems, including adverse alcohol use, anxiety, depression, distress, eating disorders, and sleep disturbances. Mental health remains a sensitive issue for ice hockey players, as stigma, a strong hockey culture, lack of mental health literacy, and negative past experiences with seeking help constitute barriers to seeking support. This scoping review aims to identify the psychological factors contributing to elite ice hockey players’ well-being. After screening the titles and abstracts of three databases within a 2002–2025 timeframe, a total of 517 articles were retrieved. Seventeen articles targeting ice hockey athletes over 14 years of age competing at an elite level were selected. Three main categories emerged from the included studies: anxiety and depressive symptoms, motivational variables, and coping strategies at different career stages. Factors such as retirement, concussions, social support, parenting style, task-approach goals, and task-oriented behavior were influential components to the well-being and mental health of elite ice hockey players. Using the Lazarus and Folkman model, the identified psychological factors may help athletes and various actors surrounding them to better understand athletes’ well-being. Full article

Incorporating external knowledge has been shown to improve emotion understanding in dialogues by enriching contextual information, such as character motivations, psychological states, and causal relations between events. Filtering and categorizing this information can significantly enhance model performance. In this paper, we present an innovative Emotion Recognition in Conversation (ERC) framework, called the Scene-Speaker Emotion Awareness Network (SSEAN), which employs a dual-strategy modeling approach. SSEAN uniquely incorporates external commonsense knowledge describing speaker states into multimodal inputs. Using parallel recurrent networks to separately capture scene-level and speaker-level emotions, the model effectively reduces the accumulation of redundant information within the speaker’s emotional space. Additionally, we introduce an attention-based dynamic screening module to enhance the quality of integrated external commonsense knowledge through three levels: (1) speaker-listener-aware input structuring, (2) role-based segmentation, and (3) context-guided attention refinement. Experiments show that SSEAN outperforms existing state-of-the-art models on two well-adopted benchmark datasets in both single-text modality and multimodal settings. Full article

The study of dynamical processes on complex networks constitutes a foundational domain bridging applied mathematics, statistical physics, systems theory, and data science. Temporal evolution, not static topology, determines the controllability, stability, and inference limits of real-world systems, from epidemics and neural circuits to power grids and social media. However, the methodological landscape remains fragmented, with distinct communities advancing separate formalisms for spreading, control, inference, and design. This review presents a unifying six-pillar framework for the analysis of network dynamics: (i) spectral and structural foundations; (ii) deterministic mean-field reductions; (iii) control and observability theory; (iv) adaptive and temporal networks; (v) probabilistic inference and belief propagation; (vi) multilayer and interdependent systems. Within each pillar, we delineate conceptual motivations, canonical models, analytical methodologies, and open challenges. Our corpus, selected via a PRISMA-guided screening of 134 mathematically substantive works (1997–2024), is organized to emphasize internal logic and cross-pillar connectivity. By mapping the field onto a coherent methodological spine, this survey aims to equip theorists and practitioners with a transferable toolkit for interpreting, designing, and controlling dynamic behavior on networks. Full article

Background/Objectives: Increasing the solid-state landscape of an active pharmaceutical ingredient (API) by generating new crystalline forms (e.g., polymorphs, cyclodextrin (CD) inclusion complexes, co-crystals, and salts) can yield products with significantly enhanced biopharmaceutical properties (especially increased water solubility), thereby improving API delivery and extending its lifetime. The aim of this study was the isolation of new solid forms of the poorly water-soluble non-steroidal anti-inflammatory drug fenbufen (FBF), for which relatively few solid phases have been reported to date. Further motivation for the study is the recent finding that it has potential for repurposing to treat acute pancreatitis. Methods: Interventions for generating new solid forms of FBF included (a) polymorph screening with a variety of solvent media, (b) attempts to form solid inclusion complexes with the native cyclodextrins α-, β-, and γ-CD using various preparative methods, and (c) co-crystallization with a series of coformers to produce co-crystals and/or molecular salts. Results: No new polymorphic forms of FBF were identified, but screening with CDs resulted in isolation and characterization of a new solid inclusion complex with γ-CD. However, co-crystallization of FBF with the water-soluble coformer isonicotinamide yielded two new products, namely a 1:1 co-crystal and an unusual multi-component ionic co-crystal, whose aqueous solubility indicated significant enhancement of FBF solubility. Conclusions: Due to its extremely low water solubility, FBF presented challenges during the study aimed at modifying its crystalline form. However, two new supramolecular forms, a co-crystal and an ionic co-crystal, were isolated, the latter phase having potential for further formulation owing to its significantly enhanced solubility. Full article

As climate change continues to endanger a sustainable global condition, a growing literature investigates how to pursue green practices to fight its effects. Individuals are the essential starting point for such bottom-up attempts, with their attitudes towards sustainability driving pro-environmental behaviors (PEBs). Objectives: Based on the available relevant literature, this scoping review aims to delve into the processes underlying people’s sustainable decision-making (SDM) associated with PEBs. Methods: A scientific literature search was performed through (a) an active database search and (b) the identification of studies via reference and citation tracking. Results were screened and selected in Rayyan. Results: Included articles (n = 30) heterogeneously reported cognitive and neural aspects of SDM shaping PEBs. These proved to (a) recruit brain areas involved in mentalizing and moral cognition (likely because of their role in processing the interplay between personal and contextual factors rather than moral considerations in themselves); (b) undergo the same modulatory influences shaping other kinds of prosocial/cooperative behaviors; and (c) include brain areas involved in attentional/monitoring and emotional/motivational processes, alongside those consistently associated with decision-making processes. Conclusions: These results help interpret the available evidence on the neuro-cognitive bases of SDM while focusing on potential interventions to foster better practices and mitigate the adverse repercussions of climate change on human and global health. Full article

Improved medical treatments have extended survival and life expectancy in adults with congenital heart defects (ACHD), placing greater emphasis on psychosocial health. Up to one-third of ACHD experience anxiety or depression, and half develop a mental illness during their lifetime. While there is solid evidence on the prevalence of mental health, many do not receive psychological, psychotherapeutic, or psychiatric treatment (PST) and the psychological care situation remains understudied. In a nationwide, online cross-sectional survey conducted in Q1 2024, 1486 ACHD aged 18 to 85 (M_age = 36.84 years; 60.8% female) registered in the German National Register for Congenital Heart Defects (NRCHD) completed self-report questionnaires on sociodemographics, illness identity (Illness Identity Questionnaire), mental well-being, and utilisation of PST. CHD diagnoses were determined in conformity with the International Pediatric and Congenital Cardiac Code (IPCCC) and CHD was classified according to Warnes et al. (simple/moderate/complex). Analyses included chi-square tests, t-tests, and binary logistic regression. Overall, 32.8% of participants reported current and/or previous PST (women 37.5%, men 25.3%). PST utilisation was significantly higher in those with complex (40.2%) compared to moderate (29.6%) and simple CHD (25.3%) (ps < 0.01). Primary treatment reasons were mental illness (41.7%) and CHD-related concerns (37.2%). Nearly half of treatments were self-initiated (45.8%) and about one-third were physician-recommended (30.8%). Logistic regression revealed CHD severity as a significant predictor of PST use (ps < 0.05), with lower odds for simple (OR = 0.48) and moderate (OR = 0.66) compared to complex CHD when controlling for sex (p < 0.001, OR = 1.87), age (p = 0.022, OR = 1.011), education level (ps between 0.060 and 0.780), and net income (ps < 0.05). Those receiving PST showed significantly higher maladaptive illness-identity scores (engulfment, rejection) and lower acceptance. Approximately one in three ACHD requires mental health support, particularly those with complex CHD. The CHD itself acts as a key stressor and treatment motivator. Findings underscore the need for integrated care linking cardiological and psychosocial services. Routine screening for psychological distress and low-threshold access to PST—also for patients with simple and moderate CHD—are essential to identify and address mental health needs early. Full article

Background/Objectives:Breast and cervical cancer screening programs are essential for early detection and timely treatment, yet participation rates remain suboptimal. Within a patient-centered care approach, engagement is increasingly viewed as a dynamic and emotionally grounded process. The literature conceptualizes three phases of engagement in healthcare decision-making: ‘recruit’, ‘retain’, and ‘sustain’. When these phases intersect with the structured pathway of cancer screening, they generate specific meaning-making challenges that shape how women relate to prevention and care. This study adopts the lens of Iterative Situated Engagement (ISE) to explore how women experience and negotiate these challenges, differentiating them across the three engagement phases. Methods: A theory-driven qualitative design was adopted. Data were collected through semi-structured interviews with 40 women aged 25–69 years participating in public breast and cervical cancer screening programs. Thematic analysis was conducted using the Framework Method. Results: In the ‘recruit’ phase, engagement was driven by Cancer Risk Monitoring, Self-care Motivation, Fear of Death Management, and Coincidence. The ‘retain’ phase emphasized Trust in Healthcare Providers, Accessibility of Services, Recurrent Invitations, and Informal Result Previews. About the ‘sustain’ phase, Continuity of Healthcare Providers, Driving Best Practices Dissemination, Flexible Organization of Healthcare Services, and Shorter Waiting Times for Results were highlighted as key factors in maintaining engagement over time. Conclusions: Women’s engagement in cancer screening emerges as a dynamic, multi-phase process shaped by psychological, emotional, and organizational levels. These findings contribute to the development of the ISE conceptual proposal, which frames participation as an iterative, situated, and meaning-making trajectory. Strengthening personalized health communication and improving the coordination of primary care services could enhance sustained participation in screening programs, supporting strategies to reduce health disparities and promote preventive practices. Full article

This study employs molecular dynamics simulations to investigate counterion effects (Li⁺, Na⁺, K⁺) on the interfacial aggregation of mixed short-chain fluorocarbon, Perfluorohexanoic acid (PFH_XA), and Sodium dodecyl sulfate (SDS) surfactants. Motivated by the need for greener surfactant alternatives and a fundamental understanding of molecular interactions governing their behavior, we demonstrate that counterion hydration radius critically modulates system organization. K⁺ ions induce superior monolayer condensation and interfacial performance compared to Li⁺ and Na⁺ counterparts, as evidenced by threefold analysis: (1) RMSD/MSD-confirmed equilibrium attainment ensures data reliability; (2) 1D/2D density profiles and surface tension measurements reveal K⁺-enhanced packing density (lower solvent-accessible surface area versus Na⁺ and Li⁺ systems); (3) Electrostatic potential analysis identifies synergistic complementarity between SDS’s hydrophobic stabilization via dodecyl chain interactions and PFH_XA’s charge uniformity, optimizing molecular-level charge screening. Radial distribution function analysis demonstrates K⁺’s stronger affinity for SDS head groups, with preferential sulfate coordination reducing surfactant-water hydration interactions. This behavior correlates with hydrogen-bond population reduction, attributed to SDS groups functioning as multidentate ligands—their tetrahedral oxygen arrangement facilitates cooperative hydrogen-bond networks, while counterion-specific charge screening competitively modulates bond formation. The resultant interfacial restructuring enables ordered molecular arrangements with lower system curvature than those observed in Li⁺ and Na⁺-containing systems. These findings elucidate counterion-mediated interfacial modulation mechanisms and establish K⁺ as an optimal candidate for enhancing PFH_XA/SDS mixture performance through hydration-radius screening. The work provides molecular-level guidelines for designing eco-friendly surfactant systems with tailored interfacial properties. Full article

Aims: Cue exposure therapy (CET) is a promising treatment approach for cocaine substance use disorder (SUD). CET specifically targets the psychological and physiological responses elicited by drug-related cues, aiming to reduce their motivational impact. To advance understanding of CET for cocaine treatment, this systematic review aims to categorise the range of cocaine cues used in research. Methods: A systematic review of the existing literature with searches conducted on PubMed and Web of Science bibliographic databases with no time constraints in August 2024 (PROSPERO: CRD42024554361). Three reviewers were independently involved in the screening, review and data extraction process, in line with PRISMA guidelines. Data extracted included participant demographics, study design, data on the cocaine cue task, and examples (if provided). Each study was appraised and received a quality score. The secondary outcome was to summarise examples for each category type identified. The data are presented as a narrative synthesis. Results: 3600 articles were identified and screened. 235 articles were included in the analysis. Cues identified included images, paraphernalia, drug-related words, cocaine smell, auditory stimuli presented via audiotapes, video recordings, scripts, and virtual reality environments, often combining multiple modalities. Included studies recruited cocaine-dependent individuals, recreational users, polydrug users, and non-cocaine-using controls. The sample sizes of the studies ranged from a single case study to a study including 1974 participants. Conclusions: This review found that studies employed a wide range of cue categories, but detailed examples were often lacking, limiting replication. The number and combination of cues varied: some studies used only cocaine-related images, while others included images, videos, physical items, and audiotapes. The level of immersion and personalisation also differed considerably. All studies used cocaine-specific cues, most commonly images or representations of cocaine substance, cocaine use or drug paraphernalia, drug preparation items, or conversations of cocaine use and its effects. The overall quality of the included studies was deemed good, with all adhering to standard research norms. While this review highlights the breath of cue types used in the literature, further research should focus on enhancing cue exposure techniques by incorporating more immersive and personalised stimuli, and by providing clearer documentation of cue characteristics to support replication and clinical translation. Full article

Inclusive education aims to ensure equitable participation for all students. Technology plays a crucial role in this endeavor by providing tools that eliminate barriers, personalize learning, and foster active participation, especially for students with functional diversity or specific needs. This research examines whether the adoption of technologies facilitates or poses challenges for achieving effective inclusive education. Through a Systematic Literature Review (SLR), the most commonly used technologies were identified and both their benefits and challenges were evaluated. The PRISMA methodology was applied, and databases such as Scopus were used, undergoing two study refinement processes, resulting in 93 primary studies that contributed to addressing the posed research questions. The findings reveal the use of various technologies in inclusive educational settings, such as screen readers, braille devices, and augmented reality technologies. Their benefits include improved accessibility, enhanced active participation, and the promotion of critical skills like critical thinking and creativity. These tools help create more motivating and equitable learning environments, which aid in reducing dropout rates and strengthening social inclusion. However, the implementation of these technologies faces significant challenges, such as high costs, lack of adequate training for teachers, social inequalities, and ethical barriers. To maximize the effectiveness of these tools, it is crucial to modernize inclusive policies and tailor educational strategies to the specific needs of each student. This study has limitations, including variability in the quality of the studies analyzed, which may affect the generalization of the results. Future research should explore the long-term impacts of technologies on inclusive education and evaluate the necessary teacher training strategies for their effective implementation. Full article

Recruiting participants for clinical trials targeting specific populations, like patients with chronic motor complete spinal cord injuries (SCIs), is challenging. The RESTORES trial evaluated spinal cord stimulation (SCS) combined with robotic neurorehabilitation for motor recovery in this population. This feasibility study enrolled three participants to assess SCS implant safety, synergistic effects of SCS and robotic rehabilitation, and clinical outcomes. Key recruitment barriers included the small patient pool, stringent eligibility criteria, patient skepticism, and logistical and emotional challenges. Strategies to address these challenges encompassed multidisciplinary collaborations with clinical centers, SCI associations, and patient support groups, including pre-surgical counselling and transparent communication. A dedicated clinical research coordinator ensured ethical compliance, logistical support, and participant engagement. Travel reimbursements, family involvement, and peer advocacy fostered accessibility and trust. Of the 115 patients screened, only 3 met the strict eligibility criteria, due to high screening failure rates and participant apprehension. Peer testimonials and family support helped enhance motivation and adherence. Ethical safeguards, like a data safety monitoring board, ensured participant safety and transparency. The RESTORES trial underscores the complexity of recruiting for pioneering interventions while highlighting the importance of tailored, patient-centric strategies. Insights gained will inform future trials and contribute to advancing SCI rehabilitation, offering hope for enhanced neurological recovery and quality of life for individuals with chronic motor complete SCI. Full article