Search Results (116)

Background: Various socket designs exist, linking the residual limb together with the prosthetic components to restore the ability to walk; however, lack of socket comfort is a frequent complaint. Objective: To evaluate the impact of socket design on end-user comfort and mobility. Methods: A randomized crossover trial was set to compare comfort and mobility of above-knee amputees (AKAs) wearing an ischial containment (IC) or subischial (I-SUB) socket. Patients actively wearing IC sockets were recruited from 10 rehabilitation centers across the country. They were then fitted for an I-SUB socket by Certified Prosthetists (CPs) as an alternate socket. Participants were randomly assigned to start with one or the other socket. After a minimum of 2 weeks, each participant evaluated the Socket Comfort Score (SCS) (primary outcome) in various situations, performed the 2-min walk test, and answered the PLUS-M questionnaire (secondary outcomes). Results: A total of 25 participants were included, of whom 23 completed the study with full (n = 21) or partial data (n = 2). SCS were improved with I-SUB compared with IC in all situations, with significant differences in general, when sitting on a rigid chair, sitting in a car, and standing. The differences in self-reported mobility and walking distance at the 2-min walk test were not significant. At the end of the study, more than 80% of the participants chose to keep the I-SUB socket for their daily use. Conclusions: For the first time, this study supports that the subischial suction socket improves comfort in daily life without negatively impacting user mobility in a group of individuals with AKA. Full article

Background/Objectives: Since October 2019, Lebanon has faced continuous sociopolitical and economic instability. Clinical psychologists have played a central role in responding to rising mental health needs, yet little is known about their own psychological well-being. Methods: This study examined mental health outcomes among 157 certified psychologists (clinical and educational psychologists) working in Lebanon. A cross-sectional study was conducted with psychologists aged 30–53 years across all Lebanese governorates, who were recruited through snowball and word-of-mouth sampling. Participants completed validated measures of depression (PHQ-9), anxiety (LAS-10), perceived stress (PSS-10), subjective well-being (WHO-5), eating attitudes (EAT-26), and self-esteem (A-SISE). Results: Results showed that 44% of participants reported at least mild depressive symptoms, 14% met criteria for anxiety, and 57% experienced moderate to high perceived stress, while most showed no risk for eating disorders. Bivariate and multivariate analyses identified self-esteem as a predictive factor, negatively associated with depression, anxiety, and stress, and positively associated with subjective well-being. Additional risk factors included younger age, being unmarried, not having children, prior psychological history, health problems, lower income, and working as an educational rather than clinical psychologist. Conclusions: These findings highlight aspects of vulnerability among psychologists and underline the need for targeted interventions for at-risk groups. Strengthening self-esteem may contribute to enhancing clinicians’ mental health. However, these conclusions should be interpreted in light of several limitations, including the small sample size, the non-probability and gender-skewed nature of the sample, partly due to the relatively limited number of practicing psychologists in Lebanon. Full article

Background: Adult scoliosis following spinal fusion and subsequent hardware removal presents complex challenges, especially when deformity progresses in both the sagittal and coronal planes. Revision surgery is often recommended but it entails considerable risks. Conservative approaches, including Schroth-based physiotherapy and bracing, offer promising alternatives for select patients, particularly older adults with comorbidities or those who decline further surgery. Case Presentation: A woman with adolescent idiopathic scoliosis (diagnosed at age 13) underwent spinal fusion with Harrington rod instrumentation and costoplasty at age 24. She was de-instrumented two years later due to infection and developed progressive thoracic hyperkyphosis, coronal imbalance, and 12 cm loss of height over two decades. At age 47, she chose conservative management instead of revision surgery. Methods: She completed a 28-month program combining Schroth-based physiotherapy supervised by a certified therapist and part-time bracing. Outcomes included radiographs, inclinometry, spirometry, spinal-muscle ultrasound, height/posture measures, and SRS-22 and ODI scores. Results: Substantial clinical improvements were observed. Thoracic kyphosis decreased from 80° to 45° (44%) and the coronal thoracic curve was reduced from 48° to 32° (33%). Lumbar lordosis increased by 6°, standing height rose by 4 cm, and forced vital capacity improved by 900 mL (33%). The Oswestry Disability Index (ODI) score improved from 4% to 0%, and SRS-22 domains (pain, function, self-image, mental health, satisfaction) showed meaningful gains. The patient returned to full physical activity and avoided further surgery. Conclusion: This case highlights the potential of Schroth-based physiotherapy with bracing to reverse postural and functional decline in complex post-fusion scoliosis. It offers a viable non-surgical option when revision surgery poses a high risk or is declined and aligns with modern rehabilitative goals focused on long-term quality of life. Full article

Research in “cybertherapy” has explored innovative ways to integrate new technologies as innovative tools in psychological treatment, such as virtual reality. Avatars, as digital representations of users within virtual environments, represent an interesting tool for psychotherapists: they could be used to assess aspects of patients’ self-representations (assessment), to promote behavioral change based on an alternative self-image (treatment), or to exercise therapists’ skills in diagnosis and assessment (formation). Yet, the use of avatars in psychotherapy is still not widespread. In the present study, 77 certified psychotherapists evaluated the three possible uses of avatars described above in terms of technology acceptance model (TAM) factors: perceived usefulness, perceived ease of use and intention-to-use. Partially confirming the TAM, the results show that perceived usefulness in particular is an effective predictor of intention to use avatars in psychotherapy for all three possible uses. Attitudes towards avatars as a psychotherapeutic tool were slightly influenced by mental health professionals’ methodological approach, with cognitive-behavioral psychotherapists showing more positive attitudes towards avatars as a training tool. On the other hand, previous experiences with other technologies (e.g., conducting therapy online or not) affected the perception of avatars’ ease of use as a treatment tool. The present study contributes to identifying factors that influence mental health professionals’ attitudes towards technological innovations in the psychotherapy profession, giving directions for future research in cybertherapy adoption. Full article

Background: Many everyday electronic devices incorporate embedded computers, allowing them to offer advanced functions such as Internet connectivity or the execution of artificial intelligence algorithms, giving rise to Tiny Machine Learning (TinyML) and Edge AI applications. In these contexts, models must be both efficient and explainable, especially when they are intended for systems that must be understood, interpreted, validated, or certified by humans in contrast to other approaches that are less interpretable. Among these algorithms, linguistic fuzzy systems have traditionally been valued for their interpretability and their ability to represent uncertainty with low computational cost, making them a relevant choice for embedded intelligence. However, in dynamic and changing environments, it is essential that these models can continuously adapt. While there are fuzzy approaches capable of adapting to changing conditions, few studies explicitly address their adaptation and optimization in resource-constrained devices. Methods: This paper focuses on this challenge and presents a lightweight evolutionary strategy, based on a micro genetic algorithm, adapted for constrained hardware online on-device tuning of linguistic (Mamdani-type) fuzzy models, while preserving their interpretability. Results: A prototype implementation on an embedded platform demonstrates the feasibility of the approach and highlights its potential to bring explainable self-adaptation to TinyML and Edge AI scenarios. Conclusions: The main contribution lies in showing how an appropriate integration of carefully chosen tuning mechanisms and model structure enables efficient on-device adaptation under severe resource constraints, making continuous linguistic adjustment feasible within TinyML systems. Full article

For behavioral obesity treatments to improve their typically minimal effects and reduce an increasing reliance on surgical and pharmacologic interventions, an enhanced understanding of theory-driven psychosocial factors is needed. Recent applied research successfully targeted the social cognitive theory-related variables of self-efficacy (SE), self-regulation (SR), and mood (e.g., total mood disturbance; TMD) to increase participants’ exercise outputs and improve their dietary behaviors to sustain weight losses. However, an improved understanding of interactions of changes in those psychosocial factors, especially within paths toward longer-term behavioral changes, is required to increase both the reliability and effectiveness of obesity interventions. Women (N = 106) participated in a 12-month, community-based cognitive–behavioral obesity intervention. Consistent with tenets of social cognitive theory, most of the treatment time was focused on building SR and SE related to both exercise and controlled eating, and improving mood (i.e., TMD), primarily through increased exercise. Improvements in SR, SE, and TMD were significant (ps < 0.001) from baseline to Months 3, 6, and 9 (except in SE over 9 months). These effect sizes were large (ds = 0.82–1.53). In line with the prediction of both exercise and dietary improvements over 12 months, paths from 3-month, to 6-month, to 9-month changes in SR → TMD → SE (B = 0.93, SE_B = 0.59, 95% CI [0.034, 2.274], and B = 0.46, SE_B = 0.25, 95% CI [0.035, 1.025], respectively) and TMD → SR → SE (B = −0.08, SE_B = 0.03, 95% CI [−0.145, −0.020], and B = −0.04, SE_B = 0.01, 95% CI [−0.070, −0.015], respectively) were significant, whereas the other possible paths incorporating changes in SR, SE, and TMD were not. Consistent with social cognitive theory and the mood–behavior model, findings supported the value of early treatment foci on interactions of TMD and SR changes in pursuit of longer-term advancements in SE and weight-loss behaviors. Full article

Background: Preliminary evidence supports high-intensity functional training (HIFT) for improving various health outcomes in non-disabled adults with overweight/obesity. It remains unknown whether HIFT produces similar benefits in individuals who are overweight/obese and also have a mobility disability (e.g., spinal cord injury, multiple sclerosis)—a population disproportionately affected by obesity-related health conditions and systemic barriers to exercise. This pilot study aimed to evaluate the feasibility and preliminary effects of a 24-week HIFT intervention, delivered at community sites by certified trainers, for adults with mobility disabilities (MDs) who were overweight/obese. Methods: Twenty adults with MD and overweight/obesity (self-reported BMI 25–46 kg/m²) enrolled in a 24-week HIFT intervention (3 days/wk, 60 min sessions) delivered at four community-based facilities by certified trainers. Feasibility indicators included recruitment, retention, and attendance; adverse events were tracked. Effect sizes (Cohen’s d) were calculated for changes in obesity-related measures, physical function, work capacity, and psychological measures from baseline to post-intervention. Results: Feasibility targets were met, with a recruitment rate of 72.2%, 76.9% retention, and 80.7% attendance. Thirteen adverse events occurred. Effects on obesity-related measures ranged from negligible to moderate, with stable weight/BMI, reduced waist circumference (45% ≥ 3 cm decrease), decreased body fat, and increased lean mass. Functional outcome effects ranged from small to large and included grip strength, balance, and walking speed. Large improvements were observed for the endurance, speed, work capacity, and self-reported physical function. Conclusions: A community-based HIFT program is feasible and may improve health outcomes in adults with MD and overweight/obesity. Full article

Background/Objectives: Viniyoga is a person-centered approach to yoga that emphasizes individualized adaptation of breath, movement, and meditative practices to support health and well-being. This qualitative study investigates the therapeutic goals of one-to-one Viniyoga from the perspective of experienced therapists. Methods: Fourteen certified Viniyoga practitioners participated in in-depth interviews, which were analyzed using Interpretative Phenomenological Analysis (IPA). This study details how Viniyoga therapists define therapeutic Viniyoga. Results: The findings identify three core therapeutic goals that guide Viniyoga therapy: restoring balance, cultivating self-regulation, and guiding transformation. Two case studies are presented to illustrate the application of these goals in clinical contexts. Conclusions: Qualitative information provided by the interviewed Viniyoga therapists supports the positive role of individualized Viniyoga therapy in contributing to sustainable healing and supporting clients’ return to balance, self-regulation, and personal transformation. The Viniyoga therapeutic model is applicable across diverse populations and in a variety of integrative and complementary healthcare settings. Full article

Whether voluntary carbon markets can effectively contribute to climate mitigation remains a debated issue. Taking Chinese Certified Emission Reduction (CCER) projects as a quasi-natural experiment, this study employed a difference-in-difference approach calibrated with a county-level panel dataset spanning 2008–2021 to examine the carbon abatement effect of CCER projects. The results show that CCER projects reduced county-level emissions by 2.8%, though this reduction falls short of the levels self-declared by project developers, implying the possibility of overstating emission reductions. The carbon abatement effect is more pronounced in biogas projects and projects verified by large agencies, underscoring the mitigation potential of biogas deployment as well as the importance of professional expertise in enhancing project quality. In addition, CCER projects generate a range of socio-economic benefits, including raising income, creating employment opportunities, and preserving farmland. Overall, this study identified the effectiveness of voluntary carbon markets, providing valuable insights for fostering their further sustainable development. Full article

English writing proficiency is pivotal to sustainable academic success and employability. In Chinese higher education, however, conventional instruction often constrains students’ self-regulation and access to individualized feedback. Drawing on self-regulated learning (SRL) and co-regulated learning (CoRL), this study investigates whether a CoRL-guided generative AI virtual teacher (CoRL-VT), designed as a “more capable other,” is associated with enhanced undergraduate writing outcomes relative to standard AI support. Using a 12-week quasi-experimental design with two intact classes (N = 61) in Anhui, China, we compared a control condition (standard AI) with an intervention (CoRL-VT). Writing proficiency was assessed via IELTS Writing Task 2 at pre- and post-test; three certified examiners scored all scripts with strong agreement (ICC = 0.87). Analyses adjusting for baseline yielded an estimated group difference favoring CoRL-VT. Teacher interview testimony aligned with the quantitative pattern, noting clearer macro-organization, richer lexical choices, and more teacherly formative feedback among CoRL-VT students. Taken together, these findings offer exploratory, descriptive evidence consistent with the potential of structured, CoRL-informed AI scaffolding in sustainable writing pedagogy and outline design principles for replicable CoRL-VT implementations in resource-conscious contexts. Full article

Background: The present study aims to evaluate the effectiveness of ESYSTA^® (Emperra GmbH E-Health Technologies, Germany), a CE-certified digital health application made to support insulin-treated diabetes patients to improve their disease management through better self-empowerment. Methods: To evaluate the effectiveness of ESYSTA^®, data from patients who used ESYSTA^® for at least 12 months and participated in an originally prospective one-arm study were evaluated. This study was conducted in cooperation with the German health insurance company AOK Nordost (2012–2015). From a real-world data pool of insured AOK Nordost patients, a control group was matched to mimic a controlled trial that allows the use of ESYSTA^® to be compared with standard care in the context of a disease management program (DMP). Results: The study results show significant and clinically relevant reductions in HbA1c values of at least 0.4% in ESYSTA^® users after 6 months. After 12 months, users achieved, on average, an HbA1c reduction of approximately 0.7%. These reductions are more pronounced compared to the matched control group. Conclusions: The present study shows the effectiveness of the digital health application ESYSTA^®. Using a matched control group further increased the internal and external validity of the study results. Full article

The scope of this paper is the development of a cost-effective wireless torque measurement system for vehicle drivetrain shafts. The prototype integrates strain gauges, an HX711 conditioner, a Wemos D1 Mini ESP8266, and a rechargeable battery directly on the rotating shaft, forming a self-contained sensor node. Calibration against a certified dynamometric wrench confirmed an operating span of ±5–50 N·m. Within this range, the device achieved a mean absolute error of 0.559 N·m. It also maintained precision better than ±2.5 N·m at 95% confidence, while real-time data were transmitted via Wi-Fi. The total component cost is below EUR 30 based on current prices. The novelty of this proof-of-concept implementation demonstrates that reliable, IoT-enabled torque sensing can be realized with low-cost, readily available parts. The paper details assembly, calibration, and deployment procedures, providing a transparent pathway for replication. By aligning with Industry 4.0 requirements for smart, connected equipment, the proposed torque measurement system offers an affordable solution for process monitoring and predictive maintenance in automotive and industrial settings. Full article

The aim of this work is to explore and understand the lived experience of nurses who chose to schedule visits with an Emotional Support Animal (ESA), i.e., a dog, during their working shift. Background/Objectives: Nursing practice is rigorous, weighted with intense responsibility that creates an environment conducive to stress and anxiety for the nurses, who have reported a higher level of work stress than other healthcare professionals. Knowing and addressing the factors impacting mental health/nurses’ well-being is crucial to providing care to patients. Stressful work environments result in burnout, compassion fatigue, depression, anxiety, suicide, and resignation. Understanding nurses’ perspectives on work related stress encourages hospitals to structure practices supporting nurses’ mental health and ability to provide quality care. Methods: A qualitative hermeneutic phenomenological approach was employed. Participants scheduled six weekly 10-min visits with Rex, a certified Service Dog for anxiety depression and PTSD, and registered ESA. A sample of 11 RNs participated in Rex visits at the workplace; field notes were taken during observations of visits. Semi-structured 30-min interviews conducted via Zoom, audio-recorded, and transcribed with NVivo were conducted. Results: Data were examined with Interpretative Phenomenological Analysis. Four main themes emerged: Preparing for the unknown, Doing the work, Refueling and resetting-Visits with Rex, What about nurses? Conclusions: This study highlights the need for nurses and hospital systems to incorporate self-care/self-reflection, including time/opportunities for nurses’ stress management during their practice. Knowledge of nurses receiving ESA interventions sheds light on how to protect/preserve the well-being of nurses practicing in this demanding profession. ESAs for nurses in the workplace offers an option to utilize dog therapy to re-energize and continue their shift renewed and refreshed. Full article

This study explores how Speech and Elocution Training (SET) activates language potential and fosters career-oriented development among higher vocational students through self-efficacy mechanisms. Through qualitative interviews with four vocational graduates who participated in SET 5 to 10 years ago, the research identifies three key findings. First, SET comprises curriculum content (e.g., workplace communication modules such as hosting, storytelling, and sales pitching) and classroom training using multimodal TED resources and Toastmasters International-simulated practices, which spark language potential through skill-focused, realistic exercises. Second, these pedagogies facilitate a progression where initial language potential evolves from nascent career interests into concrete job-seeking intentions and long-term career plans: completing workplace-related speech tasks boosts confidence in career choices, planning, and job competencies, enabling adaptability to professional challenges. Third, SET aligns with Bandura’s four self-efficacy determinants; these are successful experiences (including personalized and virtual skill acquisition and certified affirmation), vicarious experiences (via observation platforms and constructive peer modeling), verbal persuasion (direct instructional feedback and indirect emotional support), and the arousal of optimistic emotions (the cognitive reframing of challenges and direct desensitization to anxieties). These mechanisms collectively create a positive cycle that enhances self-efficacy, amplifies language potential, and clarifies career intentions. While highlighting SET’s efficacy, this study notes a small sample size limitation, urging future mixed-methods studies with diverse samples to validate these mechanisms across broader vocational contexts and refine understanding of language training’s role in fostering linguistic competence and career readiness. Full article

Coastal regions of Ecuador, particularly Esmeraldas and Manabí, face significant challenges related to energy access, waste management, and sustainable agricultural development. This study evaluates the renewable energy potential of cocoa waste biomass generated by smallholder farms in these provinces. A total of 20 cocoa farms, either certified or in the process of certification under the Rainforest Alliance standard, were surveyed to quantify the volume of agricultural and agro-industrial residues. Residual biomass generation ranged from 50 to 6500 tons per year, depending on farm size, planting density, and management practices. Spatial analysis revealed that Esmeraldas holds the highest concentration of cocoa waste biomass, with some farms reaching a gross energy potential of up to 89.07 TJ/year. Using thermochemical conversion scenarios, effective energy potential was estimated, and 75% of the farms exceeded the viability threshold of 100 MWh/year. The results confirm the feasibility of cocoa biomass as a renewable energy source, mainly when managed collectively at the community level. Incorporating this waste into decentralized energy systems supports circular economy models, enhances energy self-sufficiency, and aligns with sustainable supply chain goals promoted by certification schemes. This study contributes to national efforts in energy diversification and provides a replicable model for integrating renewable energy into rural agricultural systems. Full article