Search Results (18,503)

This study examines the diversity of terminologies associated with assistive technology (AT), a crucial field that promotes autonomy and inclusion for people with disabilities. Although the wide use of assistive technology is observed in the literature, a variety of terms are often used interchangeably, which hinders research, technological development, and the formulation of public policies. In this sense, this systematic review aimed to identify, categorise, and analyse the diversity of terms used to describe AT in the scientific literature, contributing to greater conceptual clarity and supporting structured and interdisciplinary development in the field. A comprehensive search was conducted in July 2024 across the Scopus, Web of Science, and PubMed databases, covering publications from 1989 to 2024. Eligible studies were peer-reviewed journal articles in English that conceptually defined at least one AT-related term. The selection process followed the PRISMA 2020 guidelines and included studies from Q1 and Q2 journals to ensure academic rigour. A total of 117 studies were included out of 11,941 initial records. Sixteen distinct terms were identified and grouped into five clusters based on semantic and functional similarities: Cluster 1—Technologies for assistance and inclusion. Cluster 2—Functional assistive devices. Cluster 3—Assistive interaction interfaces. Cluster 4—Assistive environmental technologies. Cluster 5—Assistive systems. A complementary meta-analysis revealed geographic and temporal trends, indicating that terms such as “assistive technology” and “assistive device” are globally dominant. In contrast, others, like “enabling technology,” are more context-specific and emerging. The findings contribute theoretically by providing a structured framework for understanding AT terminology and practically by supporting the design of public policy and interdisciplinary communication. Full article

Background/Objectives: Achieving renal access is a key step in percutaneous nephrolithotomy (PNL), with transpapillary access considered the safest anatomical approach. This prospective pilot study aimed to compare the effectiveness of freehand ultrasound-guided (F-UG) versus fluoroscopy-guided (FG) punctures in achieving anatomically accurate transpapillary access during supine PNL, confirmed by endoscopic visualization. Perioperative and postoperative outcomes were also evaluated. Methods: Forty-three patients undergoing supine PNL for renal pelvic or lower calyceal stones were prospectively enrolled and assigned to either the FG group (n = 23) or F-UG group (n = 20). Following renal access, intraoperative flexible ureteroscopy confirmed the anatomical nature of the puncture (transpapillary vs. nonpapillary). The puncture time, fluoroscopy time, operative time, complications (Clavien–Dindo classification), transfusion requirement, hospital stay, and one-month stone-free rates were recorded. Results: Transpapillary access was achieved in 95.7% of FG cases and 55.0% of F-UG cases (p = 0.003). Radiation exposure was significantly lower in the F-UG group (p < 0.001). Complication (15.0% vs. 0.0%) and transfusion rates (10.0% vs. 0.0%) were higher in the F-UG group but not statistically significant (p = 0.092 and p = 0.210, respectively). Other outcomes, including the operative time, hospital stay, and stone-free rates, were similar between groups. Conclusions: FG puncture is more effective for achieving transpapillary access, while F-UG significantly reduces radiation exposure. The endoscopic confirmation method may provide a reference for future comparative studies on access techniques in PNL. Full article

Background: Super morbid obesity (SMO), defined as a body mass index (BMI) ≥ 50 kg/m², represents a distinct and increasingly prevalent subgroup of patients undergoing bariatric surgery. Compared to individuals with lower BMI, patients with BMI ≥ 50 kg/m² often exhibit unique clinical, psychological, and social characteristics that may influence treatment outcomes. Objective: This study aimed to compare demographic, metabolic, and psychiatric profiles of patients with BMI ≥ 50 kg/m² and non-super morbid obesity (NSMO; BMI < 50 kg/m²) who were evaluated prior to bariatric surgery. Methods: A total of 319 patients were recruited between December 2022 and December 2023 at a bariatric center in Gdansk, Poland. All participants underwent a comprehensive preoperative assessment, including laboratory testing, psychometric screening (BDI, PHQ-9), and psychiatric interviews. Patients were stratified into class IV obesity and NSMO groups for comparative analysis. Results: Patients with BMI ≥ 50 kg/m² were significantly older and more likely to report a history of lifelong obesity, family history of obesity, and childhood trauma. They had higher rates of obesity-related health problems such as hypertension, obstructive sleep apnea, and chronic venous insufficiency, as well as worse liver function and lipid profiles. Although the overall psychiatric burden was high in both groups, patients with BMI ≥ 50 kg/m² reported fewer prior diagnoses of depression and eating disorders, despite similar scores on screening tools. Conclusions: Patients with BMI ≥ 50 kg/m² represent a clinically distinct population with elevated metabolic risk, complex psychosocial backgrounds, and possibly underrecognized psychiatric burden. These findings underscore the need for multidisciplinary preoperative assessment and individualized treatment strategies in this group of patients. Full article

This study investigated the possibility of partial replacement of genetically modified soybean meal (SBM) with raw white lupin (WL) seeds in growing pigs’ diets and determined its impact on performance [body weight (BW), average daily gain (ADG), and average daily feed intake (ADFI)], meat quality, and fatty acid profile (FA). A total of 54 male crossbred pigs [(Topigs Large White × Norsvin Landrace) × Duroc], aged 12 weeks, with an initial average BW of 30.30 ± 0.77 kg, were divided into three dietary groups of 18 piglets each. The control group (CON) was fed a standardized SBM-based complete feed. In the experimental groups (WL1 and WL2) the SBM was replaced with increasing levels of WL seeds [WL1-5.0% and WL2-10.0% (grower period, 30–60 kg BW), and WL1-7.0% and WL2-14.0% (finisher period, 61–110 kg BW)]. All diets were formulated to be isocaloric and isonitrogenous with similar content of total lysine and sulphur amino acids, calcium, and available phosphorus. At the end of 83 days’ fattening trial, the animals were slaughtered. Longissimus dorsi muscle (LD) was sampled for analyses of the physicochemical traits. The results show that increasing the dietary raw WL concentration decreased final BW (p = 0.039), ADG (p < 0.0001), and ADFI (p = 0.004) throughout the experimental period, especially in the second phase of feeding. Dietary treatments did not affect the pigs’ blood biochemical constituents. Concerning LD muscle characteristics, the redness color (a*) and collagen content was higher (p < 0.0001) in the WL1/WL2 vs. CON group. Beneficial decrease in the values of some textural attributes (hardness, gumminess, chewiness, and resilience) of LD in the WL1/WL2 vs. CON group was registered. The use of WL had a significant effect on the content of FAs, especially for eicosapentaenoic (p = 0.014) and n-3 PUFA (p = 0.045), which were higher than those fed the CON diet. In conclusion, WL could be used as a replacement of SBM in growing–finishing pigs’ diets, with significant improvements in the meat fatty acid profile and technological properties. Full article

Background: Double-valve infective endocarditis (DVIE) accounts for 15–20% of all endocarditis and represents a challenge due to the increased incidence of embolic events and congestive heart failure compared to infective endocarditis (IE) affecting one valve. This study aims to evaluate patients’ characteristics, surgical procedures, complications, and mortality associated with DVIE in our tertiary hospital in Italy. The Endocarditis Registry STEADY includes patients admitted with IE from January 2009 to March 2024 (n = 398). Sixty-three of them (16%) had DVIE. Methods: We conducted a retrospective single-center observational study, analyzing demographic, clinical, and microbiological data in DVIE patients, comparing those treated surgically (surgical group, SG) with those treated medically (non-surgical group, NSG). Results: The groups were homogeneous in age, microbiological yields, type of valve involved, and risk factors for infective endocarditis. The surgical group presented significantly more cancer history, intracardiac complications, and new-onset arrhythmias compared to the non-surgical group. Median hospital stay was similar in both groups. In SG, the most common postoperative complication was new rhythm disorders; other complications such as cardiac tamponade, pericardial effusion, and pneumothorax were rare. In-hospital mortality was similar between groups; however, one-year survival was higher in the surgical group (72% vs. 54%, p = 0.031). In our series, 16 patients were over 75 years old (25%), and 7 of them (44%) underwent cardiac surgery. One-year survival in the surgical group was also higher in this subgroup. Conclusions: Surgical treatment, when indicated, may improve the prognosis of patients with DVIE, including elderly patients. Full article

Objectives: The aim of the study was to investigate caries experience in correlation with self-reported oral health-related habits in a sample of blind and low-vision individuals in Croatia. Methods: The study is a part of the research in the “Project for Oral Health Promotion in Blind and Visually Impaired Persons” conducted at the Zagreb University School of Dental Medicine from 2014 to 2018. The final sample consisted of 85 adults: 42 females and 43 males; 50 blind and 35 low-vision individuals, age range 18–98. The assessment included dental examination and a questionnaire. Results: The median DMFT (Decayed, Missing, and Filled Teeth) index score was 17.0 (IQR = 12.5–22.0), with no significant difference between sexes or between blind and low-vision individuals. The occurrence of untreated caries was low (median D-component = 1.0), while the median F-component was 6.0. There was a significant increase in M-component and DMFT in older age groups. The number of untreated caries (D-component) was significantly correlated with consummation of soft drinks and smoking. Total DMFT did not correlate with frequency of tooth brushing, time since last dental visit, smoking, or level of education. Conclusions: This study revealed high caries experience among blind and visually impaired individuals that did not correlate with factors that normally influence oral health. Similar results were found in the control group, reflecting a 30-year post-war period without organized preventive care. The low number of decayed teeth reflects the availability of public dental care in Croatia; however, preventive care should be provided for both this vulnerable group and the general population. Full article

Rheumatoid arthritis (RA) is a chronic inflammatory disease frequently associated with alterations in body composition, including reduced lean mass and increased fat mass. These alterations are thought to be driven by persistent systemic inflammation, which may be influenced by inflammatory activity and by therapeutic interventions. Objectives: This pilot study aimed to provide preliminary data on changes in body composition and inflammatory activity in biologic-naive patients with active RA during the initial 6 months of TNF inhibitor treatment, and to compare baseline body composition with healthy controls. We conducted a single-center, observational, 24-week pilot study of 70 biologic-naive RA patients with moderate-to-severe disease activity and 70 matched healthy controls. Lean mass, fat mass, and lean mass index (LMI) were measured using dual-energy X-ray absorptiometry at baseline for both groups, and after 6 months only in the RA group. Clinical, laboratory, adipokines, and cytokine parameters were also recorded. At baseline, RA patients had lower lean mass and LMI than controls. Over 6 months, RA patients showed significant clinical and laboratory improvement, with a corresponding increase in lean mass and LMI. No statistically significant change was observed in fat mass. The increase in lean mass was paralleled by a reduction in inflammatory markers. The LMI was inversely associated with female sex (β = −0.562) and C-reactive protein (β = −0.432) and directly associated with body mass index (β = 0.570). Similar associations were observed for total lean mass and change in lean mass, as well as for DAS28 (β = −0.333). This pilot study provides preliminary evidence that TNF inhibitor therapy may be associated with increased lean mass and decreased inflammation in RA patients. Owing to the absence of a comparator RA group not receiving TNF inhibitors, these findings should be interpreted as hypothesis-generating. Full article

To minimize the deleterious effects of oxidative stress and improve oocyte competence, we assessed the impact of melatonin during in vitro pre-maturation (pre-IVM) in bovine cumulus–oocyte complexes (COCs). We compared three groups: control (conventional IVM), pre-IVM control (without melatonin), and pre-IVM + MTn (with melatonin). The analyses included levels of reactive oxygen species (ROS), mitochondrial activity, oocyte lipid content, and the expression of genes related to oxidative stress and lipid metabolism in oocytes and cumulus cells. We also examined embryo quality by evaluating kinetics of development and gene expression. The pre-IVM + MTn group exhibited an increase (p ≤ 0.05) in ROS levels and a decrease (p ≤ 0.05) in lipid content, while maintaining mitochondrial activity similar (p > 0.05) to that of the control group. Regarding gene expression, the effect of pre-IVM, independent of melatonin, was characterized by a decrease in FABP3 transcripts in cumulus cells and reductions in GSS and NFE2L2 transcripts in oocytes (p ≤ 0.05). The pre-IVM + MTn group also displayed a decrease (p ≤ 0.05) in CAT and SOD2 transcript levels. In terms of embryonic development, the pre-IVM + MTn group achieved a higher blastocyst rate on D7 (p ≤ 0.05) compared to the control group (30.8% versus 25.8%), but with similar rates (p > 0.05) to the pre-IVM control group (30.8% versus 35.9%). However, there was a decrease in the levels of the PLAC8 transcript. This study indicates that, under the conditions tested, melatonin did not significantly benefit oocyte competence. Full article

Introduction: The combination of ceftazidime−avibactam (CAZ-AVI) with aztreonam (ATM) may be an option for the treatment of infections due to metallo-β-lactamases (MBLs) producing bacteria, as recommended by current guidelines. MBLs protect the pathogen from any available β-lactam/β-lactamase inhibitor (BL/BLI). Moreover, in vitro and clinical data suggest that double carbapenem therapy (DCT) may be an option for such infections. Materials and Methods: This retrospective study was conducted in two mixed intensive care units (ICUs) at the University Hospital of Larissa, Thessaly, Greece, and the General Hospital of Larissa, Thessaly, Greece, during a three-year period (2022−2024). Mechanically ventilated patients with bloodstream infection (BSI) caused by K. pneumoniae resistant to all BL/BLI combinations were studied. Patients were divided into three groups: in the first, patients were treated with CAZ-AVI + ATM; in the second, with DCT; and in the third, with antibiotics other than BL/BLIs that presented in vitro susceptibility. The primary outcome of the study was the change in Sequential Organ Failure Assessment (SOFA) score between the onset of infection and the fourth day of antibiotic treatment. Secondary outcomes were SOFA score evolution during the treatment period, total duration of mechanical ventilation (MV), ICU length of stay (LOS), and ICU mortality. Results: A total of 95 patients were recruited. Among them, 23 patients received CAZ-AVI + AZT, 22 received DCT, and 50 patients received another antibiotic regimen which was in vitro active against the pathogen. The baseline characteristics were similar. The mean (SE) overall age was 63.2 (1.3) years. Mean (SE) Acute Physiology and Chronic Health Evaluation II (APACHE II) and SOFA scores were 16.3 (0.6) and 7.6 (0.3), respectively. The Charlson Index was similar between groups. The control group presented a statistically lower SOFA score on day 4 compared to the other two groups [mean (SE) 8.9 (1) vs. 7.4 (0.9) vs. 6.4 (0.5) for CAZ-AVI + ATM, DCT and control group, respectively (p = 0.045)]. The duration of mechanical ventilation, ICU LOS, and mortality were similar between the groups (p > 0.05). Comparison between survivors and non-survivors revealed that survivors had a lower SOFA score on the day of BSI, higher PaO₂/FiO₂ ratio, higher platelet counts, and lower lactate levels (p < 0.05). Septic shock was more frequent among non-survivors (60.3%) in comparison to survivors (27%) (p = 0.0015). Independent factors for mortality were PaO₂/FiO₂ ratio and lactate levels (p < 0.05). None of the antibiotic regimens received by the patients was independently associated with survival. Conclusions: Treatment with CAZ-AVI + ATM or DCT may offer similar clinical outcomes for patients suffering from BSI caused by K. pneumoniae strains resistant to all available BL/BLIs. However, larger studies are required to confirm the findings. Full article

Background: Growing disparities in development, governance, and logistics performance across countries pose challenges for global policymaking and Sustainable Development Goal (SDG) monitoring. This study proposes a classification of 137 countries based on multiple structural dimensions. The dataset for 2023 includes six components of the Logistics Performance Index (LPI), six dimensions of the Worldwide Governance Indicators (WGIs), and four proxies of the Human Development Index (HDI). Methods: The Uniform Manifold Approximation and Projection (UMAP) technique was used to reduce dimensionality and allow for meaningful clustering. Based on the reduced space, the K-means algorithm was employed to group countries with similar development characteristics. Results: The classification process allowed the identification of three distinct groups of countries, supported by a Hopkins statistic of 0.984 and an explained variance ratio of 87.3%. These groups exhibit structural differences in the quality of governance, logistics capacity, and social development conditions. Internal consistency checks and multivariate statistical analyses (ANOVA and MANOVA) confirmed the robustness and statistical significance of the clustering. Conclusions: The resulting classification offers a practical analytical tool for policymakers to design differentiated strategies aligned with national contexts. Furthermore, it provides a data-driven approach for comparative monitoring of the SDGs from an integrated and empirical perspective. Full article

Metacognitive monitoring plays a crucial role in self-regulated learning, as accurate monitoring enables effective control, which in turn impacts learning outcomes. Most studies on metacognitive monitoring have focused on learners’ monitoring abilities when they are explicitly prompted to monitor. However, in real-world educational settings, learners are more often prompted to control their learning, such as deciding whether to allocate additional time to a learning target. The primary goal of this study was to investigate whether retrieval is engaged when learners are explicitly prompted to control their learning processes by making study decisions. To address this, three experiments were conducted. In Experiment 1, participants (N = 39) studied 70 Swahili–English word pairs in a learning task. Each trial displayed a word pair for 8 s, followed by a distractor task (a two-digit mental addition) and a study decision intervention (choose “Study Again” or “Next”). After learning, participants provided a global judgment of learning (JOL), estimating their overall recall accuracy. Finally, they completed a cued recall test (Swahili cue). Responses were scored for accuracy and analyzed alongside study decisions, study decision reaction time (RT), and metacognitive judgments. Reaction times (RTs) for study decisions correlated positively with test accuracy, global judgments of learning (JOLs), and judgments of confidence (JOCs), suggesting retrieval likely underlies these decisions. Experiment 2 (N = 74, between-subjects) compared memory performance and intervention response time between single-study, restudy, retrieval (explicit recall prompt), and study decision (study decision prompt) groups to have better control over study time and cognitive processes. Although no significant group differences in test accuracy emerged, the retrieval group took longer to respond than the study decision group. Within-subject analyses revealed similar recall accuracy patterns: participants recalled successfully retrieved or “no restudy” items better than failed-retrieval or “restudy” items, implying shared cognitive processes underlying retrieval and study decision interventions. Experiment 3 (N = 74, within-subject, three learning conditions: single-study, retrieval, and study decision) replicated these findings, with no condition effects on test accuracy but longer RT for retrieval than study decisions. The similar recall accuracy patterns between retrieval and study decision interventions further supported shared cognitive processes underlying both tasks. Self-reports across experiments confirmed retrieval engagement in both retrieval and study decision interventions. Collectively, the results suggest that retrieval likely supports study decisions but may occur less frequently or less deeply than under explicit monitoring prompts. Additionally, this study explored objective, online measures to detect retrieval-based metacognitive monitoring. Full article

Objectives: Diabetes Mellitus involves demanding challenges that interfere with family functioning and routines. In turn, family and social context impacts individual glycemic control. This study aims to identify this recursive interplay, the mutual influences of family systems and diabetes management. Design: Data was collected through a cross-sectional design comparing patients, aged 22–55, with and without metabolic control. Methods: Participants filled out a set of self-report measures of sociodemographic, clinical and family systems assessment. Patients (91) were also invited to describe their perception about disease management interference regarding family functioning. We first examined the extent to which family variables grouped dataset to determine if there were similarities and dissimilarities that fit with our initial diabetic groups’ classification. Results: Cluster analysis results identify a two-cluster solution validating initial classification of two groups of patients: 49 with metabolic control (MC) and 42 without metabolic control (NoMC). Independent sample tests suggested statistically significant differences between groups in family subscales- family difficulties and family communication (p < 0.05). Binary logistic regression shed light on predictors of explained variance to no metabolic control, in four models: Sociodemographic, Clinical data, SCORE-15/Congruence Scale and Eating Behavior. Furthermore, groups differ on family support, level and sources of family conflict caused by diabetes management issues. Considering only patients who co-habit with a partner for more than one year (N = 44), NoMC patients score lower on marital functioning in all categories (p < 0.05). Discussion: Family-Chronic illness interaction plays a significant role in a patient’s adherence to treatment. This study highlights the Standards of Medical Care for Diabetes, considering caregivers and family members on diabetes care. Full article

Cystic fibrosis (CF), the most common hereditary lung disease in Caucasians, is caused by dysfunction of the cystic fibrosis transmembrane conductance regulator (CFTR). We evaluated CFTR function using a newly developed Ussing chamber system, the Multi Trans Epithelial Current Clamp (MTECC), in an in vitro model of human airway epithelia. Air–liquid interface (ALI) cultures were established from nasal brushings of healthy controls (HC) and CF patients with biallelic CFTR variants. ALI layer thickness was similar between groups (HC: 62 ± 13 µm; CF: 55 ± 9 µm). Immunofluorescence showed apical CFTR expression in HC, but reduced or absent signal in CF cultures. MTECC enabled continuous measurement of transepithelial resistance (Rt), potential difference (PD), and conductance (G_t). G_t was significantly reduced in CF cultures compared to HC (0.825 ± 0.024 vs. −0.054 ± 0.016 mS/cm²), indicating impaired cAMP-inducible ion transport by CFTR. Treatment of CF cultures with elexacaftor, tezacaftor, and ivacaftor (Trikafta^®) increased G_t, reflecting partial restoration of CFTR function. These findings demonstrate the utility of MTECC in detecting functional differences in CFTR activity and support its use as a platform for evaluating CFTR-modulating therapies. Our model may contribute to the development of personalized treatment strategies for CF patients. Full article

The application of satellite-derived sea surface temperature in coastal regions is critical for resolving the dynamics of frontal features and coastal upwelling. Here, we examine and compare sea surface temperature (SST) gradients derived from two satellite products, the Multi-Scale Ultra-High Resolution SST Product (MUR, 0.01° grid scale) and the Operational SST and Ice Analysis (OSTIA, 0.05° grid scale), available through the Group for High Resolution SST (GHRSST). Both products show similar seasonal variability, with maxima occurring in the summer time frame. Additionally, both products show an increasing trend of SST gradients near the coast. However, differences exist between the two products (maximum gradient intensities were around 0.11 and 0.06 °C/km for OSTIA and MUR, respectively). The potential contributions of both cloud cover and the collocation of the MUR SST onto the OSTIA SST grid product to these differences were examined. Spectra and coherences were examined at two specific latitudes along the coast where upwelling can occur. A major conclusion is that future work needs to focus on cloud cover and its impact on the derivation of SST in coastal regions. Future comparisons also need to apply collocation methodologies that maintain, as much as possible, the spatial variability of the high-resolution product. Full article

This study examined the distribution and disease associations of non-HLA-B*27 HLA-B alleles in Romanian spondyloarthritis (SpA) patients, aiming to address the underrepresentation of Eastern European populations in immunogenetic research. Methods: We analyzed 263 HLA-B*27-negative patients from Northeastern Romania fulfilling ASAS criteria. HLA-B genotyping was performed at two-digit resolution, and allele distributions were compared with two Romanian HLA-B*27-negative control groups (n = 335 and n = 1705 cases), using chi-square testing and logistic regression. Compared to controls, HLA-B*47 (p = 0.0007) and HLA-B*54 (p = 0.0013) were significantly enriched, while HLA-B*40 was underrepresented (p = 0.0287). Notably, HLA-B*54 was observed exclusively in axial SpA. Within the cohort, both HLA-B*13 and HLA-B*57 alleles were associated with psoriasis, while HLA-B*37 and HLA-B*41 alleles were clustered within the reactive arthritis group. The HLA-B*35 and HLA-B*18 alleles were the most frequently observed alleles across most clinical phenotypes. When comparing the frequency of HLA-B associations, the most common genotypes among SpA patients were B*08-B*18, B*13-B*35, and B*35-B*51. Notably, B*08-B*18 was more frequent in patients with radiographic sacroiliitis grade ≥ 2, while B*35-B*51 was more frequent in those with confirmed systemic inflammation, as indicated by elevated CRP or ESR levels. Analysis of peptide-binding patterns revealed a cluster of risk alleles, HLA-B*08, B*18, B*35, B*40, and B*54, sharing similar features, distinct from the canonical profile of B*27. These findings highlight the contribution of non-B*27 HLA-B alleles to SpA susceptibility in an Eastern European population and support the notion that HLA-B*27-negative SpA may represent a distinct clinical and immunological entity, driven by alternative pathogenic mechanisms. They also emphasize the importance of population-specific immunogenetic profiling and support expanding genetic characterization in HLA-B*27-negative patients. Full article