Search Results (6,944)

Background/Objectives. Heart rate variability (HRV) is the variability in the beat-by-beat heart period. Primary focal hyperhidrosis (PFHH) is a disease characterized by excessive sweat production, strongly affecting social life. Several authors define this condition as a dysautonomic disorder, mainly driven by exaggerated sympathetic activity. The aim of the study was to demonstrate a possible cardiac involvement in the disease. Other outcomes were the occurrence of dysautonomic disorders after surgery and its possible correlation with baseline characteristics. Methods. This observational, controlled trial enrolled patients with a confirmed clinical diagnosis of severe PFHH candidates to thoracoscopic sympathetic chain clamping. Before and after surgery, ECG was obtained using KardiaMobile 6L (AliveCor^®, Mountain View, CA, USA) device with a five-minute recording and HRV was analyzed using Kubios HRV Premium (Kubios©) software. Results. 111 patients were compared to 222 healthy control subjects. No differences were seen in HRV analysis between the two groups at baseline (time-domain p > 0.05, frequency-domain p > 0.05, autonomic indexes p > 0.05). When comparing autonomic function indexes in patients before and after the surgical procedure, no differences were seen in frequency-domain HRV analysis, but a blunted increase in SNS index (0.2 vs. 1.38, p 0.02). No development of systemic dysautonomic disorders nor significant compensatory hyperhidrosis were seen after the surgery. Conclusions. This study shows that PFHH is a peripheral autonomic nervous system derangement, rather than central. Sympathetic chain clamping resulted safe and effective in improving patients’ conditions, with no risks of dysautonomic disorders. Full article

Cities have become the largest consumers of resources and contributors to pollution due to urbanization. Therefore, measuring quality and maintaining standards have become crucial, as the boundaries of measurements for a city’s environmental quality are vague. This research study followed a qualitative approach to verify the factors affecting city environmental quality and to identify the boundaries of measurements using Sri Lankan cities as a case study. Data analysis was conducted using a thematic analysis approach, which adhered to the qualitative nature of the research. Findings revealed that seven main factors—energy consumption, water consumption, material and resource consumption, land utilization, disaster resilience, education, and governance—play a significant role in maintaining a city’s environmental quality. It was revealed that measuring boundaries can vary according to individual units (such as household, industrial, or commercial buildings) or city boundaries, in order to maintain quality standards. The findings revealed significant considerations for environmental quality performance, highlighting the influence of urban planning, governance, and public awareness on environmental sustainability outcomes in cities. Notably, this study contributes to a deeper understanding of how environmental quality intersects with social well-being in urban planning, affecting the quality of life and equitable access to urban resources. Full article

Regular classes in outdoor education are gaining popularity worldwide, driven by their potential to enhance a wide range of educational outcomes. The aim of this scoping review is to establish the current state of knowledge about the effects of this form of teaching on academic achievement and its associated factors. Of the 2362 articles included in the corpus, 41 studies involving 10,453 students from preschool to college were analyzed to identify provenance, type of interventions, research design and outcomes. The analyses suggest that outdoor teaching appears to improve learning in sciences, reading, writing, social studies and mathematics. Outdoor teaching seems to support the development of various factors associated with academic achievement, including self-awareness, school climate, motivation and well-being. This leads us to conclude that, in the current state of knowledge, outdoor teaching is a promising pedagogical approach. However, further research is needed to identify and understand its long-term effects across a broader range of disciplines and for a broader range of competences. Full article

Background/Objectives: Patient-reported outcome measures (PROMs) are widely used tools in orthopedic surgery for evaluating clinical outcomes, guiding research, and supporting value-based care. However, the optimal timing for collecting baseline PROMs, whether in clinic prior to surgery or on the day of surgery, remains uncertain. This study investigated whether the clinical setting (preoperative clinic vs. day of surgery) affects baseline PROMs in patients undergoing anterior cervical discectomy and fusion (ACDF). Methods: Patients undergoing elective, primary ACDF at a single institution between August 2019 and June 2021 were prospectively enrolled. Inclusion criteria included age over 18, English literacy, and eligibility for primary ACDF. Participants completed PROMIS domains, Neck Disability Index (NDI), Modified Japanese Orthopaedic Association (mJOA) score, and Visual Analog Scale (VAS) at two time points: during the preoperative clinic visit and again in the perioperative area on the day of surgery. A subgroup analysis was performed for patients with anxiety, defined as a PROMIS anxiety score ≥ 59.4. Results: A total of 63 patients were enrolled, with 48 completing both sets of surveys. The average time between the two assessments was 7.9 days (95% CI: 6.4–9.3). After Bonferroni correction (α = 0.005), no significant differences were observed in any PROMs across the two time points, including PROMIS physical function (p = 0.398), pain interference (p = 0.682), fatigue (p = 0.019), social satisfaction (p = 0.331), anxiety (p = 0.047), depression (p = 0.042), NDI (p = 0.072), mJOA (p = 0.566), VAS neck pain (p = 0.054), or VAS overall pain (p = 0.335). Subgroup analysis of anxious patients similarly revealed no statistically significant changes between settings. Conclusions: PROM scores were not meaningfully different between the preoperative clinic and the day of surgery in patients undergoing ACDF. These results are most applicable when baseline PROMs are collected within about one week of ACDF. These findings support flexibility in workflow design for PROM collection, as the timing and setting do not significantly impact baseline responses. Full article

The increasing prevalence of smartphone use has raised concerns about its impact on human psychological functioning. This literature review provides a comprehensive overview of the psychological dimensions influenced by smartphone use, spanning health psychology, individual differences, social psychology, and cognitive functioning. The review draws on findings from numerous studies, primarily conducted in highly developed Western and Asian countries, where cultural factors may influence usage patterns and psychological outcomes. Key limitations in the current body of research include geographical biases and methodological challenges such as sample homogeneity and reliance on self-report measures. Evidence suggests that excessive smartphone use can lead to addiction and is associated with negative psychological and health consequences. The review also highlights how individual differences—such as personality traits, age, and gender—affect smartphone usage. Social implications, both positive (e.g., increased connectivity) and negative (e.g., interpersonal conflict), are explored in depth. Cognitive effects are considered, particularly in relation to attention and memory, where findings suggest potential impairments in sustained focus and information retention. While the literature often emphasizes risks, this review also points to the need for further exploration of the potential benefits of smartphone use. In summary, the review offers valuable insights into the complex psychological effects of smartphones and underscores the importance of future research to better understand their nuanced impact on well-being. Full article

Psychiatric illness during childhood and adolescence is a serious public health concern. Caregivers are critical for their child’s enactment of psychiatric interventions, though caregiver distress can have serious impacts on caregivers and their child’s outcomes. The purpose of this study was to explore the associations of caregiver distress with child symptom severity, family functioning, and caregiver social support and self-care at the time of their child’s referral to outpatient psychiatry. Caregiver distress was most strongly associated with parent self-care (higher distress for parents associated with less self-care), child symptoms (higher distress associated with higher severity), and parent age (higher distress associated with younger caregivers). These findings shed light on important and evolving characteristics of caregivers, which could be considerations for child and family interventions in outpatient psychiatry, and the importance of a family approach for improving overall health. Full article

Introduction: Stroke is a leading cause of long-term disability and substantially affects the quality of life (QoL) of both survivors and their caregivers. The transition from hospital to home is a vulnerable period characterized by discontinuity of care and insufficient caregiver support. Dyadic interventions—targeting both the survivor and caregiver—have shown promise in improving recovery outcomes. This protocol outlines a mixed-methods study to evaluate the impact of a video-based training intervention on the stroke survivor–caregiver dyad during the first year post-discharge. Methods: A mixed-methods design based on the TIDieR checklist will be implemented. Stroke survivors and their caregivers will be recruited from stroke units and rehabilitation hospitals across Italy prior to discharge. Approximately 150 dyads will receive a video training intervention followed by nurse-led transitional care support. Assessments will occur at baseline (T0) and at 1 (T1), 3 (T2), 6 (T3), and 12 months (T4) post-discharge. Outcomes will include physical functioning, disability, anxiety, depression, caregiver preparedness, burden, social support, sleep quality, and both generic and stroke-specific QoL. The study is supported by a grant from the Centre of Excellence for Nursing Scholarship, Rome, July 2024. Conclusions: Integrating caregivers into transitional care through structured training and support is essential for improving dyadic outcomes after stroke. Strengthening knowledge and preparedness in both survivors and caregivers enhances recovery, reduces caregiver burden, and may alleviate healthcare system costs associated with poor post-discharge outcomes. Full article

The Parrot Optimization Algorithm (PO) represents a contemporary nature-inspired metaheuristic technique formulated through observations of Pyrrhura Molinae parrot behavioral patterns. PO exhibits effective optimization capabilities by achieving equilibrium between exploration and exploitation phases through mimicking foraging behaviors and social interactions. Nevertheless, during iterative progression, the algorithm encounters significant obstacles in preserving population diversity and experiences declining search effectiveness, resulting in early convergence and diminished capacity to identify optimal solutions within intricate optimization landscapes. To overcome these constraints, this work presents the Adaptive Differentiated Parrot Optimization Algorithm (ADPO), which constitutes a substantial enhancement over baseline PO through the implementation of three innovative mechanisms: Mean Differential Variation (MDV), Dimension Learning-Based Hunting (DLH), and Enhanced Adaptive Mutualism (EAM). The MDV mechanism strengthens the exploration capabilities by implementing dual-phase mutation strategies that facilitate extensive search during initial iterations while promoting intensive exploitation near promising solutions during later phases. Additionally, the DLH mechanism prevents premature convergence by enabling dimension-wise adaptive learning from spatial neighbors, expanding search diversity while maintaining coordinated optimization behavior. Finally, the EAM mechanism replaces rigid cooperation with fitness-guided interactions using flexible reference solutions, ensuring optimal balance between intensification and diversification throughout the optimization process. Collectively, these mechanisms significantly improve the algorithm’s exploration, exploitation, and convergence capabilities. Furthermore, ADPO’s effectiveness was comprehensively assessed using benchmark functions from the CEC2017 and CEC2022 suites, comparing performance against 12 advanced algorithms. The results demonstrate ADPO’s exceptional convergence speed, search efficiency, and solution precision. Additionally, ADPO was applied to wind power forecasting through integration with Long Short-Term Memory (LSTM) networks, achieving remarkable improvements over conventional approaches in real-world renewable energy prediction scenarios. Specifically, ADPO outperformed competing algorithms across multiple evaluation metrics, achieving average R² values of 0.9726 in testing phases with exceptional prediction stability. Moreover, ADPO obtained superior Friedman rankings across all comparative evaluations, with values ranging from 1.42 to 2.78, demonstrating clear superiority over classical, contemporary, and recent algorithms. These outcomes validate the proposed enhancements and establish ADPO’s robustness and effectiveness in addressing complex optimization challenges. Full article

Universities play a critical role in shaping sustainable mobility strategies, especially in urban contexts where the institutional transport system can influence environmental and social outcomes. This study integrates Environmental and Social Life Cycle Assessment (E-LCA and S-LCA) to evaluate the current university transport system from internal combustion engines, diesel, and compressed natural gas (CNG), focusing on the operation and maintenance phases. Also, it compares seven scenarios, including electric, renewable sources, and biodiesel technologies. Environmental impacts were assessed using the ReCiPe 2016 midpoint method, which considers the following impact categories: Global Warming Potential (GWP); Ozone Formation, Human Health (OfHh); Ozone Formation, Terrestrial Ecosystem (OfTe); Terrestrial Acidification (TA); and Fine Particulate Matter Formation (FPmf). The sensitivity analysis explores scenarios to assess the effects of technological transitions and alternative energy sources on the environmental performance. Social impacts are assessed through a Social Performance Index (SPI) and Aggregated Social Performance Index (ASPI), which aggregates indicators such as safety, travel cost, punctuality, accessibility, and inclusive design. Accessibility emerged as the lowest indicator (ranging from 0.61 to 0.67), highlighting opportunities for improvement. Our findings support decision-making processes for integrating sustainable transport strategies into a University Mobility Plan, emphasizing the importance of combining technical performance with social inclusivity. Full article

By 2040, more than 80 million Americans will be aged ≥65, yet contemporary senior living communities still operate on a hospitality-first model developed for healthier cohorts three decades ago. This commentary argues that the next generation of senior living must pivot from hotel-style amenities to person-centric health platforms that proactively coordinate medical, functional, and social support. We outline four mutually reinforcing pillars. (1) Data infrastructure that stitches together clinical, functional, and social determinants of health enables continuous risk stratification and early intervention. (2) Ambient and conversational artificial-intelligence tools can extend sparse caregiving workforces while preserving resident autonomy. (3) Value-based contractual arrangements—for example, Medicare Advantage special-needs plans embedded within senior living sites—can realign financial incentives toward prevention rather than occupancy. (4) Targeted policy levers, including low-income housing tax credits for the “forgotten middle” and outcomes-based regulatory frameworks, can catalyze adoption at scale. Ultimately, re-architecting senior living around integrated technology, value-based financing and supportive regulation can transform these communities into preventive-care hubs that delay nursing home entry, improve quality of life, and reduce total cost of care. Full article

Cocaine use remains a major public health concern, with rising global prevalence and a well-established profile of neurotoxicity and addictive potential. While the central nervous system has been the primary focus of cocaine research, emerging evidence indicates that cocaine also disrupts male reproductive physiology. In the testis, cocaine alters the endocrine microenvironment, induces cell-specific damage, and disrupts spermatogenesis. Cocaine also interferes with epigenetic programming in germ cells and mature sperm, potentially leading to heritable epimutations. Epidemiology data reveal that approximately two-thirds of regular cocaine users are males of reproductive age, and preclinical models have documented numerous behavioral and molecular alterations in their offspring, often linked to paternal cocaine exposure—such as increased drug resistance or vulnerability, altered anxiety-like behavior, impaired learning/memory, disrupted social behaviors, and shifts in neural circuitry and gene expression in reward-related brain regions. This review aims to integrate findings from studies that have independently examined testicular dysfunction, germline epigenetic reprogramming, and offspring outcomes, offering a unified perspective on their potential interconnections and highlighting future directions for research in the field of epigenetic inheritance. Full article

This paper investigates how Sustainable Development Goals SDG 3 (Health and Well-being) and SDG 10 (Reducing Inequality) interacted during the period 2009–2021 within the context of income disparities in the European Union and Ukraine. The central assumption is that lowering income inequality improves overall population health. The research proposes a conceptual model with four main elements: classifying countries according to their Gini index along with their performance on SDG 3 and SDG 10; analyzing how income inequality and progress on SDG 10 influence health outcomes (SDG 3); categorizing countries based on the strength of links between inequality measures and well-being indicators; and interpreting these results in the context of Ukraine’s European integration aspirations. Methodologically, cluster analysis, correlation and regression models, and semantic differentiation are applied. The findings show that a reduction in income inequality positively affects health and well-being. Nonetheless, Ukraine continues to face considerable structural and institutional hurdles. From a governance standpoint, the study highlights the need for cohesive policies that integrate economic, health, and social dimensions. Effective public management should coordinate national reforms to match EU healthcare and social policy standards. Strengthening institutions, ensuring fair access to healthcare services, and adopting inclusive policy instruments remain crucial to advancing both SDG 3 and SDG 10 targets, as well as supporting Ukraine’s broader integration with the European Union. Full article

Objective: To analyze the association between physical activity, health-related quality of life (HRQoL), and perceived barriers to physical activity with the risk of symptoms of depression, anxiety, and stress in Chilean adolescents. Method: A quantitative, cross-sectional, descriptive-correlational study was conducted with a sample of 351 secondary school students (mean age = 15.75 ± 1.47 years) from several educational institutions in the south-central region of Chile. Validated instruments were used to assess physical activity (PAQ-A), symptoms of mental health (DASS-21), HRQoL (Kidscreen-52), and the short scale of barriers to physical activity. For exploratory purposes, mental health outcomes were dichotomized based on standard cut-off scores, and binary logistic regression models were estimated to identify associated factors. Results: Based on the binary categorization, a substantial proportion of students exceeded the risk thresholds for depressive (54.4%), anxiety (63%), and stress symptoms (42.2%). Across models, lower physical activity levels, reduced autonomy and weaker relationships with parents, and barriers related to self-concept and motivation were consistently associated with higher mental health risk. Additionally, passive commuting and the perceived school environment emerged as specific predictors of stress and depression risk, respectively. Conclusions: These findings suggest that individual and contextual factors linked to lifestyle behaviors and perceived social support may play a critical role in adolescent mental health, and could represent key targets for school-based interventions. Full article

Autism Spectrum Disorder (ASD) presents unique challenges in social interaction, communication and emotional regulation. Recent research has explored the potential influence of anime consumption among children with ASD, and the current findings suggest both beneficial and adverse effects. This review examines the role of anime in fostering social learning, emotional resilience, and cognitive engagement while also addressing concerns regarding its cultivation of social withdrawal, unrealistic expectations, and over-reliance on fictional narratives. By analyzing existing literature, this paper provides insights into the nuanced relationship between anime and ASD, highlighting the possibility that patterns of engagement may be associated with both positive and negative outcomes. Understanding these dynamics is crucial for parents, educators, and clinicians seeking to support the well-being and development of children with ASD. Full article

Sustainable energy entrepreneurs promote sustainable development by focusing more on energy efficiency. This study examines the interdependence and driving–dependent relationships among the socioeconomic factors (SEFs) influencing sustainable energy enterprises (SEEs). A mixed-methods approach is used, beginning with a literature review and expert consensus, followed by total interpretive structural modeling (TISM) and cross-impact matrix multiplication applied to classification (MICMAC) analysis. Seven key SEFs are finalized through interviews with 12 experts. Data are then collected from 11 SEEs. The study reveals that the regulatory and institutional framework emerges as the primary driving factor influencing other SEFs, including financial accessibility, market demand, technological innovation, and infrastructure readiness. Social and cultural acceptance is identified as the most dependent factor. The study proposes future research directions by identifying the United Nations sustainable development goals (SDGs) related to the antecedents, decisions, and outcomes with theoretical linkages through the Antecedents–Decisions–Outcomes (ADO) framework. The major SDGs identified are SDG 4 (education), SDG 7 (energy), SDG 9 (industry), SDG 11 (communities), and SDG 13 (climate). The study highlights that regulatory support, funding access, skill development, and technology transfer are required areas for strategic focus. Understanding the hierarchy of SEs supports business model innovation, investment planning, and risk management. Full article