Search Results (35)

Background: Instrument-assisted soft-tissue mobilization (IASTM) is a popular intervention used for myofascial treatment. Healthcare professionals using IASTM must consider precautions and contraindications prior to administering the intervention. A recent international Delphi survey of IASTM experts recommended a list of 39 conditions to be considered as precautions and contraindications. The clinical relevance of these recommendations among healthcare professionals is of interest. The purpose of the survey was to explore healthcare professionals’ agreement regarding the IASTM Delphi recommendations for precautions and contraindications. Methods: A 16-question electronic survey was emailed to members of the Academy of Orthopedic Physical Therapy, American Academy of Sports Physical Therapy, National Athletic Trainers Association, and members of private physical therapy and athletic training Facebook^® and LinkedIn™ groups. Survey inclusion criteria included being a healthcare professional who has clinical experience using IASTM with patients. The strength of agreement grade scale was used to explore professionals’ opinions and agreement with the expert recommendations. Results: Four hundred and forty-five professionals (men = 52%; women = 46%; other = 2%) (mean age = 49 ± 12.33 years old) completed the survey. Most respondents (mean = 62%) agreed with 12 of 39 recommended conditions across the strength of agreement grade categories. The conditions included five precautions, four contraindications, and three conditions that could be both. Respondents also listed 32 other conditions they felt were relevant. Discussion: These survey results illustrate diversity among professionals’ agreement with expert recommendations. This may be explained by variations in clinical practice patterns and gaps in the research on this topic. The IASTM Delphi study’s recommended list of precautions and contraindications provides valuable information but is not all-inclusive, as other conditions may exist for different patients. When exploring understudied topics, researchers may want to begin with a Delphi study to establish expert recommendations, followed by an assessment of their clinical relevance through related survey studies of healthcare professionals’ agreement on the topic. Conclusions: This exploratory survey introduced a novel method of assessing the clinical relevance of a Delphi study on IASTM precautions and contraindications among healthcare professionals. Full article

Soft tissue sarcomas (STSs) are a rare and highly heterogeneous group of tumours originating from mesenchymal cells, characterized by significant clinical and biological diversity. Due to this complexity, STSs present considerable challenges in both diagnosis and treatment, requiring an expert, multidisciplinary, and coordinated approach. To address these challenges, a multidisciplinary team of experts from the Spanish Group for Research in Sarcomas (GEIS) has developed a comprehensive, evidence-based consensus guideline that incorporates the latest advancements in biology, imaging techniques, and treatment options. The primary objective of this guideline is to provide clear and practical, up-to-date recommendations addressing the key questions that arise in the management of STSs. This approach aims to support therapeutic decision-making, enhance overall patient management, and ultimately improve clinical outcomes for patients affected by STSs. Key recommendations include the use of MRI as the preferred imaging modality prior to biopsy and ensuring that all patients are referred to specialised sarcoma centres with a multidisciplinary team for diagnosis and treatment. Full article

This study assessed ten alternatives, comprising nine power generation technologies and Battery Energy Storage Systems (BESS), using a combined hybrid approach based on group Multi-Criteria Decision-Making (MCDM) methods. Specifically, AHP was employed for determining criteria weights, while fuzzy VIKOR was utilised for ranking the alternatives. Six electricity sector experts evaluated each technology, organised within a hierarchical decision model that included four main criteria: economic, environmental, technical, and social, along with 13 subcriteria. To mitigate subjectivity in criteria weights stemming from diverse expert backgrounds, a consensus technique was implemented post-AHP. Fuzzy VIKOR was employed to address uncertainty in expert ratings. The findings revealed a significant preference towards renewable technologies, with Photovoltaic (PV) and Wind at the forefront, whereas Coal occupied the lowest position. A validation process was conducted using BWM for criteria weights and fuzzy TOPSIS for ranking alternatives. This hybrid soft computing method’s key contributions include its modular design, allowing for the sequential determination of criteria weights, followed by the calculation of alternative rankings, fostering interactive and collaborative evaluations of various energy mixes by expert groups. Additionally, the study evaluated three emerging energy technologies: BESS, Small Modular Nuclear Reactors (SMRs), and Hydrogen, highlighting their potential in the evolving energy landscape. Full article

Across the world, people are exploring fields where AI (Artificial Intelligence) and VR (Virtual Reality) can be harnessed to unlock new possibilities and drive innovation. The aim of this article was to review the potential and assess the feasibility of using virtual reality technology in soft skills training (including people management, stress management, communication, conflict resolution, and sales). A project was developed featuring an application that utilizes virtual reality and artificial intelligence to facilitate communication with a virtual coach. The application operates on Meta Quest 3 virtual reality goggles (Meta Platforms, Inc., Menlo Park, CA, USA). Tests of the presented solution confirm market trends, highlighting the potential for achieving positive training outcomes through immersive technologies. The conclusions outline opportunities for improvement and further development of such solutions. This study applied a quasi-experimental model with pretest, posttest, and four-week follow-up measurements. The effectiveness of VR training was evaluated using a knowledge test (0–100%), a self-assessment scale of soft skills (Likert 1–5), expert behavior observation (0–10 scale), and posttraining surveys. The VR group demonstrated significantly higher gains in knowledge, soft skills, and behavioral performance with knowledge retention reaching 89% after four weeks. These results confirm the effectiveness of immersive VR training and its alignment with current market trends in innovative professional development. Full article

Liver metastases from soft tissue sarcoma (STS) (excluding gastrointestinal stromal tumors) are rare and more commonly arise from retroperitoneal and intra-abdominal primary sites. Chemotherapy remains the mainstay of treatment for disseminated disease, but its effectiveness is limited and patients typically have a dismal prognosis with short survival. However, when metastases are confined to the liver (without pulmonary involvement), some patients may benefit from local techniques, either surgical or nonsurgical, that can provide long periods of disease-free survival. Due to the rarity of STS, especially with liver metastases, and the heterogeneity of histologies and biological behavior, there is a lack of standardized treatment guidelines and universally accepted criteria for this specific setting. To fill this gap, a multidisciplinary working group of experts in sarcoma and liver surgery reviewed the literature and available evidence and developed a set of clinical recommendations to be voted and discussed in the I Ibero-American Consensus on the Management of Metastatic Sarcoma, held at the III Spanish-Portuguese Update Meeting on the Treatment of Sarcomas in May 2024. Herein, the voting results of this meeting and the resulting consensus recommendations are presented, and their applicability, strengths, and limitations are discussed. Full article

This paper presents N-bipolar soft expert (N-BSE) sets, a novel framework designed to enhance multi-attribute group decision-making (MAGDM) by incorporating expert input, bipolarity, and non-binary evaluations. Existing MAGDM approaches often lack the ability to simultaneously integrate positive and negative assessments, especially in nuanced, multi-valued evaluation spaces. The proposed N-BSE model addresses this limitation by offering a comprehensive, mathematically rigorous structure for decision-making (DM). Fundamental operations of the N-BSE model are defined and analyzed, ensuring its theoretical consistency and applicability. To demonstrate its practical utility, the N-BSE model is applied to a general case study on sustainable energy solutions, illustrating its effectiveness in handling complex DM scenarios. An algorithm is proposed to streamline the DM process, enabling systematic and transparent identification of optimal alternatives. Additionally, a comparative analysis emphasizes the advantages of the N-BSE model over existing MAGDM frameworks, highlighting its capacity to integrate diverse expert opinions, evaluate both positive and negative attributes, and support multi-valued assessments. By bridging the gap between theoretical development and practical application, this paper contributes to advancing DM methodologies. Full article

Percutaneous Osseointegrated Implants (POI) affix artificial limbs to the body after amputation. Several adverse events challenge mainstream uptake of this technology. This study aims to achieve a consensus regarding “the challenges and adverse events to POI integration and long-term fixation in limb amputation”. We sought a panel of clinical experts divided by profession into surgical, clinical, or clinical academic categories. We used a real time eDelphi method to develop consensus on both the challenges and adverse event items, enabling anonymity, iteration, controlled feedback, and statistical aggregation of group responses. The full panel agreed that the most impactful items are amongst 10 key challenges and eight adverse events. Panellists were in consensus regarding the five most impactful challenges, which were, in decreasing order: patient selection, absence of a multidisciplinary team, design of the implant, soft tissue stability and an experienced surgical team. Panellists considered the five most impactful adverse events, in decreasing order, to be the following: no biological fixation, deep infection, aseptic loosening, no mechanical fixation, and implant breakage. Consensus was obtained on implant breakage and deep infection items. The proportion of consensus from the whole panel across all items was in line with the literature, and we observed an improvement in consensus once the panel was stratified based on job, expertise and implant system. Full article

This study is based on an investigation of shared mobility in Chinese cities, which identifies the factors affecting the sustainable development of shared mobility based on the theoretical framework of TDM (travel demand management). Through a literature review and expert interviews, the FUZZY-DEMATEL-ISM-MICMAC integration model was used to screen 21 influencing factors from aspects that fit the research theme. Triangular fuzzy numbers are used to quantify the subjective scores of nine expert groups and weaken the subjective influence of expert scores. The logical relationships among DEMATEL technology-building factors and ISM technology-based factors are divided into levels. The MICMAC technique is used to divide the types of factors according to the driving power and dependency. The results show that (1) the influence factors of the “soft strategy” and “hard strategy” in the framework of TDM are determined. In the soft strategy, we should focus on “shared mobility education” (shared mobility education, shared mobility publicity and shared mobility “environment” information) and “community organization” (community organization and advocacy and organizational interaction). In the hard strategy, we should focus on “traffic planning and measures”, “dedicated lanes”, “parking facilities”, and “financial subsidies”. (2) The ISM recursive structure model is divided into five layers. Among them, shared mobility education, shared mobility operating technology, and organizational interaction are at the deep root level, which can continuously influence other factors in the long run. (3) In MICMAC, the number of related factors is large. When making decisions on these factors, managers should comprehensively consider the correlation of factors and adjust the use of factors from an overall perspective. This study can help managers identify the key factors affecting the sustainability of shared mobility and make targeted recommendations. Full article

Peritoneal sarcomatosis is a rare malignant disease with a poor prognosis, secondary to peritoneal dissemination of abdominopelvic soft tissue sarcomas. Its rarity, together with the characteristic histological heterogeneity and the historically poor response to systemic treatments, has prevented the establishment of widely accepted treatment criteria with curative intent. In this sense, radical cytoreductive surgery (CRS) with peritonectomy procedures and hyperthermic intraperitoneal chemotherapy (HIPEC), widely used in peritoneal carcinomatosis with excellent results, have not had the same evolutionary development in patients with peritoneal sarcomatosis. A multidisciplinary working group of experts in sarcomas and peritoneal oncological surgery established a series of recommendations based on current scientific evidence for the management of peritoneal sarcomatosis, taking into account the different histological subgroups of abdominopelvic sarcomas that can cause it depending on their origin: retroperitoneal sarcomas, uterine sarcomas, and visceral/peritoneal sarcomas of GIST (gastrointestinal stromal tumor) and non-GIST origin. This article shows the results of sarcoma experts’ voting on the recommendations presented during the I Ibero-American Consensus on the Management of Peritoneal Sarcomatosis, which took place during the recent celebration of the III Hispanic-Portuguese Meeting for Updates on the Treatment of Sarcomas. Full article

Rural tourism, in the form of small-scale, locally owned tourism businesses, has become a priority that must be supported by the government to be more beneficial for the local community. The objective of this study was to develop a conceptual model of rural tourism in order to make rural tourism in Bali more competitive globally. This research was conducted in Bali during April–June 2020 by following a systems thinking approach. The methodology employed was a soft systems methodology and utilized interpretive structural modeling (ISM). Twenty persons were chosen purposively as key informants (experts). Data collection was carried out through focus group discussions (FGDs) and questionnaires. The results indicated that the goals of sustainable rural tourism are to improve local community welfare, to conserve the environment, and to preserve culture and heritage. Managing rural tourism requires efforts in destination quality, service excellence, hospitality, reasonable pricing, and ease of access. Finally, this paper proposes methods to support sustainable rural tourism in Bali. Full article

The value of construction projects in Indonesia is significantly enhanced by partnering, leading to the adoption of the model by the government. The Indonesian government, through the Ministry of Finance, is developing the partnering model based on Public–Private Partnerships (PPPs) projects to further accelerate extensive infrastructure development. By leveraging PPPs, these projects intend to bridge the funding gap experienced by the government to facilitate swift infrastructure development and enhance the value of construction projects even further. Therefore, this study aimed to examine PPPs, such as the solicited projects occurring in Indonesia. Solicited projects were government-initiated PPPs based on long-term development plans. A qualitative method was adopted, conducting in-depth analyses at three locations with solicited PPP projects. Using Soft System Methodology (SSM) and expert Focus Group Discussion (FGD) through the Delphi method, this study investigated the interactions and depth of partnering in PPP projects. The obtained results emphasized the positive impact of solicited projects on Indonesian infrastructure development, addressing the funding gap experienced by the government. This study further contributed new insights for stakeholders and academics in the development of the projects in Indonesia, emphasizing the necessity of extensive development to support the implementation. Full article

Social robots have the potential to support health and quality of life for children experiencing anxiety. We engaged families with lived experiences of pediatric anxiety in social robot development to explore desired design features, application areas, and emotion functionalities of social robots in anxiety care. We conducted 10 online co-creation workshops with (1) children with anxiety aged 7–13 (n = 24) with their family members (n = 20), and (2) youth with anxiety aged 14–18 (n = 12). Workshop participation included a validated robot expectations scale, anonymous polls, and discussion. Transcripts and text responses were subjected to content analysis. A lived experience expert group provided feedback throughout the research. Participants desired a pet-like robot with a soft texture, expressive eyes, and emotion detection to support activities of daily living. Specific anxiety-related applications included breathing exercises, managing distressing thoughts, and encouragement. Emotional alignment, the design of a robot’s emotional display, and the emotional impacts of an interaction were discussed. Privacy and the replacement of human interaction were concerns. We identify pediatric anxiety-specific design features, applications, and affective considerations for existing and future social robots. Our findings highlight the need for customizability and robust emotional functionality in social robot technologies intended to support the health and care of children living with anxiety. Full article

The rapid development of computers and robots has seen robotic minimally invasive surgery (RMIS) gradually enter the public’s vision. RMIS can effectively eliminate the hand vibrations of surgeons and further reduce wounds and bleeding. However, suitable RMIS and virtual reality-based digital-twin surgery trainers are still in the early stages of development. Extensive training is required for surgeons to adapt to different operating modes compared to traditional MIS. A virtual-reality-based digital-twin robotic minimally invasive surgery (VRDT-RMIS) simulator was developed in this study, and its effectiveness was introduced. Twenty-five volunteers were divided into two groups for the experiment, the Expert Group and the Novice Group. The use of the VRDT-RMIS simulator for face, content, and structural validation training, including the peg transfer module and the soft tissue cutting module, was evaluated. Through subjective and objective evaluations, the potential roles of vision and haptics in robot surgery training were explored. The simulator can effectively distinguish surgical skill proficiency between experts and novices. Full article

Soft tissue sarcomas (STS) are an uncommon and biologically heterogeneous group of tumors arising from mesenchymal cells. The incidence is estimated at five cases per 100,000 people per year. Retroperitoneal sarcomas (RPS) account for 10–15% of all STS, and their management depends on their anatomical characteristics and histotype. Due to their very low incidence, it is recommended that RPS be treated in reference centers and evaluated by an experienced multidisciplinary team (MDT). In Spain, the Spanish Group for Research in Sarcomas (GEIS) brings together experts from various specialties to promote research on sarcomas and improve treatment results. This paper summarizes the GEIS recommendations for the diagnosis, treatment, and follow-up of patients with RPS. Full article

This study examines the occurrence of the artificial sweetener aspartame (E951) in foods and beverages sampled by food control authorities in Germany between 2000 and 2022. The dataset was obtained through the Consumer Information Act. Out of 53,116 samples analyzed, aspartame was present in 7331 samples (14%), of which 5703 samples (11%) in nine major food groups were further evaluated. The results showed that aspartame was most commonly found in powdered drink bases (84%), flavored milk drinks (78%), chewing gum (77%), and diet soft drinks (72%). In the solid food groups, the highest mean aspartame content was detected in chewing gum (1543 mg/kg, n = 241), followed by sports foods (1453 mg/kg, n = 125), fiber supplements (1248 mg/kg, n = 11), powdered drink bases (1068 mg/kg, n = 162), and candies (437 mg/kg, n = 339). Liquid products generally had the highest aspartame content in diet soft drinks (91 mg/L, n = 2021), followed by regular soft drinks (59 mg/L, n = 574), flavored milk drinks (48 mg/kg, n = 207), and mixed beer drinks (24 mg/L, n = 40). These results suggest that aspartame is commonly used in some foods and beverages in Germany. The levels of aspartame found were generally within the legal limits set by the European Union. These findings provide the first comprehensive overview of aspartame in the German food market and may be particularly useful in informing the forthcoming working groups of the WHO International Agency for Research on Cancer (IARC) and the WHO/FAO Joint Expert Committee on Food Additives (JECFA), which are in the process of evaluating the human health hazards and risks associated with the consumption of aspartame. Full article