Search Results (8,704)

Carbapenem-resistant Klebsiella pneumoniae (CRKP) has become one of the most serious problems confronting modern healthcare, particularly in intensive care units where patients are highly susceptible, procedures are frequent, and antibiotic exposure is often prolonged. In this review, carbapenem resistance in K. pneumoniae is presented not as a fixed feature of individual bacteria, but as a process that is constantly changing and closely interconnected. We bring together evidence showing how the spread of successful bacterial lineages, the exchange of resistance genes, and gradual genetic adjustment combine to drive both the rapid spread and the long-lasting presence of resistance. A major focus is placed on mobile genetic elements, including commonly encountered plasmid backbones, transposons, and insertion sequences that carry carbapenemase genes such as blaKPC, blaNDM, and blaOXA-48-like. These elements allow resistance genes to move easily between bacteria and across different biological environments. The human gut plays a particularly important role in this process. Its microbial community serves as a largely unseen reservoir where resistance genes can circulate and accumulate well before infection becomes clinically apparent, making prevention and control more difficult. This review also discusses the key biological factors that shape resistance levels, including carbapenemase production, changes in the bacterial cell membrane, and systems that expel antibiotics from the cell, and explains how these features work together. Advances in molecular testing have made it possible to identify resistance more quickly, supporting earlier clinical decisions and infection control measures. Even so, current tests remain limited by narrow targets and may miss low-level carriage, hidden genetic reservoirs, or newly emerging resistance patterns. Finally, we look ahead to approaches that move beyond detection alone, emphasizing the need for integrated surveillance, thoughtful antibiotic use, and coordinated system-wide strategies to lessen the impact of CRKP. Full article

Conversational agents are transforming digital interactions across various domains, including healthcare, education, and customer service, thanks to advances in large language models (LLMs). As these systems become more autonomous and ubiquitous, understanding what constitutes high-quality interaction from a user perspective is increasingly critical. Despite growing empirical research, the field lacks a unified framework for defining, measuring, and designing user-perceived interaction quality in human–artificial intelligence (AI) dialogue. Here, we present an integrative review of 125 empirical studies published between 2017 and 2025, spanning text-, voice-, and LLM-powered systems. Our synthesis identifies three consistent layers of user judgment: a pragmatic core (usability, task effectiveness, and conversational competence), a social–affective layer (social presence, warmth, and synchronicity), and an accountability and inclusion layer (transparency, accessibility, and fairness). These insights are formalised into a four-layer interpretive framework—Capacity, Alignment, Levers, and Outcomes—operationalised via a Capacity × Alignment matrix that maps distinct success and failure regimes. It also identifies design levers such as anthropomorphism, role framing, and onboarding strategies. The framework consolidates constructs, positions inclusion and accountability as central to quality, and offers actionable guidance for evaluation and design. This research redefines interaction quality as a dialogic construct, shifting the focus from system performance to co-orchestrated, user-centred dialogue quality. Full article

Canada’s ageing population continues to grow rapidly and significantly more diverse, which will require unique health and home service needs. The COVID-19 pandemic exacerbated existing challenges in Canada’s healthcare system and demonstrated the need for long-term care (LTC). Semi-structured interviews were conducted with 17 decision makers, managers, and leaders in long-term ethnically focused facility care. Braun & Clarke’s six-stage process of thematic analysis was applied using an iterative, deductive approach to examine the experiences of stakeholders involved in the operational, managerial, financial, and clinical aspects of an ethnicity-focused LTC. Findings highlighted salient characteristics of impactful ethnicity-focused care and factors were uniquely shaped by the delivery of culturally specific care. Key subthemes included social isolation and emotional impact, operational and logistic difficulties during COVID-19, mitigation measures implemented in response, and the social, behavioural, and health benefits observed among seniors living in these LTC homes. Participants identified political and economic constraints (e.g., provincial funding) to establishing ethnicity-focused care homes but proposed several solutions and highlighted potential benefits that could support successful implementation. Analysis of experiences of operational challenges in safely and adequately running ethnicity-focused LTC reinforces the value of ethnicity-focused LTC during times of crisis such as the COVID-19 pandemic, as they provide a culturally safe and familiar space with preventive measures applied in a timely manner for seniors to engage with their peers in an environment that meets their health needs, ensuring safety standards. Full article

Background/Objectives: Pelvic exenteration is a radical procedure performed for recurrent gynecologic cancers. The goal of exenteration is to prolong survival, but this procedure also results in extensive tissue loss and consequently high morbidity. Reconstruction using vascularized flaps, particularly the VRAM flap, is crucial to restoring pelvic integrity and decreasing complications resulting from extensive tissue loss. With the rise of minimally invasive surgery, the traditionally open abdominal approach to exenteration and reconstruction can now be performed with the assistance of robotic platforms. This review aims to summarize available evidence, describe techniques, and propose future directions for robotic rectus flap reconstruction after pelvic exenteration. Methods: This narrative review was conducted following the SANRA guidelines for narrative synthesis. A comprehensive search of PubMed, Embase, Scopus, and Web of Science was conducted for studies published between January 2000 and November 2025 on pelvic exenteration followed by robotic rectus abdominis flap reconstruction in gynecologic oncology. Eligible studies were retrospective or prospective reports, technical descriptions, case series, or comparative analyses. Non-robotic techniques and animal studies were excluded. Although the primary focus was gynecologic oncology, technically relevant studies from other oncologic disciplines were included when the reconstructive approach was directly applicable to pelvic exenteration. Extracted data included patient demographics, surgical details, and perioperative and oncologic outcomes. Results: The literature search identified primarily case reports and small single-center series describing robot-assisted rectus muscle-based flap reconstruction after pelvic exenteration. Reported cases demonstrated technical feasibility and successful flap harvest using robotic platforms, with adequate pelvic defect coverage. Potential benefits, such as reduced wound morbidity and preservation of a minimally invasive workflow, have been described. However, patient numbers were small, techniques varied, and standardized outcome measures or comparative data with open approaches were lacking. Conclusions: Robotic rectus flap reconstruction represents a promising advancement in pelvic exenteration surgery, potentially reducing morbidity and improving recovery. Further research, including multicenter prospective studies, is needed to validate these findings and establish standardized protocols. Full article

To enhance PharmD student leadership and advocacy skills, combat the paucity of trained pre-health advisors for pharmacy admissions, augment community relationships, and increase pharmacy admissions volume, we designed, implemented, and assessed PAALS, a Pre-health Academic Advising and Leadership System. PAALS was grounded in Astin’s Theory of Student Involvement and evaluated using the RE-AIM implementation science framework. RE-AIM measured outcomes across Reach, Effectiveness, Adoption, Implementation, and Maintenance as indicators of PAALS’s scale, fidelity, sustainability, and institutional embedding. Analysis of PAALS using the RE-AIM framework demonstrated the following outcomes: (1) Reach: 42 P1-P3 PharmD students participated as mentors; external partnerships expanded from 2 to 8 regional high schools and community programs; and more than 25 mentored learners successfully matriculated into the PharmD program. (2) Effectiveness: students enacted sustained leadership, advocacy, and mentoring roles. (3) Adoption: voluntary uptake of mentoring and governance roles by PharmD students occurred with repeated engagement by external partner institutions. (4) Implementation: Core program components were delivered consistently using existing institutional resources. (5) Maintenance: PAALS remained operational across five academic years despite student turnover, with leadership succession and institutional embedding sustained across cohorts. Our findings demonstrate that student-led advising and advocacy ecosystems address critical gaps in pharmacy-specific pre-health advising models. Full article

Accurate displacement field measurement by holographic interferometry requires robust analysis of high-density fringe patterns, which is hindered by speckle noise inherent in any interferogram, no matter how perfect. Conventional skeletonization methods, such as edge detection algorithms and active contour models, often fail under these conditions, producing fragmented and unreliable fringe contours. This paper presents a novel skeletonization procedure that simultaneously addresses three fundamental challenges: (1) topology preservation—by representing the fringe family within a physics-informed, finite-dimensional parametric subspace (e.g., Fourier-based contours), ensuring global smoothness, connectivity, and correct nesting of each fringe; (2) extreme noise robustness—through a robust strip integration functional that replaces noisy point sampling with Gaussian-weighted intensity averaging across a narrow strip, effectively suppressing speckle while yielding a smooth objective function suitable for gradient-based optimization; and (3) sub-pixel accuracy without phase extraction—leveraging continuous bicubic interpolation within a recursive quasi-optimization framework that exploits fringe similarity for precise and stable contour localization. The method’s performance is quantitatively validated on synthetic interferograms with controlled noise, demonstrating significantly lower error compared to baseline techniques. Practical utility is confirmed by successful processing of a real interferogram of a bent plate containing over 100 fringes, enabling precise displacement field reconstruction that closely matches independent theoretical modeling. The proposed procedure provides a reliable tool for processing challenging interferograms where traditional methods fail to deliver satisfactory results. Full article

Background: Population aging has increased attention on the quality of life and successful aging of older adults. Objective: To examine urban–rural differences in subjective quality of life and self-rated successful aging, explore associations with psychosocial factors, and identify predictors of successful aging, including potential moderating effects of place of residence and chronic illness. Methods: A cross-sectional study was conducted among 403 adults aged ≥ 60 years in Eastern Croatia. Measures included a sociodemographic questionnaire, the Self-assessment of Successful Aging Scale (SSAS), and the Personal Wellbeing Index (PWI). Data were analyzed using nonparametric tests (Mann–Whitney U, Spearman’s correlation), linear regression, and moderation analyses. Significance was set at p < 0.05. Ethical approval was obtained (Class: 602-01/24-12/02; IRB: 2158/97-97-10-24-36). Results: Rural participants reported lower PWI scores (p = 0.005) and self-rated successful aging (p < 0.001) than urban participants. Active community involvement was positively associated with quality of life (Rho = 0.46; p < 0.001), whereas regret about missed opportunities and past actions was negatively associated (Rho = −0.20; p < 0.01). Regression analyses explained 48.3% of the variance in SSAS, with higher PWI scores being strongly associated with higher SSAS scores, and rural residence and chronic illness being associated with lower SSAS scores. Moderation analyses indicated that the association between PWI and SSAS was consistent across different environmental contexts and in the presence of illness. Conclusions: Older adults living in rural areas reported lower quality of life and self-rated successful aging compared with those in urban and suburban areas, with subjective wellbeing emerging as a key predictor. Promoting social engagement and addressing psychosocial barriers may enhance successful aging, particularly in rural populations. Findings suggest that social engagement and psychosocial support are associated with higher level of perceived successful aging, indicating potential areas for future community-based or healthcare interventions. Full article

The sustained interest in efficient, low-cost, and straightforward-to-manufacture lasers has prompted intense research into organic semiconductor laser emitter materials in recent decades. The main focus of this research is determining the optical gains and losses of amplified spontaneous emission (ASE) in order to describe materials by their amplification signature. A method that has been used for decades as the standard technique for determining gain characteristics is the variable-stripe-length (VSL) method. The success of the VSL method has led to the development of further measurement techniques. These techniques provide a detailed insight into the nature of optical amplification. One such method is the scattered emission profile (SEP) method. In this study, we present an extension of the SEP method, the Diffracted Emission Profile (DEP) method. The DEP method is based on the detection of ASE by partial decoupling of waveguide modes diffracted by a one-dimensional grating integrated into a planar waveguide. Diffraction causes a proportion of the intensity to exit the waveguide, transferring the growth and decay process of the waveguide mode to the transverse mode profile of the diffracted mode. In the present article, an approach to determine the amplification signature of an organic copolymer is presented, utilizing partial decoupled radiation. Full article

Porous NiCo₂O₄ nanomaterials were synthesized using in situ-generated polyacrylamide as a template, with cobalt nitrate, nickel nitrate, and urea serving as raw materials. XRD and FESEM analyses confirm the successful formation of spinel-structured NiCo₂O₄ electrode materials featuring a 3D macroporous/mesoporous architecture and an average crystalline size of approximately 8.1 nm, obtained through calcination of the amorphous precursor. Electrochemical evaluation of the as-prepared NiCo₂O₄ reveals that the specific capacitance retained at 10 A g⁻¹ reaches 88.9% of the value measured at 1 A g⁻¹, demonstrating excellent rate capability. Furthermore, the material exhibits a gradual increase in specific capacity over 3000 charge–discharge cycles, achieving a capacitance retention of up to 246.5%, which indicates good cycling stability and superior capacity retention. Full article

Gadolinium-doped hydroxyapatite nanoparticles (HapGd NPs) have emerged as promising multifunctional platforms for biomedical applications due to their unique combination of biocompatibility, structural tunability, and magnetic responsiveness. In this work, HapGd nanoparticles were synthesized using a microwave-assisted method and subsequently functionalized with curcumin and folic acid to enhance therapeutic efficiency and selective targeting. The synthesized nanostructures were characterized using various techniques, including X-ray diffraction (XRD), transmission electron microscopy (TEM), Fourier-transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), vibrating sample magnetometry (VSM), and relaxometry. Structural analyses revealed successful incorporation of Gd³⁺ ions into the Hap lattice, resulting in reduced unit cell volume and slight lattice distortion, while preserving the apatite crystalline framework. Surface functionalization with curcumin and folic acid was confirmed through spectroscopic characterization, demonstrating effective molecular attachment. Nuclear Magnetic Resonance (NMR) relaxation measurements indicated that Gd doping endowed paramagnetic behavior suitable for contrast enhancement in magnetic resonance imaging (MRI). Relaxometry studies revealed a strong linear correlation between 1/T₁ and the Gd³⁺ concentration, especially in the functionalized samples, with performance comparable to the commercial contrast agent Omniscan™. The developed HapGd-based nanoplatform exhibits integrated diagnostic and therapeutic potential, providing a foundation for future research in biomedical applications. Full article

Fused deposition modeling (FDM) suffers from unpredictable mechanical properties in nominally identical prints. Current quality assurance relies on destructive testing or expensive post-process inspection, while existing machine learning approaches focus primarily on printing parameters rather than real-time thermal environments. The objective of this proof-of-concept study is to develop a low-cost, non-destructive framework for predicting tensile strength during FDM printing by directly measuring convective thermal gradients surrounding the print. To accomplish this, we introduce thermal fingerprinting: a novel non-destructive technique that combines Background-Oriented Schlieren (BOS) imaging with machine learning to predict tensile strength during printing. We captured thermal gradient fields surrounding PLA specimens (n = 30) under six controlled cooling conditions using consumer-grade equipment (Nikon D750 camera, household hairdryers) to demonstrate low-cost implementation feasibility. BOS imaging was performed at nine critical layers during printing, generating thermal gradient data that was processed into features for analysis. Our initial dual-model ensemble system successfully classified cooling conditions (100%) and showed promising correlations with tensile strength (initial 80/20 train–test validation: R² = 0.808, MAE = 0.279 MPa). However, more rigorous cross-validation revealed the need for larger datasets to achieve robust generalization (five-fold cross-validation R² = 0.301, MAE = 0.509 MPa), highlighting typical challenges in small-sample machine learning applications. This work represents the first successful application of Schlieren imaging to polymer additive manufacturing and establishes a methodological framework for real-time quality prediction. The demonstrated framework is directly applicable to real-time, non-contact quality assurance in FDM systems, enabling on-the-fly identification of mechanically unreliable prints in laboratory, industrial, and distributed manufacturing environments without interrupting production. Full article

Objectives: To evaluate whether preoperative anterior segment optical coherence tomography (AS-OCT) parameters differ according to Big Bubble (BB) formation during deep anterior lamellar keratoplasty (DALK) in patients with TGFBI-related corneal stromal dystrophies (CSD). Methods: This retrospective cohort study included 17 eyes from 12 patients undergoing DALK with an attempted BB technique. Stromal deposit depth was assessed by AS-OCT using both a categorical depth-based classification (anterior, mid-, and posterior stroma) and continuous measurements of stromal involvement (µm). The ratio between stromal involvement and the thinnest corneal point was calculated. Intraoperative data included BB success, BB type, and complications. Inter-eye correlation was accounted for in comparisons of continuous variables using linear mixed-effects models. Results: BB formation was achieved in 11 of 17 eyes (64.7%), with type 1 BB observed in all successful cases. BB success was observed in all eyes with anterior or mid-stromal involvement and in 33.3% of eyes with posterior stromal involvement. Greater stromal deposit depth and a higher stromal-depth-to-thinnest-point ratio were observed in eyes in which BB formation failed (p < 0.01). No intraoperative perforations or conversions to penetrating keratoplasty occurred. Inter-observer agreement for AS-OCT measurements was high. Conclusions: BB failure was more frequent in eyes with greater absolute and relative stromal deposit depth, as assessed by preoperative AS-OCT during DALK in TGFBI-related CSD. These AS-OCT-derived parameters may support surgical planning and improve patient selection for BB DALK in this clinical setting. Full article

Background: Awake carotid endarterectomy (CEA) under local anesthesia demands an optimal sedation strategy that ensures patient comfort while preserving the ability for real-time neurological assessment. Dexmedetomidine (DEX) and remifentanil (REMI) are widely used agents, but direct comparisons in this setting remain scarce. Methods: Exploratory, retrospective, single-center study of awake CEA (March–July 2019). DEX or REMI infusions were titrated to a Richmond Agitation–Sedation Scale (RASS) of −1 to −2. Outcomes were sedation failure (RASS ≥ +2 despite maximum infusion rate), bradycardia, hypotension, and neurologic events. Statistical analyses used χ² test (categorical variables) and Student’s t-test or Mann–Whitney test (continuous variables). Associations were assessed with Firth’s logistic regression (univariable and bivariate models), reporting odds ratios (OR) with 95% confidence intervals (CI_95%). Trends in the Bispectral Index (BIS), hemodynamic, and respiratory parameters were assessed using two-way repeated-measures Analysis of Variance (ANOVA). A p-value < 0.05 was considered significant. Results: Fifty-two patients were included (DEX = 25; REMI = 27). DEX group showed more frequent sedation failure (32.0% vs. 3.7%; p = 0.020), bradycardia (36.0% vs. 3.7%; p = 0.009), and hypotension (28.0% vs. 0%; p = 0.011). DEX was associated with increased risk in sedation failure (OR 8.58, CI_95% 1.70–85.81), bradycardia (OR 10.17, CI_95% 2.05–101.21), and hypotension (OR 22.30, CI_95% 2.46–2959.60); the direction of associations remained consistent in bivariate models adjusted for baseline confounders. ANOVA showed group-by-time interactions for BIS, heart rate, mean arterial pressure, and end-tidal CO₂. No intraoperative complications or adverse outcomes were observed. Conclusions: In this retrospective cohort of awake CEA, DEX was associated with higher rates of sedation failure and hemodynamic adverse events compared with REMI, without an apparent impact on procedural success. Given non-random allocation and baseline imbalances, these findings are hypothesis-generating and warrant confirmation in larger, robust, and prospective studies. Full article

Objective: To assess the effectiveness of a fixed contrast injection protocol—75 mL of contrast followed by 40 mL saline at 5 mL/s with an injection duration of 23 s—in achieving diagnostic enhancement in coronary CT angiography (CCTA) using 64-slice detector CT scanner. Materials and Methods: 456 consecutive patients with suspected coronary disease who underwent CCTA on a 64-slice detector CT scanner between January 2023 and December 2024 and were retrospectively enrolled. Each patient received 75 mL of contrast medium followed by 40 mL of saline at a flow rate of 5 mL/s, with a total injection duration of 23 s. Two radiologists, blinded to patient information, independently measured the contrast enhancement (HU) values in the coronary segments, ascending and descending aorta, and left ventricle. Attenuation levels ≥250 HU were considered diagnostic. Patients were grouped by body weight into two categories: Group 1 (≤75 kg) and Group 2 (>75 kg). The independent t-test and Mann–Whitney U test were used to compare HU values in each vessel between the two groups, while the Chi-square test was applied to compare enhancement success rates (HU ≥ 250) between the groups per vessel. Results: A total of 281 patients (mean age: 51.88 years ± 11.15 [SD]; 167 male, 114 female), were included. Statistically significant differences in the HU enhancement measurements were found between groups (p < 0.001–0.007). However, all segments showed mean and median HU values above 250 HU. Enhancement success rates were significantly higher in Group 1 (p = 0.005–0.04), except in the ascending aorta, descending aorta, left main coronary artery, middle right coronary, distal right coronary artery, and middle left circumflex artery, where the rates were statistically comparable between the groups (p = 0.054–0.61). Conclusions: A fixed contrast protocol (75 mL of contrast medium followed by 40 mL of saline at a 5 mL/s flow rate with a total injection duration of 23 s) appears to be feasible for achieving diagnostic contrast enhancement in CCTA using a 64-slice multidetector CT scanner. This protocol may offer a simplified alternative to individualized, weight-based contrast dosing strategies. Full article

Objectives: We aimed to assess sex differences in benefits from cardiac rehabilitation and the impact of comorbidities. Methods: We analyzed 3239 individuals with cardiovascular diseases (81.2% males) who participated in a three-week cardiac rehabilitation program at Bad Schallerbach center (Upper Austria). Training success was measured by maximal oxygen consumption (VO₂ max). Sex-specific differences in baseline characteristics were assessed using t-tests/chi² tests. Associations between covariates and the outcome were evaluated with baseline-adjusted univariate analysis of variance/linear regression models. Covariates significant at α = 0.05 were included in a multivariable linear regression model, which was refined by backward selection based on the best Akaike information criterion. The final model was used to test the relationship between sex and the outcome. Results: The mean age and BMI were 63.9 years and 27.5 kg/m² for males and 67.2 years and 27.4 kg/m² for females. Males had higher baseline VO₂ max compared to females (26.18 mL/min/kg vs. 23.55 mL/min/kg, p < 0.001), and a greater change in VO₂ max after rehabilitation was seen in males compared to females (3.64 mL/min/kg vs. 2.77 mL/min/kg, p < 0.001). Female sex was associated with a 1.4-point-lower change in VO₂ max after adjustment for comorbidities, sex, and training intensity (β coefficients = −1.409; CI 95% −0.410, −0.104; p < 0.001). Heart valve surgery (β coefficients = −0.90; CI 95% −1.444, −0.366; p < 0.001) and diabetes mellitus (β coefficients = −1.207; CI 95% −1.926, −0.488; p < 0.0001) were associated with lower changes in VO₂ max in both sexes. Conclusions: Our findings suggest that females and individuals with specific comorbidities benefit less from cardiac rehabilitation and support the creation of personalized rehabilitation programs. Full article