Search Results (13,754)

Hemophilia is an X-linked inherited bleeding disorder characterized by joint hemorrhages and progressive arthropathy. While mutation type is known to influence disease severity, its impact on postural balance strategies has remained unclear. This cross-sectional study investigated the relationship between gene mutation type and postural control in hemophilia A patient using center of pressure (CoP) analysis and radiographic joint assessment with the Pettersson score. Thirty-five participants were divided into an INV group (intron 22 or intron 1 inversion of the F8 gene) and a NonINV group (other mutations). While the Pettersson scores and traditional time-domain CoP parameters (sway area, velocity) were comparable between groups, frequency domain analysis revealed a significant difference. INV group exhibited significantly higher energy content above 2 Hz in the anteroposterior direction compared to NonINV group. This genotype-specific spectral signature emerged despite comparable radiographic arthropathy and conventional CoP metrics, suggesting that frequency-domain CoP analysis can uncover subclinical postural adaptations in hemophilia A. These findings highlight the need for targeted proprioceptive training in this specific subpopulation to prevent subclinical instability and potential falls. Full article

Adolescence and early adulthood are critical developmental periods marked by an increasing vulnerability to emotional dysregulation and social difficulties, highlighting the need for engaging psychosocial interventions. This protocol presents a pilot study on the efficacy, feasibility, and acceptability of a structured group intervention based on Role-Playing Games (RPGs), designed to promote and support psychological well-being in transitional-aged youths. The study plans to recruit 54 participants (aged 15–24) who will take part in a 12 weekly, 2 h RPG-based intervention facilitated by trained clinicians. These clinicians will guide patients through narrative role-playing and a guided mentalization-based therapy through the gaming experience. All participants will be assessed at pre-, mid- and post-intervention, as well as during the 1- and 6-month follow-up, in the following dimensions: (a) mood, (b) anxiety, (c) emotional regulation, (d) alexithymia, and (e) coping skills. The following assessment tools will be administered: Hospital Anxiety and Depression Scale (HADS), Difficulties in Emotion Regulation Scale (DERS), Toronto Alexithymia Scale (TAS-20), and Coping Orientation to Problems Experienced (Brief-COPE). We expect the trial pilot will demonstrate good feasibility, greater participant engagement and treatment adherence, and improvements in all emotional and affective dimensions. This study seeks to establish foundational data to inform larger randomized controlled trials, with a follow-up, positioning RPG-based group interventions as potentially accessible, engaging, and convenient tools within youth mental health services. Full article

Background and Objectives: Spinal infections represent a heterogeneous group of diseases where primary or secondary etiological classification is fundamental for diagnosis and clinical decision-making. The aim is to present multicenter data evaluating etiological patterns associated with comorbidity. This study investigated the etiological distribution of spinal infections in a multicenter cohort and examined the relationships between chronic kidney disease (CKD) and diabetes mellitus (DM) and primary and secondary spinal infection etiologies, which emerged in the study and are thought to contribute to the literature. Materials and Methods: For this early-phase exploratory modelling study, a ridge-penalized logistic regression (L2) model was trained using repeated nested cross-validation (outer 5-fold stratified CV ×10 repetitions; inner 5-fold CV) to generate out-of-fold (OOF) probabilities. The penalty parameter (C) was optimized by minimizing log-loss. All preprocessing was performed within the CV pipeline to prevent data leakage. A supplementary Firth-penalized analysis was conducted as a plausibility check, using the CKD0/DM0 group as reference. Results: The model demonstrated effective discrimination between spinal infection probabilistic profiles (OOF AUC 0.762; conditional OOF bootstrap 95% CI 0.608–0.885). A contrasting probabilistic profile concordance was observed: DM-only patients had a high likelihood of secondary infection (observed secondary risk 93.3%; mean OOF estimated probability 84.4%), compared to a higher likelihood of primary infection in CKD-only patients (observed secondary risk 15.4%, which translates to a primary risk of 84.6%; mean OOF estimated probability 21.8%). Calibration was near-ideal (intercept 0.069; slope 1.028). Decision curve analysis showed a clear utility between the thresholds of 0.15 and 0.84. There were no CKD+DM+ cases (n = 0); analyses were restricted to supported strata. Conclusions: In this multicenter analysis of spine infections, CKD was predominantly related to primary spine infection etiology, whereas DM was more frequently related to secondary spine infections. These findings emphasize the potential role of comorbidity profiles in etiologic classification and need to be confirmed in larger multicenter cohorts. Full article

Background: Occupational noise-induced hearing loss (ONIHL) remains one of the most prevalent occupational diseases globally and in South Africa. Despite awareness and regulatory frameworks, consistent use of hearing protection devices (HPDs) is suboptimal in high-noise industries. Aim: To investigate patterns of HPD use and the factors influencing compliance among workers in an aluminium manufacturing company exposed to noise levels exceeding 85 dB(A). Methods: A cross-sectional survey was conducted with 115 workers, including 68.7% males and 31.3% females. Chi-square tests assessed associations between categorical variables, and logistic regression identified significant predictors of consistent HPD use. Results: Although 94.8% of workers were aware of the risks of hazardous noise, only 51.3% reported always using HPDs. Gender, education level, type of HPD, type and duration of noise exposure, and perceived susceptibility to hearing loss were significantly associated with consistent HPD use. Logistic regression revealed that gender, type of HPD, type of noise exposure, and perceived susceptibility significantly predicted consistent use. Conclusions: Despite high awareness and access to HPDs, consistent use remains moderate and is influenced by demographic, perceptual, device-related, and workplace factors. Findings highlight the need for targeted interventions, training, and workplace strategies to improve HPD compliance and prevent ONIHL. Full article

Surgically created native arteriovenous fistulas (AVFs) remain the preferred vascular access for chronic hemodialysis, yet they are limited by substantial early failure and progressive consumption of venous capital. Endovascular arteriovenous fistulas (endoAVFs, also referred to as percutaneous AVFs) have become a catheter-based alternative to surgical AVF (sAVF). We conduct an updated narrative, practice-oriented review of the literature on endoAVF creation, and we qualitatively synthesize evidence. Two devices are currently available in contemporary clinical practice: a dual 4 Fr-catheter, fluoroscopy-guided radiofrequency system (WavelinQ) and a single 6 Fr-catheter, ultrasound-guided thermal resistance system (Ellipsys). Across prospective studies and real-world series, endoAVF creation is consistently reported to have high technical success, with low major complication and infection rates. Clinical usability can often be achieved within weeks when ultrasound-based surveillance and protocol-driven maturation assistance are implemented; however, adjunctive procedures are frequently required and should be anticipated in program planning and informed consent. Observational comparisons and pooled analyses indicate broadly comparable functional outcomes versus surgery in selected cohorts, while estimates of primary patency and maintenance burden vary substantially across studies. Overall, endoAVFs represent a feasible, minimally invasive, vessel-sparing option that can be integrated into multidisciplinary access pathways in anatomically suitable candidates and experienced centers, complementing rather than replacing surgical strategies within a distal-first plan. Recent society practice guidance further emphasizes standardized mapping, expectation setting, troubleshooting algorithms for non-maturation, and dialysis-unit cannulation training to support consistent implementation. Pragmatic comparative studies and long-term registries using standardized endpoints, paired with healthcare-system-specific economic analyses, are needed to better define durability, resource use, and patient-centered outcomes over the full-access life cycle. Full article

Background: A sedentary behavior and being overweight represent major public health issues associated with both physical and psychological risks. Based on self-determination theory (SDT), the psychoeducational intervention PsicoFIT—a component of the TIGREFIT program—aims to foster motivation toward physical activity, to promote healthy habits, and to reduce psychological ill-being in sedentary adults who are overweight and are fans of a football club. Methods: This protocol corresponds to a longitudinal comparative pragmatic clinical trial, designed in accordance with the recommendations of the SPIRIT Statement. The intervention, preceded by a training program for the coaches involved, will comprise 12 weekly modules delivered in two modalities: (1) face-to-face, through group sessions, and (2) semi face-to-face, through short video capsules hosted on a digital platform. Changes associated with the intervention will be evaluated using hierarchical multiple regression and pre-post comparisons, assessing baseline and post-intervention data within and between the intervention modalities. Primary outcomes will include changes in healthy lifestyle and burnout as indicators of well-being and ill-being, respectively. Secondary outcomes will assess basic psychological needs satisfaction and autonomous motivation as potential mediators of these effects, as well as the coach’s controlling interpersonal style as a possible contextual predictor. The modality of participation will be analyzed as a potential moderator of the observed changes. Finally, the acceptability and perceived contribution of the intervention will be explored through a focus group. Discussion: PsicoFIT will provide a methodological framework for designing interventions within multicomponent programs aimed at promoting healthy lifestyles and psychological well-being in sedentary adults who are overweight, considering the social context of football fandom and allowing for an exploration of the impact of the face-to-face and semi-face-to-face modalities. Future empirical application of the protocol will help verify its effectiveness, guide adaptations across contexts, and contribute to the development of evidence-based interventions. Conclusions: The implementation of PsicoFit will allow for the evaluation of its effectiveness, psychological mechanisms, and delivery modalities, thus guiding future evidence-based interventions in sport. Full article

Background: People living with dementia in nursing homes commonly experience progressive impairments in cognition, communication, and functional ability, contributing to neuropsychiatric symptoms and reduced quality of life. As verbal communication declines, non-verbal communication (NVC) including facial expressions, gestures, eye contact, posture, and touch becomes increasingly important for maintaining meaningful interactions. Objectives: This study aims to explore current NVC practices between nursing home staff and residents living with dementia. Methods: A mixed methods, cross-sectional design was employed. NH staff completed an anonymous online questionnaire consisting of 13 items assessing NVC use and demographic characteristics. Quantitative items were rated using Likert scales, and qualitative responses were analysed using Giorgi’s phenomenological approach. Results: Quantitative findings showed that residents most frequently relied on facial expressions, reported as used very often in 24 of 33 NHs, followed by eye contact in 17 NHs and touch in 16 NHs. NH staff also reported extensive use of NVC during care interactions, particularly facial expressions (very often in 79% of NHs), eye contact (82%), and hand gestures (76%). Qualitative findings underscored the central role of NVC in interpreting residents’ needs, fostering emotional connection, and managing behavioural and psychological symptoms of dementia through subtle cues, visual prompts, and individualised strategies. Conclusions: Overall, the findings demonstrate that NVC is a fundamental component of communication and care delivery in dementia settings and highlight the need for structured training interventions to support staff in recognising and responding effectively to non-verbal signals. Full article

Veterinary education is academically demanding and emotionally intensive, affecting student performance, well-being, and long-term professional development. This narrative review synthesizes current evidence on academic stressors, admissions predictors, coping mechanisms, and institutional responses in veterinary training. Cognitive indicators such as Grade Point Average (GPA) and standardized test scores reliably predict early performance in pre-clinical biomedical courses. However, these measures do not adequately capture essential non-cognitive attributes, including resilience, adaptability, motivation, and communication skills, which are critical for sustained success in clinical environments. Holistic admission approaches show promise but remain inconsistently validated across institutions. Academic stress in veterinary programs arises from heavy curricular loads, frequent high-stakes assessments, financial pressures, and transitions into clinical training. Persistent stress exposure is associated with anxiety, depressive symptoms, and burnout risk. Evidence suggests that structured wellness initiatives, peer mentoring, and resilience-building programs can mitigate these effects when embedded systematically within the curriculum. Current literature is largely cross-sectional and geographically concentrated in Western educational contexts, limiting causal inference and generalizability. Longitudinal, multi-institutional research linking admissions profiles to academic trajectories and psychological outcomes is needed. Integrating cognitive and non-cognitive evaluation with sustained institutional support may enhance retention, academic performance, and professional preparedness in veterinary education. Full article

Background and Objectives: Hand and wrist scars alter physical appearance and can result in functional impairments and psychosocial difficulties. Although these effects are clinically important, rehabilitation services in Saudi Arabia lack consistent and standardised scar assessment protocols. The limited use of validated outcome measures hinders both clinical practice and research. Standardised scar assessment is essential for evidence synthesis, developing new scar care interventions and promoting best outcomes. We aim to investigate healthcare professionals’ perspectives on key scar outcome domains for evaluating hand and wrist scars and identify gaps in current practice and training needs to support the development of evidence-based guidelines. The study design is a cross-sectional descriptive study. Materials and Methods: The Saudi Commission for Health Specialties distributed a survey to 5000 randomly selected licensed healthcare professionals. The adapted questionnaire obtained sociodemographic data, professional experience, and ratings of scar outcome domains using a five-point Likert scale. Descriptive statistics were used for the analyses. Results: The analysis included 74 completed responses (response rate, 41.5%). Nurses (32.4%) and occupational therapists (29.7%) represented the largest groups. Only 37.8% of the participants reported receiving specialised training in scar assessment. Furthermore, the use of outcome measures remained limited, with 41.3% utilising clinician-reported outcome measures (CROMs) and 54.05% using patient-reported outcome measures (PROMs). The Vancouver Scar Scale and Patient and Observer Scar Assessment Scale were the most frequently used assessment tools. Clinicians primarily evaluated physical symptoms, including hypersensitivity (69.8%) and pain (67.6%), as well as scar characteristics such as colour (62.2%), adhesion (65.8%), and thickness (64.9%). Psychological factors were also considered important, particularly self-confidence (59.5%), acceptance of the scar (60.3%), and satisfaction with the scar (60.8%). Conclusions: Healthcare professionals in Saudi Arabia recognise the complex effects of hand and wrist scarring; however, they show limited integration of validated assessment tools, especially patient-reported outcome measures, in clinical practice. This gap suggests the need for targeted training, interdisciplinary educational initiatives, and efforts to strengthen standardised approaches to scar assessment. Exploring the development of future national guidance and engaging in international efforts to develop a core outcome measurement set may support evidence-based evaluation and improved long-term patient outcomes. Full article

The proliferation of digital health education content (DHEC) offers a transformative opportunity for medical training worldwide. While students in high-income countries routinely integrate these tools, their use and impact in low-resource settings such as Mozambique remain poorly understood. Exploring this topic offers interesting possibilities at the intersection of global health equity, digital literacy, and pedagogical innovation. This study assessed how Mozambican medical students engage with online health videos, examining the types of content they search for, preferred platforms, perceived benefits, and attitudes toward integrating these materials into medical training. A quantitative cross-sectional survey was administered to 151 second-year medical students at the Catholic University of Mozambique and Alberto Chipande University. A structured online questionnaire, comprising multiple-choice, Likert-scale, and open-ended questions, was used. Data were analyzed using descriptive statistics, cross-tabulation, chi-square test, and Cramer’s V effect size. All students (100%) reported searching for online health videos. They primarily do so via YouTube (92.1%) and use mobile phones (98.7%). Students mainly searched topics related to basic biomedical sciences (60%). They reported that video enhances their learning (86.8%), academic work (11.3%), and other skills (1.9%). Mean scores for utility (4.06), self-reported knowledge gain (4.05), and interest in continuing use (4.30) reflected positive perceptions. Furthermore, an overwhelming majority (91.4%) supported the institutional production of educational videos, whereas 8.6% disagreed, citing videos as a tool that diverts students’ focus from reading and a preference for traditional classes. No statistically significant gender-based differences were observed in usefulness, learning levels, or core interest in continuing to search for online videos (p > 0.05). Online health videos are widely used and positively perceived by Mozambican medical students as a supplementary learning tool. The findings highlight the need for institutions to create curriculum-aligned video libraries and strengthen students’ digital literacy, an affordable strategy for enhancing medical education in low-resource contexts. Full article

Glaucoma is a leading cause of irreversible blindness in Africa, with disease burden exacerbated by limited access to eye care, shortages of trained ophthalmologists, and socioeconomic disparities. This review synthesizes prospective and interventional studies evaluating glaucoma management modalities and associated clinical outcomes in an African population. Trabeculectomy remains the predominant surgical intervention, achieving success rates of approximately 80%, with enhanced outcomes when augmented with anti-metabolites such as mitomycin-C or 5-fluorouracil. Laser-based interventions, including selective laser trabeculoplasty and transscleral cyclophotocoagulation, demonstrate moderate to high efficacy in reducing intraocular pressure, while nonpenetrating surgeries such as deep sclerectomy, viscocanalostomy, and canaloplasty provide substantial pressure reduction with fewer complications. Pediatric interventions, notably goniotomy, show efficacy in lowering intraocular pressure, although region-specific evidence remains limited. Evidence on pharmacological intervention remains scarce, fragmented, with high rates of non-adherence frequently reported, highlighting the need for rigorously-designed outcome-oriented studies to inform clinical practice. Adoption of newer surgical and laser techniques is constrained by cost, limited equipment, and insufficient subspeciality expertise. Improving glaucoma outcomes in Africa will require strategic expansion of access to effective treatments, strengthen local surgical capacity, and prioritize evidence-based research. Collectively, these efforts will provide a more robust framework to optimize glaucoma management and reduce the burden of irreversible blindness across the continent. Full article

This study presents a pioneering approach, integrating infrared thermography and deep learning to analyse surface oxide layers on AISI 1045 steel, addressing the critical need for advanced monitoring in steelmaking processes. Using thermography for observation and semantic segmentation for accurate identification, 50 tests between 200 and 700 °C were analysed in a Joule-controlled heating system to study the formation and thickening of oxide layers on steel surfaces. A convolutional neural network (CNN), specifically SegNet, was trained for semantic segmentation, facilitating detailed analysis. The model achieved an overall accuracy of 96.40% in identifying the presence of oxide. By quantifying pixelation changes, relationships in oxide evolution kinetics were obtained, and by quantifying the activation energy in isothermal cases, the magnitude is in the range reported by other works. The approach also highlighted the potential for non-destructive monitoring and control on a large scale without compromising personnel safety. This potential could improve industrial process control, predict surface quality or provide data relevant to sub-processes. Full article

Slow-oscillation neurofeedback (NF), encompassing slow cortical potential (SCP), infra-low-frequency (ILF), and infra-slow-fluctuation (ISF) protocols, has gained increasing interest as a non-pharmacological intervention in pediatric mental health and neurodevelopmental care. This narrative review synthesizes peer-reviewed literature on the clinical efficacy of slow-oscillation NF in children and adolescents across various conditions, including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), epilepsy, tic disorders, and eating-related concerns. SCP NF is the most extensively studied protocol and shows preliminary efficacy in reducing ADHD symptoms, particularly among individuals capable of learning self-regulation. For ASD and other conditions, early evidence from primarily small-scale or uncontrolled studies suggests possible benefits in emotional regulation, impulsivity, and behavioral symptoms, though findings remain mixed and often non-specific. Methodological heterogeneity, including variation in control conditions, training protocols, and outcome measures, limits the comparability of results. ILF and ISF protocols, while promising, are still emerging and require further validation. Overall, slow-oscillation NF appears to offer potential as a personalized therapeutic option for pediatric populations, but robust, well-controlled trials are needed to clarify its clinical utility and optimize its integration into multimodal care. Full article

Background: Emotion recognition ability (ERA) plays a central role in children’s socio-emotional functioning, supporting early social interactions. This study examined whether ERA shows a pre–post change in a classroom-based training context and explored the association between ERA and socio-emotional adjustment. A secondary aim was to compare ERA between children with and without behavioral difficulties. Methods: A quasi-experimental study using a controlled non-randomized pre–post design was conducted. The sample included 159 children attending four public elementary schools. Study 1 compared an experimental and a control group assessed before and after the intervention using the DANVA-2-RV. Study 2 examined associations between ERA and behavioral functioning assessed via teacher reports (SDQ-TV) using correlational and group comparison analyses. Results: In Study 1, multivariate analyses revealed a significant main effect of Time, indicating overall variation across assessment points, whereas the Time × Group interaction was not statistically significant. Follow-up analyses were therefore interpreted descriptively. In Study 2, lower ERA was associated with higher socio-emotional difficulties, particularly peer problems. Conclusions: Across both studies, ERA varied over time regardless of group condition and was linked to socio-emotional adjustment in early childhood. However, the findings do not support a causal interpretation attributing these changes to the intervention. Future randomized studies are needed to determine whether targeted interventions can effectively modify ERA. Full article

Machine Learning (ML) modeling for disaster management is a growing field, but existing works focus more on mapping the extent of floods or broad categories of damage and they lack methods for explainability to help users understand model outputs. In this study, we propose Flood Assessment using Dempster–Shafer Fusion (FADS-Fusion), a tool for addressing post-flood damage assessment using Dempster–Shafer fusion to combine outputs from multiple deep learning models. FADS-Fusion is generalized to use any pretrained models, once outputs are post-processed for consistency, making it applicable for other disaster management or change detection applications. The novelty of our work comes from the application of Dempster–Shafer for multi-model fusion and uncertainty quantification on a flood dataset for segmenting both buildings and roads. We trained and evaluated models using the SpaceNet 8 challenge dataset and demonstrated that the fusion of the SpaceNet 8 Baseline (SN8) and Siamese Nested UNet (SNUNet) models has a modest overall improvement +1.93% to mAP, while a +12.3% increase for Precision and a −15.0% decrease in Recall are statistically significant compared to the baseline. FADS-Fusion also quantifies uncertainty by using the conflict of evidence, with a discount factor, with Dempster–Shafer fusion as both a quantitative and qualitative explainability method. While uncertainty correlates with a drop in performance, this relationship depends on values for class-weighted uncertainty and location. Mapping uncertainty back onto the original image allows for a visual inspection on fusion quality and indicates areas where a human will need to reassess. Our work demonstrates that FADS-Fusion improves post-flood segmentation performance and adds the benefit of uncertainty quantification for explainability, an aspect important for reliability and user decision-making but understudied in ML for disaster management in the literature. Full article