Search Results (1,260)

Background: The use of lower limb prosthesis can impact all aspects of daily life, activities and participation. Various studies have compared the microprocessor-controlled knee (MPK) to the non-microprocessor-controlled knee (NMPK) using a variety of different outcome measures, but results are inconsistent and raise the question of which type of knee is most effective. Therefore, we aimed to assess the effect of MPKs compared to NMPKs across all classified ICF domains in adult prosthesis users. Methods: Participants performed baseline measurements with the NMPK (T0). One week later, they started a four-to-six-week trial period with the MPK. Afterward, measurements were repeated with the MPK (T1). Functional tests (6MWT, TUG-test and activity monitor) and questionnaires (ABC, SQUASH, USER-P and PEQ) were used. For statistical analyses, paired t-tests, Wilcoxon signed-rank tests and Chi² test were applied. The Benjamini–Hochberg procedure was applied to correct for multiple testing. Results: Twenty-five participants were included. Using an MPK compared to an NMPK significantly resulted in improvements in balance and walking confidence, safety, walking distance and self-reported walking ability, as well as a decrease in number of stumbles and falls. Additionally, participants using an MPK were significantly more satisfied with their participation, experienced fewer restrictions, reported greater satisfaction with the appearance and utility of the MPK, experienced less social burden and reported better well-being, compared to using an NMPK. Conclusions: Using an MPK instead of an NMPK can lead to significant improvements in all classified ICF domains, such as improved walking ability, confidence and satisfaction and reduced fall risk. Full article

China’s rapid urbanization has driven tremendous socioeconomic development while posing new forms of social–spatial inequalities that challenge environmental sustainability and spatial justice. This study investigates urban park-accessibility patterns across 10 s-tier provincial capital cities in China, examining how these patterns relate to housing-price dynamics to reveal diverse manifestations of social–spatial (in)justice. Using comprehensive spatial analysis grounded in distributive justice principles, we measure park accessibility through multiple metrics: distance to the nearest park, park size, and the number of parks within a 15 min walk from residential communities. Our findings reveal significant variation in park accessibility across these cities, with distinctive patterns emerging in the relationship between housing prices and park access that reflect different forms of social–spatial exclusion and inclusion. While most cities demonstrate an unbalanced spatial distribution of parks, they exhibit different forms of this disparity. Some cities show consistent park access across housing-price categories, while others display correlations between high housing prices and superior park accessibility. We argue that these divergent patterns reflect each city’s unique combination of economic development trajectory, politically strategic positioning within national urban hierarchies, and geographical constraints. Through this comparative analysis of second-tier cities, this study contributes to broader understandings of social–spatial (in)justice and urban environmental inequalities within China’s urbanization process, highlighting the need for place-specific approaches to achieving equitable access to urban amenities. Full article

Background/Objectives: Spacer dislocation is among the most frequent mechanical complications after revision total hip arthroplasty for periprosthetic hip infection. Spacer dislocations may be managed conservatively, but there are no guidelines on the rehabilitation of these patients, and the restriction of weight bearing is still under debate. Methods: We first report the case of a patient with hip spacer cranial dislocation, judged unfit to be surgically treated once more for a medium period, who started a rehabilitation program with partial weight bearing. Results: After two weeks of inpatient rehabilitation, the patient started to maintain the standing position with partial weight bearing on the affected side. Following hospital discharge we continued rehabilitation in the outpatient clinic. Despite the finding of the denervation of the ipsilateral quadriceps, three months after admission, she was able to walk for short distances using a walker, initially with the help of a therapist and then with supervision. About one year later, she was able to undergo the reimplantation of the definitive prosthesis. Conclusions: Despite the spacer dislocation, walking short distances is a feasible goal, even with assistance, wearing a brace and using a walker. Future research is needed to confirm and expand upon this observation and to understand the mechanisms underlying the development of neurological complications to implement effective prevention strategies. Full article

Background/Objectives: Patients undergoing open aortic and valvular surgery often experience postoperative deconditioning, yet research on the role of inpatient cardiac rehabilitation (CR) in this population remains limited. This study aimed to examine the effects of inpatient CR on muscle strength, mobility, psychological well-being, and quality of life in patients recovering from open aortic surgery. Methods: We conducted a retrospective study using the medical records of patients who participated in inpatient CR after open aortic surgery. Functional and psychological outcomes were evaluated using the Medical Research Council (MRC) sum score, Timed Up and Go (TUG) test, Five Times Sit-to-Stand test (5STS), Six-Minute Walk Distance (6MWD), Berg Balance Scale (BBS), Modified Barthel Index (MBI), Patient Health Questionnaire-9 (PHQ-9), and the EuroQol-5D (EQ-5D). Pre- and post-rehabilitation scores were compared to assess changes in functional status, mobility, and quality of life. A post-discharge satisfaction survey was also analyzed. Results: A total of 33 patients were included. Significant improvements were observed in MBI (p < 0.001), MRC sum score (p < 0.001), 6MWD (p < 0.001), BBS (p < 0.001), TUG (p = 0.003), 5STS (p < 0.001), EQ-5D (p = 0.011), and PHQ-9 (p = 0.009) following inpatient CR. Patients with lower baseline mobility (6MWD ≤ 120 m) exhibited greater improvement in MBI (p = 0.034). Of the 33 patients, 26 completed the satisfaction survey; most reported high satisfaction, perceived health improvements, and willingness to recommend the program. Conclusions: Inpatient CR following open aortic and valvular surgery resulted in significant gains in muscle strength, mobility, psychological health, and overall quality of life. Patients with greater initial impairment demonstrated especially notable functional improvement, supporting the value of tailored CR in this population. Full article

Background/Objectives: Prehabilitation is a multimodal intervention introduced in preparation for various surgical procedures. The most effective treatment for obesity is bariatric surgery. Physiotherapy during prehabilitation for bariatric surgery may be an effective method of functional capacity improvement. We aimed to evaluate the impact of an individual outpatient 12-week, exercise-based physiotherapy program featuring prehabilitation on functional status, exercise tolerance, everyday mobility, and fatigue among patients qualified for bariatric surgery. Methods: The completion of an individual outpatient 12-week, exercise-based physiotherapy program during prehabilitation was an inclusion criterion for the study group. Participants included in the study and control groups were assessed twice, after enrollment into the prehabilitation program (the first assessment) and after prehabilitation but before surgery (the second assessment). Both assessments involved functional tests (a six-minute walking test [6MWT], a timed up and go test [TUG], a chest mobility test, anthropometric measures, a mobility index [Barthel], and a modified Borg scale). The collected anthropometric data and values from the 6MWT were used to create original linear models. This study followed STROBE recommendations. Results: The study group and control group did not differ statistically in terms of their anthropometric data. Statistically significant results were obtained between the first and second assessments in both groups in terms of body weight and waist circumference. However, only the study group showed improved results in the TUG test (p = 0.0001) and distance in the 6MWT (p = 0.0005). The study group presented with the normalization of blood pressure (BP) after exertion in the second assessment (systolic BP p = 0.0204; diastolic BP p = 0.0377), and the 6MWT results were close to the norms. According to the original linear model used to predict performance in the 6MWT, the primary modifiable determinant of exercise tolerance was the participant’s weight, while gender served as a non-modifiable determinant. Conclusions: Exercise-based physiotherapy in prehabilitation was associated with improved functional capacity in patients preparing for bariatric surgery, contributing to the improvement in 6MWT results in relation to the norms as well as exercise tolerance. Body weight may be an independent factor determining distance in the 6MWT for patients undergoing prehabilitation for bariatric surgery. Full article

Phishing attacks pose significant risks to security, drawing considerable attention from both security professionals and customers. Despite extensive research, the current phishing website detection mechanisms often fail to efficiently diagnose unknown attacks due to their poor performances in the feature selection stage. Many techniques suffer from overfitting when working with huge datasets. To address this issue, we propose a feature selection strategy based on a convolutional graph network, which utilizes a dataset containing both labels and features, along with hyperparameters for a Support Vector Machine (SVM) and a graph neural network (GNN). Our technique consists of three main stages: (1) preprocessing the data by dividing them into testing and training sets, (2) constructing a graph from pairwise feature distances using the Manhattan distance and adding self-loops to nodes, and (3) implementing a GraphSAGE model with node embeddings and training the GNN by updating the node embeddings through message passing from neighbors, calculating the hinge loss, applying the softmax function, and updating weights via backpropagation. Additionally, we compute the neighborhood random walk (NRW) distance using a random walk with restart to create an adjacency matrix that captures the node relationships. The node features are ranked based on gradient significance to select the top k features, and the SVM is trained using the selected features, with the hyperparameters tuned through cross-validation. We evaluated our model on a test set, calculating the performance metrics and validating the effectiveness of the PhishGNN dataset. Our model achieved a precision of 90.78%, an F1-score of 93.79%, a recall of 97%, and an accuracy of 93.53%, outperforming the existing techniques. Full article

In low- and middle-income countries, notably in rural agricultural populations exposed to environmental and occupational dangers, respiratory impairment and noncommunicable diseases (NCDs) are major public health issues. This cross-sectional study examined the associations between lung function, functional capacity, and cardiovascular responses to the Six-Minute Walk Test (6MWT) in 137 adults from San Pa Tong District, Northern Thailand. Lung function was assessed using spirometry, and participants were classified accordingly. Hemodynamic parameters, including blood pressure, heart rate, rate-pressure product, and oxygen saturation, were measured before and after the 6MWT. Participants with impaired lung function walked significantly shorter distances (p = 0.004), and walking distance was positively correlated with forced vital capacity (FVC) and forced expiratory volume in one second (FEV₁). Logistic regression confirmed that walking distance independently predicted lung function impairment after adjusting for age and sex. Cardiovascular responses to exercise also varied significantly across demographic subgroups. These findings support the use of the 6MWT as a practical, cost-effective, and scalable method for detecting lung function impairments in resource-limited rural settings. To our knowledge, this is among the first studies to demonstrate the predictive value of the 6MWT for lung function impairment in a Southeast Asian agricultural population. Full article

Urban green spaces (UGS) are essential for residents’ well-being, environmental quality, and social cohesion. However, previous studies have typically employed undifferentiated analytical frameworks, overlooking UGS types and failing to adequately measure the structural disparities of different UGS types within residents’ walking distance. To address this, this study integrates Gaussian Two-Step Floating Catchment Area models, Simpson’s index, and the Gini coefficient to construct an accessibility–diversity–equality assessment framework for UGS. This study conducted an analysis of accessibility, diversity, and equity for various types of UGSs under pedestrian conditions, using the high-density city of Shenzhen, China as a case study. Results reveal high inequality in accessibility to most UGS types within 15 min to 30 min walking range, except residential green spaces, which show moderate-high inequality (Gini coefficient: 0.4–0.6). Encouragingly, UGS diversity performs well, with over 80% of residents able to access three or more UGS types within walking distance. These findings highlight the heterogeneous UGS supply and provide actionable insights for optimizing green space allocation to support healthy urban development. Full article

This study aimed to investigate the effects of augmented reality (AR) treadmill walking training on cognitive function, body composition, physiological responses, and acceptance among older adults. Additionally, it analyzed the relationships between body composition, physiological responses, and the acceptance of AR technology. A randomized controlled trial was conducted, recruiting 60 healthy older adults, who were assigned to either the experimental group (AR treadmill walking training) or the control group (traditional treadmill walking training). The assessments included cognitive function evaluation (stride length, walking speed, and balance test), body composition (BMI, skeletal muscle mass, fat mass, and body fat percentage), and physiological responses (heart rate, calorie expenditure, exercise duration, and distance covered). Furthermore, the AR Acceptance Scale was used to assess perceived ease of use, perceived usefulness, attitudes, and behavioral intentions. The results indicated that AR treadmill walking training had significant positive effects on improving cognitive function, optimizing body composition, and enhancing physiological responses among older adults. Compared with the traditional training group, the experimental group demonstrated better performance in stride length, walking speed, and balance tests, with increased skeletal muscle mass and reduced body fat percentage. Additionally, improvements were observed in heart rate regulation, calorie expenditure, exercise duration, and distance covered, reflecting enhanced exercise tolerance. Moreover, older adults exhibited a high level of acceptance toward AR technology, particularly in terms of attitudes and behavioral intentions, as well as perceived usefulness. This study provides empirical support for the application of AR technology in promoting elderly health and suggests that future research should explore personalized adaptation strategies and long-term effects to further expand the potential value of AR technology in elderly exercise. Full article

Background/Objectives: Sotatercept has demonstrated efficacy in pulmonary arterial hypertension (PAH), but its use has not been studied in patients with Group 3 pulmonary hypertension (PH). Additionally, patients with connective tissue disease-associated PAH (CTD-PAH) were underrepresented in the STELLAR trial. Given the limited treatment options for pulmonary hypertension in patients with interstitial lung disease (PH-ILD), this study aimed to evaluate the use of sotatercept in CTD-PAH patients with concomitant ILD. Methods: Eligible patients (n = 7) had a confirmed diagnosis of CTD-PAH with concomitant ILD. The patients were already receiving background PAH therapy. Baseline hemodynamic and clinical measurements were reassessed after 24 weeks of sotatercept therapy. The variables assessed included six-minute walk distance (6MWD), pulmonary vascular resistance (PVR), echocardiographic right ventricular systolic pressure (eRVSP), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, World Health Organization (WHO) functional class, and supplemental oxygen requirements. Results: The study included seven patients with a mean age of 57 years (range: 39–73 years). After 24 weeks, the mean 6MWT distance increased from 211 m to 348 m (p < 0.01). Mean PVR decreased from 7.77 WU at baseline to 4.53 WU (p < 0.01). Mean eRVSP decreased from 79.43 mmHg to 54.14 mmHg (p < 0.01). NT-proBNP decreased from 3056.86 pg/mL to 1404.29 pg/mL (p < 0.01). The WHO functional class and supplemental oxygen requirements improved in all patients. Conclusions: Sotatercept was tolerated in patients with CTD-PAH and ILD, with no evidence of adverse respiratory effects. When added to foundational PAH therapy, sotatercept resulted in significant improvements across multiple parameters. These findings suggest that sotatercept may be a promising therapeutic option as an adjunctive treatment in this patient population. Full article

Blind and visually impaired (BVI) people face significant challenges in perception, navigation, and safety during travel. Existing infrastructure (e.g., blind lanes) and traditional aids (e.g., walking sticks, basic audio feedback) provide limited flexibility and interactivity for complex environments. To solve this problem, we propose a real-time travel assistance system based on deep learning. The hardware comprises an NVIDIA Jetson Nano controller, an Intel D435i depth camera for environmental sensing, and SG90 servo motors for feedback. To address embedded device computational constraints, we developed a lightweight object detection and segmentation algorithm. Key innovations include a multi-scale attention feature extraction backbone, a dual-stream fusion module incorporating the Mamba architecture, and adaptive context-aware detection/segmentation heads. This design ensures high computational efficiency and real-time performance. The system workflow is as follows: (1) the D435i captures real-time environmental data; (2) the processor analyzes this data, converting obstacle distances and path deviations into electrical signals; (3) servo motors deliver vibratory feedback for guidance and alerts. Preliminary tests confirm that the system can effectively detect obstacles and correct path deviations in real time, suggesting its potential to assist BVI users. However, as this is a work in progress, comprehensive field trials with BVI participants are required to fully validate its efficacy. Full article

Generation Z (Gen Z; born 1997–2012) is reshaping global tourism through digital fluency, ethical awareness, and a desire for authentic, sustainable travel experiences. This study surveys 413 Gen Z travelers across France, Portugal, Romania, and the USA to map their booking behaviors, information sources, transport modes, accommodations, dining practices, and leisure activities. The findings reveal a strong preference for independent online bookings and social-media-influenced destination choices (Instagram, TikTok), with air and car travel being used for long-distance journeys and walking/public transit being used for local journeys. Accommodation spans commercial hotels and private rentals, while informal, local dining and nature- or culture-centered leisure prevail. Chi-square tests were performed to identify differences between countries. To reveal distinct traveler segments and their country’s modulations towards sustainability, a hierarchical cluster analysis was performed. The results uncover four segments: “Tech-Active, Nature-Oriented Minimalists” (32.3% in France); “Moderate Digital Planners” (most frequent across all countries, particularly dominant among Romanian respondents); “Disengaged and Indecisive Travelers” (overrepresented in the USA); and “Culturally Inclined, Selective Sustainability Seekers” (>30% in France/Portugal). Although sustainability is widely valued, only some segments of the studied population consistently act on these values. The results suggest that engaging Gen Z requires targeted, value-driven digital strategies that align platform design with the cohort’s diverse sustainability commitments. Full article

Promoting behavioral change in mobility is essential for sustainable urban development. This study evaluates the effectiveness of gamified challenges in fostering sustainable travel behaviors among high school students and teachers within the High School Challenge (HSC) 2024 campaign in Lecco, Italy. Over a 13-week period, participants tracked their commuting habits via gamified mobile application, Play&Go, that awarded points for sustainable mobility choices and introduced weekly challenges. Using behavioral (GPS-based tracking) and self-report data, we assessed the influence of challenge types, player characteristics (HEXAD Player Types, Big Five traits), and user experience evaluations on participation, retention, and behavior change. The results show that challenges, particularly those based on walking distances and framed as intra-team goals, significantly enhanced user engagement and contributed to improved mobility behaviors during participants’ free time. Compared to the 2023 edition without challenges, the 2024 campaign achieved better retention. HEXAD Player Types were more predictive of user appreciation than Personality Traits, though these effects were more evident in subjective evaluations than actual behavior. Overall, findings highlight the importance of tailoring gamified interventions to users’ motivational profiles and structuring challenges around SMART principles. This study contributes to the design of behaviorally informed, scalable solutions for sustainable mobility transitions. Full article

Background: Heart failure (HF) is frequently associated with skeletal muscle wasting, reduced functional capacity, and malnutrition. High-protein diets offer a promising nutritional intervention to improve these outcomes in individuals with HF. Objective: This systematic review evaluated randomized controlled trials of high-protein dietary interventions in HF populations, with emphasis on intervention characteristics, quantitative benefits, and risk of bias. Methods: We conducted a comprehensive search in PubMed, MEDLINE, Embase, and Cochrane CENTRAL from inception to June 2025. Eligible studies enrolled adults (≥18 years) with HF, implemented high-protein regimens (≥1.1 g/kg/day or ~25–30% of energy), and reported on functional capacity, body composition, muscle strength, clinical outcomes, or biochemical markers. Two reviewers independently screened, extracted data, and assessed bias (Cochrane RoB 2). Heterogeneity in dosing, duration, and outcomes precluded meta-analysis; we therefore provide a narrative synthesis. Results: Ten trials (nine randomized controlled trials, one pilot) involving 1080 patients (median n = 38; range 21–652) were included. High-protein interventions yielded mean improvements in six-minute walk distance of +32 ± 14 m, lean body mass gain of +1.6 ± 0.9 kg, and 9 ± 4% enhancement in quality-of-life scores; muscle strength effects varied from −2% to +11%. Two studies reported an 18% reduction in HF readmissions (p < 0.05). The risk-of-bias assessment identified two low-risk, three moderate-risk, and one high-risk study. Key limitations include small sample sizes, varied protein dosing (1.1–1.5 g/kg/day), short follow-up (2–6 months), and outcome heterogeneity. Conclusions: High-protein dietary strategies appear to confer modest, clinically relevant gains in functional capacity, nutritional status, and HF readmission risk. Larger, well-powered trials with standardized dosing and longer follow-up are necessary to establish optimal protein targets, long-term efficacy, and safety. Full article

In response to the challenge of multi-objective optimal scheduling and efficient solution of hydropower stations under large-scale renewable energy integration, this study develops a multi-objective optimization model with the dual goals of maximizing total power generation and minimizing the variance of residual load. Four complementarity evaluation indicators are used to analyze the wind–solar complementarity characteristics. Building upon this foundation, Hyper-dominance Evolutionary Algorithm (HEA)—capable of efficiently solving high-dimensional problems—is introduced for the first time in the context of wind–solar–hydropower integrated scheduling. The case study results show that the HEA performs better than the benchmark algorithms, with the best mean Hypervolume and Inverted Generational Distance Plus across nine Walking Fish Group (WFG) series test functions. For the hydro-wind-solar scheduling problem, HEA obtains Pareto frontier solutions with both maximum power generation and minimal residual load variance, thus effectively solving the multi-objective scheduling problem of the hydropower system. This work provides a valuable reference for modeling and efficiently solving the multi-objective scheduling problem of hydropower in the context of emerging power systems. This work provides a valuable reference for the modeling and efficient solution of hydropower multi-objective scheduling problems in the context of emerging power systems. Full article