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Nursing practice is increasingly enacted within environments structured by intelligent technologies that filter perception, generate classifications and shape clinical priorities. While nurse scholars have begun to examine moral agency in the context of artificial intelligence, much of the broader ethical discourse on AI in healthcare continues to foreground governance, safety and institutional accountability, leaving the conditions under which nurses exercise professional moral responsibility comparatively under-theorized. This paper argues that technology-mediated care constitutes a moral environment that reshapes how responsibility is distributed, interpreted and enacted in clinical practice. Drawing on nursing ethics and socio-technical thought, it distinguishes between technical delegation and moral delegation, clarifying that while intelligent systems may inform action, they cannot assume moral answerability. Nursing moral agency is reconceptualized as relationally oriented moral perception, interpretive judgement and accountable action that remains fundamentally non-delegable, even under conditions of extensive mediation. Boundary-setting is advanced as a disciplined ethical practice through which nurses delineate the limits of technological authority and sustain professional responsibility. By articulating moral agency as both situated and irreducible, this analysis contributes a conceptual framework for understanding ethical responsibility in the Fifth Industrial Revolution and re-centres the nurse as the accountable moral subject within technology-mediated care.
At the frontiers of X-ray and high-power laser optics, Professor Zhanshan Wang has made outstanding contributions from fundamental mechanism to fabrication technologies and high performance applications over the last 25 years. As a Professor at Tongji University, he leads the Innovative Research Group of the National Natural Science Foundation of China, pioneered a novel theoretical framework for the synergistic tailoring of spectral response, electric field distribution, irradiation damage and optical loss in thin films optics. He developed high-precision characterization methods for resolving atomic-scale defects in coatings, invented a full-process and quantitative fabrication technology for thin film optics. By establishing premier research platforms and cultivating a highly skilled scientific team, his sustained efforts have greatly improved the performance of X-ray and optical thin-film devices which have been widely applied in synchrotron radiation, high power laser facilities, and space telescope. In this interview, he reflects on the scientific concepts guiding his research on X-ray and laser optics, the philosophy behind cultivating a world-class research team, and his vision for the future of optical science and technology.
Background: As a crucial transitional period from campus to society, providing comprehensive undergraduate health psychological care is essential for addressing Social Anxiety Disorder (SAD). Current global healthcare research is actively exploring innovative digital interventions, with a specific focus on leveraging Augmented Reality (AR) as a transformative auxiliary tool in clinical settings. Methods: This study investigates the factors influencing the acceptance of AR-assisted Cognitive Behavioral Therapy (CBT) within student healthcare frameworks by developing a research model based on the Technology Acceptance Model (TAM). The framework incorporates key clinical and behavioral constructs: self-efficacy (SE), facilitating conditions (FC), and social influence (SI). Results: SE, FC, and SI significantly and positively impact the willingness to adopt AR technology for mental health purposes. Based on these findings, practical recommendations are provided for healthcare technology developers, therapists, and university psychological care providers to enhance the integration of AR-assisted CBT. Conclusions: Strengthening these digital pathways is vital for improving healthcare outcomes and enabling students to navigate future social and professional environments effectively. Because the sample consisted solely of Chinese undergraduate students, the findings should be interpreted within this specific cultural and educational context and require further validation in cross-cultural and multi-regional samples.
As smart older adult care shifts from basic information support to more continuous algorithm-driven care, concerns have grown about whether such systems support older adults' independence or weaken their sense of autonomy. Although previous research has focused mainly on technology acceptance, less is known about how algorithmic care shapes perceived autonomy and through which psychological pathways this occurs. This study examined whether perceived algorithmic care intensity reduces older adults' perceived autonomy in community smart care settings, whether decisional substitution and perceived surveillance mediate this relationship, and whether digital literacy moderates these effects. A 3-stage design was adopted. First, a qualitative prestudy with 15 older adults was conducted to refine the focal constructs and measures. Second, a vignette-based experiment with 233 valid participants tested the effects of algorithmic care intensity on decisional substitution, perceived surveillance, and perceived autonomy. Third, a community-based survey with 298 valid participants examined the moderated mediation model in real-world smart older adult care settings. In study 1, compared with the low-intensity condition, the high-intensity condition significantly increased decisional substitution and perceived surveillance, while reducing perceived autonomy. Indirect effects through decisional substitution (effect=-0.072, 95% CI -0.144 to -0.016) and perceived surveillance (effect=-0.084, 95% CI -0.161 to -0.019) were both significant. In study 2, perceived algorithmic care intensity positively predicted decisional substitution (β=.400, P<.001) and perceived surveillance (β=.440, P<.001), and negatively predicted perceived autonomy (β=-.356, P<.001). The indirect effects through decisional substitution (effect=-0.112, 95% CI -0.172 to -0.065) and perceived surveillance (effect=-0.149, 95% CI -0.215 to -0.093) were significant. Digital literacy significantly weakened the effect of algorithmic care intensity on decisional substitution (β=-.174, P=.002), but not on perceived surveillance (β=-.071, P=.18). Algorithmic care may undermine older adults' perceived autonomy both directly and indirectly through decisional substitution and perceived surveillance. Digital literacy appears to be a selective rather than universal buffer. These findings extend smart older adult care research beyond technology acceptance and clarify the tension between empowerment and control in algorithmic care.
Biological computers, or 'biocomputers', are being engineered with brain organoids integrated with in silico hardware and software components. This technology promises to advance our mechanistic understanding of cognitive processes by embodying in vitro neural systems within virtual learning environments. Yet, biocomputers raise ethical and moral questions, such as whether evidence of consciousness indicates that embodied neural systems have moral status. To better understand the relationship between signs of consciousness and ethical concerns, we conducted an exploratory study to investigate public views toward biocomputers. We examined whether the public's tendency to attribute consciousness to human and non-human entities guides moral reasoning about biocomputers. We discovered a latent structure underlying public views on the distribution of consciousness. Specifically, we identified three cluster groups, characterized by opinions on the scope of consciousness. These cluster groups were highly predictive of views toward the cognitive capacities and moral status of biocomputers. Respondents in our sample exhibited strong support for research on and creation of biocomputers, and for some, support increased as biocomputers were perceived to be more conscious-a relationship that appears to conflict with conventional reasoning in moral philosophy. Future studies will help determine the prevalence of these views among stakeholders and demographically representative publics at local, national, and global scales whose ethical judgements will inform regulation, oversight, and governance of engineered neural systems.
Mobile information technology (IT) is increasingly being used in the health care sector, and it can play a critical role in both the care of children with congenital heart disease (CHD) and the quality of life of their families. This study aimed to conduct a scoping review of the application of mobile health (mHealth) technologies in the care of children with CHD. We summarized the forms of mHealth interventions and effects on CHD to provide a reference for future research in this field. We searched PubMed; Embase; Web of Science; the Cochrane Library; CINAHL; China National Knowledge Infrastructure; Wanfang Data; the Chinese Biomedical Database; VIP Chinese Science and Technology Journal Database; National Guideline Clearinghouse of the United States; the website of the Registered Nurses' Association of Ontario, Canada; the Guidelines International Network; the American Heart Association; and the American Association of Cardiovascular and Pulmonary Rehabilitation. The search period was from the establishment of the databases to June 12, 2025. The retrieved literature was screened and analyzed. A total of 519 Chinese- and English-language articles were identified, with 44 (8.5%) studies meeting the inclusion criteria. The primary forms of mHealth interventions for patients with CHD included mobile apps, wearable devices, and remote monitoring equipment. The findings indicated that mHealth technologies could improve exercise capacity, nutritional status, psychological well-being, and quality of life in children with CHD. The application of mHealth in the care of children with CHD is feasible and demonstrates positive effects. Future research should emphasize peer education and patient privacy protection while further exploring remote education and health management based on theoretical frameworks and intelligent ITs to enhance quality of life for both children with CHD and their parents.
Understanding how lifelong learners adopt generative artificial intelligence (GenAI) is critical for effectively integrating these tools into lifelong education systems. Drawing on the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2), this study employs Partial Least Squares Structural Equation Modeling (PLS-SEM) and fuzzy-set Qualitative Comparative Analysis (fsQCA) to examine GenAI adoption among 436 lifelong learners. PLS-SEM reveals that performance expectancy, effort expectancy, social influence, hedonic motivation, price value, and habit significantly predict behavioural intention, which in turn predicts usage behaviour. fsQCA identifies four types of configurational pathways to high behavioural intention and four to high usage behaviour, revealing concurrent factor combinations that are associated with adoption. These findings offer evidence-based guidance for integrating GenAI in lifelong education.
With the continuous increase in the global prevalence of diabetes, the prevention and treatment of diabetic retinopathy (DR) have become a global public health challenge. In China, due to population aging, lifestyle changes, and advances in medical diagnostic technology, the incidence and detection rate of DR have been increasing year by year. Therefore, exploring effective management and follow-up models for DR is of paramount importance in reducing the blindness rate caused by DR and improving the quality of life of patients. Based on the KPAI theory, a questionnaire for postoperative follow-up needs of patients with diabetic retinopathy was developed to determine the effectiveness of the questionnaire. The content of intelligent follow-up was adjusted based on the results of the needs questionnaire survey, and the changes in disease knowledge, physical, psychological, and social aspects of postoperative follow-up patients were evaluated. A total of 1372 patients with diabetic retinopathy who received treatment in our hospital's wards from January 2023 to December 2023 were selected. Among them, 278 patients underwent a postoperative follow-up needs survey, with 347 patients undergoing routine follow-up and 445 patients undergoing intelligent follow-up, with a follow-up time of one week after surgery. In the first participation of patients in intelligent follow-up, 20 patients were randomly selected for follow-up one month and three months after surgery to assess changes in patient indicators. The scale finally determined 16 items, including information acquisition, postoperative self-management, psychological emotions, and social integration, with a Cronbach's α coefficient of 0.662, I-CVI range of 0.714 to 1, and an S-CVI value of 0.929. After routine follow-up and intelligent follow-up, negative social emotions, public health positive index, and scores of depression-anxiety-stress were statistically significant (P < 0.05). The boxplots after intelligent follow-up in the first week, one month, and three months all showed an improving trend. The questionnaire for postoperative follow-up needs of patients with diabetic retinopathy based on KPAI has clinical utility. The use of an intelligent follow-up system is beneficial to the postoperative recovery of patients with diabetic retinopathy and improves the physical and mental health of patients.
To systematically evaluate the current state of research on symptom clusters in patients with chronic obstructive pulmonary disease (COPD) and the impact of identifying symptom clusters on health-related quality of life (HRQoL) outcomes. A systematic review. Two reviewers independently screened the studies against the eligibility criteria. Studies were assessed for risk of bias using the Appraisal tool for Cross-Sectional Studies (AXIS tool). Data were extracted using a pre-developed extraction tool and thematically analysed. Databases searched included EMbase, PubMed, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database and China Science and Technology Journal Database. Searches were conducted from inception to June 12, 2025. Eighteen studies were included. Symptom clusters were identified using two tool types, including four multi-symptom and 18 single symptom evaluation tools. Common symptom clusters are respiratory-related symptom cluster, psychological-related symptom cluster, sleep-related symptom cluster and fatigue-related symptom cluster. Seven studies found significant negative associations between symptom clusters and HRQoL. Six studies reported the negative effect of each symptom cluster on HRQoL, but only one study showed no association for the sleep-related cluster. The study of COPD symptom clusters still lacked general evaluation tools and statistical methods. Robust studies are needed to deeply explore the differential impact of symptom clusters across various dimensions of HRQoL. Our findings may make symptom management strategies based on the perspective of symptom clusters possible. In clinical practice, nurses should prioritize identifying and intervening in the symptom clusters with the most significant impact on HRQoL, thereby promoting the transformation of the nursing model from 'single-symptom management' to 'multi-symptom collaborative management.' This study adheres to PRISMA and SWiM reporting guidelines. No Patient or Public Involvement because of the systematic review. PROSPERO: CRD42024606544.
Depression is prevalent and debilitating. Although interventions exist, they are rarely delivered in accessible, scalable ways that retain their effectiveness. Cognitive behavioral immersion (CBI) is a coach-led cognitive behavioral skills program delivered in social virtual worlds that offers a potential solution. This parallel-group, web-based randomized controlled superiority trial compared CBI accessed via virtual reality headsets (CBI-VR) or flat-screen devices (CBI-FS) to a delayed access control. Inclusion criteria included a clinical level of depression symptoms, age ≥18 years, able and willing to give informed consent, access to a computer with an internet connection, and ability to speak and read English. Eligible participants were randomized using a random number generation script in a 1:1:1 ratio to conditions. CBI consisted of 8 weekly 1-hour groups led by coaches who taught cognitive behavioral skills. The intervention lasted 8 weeks; follow-up lasted 6 months. The primary outcome was depression symptoms; secondary outcomes were anxiety symptoms and quality of life. Recruitment and study procedures were conducted online. Outcomes were assessed through electronic self-report questionnaires. The study was unblinded. Hierarchical linear modeling was used to examine differences in rates of change among conditions. We explored the sense of presence as a potential mediator of intervention response. Participants were recruited from February 2024 to January 2025; n=102 were randomized to each condition. Participants randomized to CBI-VR and CBI-FS attended an average of 5 intervention sessions. Primary analyses included all participants in the intent-to-treat sample that completed ≥2 outcome surveys to estimate within-person change (CBI-VR: n=98; CBI-FS: n=86; control: n=102). CBI-VR showed faster reductions in depressive and anxiety symptoms than either CBI-FS (depression: β=.21; 95% CI 0.02-0.40; P=.03 and anxiety: β=.20, 95% CI 0.03-0.38; P=.02) or the control (depression: β=.31, 95% CI 0.13-0.48; P<.001 and anxiety: β=.18, 95% CI 0.01-0.34; P=.03) across the 8-week intervention, with improvements largely maintained over the 6-month follow-up. CBI-VR also showed greater improvements in general quality of life (β=-1.02; 95% CI -1.63 to -0.40; P=.001) and psychological well-being (β=-1.01, 95% CI -1.44 to -0.59; P<.001) than the control from pre- to postintervention. The sense of physical presence in the environment was associated with CBI-VR's effects on depression symptoms (ab=-0.85, 95% CI -1.71 to -0.15). No adverse effects occurred in any group. This study evaluated the efficacy of an innovative coach-led cognitive behavioral skills group delivered via VR. To our knowledge, our trial is the first to demonstrate that CBI delivered via VR is effective. These findings extend prior work on digital cognitive behavioral therapy by supporting CBI-VR as an effective and viable intervention package for depression and anxiety symptoms. These findings may help inform future research on suitable technology that can help bridge mental health care gaps.
Pelvic inflammatory disease (PID) is a common infectious condition of the female upper genital tract that imposes a substantial global burden on women's reproductive health and overall quality of life. This narrative review aims to comprehensively synthesize current evidence on the inducing factors and complication risks of PID. We conducted a systematic literature search in PubMed, Embase, and Web of Science databases from January 2010 to December 2025, prioritizing high-quality evidence including systematic reviews, meta-analyses, large-scale population-based cohort studies, and national registry data. The review systematically categorizes PID etiologies into sexually transmitted infections, cervicovaginal dysbiosis, iatrogenic procedures (intrauterine device insertion, assisted reproductive technology, and intrauterine manipulations), anatomical abnormalities, underlying gynecological conditions, lifestyle habits, and environmental exposures, with a particular focus on the emerging role of cervicovaginal microbiota in idiopathic PID. Beyond well-established reproductive sequelae such as tubal infertility, ectopic pregnancy, and chronic pelvic pain, we also summarize evidence linking PID to a broad spectrum of under-recognized systemic complications, including ovarian and colorectal cancer, cardiovascular and metabolic disorders, intestinal obstruction, and mental health problems. The findings underscore the critical importance of early diagnosis, appropriate antimicrobial treatment, and comprehensive risk stratification for optimizing clinical outcomes and reducing the long-term burden of PID.
Chronic spontaneous urticaria (CSU) is a burdensome skin disorder that may remain inadequately controlled with standard H1 antihistamines (H1 AHs). Evidence on adolescents with CSU is limited. This 16-week study evaluated the safety and effectiveness of omalizumab in Chinese adolescents (≥12 to <18 years) with CSU who remained symptomatic despite H1 AH treatment (treatment period: 12 weeks; safety follow-up: 4 weeks). Safety assessments and routine clinical evaluations were performed. Effectiveness and quality of life were analyzed using the weekly urticaria activity score (UAS7), weekly itch severity score (ISS7), Urticaria Control Test (UCT), and Children's Dermatology Life Quality Index (CDLQI). All 55 enrolled participants completed the study. Twenty-two participants (40.0%) experienced ≥1 treatment-emergent adverse event (TEAE). No serious adverse events, adverse events of special interest, deaths, or TEAEs leading to treatment discontinuation occurred. At Week 12, changes from baseline in ISS7 and UAS7 were -11.73 and -25.07, respectively; 70.9% participants achieved well-controlled CSU (UCT ≥ 12). The absolute mean change in CDLQI was -9.7 (relative improvement at Week 12: -81.5%). Omalizumab demonstrated a favorable safety profile and clinically meaningful effectiveness in Chinese adolescents with CSU who remained symptomatic despite H1 AH therapy and is a valuable option for this underrepresented population.
I contrast Singh's subjective functionalism with structuralist-related approaches in anthropology, where "attractors" are not isolated packages of beliefs and practices but robust relationships between such packages within cultural systems. While impressive in its synthesis, Singh's account falls short of explaining a defining feature of human culture: its holistic nature. I use shamanism as an illustrative example.
The ability to understand emotional prosody is directly relevant to effective social communication. Typically developing (TD) children at age 3 start to understand emotional prosody in both native and foreign languages, but it remains unclear whether autistic children demonstrate a similar pattern. To address this, this study examined Mandarin-speaking autistic children's understanding of two basic emotional prosody, happy and sad, across languages. We manipulated the language where emotional prosody was presented: familiar (Mandarin) versus unfamiliar (French and Spanish). Autistic 3- and 5-year-olds and age-matched TD children completed a face-sound matching task where they were asked to point at the emotional face that matched the spoken sentence they heard. Autistic children exhibited similar patterns to age-matched TD peers in the native language condition but showed significantly lower accuracy when responding to emotional prosody in foreign languages. Importantly, however, autistic children's performance across all language conditions was above chance, and within-group analysis showed that they performed better in the native language condition than in the foreign language conditions. These findings suggest that autistic children can decode emotional prosody across languages, although their ability to process emotional prosody in foreign languages is less developed than TD children. This pattern might reflect fundamentally different mechanisms between the two groups. Alternatively, it could also be explained by shared mechanisms between the two groups, with the difference reflecting autism-related neurocognitive characteristics constraining autistic children's processing efficiency. In addition, the native language advantage can be leveraged to support emotional communication in autistic children.
Assessing water resources carrying capacity (WRCC) is essential for regional high-quality development. However, most existing WRCC assessment models fail to handle uncertainties and mixed data arising from multiple criteria, which compromises their practical applicability. To address this limitation, this study integrates cumulative prospect theory (CPT) with the PAMSSEM outranking method to develop a novel intuitionistic fuzzy CPT-PAMSSEM model. Then the proposed method is validated through a case study of four cities in the middle and lower reaches of the Tuojiang River Basin. Results show that: (1) WRCC varies significantly across the four cities: Luzhou and Ziyang show favorable conditions, Zigong is near the critical threshold, and Neijiang faces a severe water resource shortage crisis. (2) the proposed model markedly improves the discrimination of different evaluation results, achieving a differentiation level approximately 3-6 times greater than that of conventional methods. These findings provide actionable insights for sustainable water management.
Osteoporotic vertebral fractures (OVFs) significantly impact morbidity, mortality, function and quality of life. Stable fractures with controllable pain can be managed conservatively. Those that remain painful can be treated with minimally invasive measures of vertebral augmentation (VA). In contrast, severe and unstable OVFs risk collapse, progressive kyphosis and neurological damage. Conventional VA is considered insufficient for these unstable fractures, making surgical stabilisation necessary to restore spinal load-bearing capacity, and allow fast and painless mobilisation. However, spinal surgery in elderly osteoporotic patients is challenging due to tissue fragility and common comorbidities. In addition, poor bone quality increases the risk of surgical implant failure, new fractures, complications and re-intervention.This trial aims to assess the non-inferiority of a novel minimally invasive interventional technique, called stent-screw assisted internal fixation (SAIF), compared with multilevel surgical stabilisation in terms of quality of life and radiological outcomes such as vertebral height restoration and kyphotic correction in patients with unstable OVFs. This is a multicentre, parallel-group, randomised controlled non-inferiority trial that will be conducted in four European centres.A total of 140 patients with type Osteoporotic Fracture (OF) 3-5 OVFs (according to the AO Spine-DGOU Osteoporotic Fracture Classification System) will be randomised 1:1 to receive either SAIF intervention or surgical stabilisation.The primary outcome is to determine whether the effect of SAIF intervention is not inferior to surgical stabilisation on pain and quality of life at 1-year follow-up.The principal secondary outcomes are to evaluate whether the effect of the SAIF intervention is not inferior to surgical stabilisation in terms of radiological outcome and cost-effectiveness. Ethics approval was obtained from the Ethics Committee of the Canton Ticino, Switzerland (CE 4004). Results will be disseminated through international publications in peer-reviewed journals, in addition to international conference presentations. NCT07071870.
Photovoltaic power generation has been widely applied worldwide. Compared with investment decisions for conventional power projects, photovoltaic projects are exposed to higher investment risks. As relevant technologies continue to mature, government supportive policies will gradually be scaled back year by year. Accordingly, investment decisions for photovoltaic schemes will confront growing uncertainties and associated risks. In this context, evaluating the investment risks of photovoltaic projects carries both practical value and theoretical significance. The risk assessment of engineering projects under the influence of new quality, productive forces may be contemplated from the multiple-attribute group decision-making (MAGDM) perspective, wherein Logarithmic TODIM methodology plays an essential role in the current solution landscape. As the focus shifts to evaluating engineering project risks in terms of quality, productive forces, inherent uncertainties are involved in the decisions, and single-valued neutrosophic sets (SVNSs) are employed to represent the ambiguity of information. Therefore, this paper proposes a novel integrated SVNN-LogTODIM approach to deal with MAGDM issues in a neutrosophic environment. To demonstrate the applicability and validity of the proposed approach, a comprehensive numerical example is provided for evaluating the engineering project risk of photovoltaic power generation projects to support high-standard production.
Obtaining informed consent from research participants is an ethical imperative. In mental health research, cognitive deficits can impair the ability to provide individual consent. This study explored the consenting practices of key research team members to enhance comprehension in research involving individuals with schizophrenia and bipolar affective disorder at the national referral mental health hospital in Uganda. The study was conducted at a national referral mental hospital in Uganda. In-depth interviews were conducted with 21purposively selected participants. Audio recordings were transcribed, and transcripts were managed using NVivo 14. Data were analyzed using inductive thematic analysis. Two themes emerged from the findings: (1) key considerations during the informed consent process, and (2) reported practices for enhancing participants' understanding of the research and medical terms. Researchers reported that participants' capacity to consent was maintained through follow-up to see if they still had capacity in the course of participation. They kept participants interested in consent discussions through building rapport, listening to them attentively, and dedicating more time to ensure effective interaction. Caregivers played an important role in consenting. Researchers perceived that comprehension of consent was supported through reading the consent information to participants verbatim, using iterative learning, and consultation with the community and health professionals who routinely interact with participants. Researchers reported using ongoing consent discussions, rapport building, caregiver involvement, iterative learning, and adaptation of study information to local contexts. These findings suggest the perceived value of contextual and relational factors in supporting autonomy during the consent process for persons with schizophrenia and bipolar affective disorder.
Medical and welfare facilities in the Noto region of Japan were severely affected by the 2024 Noto Peninsula earthquake and subsequent torrential rains. Staff working in these facilities were disaster survivors and frontline caregivers with limited psychological support. Nonverbal social robots may provide companionship and emotional comfort; however, their effects on the health-related quality of life (QoL) and well-being of care staff in disaster-affected settings remain unclear. This study explored whether introducing a nonverbal artificial intelligence communication robot was associated with changes in health-related QoL and well-being among care facility staff working under disaster conditions. Secondary objectives were to evaluate safety, acceptability, and intention to continue use. This pragmatic, exploratory pilot study used an ABAB design conducted between February 2025 and June 2025. After a 2-week baseline period, staff in dementia care, general care, and short-stay units underwent 2-week intervention, withdrawal, reintervention, and withdrawal phases. Questionnaires were administered at each phase end. The primary outcomes were health-related QoL (EQ-5D-5L), well-being (World Health Organization-5 Well‑Being Index), and positive mental health (Mental Health Continuum-Short Form). Friedman tests compared outcomes across the 5 phases, and effect sizes were expressed as Kendall W. Safety, acceptability, and intention to continue use were compared between the first and second intervention phases using Wilcoxon signed rank tests with Bonferroni adjustment and rank-biserial correlations as effect sizes. Of the 58 staff who completed the baseline assessment, 49 (84.5%) were included in the analytic sample (25 in dementia care, 12 in general care, and 12 in short-stay units). Among these participants, 40 (81.6%) were women, and 38 (77.6%) reported disaster-related damage to their homes or families. In the pooled analysis, no phase effect was observed for the EQ-5D-5L (P=.10; Kendall W=0.032, negligible), the World Health Organization-5 Well‑Being Index (P=.70; Kendall W=0.016, negligible), or the Mental Health Continuum-Short Form (P=.44; Kendall W=0.022, negligible). No robot-related adverse events were reported. In the dementia care unit, nominal unadjusted differences were observed for "made me feel calm" (P=.045; rank-biserial correlation r=0.571, large), "like" (P=.03; r=0.559, large), and "felt at peace" (P=.02; r=0.718, large); however, none remained statistically significant after Bonferroni correction. The short-term use of a nonverbal artificial intelligence communication robot did not measurably improve health-related QoL or well-being among staff in disaster-affected care facilities. Deployment appeared feasible and was not associated with reported adverse events, but efficacy as a mental health support intervention remains unproven. Exploratory acceptability and interaction signals may inform future adequately powered studies.
Acute Intermittent porphyria (AIP) is a rare autosomal dominant disorder of heme biosynthesis characterized by severe acute neurovisceral attacks. Despite available therapies many individuals continue to experience chronic residual symptoms that impair quality of life. Complementary and alternative medicines (CAMs) are widely used in other chronic conditions but their use among individuals with AIP is not well understood. Therefore, we explored patients' experiences through a cross-sectional, anonymous online survey assessing the use and perceived effectiveness of CAMs and cannabis among adults with AIP. Participants were recruited through the Longitudinal Study of the Porphyrias Consortium and a patient advocacy group listserv. Eighty-two individuals (87.8% female; mean age 43.9 ± 13.6 years) completed the survey. Most respondents (92.7%) had experienced acute attacks, and 68.3% reported chronic symptoms such as fatigue (71.4%), muscle weakness (60.7%), and nausea (55.4%). Self-help practices were widely adopted, including meditation (53.7%), relaxation techniques (57.3%), massage (50.0%), and yoga (47.6%), and rated helpful by most users. Chiropractors (17.1%) and acupuncturists (14.6%) were the most frequently visited CAM providers and often reported as being beneficial. Cannabis use was reported by 68.3% of respondents, primarily for symptom management, though perceived effects varied. CAM and cannabis use are prevalent in individuals with AIP to manage persistent symptoms. These findings highlight unmet needs in AIP management and emphasize the importance of further research to evaluate the safety, effectiveness, and integration of CAMs into patient-centered care strategies.