The Nine-Hole Peg Test (9-HPT) is widely used in clinical settings but typically relies on the assessor's expertise to record execution time. Here, we propose a novel sensorized 9-HPT capable of automatically measuring total execution time and, importantly, extracting a set of newly defined temporal parameters that enable a more detailed and objective characterization of task performance. We first demonstrated concurrent validity between the sensorized 9-HPT and stopwatch-based measurements recorded by an assessor (ρ always > 0.98; p < 0.001) in healthy participants. Agreement between methods was further supported by the Bland-Altman analysis, showing negligible bias and narrow limits of agreement. A linear mixed-effects model confirmed no systematic differences between methods but showed significant differences between dominant and non-dominant hands. Test-retest reliability of total completion time, assessed across two sessions, was good for both the dominant (ICC = 0.81) and non-dominant (ICC = 0.74) hands. The newly introduced temporal parameters also showed significant reliability (ICC = 0.73-0.78), particularly for the dominant hand. Overall, these findings support the reliability of the sensorized 9-HPT for standard outcome measures and highlight its added value in providing novel temporal metrics that more precisely capture the different phases of task execution.
Endoscopic submucosal dissection (ESD) requires advanced skills and extensive training, with a particularly steep learning curve for colonic ESD. Since 2021, the French Society of Digestive Endoscopy (SFED) has implemented a structured curriculum based on European Society of Gastrointestinal Endoscopy (ESGE) ESD curriculum. This study aimed to assess its effectiveness and predictive factors of competency. Participants enrolled in the first three SFED ESD training years (2021-2023) were included. After online education and a standardized hands-on training week, trainees documented every ESD performed at their center. A Successful ESD was defined as an en-bloc R0 resection without surgery for a procedure-related adverse event. Competency thresholds were set at >90% R0 resection and <1% surgery for complications. Forty-five trainees performed 2,051 ESDs. The median age was 36 years, 70.7% were men, with six years of endoscopy experience (IQR 4-10). Lesion were mainly colorectal (42.9% rectal, 42.7% colonic) with a median size of 45 mm (IQR 34-60). En-bloc and R0 resections were achieved in 93.6% and 85.8% of cases, respectively. Surgery for complication was required in 0.9%. The overall success rate was 92.7%. By study end, 80% of students reached competency, requiring a median of 21 ESDs. Predictive factors of success included lesion location (rectum > colon). Age (HR 0.92 [0.86-0.99]; p=0.03) and prior experience (HR 0.91 [0.84-0.99]; p=0.03) were inversely correlated with competency. Training in a high-volume ESD center (>100 ESD/year) accelerated competency acquisition (p=0.008). This first evaluation of the ESGE/SFED ESD curriculum in France demonstrates that ESD competency is achievable after structured training, even without extensive prior endoscopy experience.
The evolution of soft robots into embodied intelligent systems relies fundamentally on precise proprioception. However, a universal solution for capturing continuous deformations during diverse interactions, particularly in spatially confined interventional scenarios, remains lacking. Here, we introduce a deep learning-enabled versatile shape perception method based on a single-ended multimode fiber (MMF). By leveraging the intrinsic integration advantages of optics, our minimalist reflective architecture physically eliminates the dependence on complex demodulation units and distal devices. Furthermore, treating chaotic optical speckle fields as data streams encoding high-dimensional shape information, reconfigurable neural decoders resolve a single physical channel into versatile perception modes tailored to heterogeneous tasks: discrete state confirmation on soft grippers (>99% accuracy), continuous shape tracking on bionic dexterous hands (~5-fold spatial resolution enhancement), and intuitive 3D morphological reconstruction of soft surgical robots (IoU>0.93). Overall, our work establishes a versatile framework for breaking hardware adaptability limits via computation, laying a solid foundation for closed-loop control in digital twins of soft robots.
Rotating shift work affects circadian alignment and sleep continuity, resulting in cognitive impairment and low-grade systemic inflammation in healthcare professional. We assessed the effectiveness of lemborexant 5 mg (LEM5) on sleep, neurocognitive function, inflammatory biomarkers, and health-related quality of life in hospital rotating shift workers experiencing sleep disorders. Rotating shift workers aged 20 to 60 years, experiencing inadequate sleep opportunity and suboptimal sleep quality, were randomized in a 1:1 ratio to receive LEM5 or a matching placebo for a duration of 3 weeks, with follow-up extending to 6 weeks. Sleep was evaluated by Fitbit Inspire 2 actigraphy and approved Thai versions of questionnaires (ESS, PSQI). Cognitive outcomes included MoCA, DSST, and GP. Plasma BDNF, IL-6, and CRP levels were assessed at baseline and at week 6. Forty-seven participants were randomized (LEM5 n = 25, placebo n = 22), and all completed the follow-up. LEM5 yielded significant improvements in MoCA, DSST, and GP completion times for both hands (all p < 0.001). LEM5 significantly decreased IL-6 and CRP levels, whereas variations in BDNF remained comparable between groups. Actigraphy revealed persistent benefit over 42 days in TST, sSOL, WASO, deep NREM sleep, REM sleep, and SE. The PSQI and EQ-5D visual analogue scores shown considerable improvement with LEM5. Somnolence and nightmares were more prevalent with LEM5; nevertheless, no significant adverse events occurred. LEM 5 improved sleep architecture, cognitive function, inflammatory profiles, and health-related quality of life in rotating shift healthcare workers, indicating its promise as a therapeutic intervention for this high-risk demographic.
Background Schools are key environments for children's daily lives, where urgent events such as syncope, hypoglycemia, seizures, and minor trauma can occur. In Italy, the absence of school nurses and the lack of mandatory first aid training for all teachers place initial emergency management largely on educational staff, whose preparation is variable. Enhancing first aid culture and readiness is therefore essential for prevention, early recognition, and timely response. Aim To assess the training level and preparedness of teachers-from nursery to lower secondary school-in managing pediatric urgent and emergency situations within school settings. Material and Methods A multicenter, descriptive, cross sectional observational study was conducted (April-October 2025) using a structured questionnaire integrating two validated instruments. Participants were recruited from nursery, kindergarten, primary, and lower secondary schools in the Marche region (Italy). Data were summarized as proportions with 95% CIs (Clopper-Pearson). Associations were tested with chi square (exact tests as needed), with effect size via Cramér's V. Significance α=0.05. Correct CPR sequence knowledge was estimated as prevalence. Results The sample included nursery (n=8), kindergarten (n=12), primary (n=23), and lower secondary (n=24) teachers, mostly aged 26-50 years; 64.2% held a university degree. While 91% reported first aid knowledge and 88% had attended at least one course, only 7.5% felt genuinely prepared; 64.2% felt insecure and 28.4% unprepared, and ~90% requested further practical training. Scenario items revealed procedural gaps: only 55.2% prioritized assessing consciousness in an injured/unconscious student; 71.6% would avoid manipulating a sprained ankle; responses on bleeding were split (direct pressure 52.2% vs gentle tamponing 46.3%). Diabetes knowledge was stronger (e.g., insulin via injection 95.5%; insulin does not raise glucose 92.5%), yet uncertainty remained for managing acute episodes on site. On epilepsy, misconceptions were largely rejected, but causal attributions mixed genetics (47.8%) and emotional factors (41.8%). Practical first aid sequencing showed fragmentation; only ~33% (95% CI 22-45%) knew the correct CPR sequence. Training was strongly associated with perceived preparedness (χ²(2)=22.95; p<0.001; V=0.59), age and seniority with lower confidence (V=0.66 and 0.61, respectively), and perception moderately with correct CPR sequence (p=0.003; V≈0.42). Training alone did not correlate with correct CPR sequencing (p=0.366). Discussion Current training reduces outright unpreparedness but often leaves teachers in a state of operational insecurity. Confidence and competence-especially CPR sequencing-appear to require hands on practice, realistic simulations, and regular refreshers rather than single-course exposure. Conclusions Teachers show acceptable theoretical awareness in selected areas but significant practical uncertainties in first aid, especially CPR and initial assessment. Structured, periodic, skills based programs and competency verification are priorities. Integrating the school nurse as a health educator could provide sustainable, on site support for training and emergency readiness.
Surveillance of dog-mediated rabies in India remains constrained, especially in livestock and other animals by limited diagnostic access, biosafety concerns, fragmented reporting systems, and weak integration between field veterinary services and laboratories. Public-private partnerships (PPPs) and One Health oriented capacity building are increasingly promoted as strategies to address these gaps, yet evidence on such approaches remains limited. A two-day workshop titled "Skill Enhancement of Field Veterinarians to Improve Surveillance of Dog-Mediated Rabies in Livestock and Wildlife in Assam" was organised on 25-26 July 2024 in Guwahati, Assam to strengthen field-level rabies surveillance by building sampling and transport capacity, introducing rapid LFA-based diagnostics, enhancing data reporting practices, and promoting a One Health perspective. This article aims to provide implementation of insights into rabies surveillance through One Health collaboration using a PPP approach. This study presents an implementation-focused qualitative analysis through a PPP-led capacity-building workshop for field veterinarians in Assam, India. Structured group discussions held prior to hands-on training explored perceived barriers, operational challenges, and feasible strategies for improving animal rabies surveillance in resource-limited settings. Discussion outputs were thematically analysed to identify recurring system-level constraints and opportunities. Thirty-two field veterinarians from 18 districts and one NGO participated in the workshop. Thematic analysis of group discussions highlighted five interlinked themes influencing rabies surveillance: (i) biosafety and sampling constraints at field level, (ii) limited diagnostic reach and transport logistics, (iii) uncertainty around rapid test interpretation and confirmatory pathways, (iv) fragmented reporting and feedback mechanisms, and (v) the need for institutional coordination across veterinary, public health, and wildlife sectors. This implementation report demonstrates how PPP-based One Health capacity building can generate practice-based insights from frontline veterinarians and inform feasible approaches to decentralise and strengthen animal rabies surveillance in resource constrained settings.
Pharmacogenomics (PGx) can optimise cardiovascular therapy, yet routine integration in cardiology remains limited. In the United Arab Emirates, a hybrid public-private health system, the real-world PGx use is still emerging. However, there is limited understanding of how cardiologists perceive and navigate PGx implementation within such complex health system contexts. To examine cardiologists' perspectives on the feasibility, barriers, and facilitators of implementing PGx using the Consolidated Framework for Implementation Research (CFIR). A qualitative study using an abductive analytical approach was conducted through semi-structured interviews with 15 cardiologists from public and private institutions. Participants were recruited via purposive, convenience, and snowball sampling. Interviews were transcribed verbatim and thematically analysed in NVivo. The CFIR guided the analysis across intervention characteristics, outer setting, inner setting, individual characteristics, and process. Clinicians expressed strong conceptual support for PGx, especially in higher-risk scenarios, but reported limited hands-on exposure and confidence. Barriers included perceived test complexity, cost, and lack of reimbursement; insufficient laboratory capacity and EHR integration; unclear workflows and role ownership; and turnaround times misaligned with acute care. Outer-setting constraints (ambiguous policy signals and payer criteria) and inner-setting variability (resources, leadership engagement, and communication pathways) further limited uptake. Reported facilitators included multidisciplinary service models (with input from pharmacists and genetics), targeted case-based training, initial deployment in non-acute contexts, and the structured capture of results with EHR-embedded clinical decision support. PGx implementation in cardiology within the UAE is shaped by structural, organisational, and workforce-level gaps. Addressing these through targeted clinical guidance, improved training, stronger reimbursement mechanisms, enhanced laboratory capacity, and integrated digital decision support may enable more equitable and scalable adoption. These findings provide actionable insights for health systems seeking to operationalise PGx within diverse or hybrid healthcare contexts.
Three enzyme immunoassays (EIAs) were evaluated on two platforms each for detecting Cryptosporidium, Giardia, and Campylobacter in stool samples compared to reference methods. The Cryptosporidium EIAs run on stool specimens in three preservative media showed 100% agreement with direct fluorescent antibody (DFA) testing and high correlation with the microscopic method. The Giardia EIAs demonstrated 100% concordance for positive, but only moderate overall correlation with the microscopic method. The Campylobacter EIAs had 93.5% sensitivity (out of 65 positives) and 100% specificity compared to the culture method. Automation on a DS2 system for these three EIAs, along with five others, yielded acceptable performance (92.5-100% accuracy, 100% precision) compared to manual methods. The automation saved labor time and improved operational efficiency, but may not be cost-effective for low-volume runs due to the labor required for automation not scaling proportionally with sample numbers. In conclusion, EIAs are preferred for detecting protozoan parasites in stool, with the Cryptosporidium EIA showing potential as a semi-quantitative assay and a reference method. Automation benefits high-throughput laboratories, but may not be as advantageous for low-volume laboratories.IMPORTANCEEnzyme immunoassay (EIA) is a widely used method in clinical laboratories to detect pathogens in stool samples related to diarrhea diseases. This study evaluated the performance of three EIAs for detecting Cryptosporidium, Giardia, and Campylobacter antigens compared to their gold standard methods. The Cryptosporidium EIAs matched the direct fluorescent antibody (DFA) testing and had a high correlation with microscopic findings (99.7%). The Giardia EIAs showed 100% concordance for positive but lower specificity (58%) and moderate correlation with microscopic results (87.4%). The Campylobacter EIA had 93.5% sensitivity (n = 65 positive samples) with few discrepancies. Automating these three and five other EIAs using a DS2 system (Dynex) yielded good accuracy (92.5-100%) and 100% precision compared to manual methods. While automation saved hands-on time for high-volume assays, it may not be cost-effective for low-volume laboratories.
Bloodstream infection is a time-critical diagnosis; however, the vast geographic distances in rural and remote locations lead to prolonged specimen transport times, which can impact the timeliness and quality of results. In this retrospective observational study, we evaluated the performance and timeliness of the BIOFIRE FilmArray Blood Culture Identification 2 (BCID2) nucleic acid amplification test conducted on positive blood culture broth fluid in two very remote hospital laboratories in the Northern Territory, Australia, and compared the results to conventional testing done in central laboratories in the laboratory network. We reviewed 343 blood cultures, from which 366 organisms were identified, collected between January 2021 and August 2024. In 207/228 (90.8%) blood cultures with at least one pathogen, the clinically significant organism(s) were detected by BCID2. Concordance between BCID2 and conventional identification methods for organisms on the BCID2 panel was 98.3% (95% confidence interval 96.1%-99.4%). Seventy-four organisms isolated had no BCID2 target; of these, 21 were pathogens, 15 of which were Burkholderia pseudomallei. A total of 126 organisms were considered contaminants; 71 (56%) of these were detected by BCID2. Importantly, BCID2 detections preceded conventional identification results by a median of 2.8 days (interquartile range 2.0-3.1 days). The BCID2 panel performed well in the hands of general scientists and substantially improved the timeliness of bloodstream pathogen identification in our setting. The need for additional targets, including B. pseudomallei and common contaminants, was identified.IMPORTANCEBloodstream infection is a life-threatening condition requiring urgent treatment, and blood cultures are the mainstay of diagnosis. Timely incubation and processing of blood cultures maximize yield and clinical utility; however, prolonged specimen transport times in rural areas can impact the quality of results. We investigated the performance and timeliness of a rapid multiplex nucleic acid amplification test (the Blood Culture Identification 2 [BCID2] panel) for detection of bacteria and yeasts in positive blood culture broth fluid in two small remote Australian hospital laboratories. Formal organism identification and susceptibility testing were subsequently conducted in larger, central laboratories. We found that the BCID2 panel detected the clinically significant organism(s) in 90.8% of blood cultures with at least one pathogen, with 98.3% concordance between BCID2 and conventional identification methods for organisms on the panel. BCID2 detections preceded conventional identification by a median of 2.8 days. The assay substantially improved the timeliness of bloodstream pathogen identification in the two remote regions.
Calcinosis cutis (CC) is disabling for systemic sclerosis (SSc) patients, and quantitative outcomes and treatments are needed. We performed computer-assisted mapping of CC lesions on computed tomography (CT) exams and quantified CC during sodium thiosulfate (STS) treatment. In a pilot study, SSc-CC patients underwent CT imaging of a painful lesion followed by 6-12 month 25% STS, intradermal monthly injections or twice daily cream, treatment. Post-treatment CT exams were obtained, and three assessors used open-source software (BIS Web) to map and quantify CC volume, termed Scleroderma Calcinosis Cutis Score (SC2S). Results were compared to the Scleroderma Clinical Trials Consortium Radiologic Scoring System for Hand Calcinosis as appropriate. Five women with SSc-CC involving the arm, ischial tuberosities, hands (two patients) and patellae, received topical (n = 2) or intradermal (n = 3) STS. Lesion mapping with BIS Web showed high inter-rater agreement between independent assessors (intraclass correlation coefficient = 0.93). SC2S revealed 75% and 10% reductions in left and right buttock, respectively; 28% reduction in arm; 18% increase in left forefinger; 27% increase in right hand; and 12% reduction in left, and 4% increase in right, patellae, respectively. CC volume differences on repeated measures one-week apart were ≤3%. Mapping time ranged from <30 minutes for arm and buttock, to > 4h for finger/hand and patellae. SC2S may be a highly reproducible, broadly applicable, quantitative outcome that is sensitive to CC change. SC2S highlights the variable response of SSc-CC to STS treatment. Future work to automate CC mapping will reduce lesion mapping time.
Despite notable differences in cancer incidence and outcomes, fewer American Indians have participated in cancer research and genomic testing relative to their population size. Contributing factors include historical scientific mistrust, lack of culturally appropriate research methodologies, and limited access. With the launch of a cancer genomic sequencing trial in American Indians from the Southwestern United States (US), clinicians and staff encountered challenges engaging patients, recognizing the complexity of research in this population. We describe a novel approach to educate study team members regarding genomic cancer testing and research in American Indian populations. Clinical faculty and staff investigators participated in (1) hands-on experiential workshops related to core beliefs and healthcare in American Indians and (2) the development of provider-facing educational materials. After participation in the workshops, investigators, including American Indian researchers, created two sets of provider-facing materials and implemented them in clinic. The first provided a summary detailing trial eligibility, procedures, and privacy safeguards. The second outlined topics fostering respectful engagement of American Indians in research, outlining core beliefs including the importance of family and community in decisions, a framework of inherent cycles in human life and nature, the importance of visual aids, and the complementary nature of traditional healing. An approach incorporating cultural training for clinicians and staff is feasible when engaging American Indians of the Southwestern US in genomic research. This methodology may serve as a model for future initiatives to engage with American Indians in cancer research and in both clinical and research related genomic testing.
To report 6 eyes of 4 patients with superior keratoconus and its occurrence in conjunction with inverse Bell phenomenon in which the eye rotates downward on eye closure. A retrospective review and analysis was performed on all patients with keratoconus who presented to our cornea service between August 2022 and December 2025. Patient demographics, clinical examination findings, and Pentacam anterior segment tomography imaging (Oculus, Arlington, WA) were reviewed. All patients with superior keratoconus had an inverse Bell phenomenon. A 27-year-old man (patient 1), a 15-year-old boy (patient 2), a 60-year-old man (patient 3), and a 29-year-old woman (patient 4) with clinical and topographic findings of keratoconus with a superior cone were identified. Patients 1 and 3 had unilateral superior keratoconus, and patients 2 and 4 had bilateral superior keratoconus. All patients initially denied eye rubbing, atopy, and family history of keratoconus; however, all patients slept on their side or face with their hands pressed against their eyes, and patients 1 and 3 had floppy eyelid syndrome. Superior keratoconus and inverse Bell phenomenon are both rare ophthalmic findings alone and co-occur in these patients. The inverse Bell phenomenon exposes the superior corneal to mechanical pressure on lid closure and further supports the role of mechanical pressure on the development of keratoconus.
To be clinically useful in goal-directed fluid therapy, a fluid challenge (FC) must achieve a large enough blood volume change (ΔBV) to materially change ventricular preload and stroke volume (ΔSV). The same % change in BV for all the subsequent FCs must also be achieved. We explored under what circumstances these prerequisites can be met by referring to data from a clinical trial where 111 patients underwent three successive intravenous FCs using crystalloid (Ringer´s lactate) or colloid (hydroxyethyl starch), involving a total of 9 mL/kg of fluid, just after induction of general anaesthesia. The three FC using crystalloid fluid increased SV by 2.5% while the colloid increased the SV by 29.2% (medians, P < 0.001). Moreover, crystalloid expanded the BV by 20.8% while the corresponding expansion by colloid was 29.5% (P < 0.001). The cardiac response to increased BV was normalized by calculating the ΔSV%/ΔBV% ratio, which was much lower at 0.12 for the crystalloid fluid versus 0.98 for colloid (P < 0.001). The poor SV response can possibly be explained by the underlying changes in the mean circulatory filling pressure, which suggest crystalloid FCs was less effective in increasing the stressed blood volume (preload). On the other hand, the inferior BV expanding effect of crystalloid is likely due to the fast tissue redistribution pharmacokinetic profile of administered boluses. Finally, the cardiac response to the first FC and impact on oxygen delivery became falsely low in both groups due to a reflex redistribution of a substantial volume of interstitial fluid into the circulation after anaesthetic induction. Differences in effectiveness between crystalloid and colloid fluid when providing repeated FCs increase the risk of false negative indications of fluid non-responsiveness when crystalloid is used.
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Mobile health consists of SMS reminders, smartphone applications, mobile telemedicine, and mobile applications that can improve access to healthcare, improve adherence to the treatment process, and facilitate communication between patients and providers. In Ethiopia, mobile health adoption is growing rapidly; however, there is limited systematic review research on how mobile health is currently being utilized and the factors influencing its use. This systematic review summarizes available studies to evaluate the current level of mobile health utilization in Ethiopia and what factors are related to its utilization. A systematic review was performed on PubMed, the Scopus database, African Journals Online, and Google Scholar as of November 25, 2025, for research articles that report the use of mobile health by patients, healthcare professionals, and university students in Ethiopia. The articles were reviewed and evaluated for quality of evidence, and data extraction was done using a standard template and the Joanna Briggs Institute method of determining the quality of evidence. Utilization rates for mobile health ranged from a low of 13% to a high of 71.2%, with increased levels of use noted for physicians, antiretroviral therapy patients, and students. On the other hand, younger-aged individuals, those living in urban areas, those who have received a college education, those who have a favorable attitude toward mobile health, and those who have technical skills, perceived usefulness, ease of use, internet access, and availability of technical support were all found to contribute positively to mobile health utilization. This systematic review identified varying levels of mobile health utilization across different settings and population groups in Ethiopia. Commonly reported factors associated with mHealth use included digital literacy, technical skills, internet access, positive attitudes toward mHealth, and availability of technical support. To increase the level of mobile health use, it is important to improve users' attitudes, provide technical support, enhance digital skills, and develop necessary infrastructures.
Valvuloplastic esophagogastrostomy using the double-flap technique (DFT) after proximal gastrectomy and lower esophagectomy for esophagogastric junction cancer (EGJC) is effective for reflux prevention and has a low anastomotic leakage rate, making it suitable for mediastinal reconstruction. When the transhiatal approach becomes difficult, intrathoracic reconstruction provides a safer option. Although several reports have described robot-assisted intrathoracic DFT, thoracoscopic intrathoracic DFT has been reported only in isolated cases, and its technical feasibility and reproducibility have not been evaluated as a case series. We present a consecutive six-patient case series of thoracoscopic intrathoracic DFT following laparoscopic proximal gastrectomy and lower esophagectomy. After preparation of a seromuscular flap, the remnant stomach was elevated into the thoracic cavity without torsion. The posterior esophageal wall was fixed to the flap using a single barbed suture placed in a continuous fashion with four bites, followed by 90° rotation of the esophagogastric axis to bring the anastomotic site into direct view. A full-circumference hand-sewn esophagogastrostomy using single-knot sutures was then completed, and the flap was closed. All procedures were completed thoracoscopically without conversion. The median reconstruction time was 78 minutes, and no anastomosis-related complications were observed. This case series demonstrates the technical feasibility and reproducibility of thoracoscopic intrathoracic DFT for mediastinal esophagogastrostomy. Standardized exposure using posterior fixation and 90° rotation allows stable intracavitary suturing and supports the safe application of this valve-forming reconstruction in the thoracic cavity.
Glass fiber-reinforced polymer composites (GFRP) are widely used in engineering applications thanks to their high performance. This research investigates how various hybrid reinforcement techniques influence the flexural and shear performance of GFRP laminates. The composite materials were produced by integrating nonwoven glass tissues with woven glass fabrics, along with single and hybrid nanoscale fillers. Silica (SiO₂) and carbon (C) nanoparticles at different weight fractions were selected as nano-reinforcements for their cost-effectiveness. Seven composite variants were made by hand lay-up, including an unmodified GFRP reference and six hybrid configurations. Sonication and magnetic stirring methods were used to disperse nanoparticles in the epoxy matrix uniformly. Flexural performance was assessed by the three-point flexural test, while shear performance was assessed using the short beam shear and Iosipescu tests to measure both in-plane and interlaminar shear strength. When compared to the unmodified GFRP reference, samples with 0.5 wt% carbon black showed better shear and flexural performance. Hybrid reinforcement using 0.25 wt% carbon black combined with 0.25 wt% silica achieved the highest flexural strain increase (21%) and an 8% gain in flexural strength. This indicates improved ductility without compromising shear performance. However, higher concentrations of hybrid fillers negatively affect mechanical behavior.
Accurate stress monitoring is critical for high-risk professions like firefighting, yet existing wearable solutions face challenges balancing accuracy with practical usability. While electrodermal activity (EDA) offers a non-invasive, single-sensor approach, current automated feature extraction methods fail to capture stress-discriminative patterns effectively. We developed a hybrid stress detection pipeline combining 20 hand-crafted physiological features with 32 deep-learned features from a supervised convolutional autoencoder. Unlike traditional unsupervised approaches optimized solely for signal reconstruction, our architecture employs a dual-head design with weighted classification loss to guide feature learning toward stress discrimination. The system was validated on the WESAD dataset (15 subjects) using rigorous leave-one-subject-out (LOSO) cross-validation, along with comprehensive preprocessing, including cvxEDA decomposition, adaptive artifact detection, and physiological peak validation. Our optimized K-Nearest Neighbors classifier achieved 98.62% accuracy, surpassing the industry-standard PyEDA benchmark (97.0%) by 1.62 percentage points. The model demonstrated 97.58% sensitivity (true positive rate) and 98.92% specificity (true negative rate), with only 2.42% false negatives-critical for safety-critical applications. Ablation studies revealed that unsupervised autoencoder features alone achieved only 55% accuracy, increasing to 89% with supervised learning and 98.62% with the hybrid approach, representing a 43.62-percentage-point improvement. This work demonstrates that combining domain-specific physiological knowledge with label-aware deep learning produces more discriminative features than either approach alone. The resulting system successfully translates complex probabilistic outputs into an interpretable 1-10 stress score, providing a practical foundation for real-time stress monitoring in wearable devices for first responders.
Neurodiversity and Autism - A Critical Examination of a Popular Concept Abstract: Neurodiversity refers to the natural diversity of human beings and thus emphasizes the natural range of differences between people. As simple, convincing, and popular as this assumption is, the interpretations, conclusions, and implications of this statement are just as varied. This article focuses on the scientific basis of the concept, on the one hand, and on autism and divergence, on the other. It outlines the implications regarding biological determinism, identity, and the effects on diagnosis and therapy, and examines and critically reflects on the demands arising from the concept. The author concludes that the claim of "neurological difference" posited in the context of neurodiversity - which asserts a fundamental, innate distinctiveness and, at the same time, a specific mode of functioning, as well as the determination of a person´s identity by these factors - has not been sufficiently substantiated by empirical research. Clinical evidence regarding the etiology, heterogeneity, course, and changeability of the diagnoses encompassed by this concept is not compatible with the assumed determinism regarding a person´s identity. Neurodiversity is an important approach to reducing stigmatization and promoting acceptance of difference, but diversity should not be limited by new stereotypes, and in-group-out-group processes are not helpful regarding acceptance, openness, and tolerance. Diagnoses instrumentalized in the sense of identity formation, stabilization, and justification for otherness do not imply an appreciative attitude toward those whose deficits, limited behavioral and developmental possibilities, suffering, and impairments are described by the diagnoses. Zusammenfassung: Unter Neurodiversität wird die natürliche Vielfalt menschlichen Seins verstanden und damit die natürliche Bandbreite der Unterschiede zwischen Menschen betont. So einfach wie überzeugend und populär diese Annahme ist, so verschieden sind die Auslegungen und Implikationen. In diesem Artikel wird auf die wissenschaftliche Fundierung des Konzepts sowie auf die Thematik des Autismus im Sinne von Divergenz fokussiert. Es werden die Implikationen in Bezug auf biologische Determiniertheit, Identität, Auswirkungen auf Diagnostik und Therapie dargestellt, sowie auf die sich aus dem Konzept ergebenden Forderungen eingegangen und kritisch reflektiert. Zusammenfassend lässt sich nach Einschätzung der Autorin zu den Implikationen sagen, dass die im Sinne der Neurodivergenz angenommene „neurologische Differenzbehauptung“ in der behaupteten grundlegenden, angeborenen Verschiedenartigkeit und gleichzeitig spezifischen Funktionsweise sowie deren Determinierung für die Identität einer Person durch empirische Forschung nicht ausreichend belegt ist. Neurodiversität ist ein wichtiger Ansatz, um Stigmatisierung zu reduzieren und Akzeptanz für Andersartigkeit zu fördern, jedoch sollte die Vielfalt nicht durch neue Stereotypien eingeschränkt werden, und In-Group-Out-Prozesse sind im Sinne von Akzeptanz, Offenheit und Toleranz nicht hilfreich. Diagnosen zu instrumentalisieren im Sinne einer Identitätsfindung, -stabilisierung und Berechtigung für Andersartigkeit lässt daran zweifeln, dass eine wertschätzende Haltung gegenüber denen eingenommen wird, deren Defizite, eingeschränkte Verhaltens- und Entwicklungsmöglichkeiten, Leid und Beeinträchtigung, die Diagnosen beschreiben.
Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) in children refers to the systemic mineral and bone metabolism disorders caused by CKD, including biochemical abnormalities, abnormalities in bone turnover, mineralization, quality, and ectopic calcification. Like the adult patients, mineral metabolism and bone structure abnormalities are universally present in children with CKD. But there have been no guidelines specifically for the children in the past. The medication treatment and clinical practices for children are usually based on those for adults, lacking targeted guidance. On the one hand, the children are in the process of growth and development, and the adult guidelines do not take into account the characteristics of children. On the other hand, the medication range for children is different from that of adults, and new drugs have been verified and tested in children. Hence, based on the developmental characteristics of children, combined with expert opinions from adults, children, kidney, nutrition, and medicine, this guideline was initiated by the Subspecialty Group of Nephrology, the Society of Pediatrics, Chinese Medical Association. It answered 15 important clinical questions related to the diagnosis and treatment of pediatric CKD-MBD, aimed to provide individualized treatment plans considering the clinical characteristics of CKD children and their treatment goals, while also addressing the needs of their growth and development.