Communication is a cornerstone of medical practice. Clear dialogue between healthcare professionals, patients, and families underpins trust, shared decision-making, and patient satisfaction. Remote consultations have increased reliance on telephone communication, introducing additional challenges. Communication is already a leading source of healthcare complaints, and remote interactions can further complicate clarity, empathy, and structure. To address these challenges, a structured telephone communication tool, ISBAR Plus, was developed. This tool builds on the established ISBAR framework ('Introduction', 'Situation', 'Background', 'Assessment', 'Recommendation'), already used for clinical communication in healthcare settings, and adapts its core principles for telephone-based delivery of difficult information. The ISBAR Plus tool comprises 'Prepare', 'Introduction', 'Situation', 'Background', 'Acknowledge shock', 'Recommendation', with each element containing detailed description. A dedicated ISBAR Plus training programme was also designed to support nurses and doctors in applying the tool effectively in practice. To evaluate the impact of the ISBAR Plus telephone communication tool and associated training programme on nurses' and doctors' ability to deliver bad news by telephone. A single-group pre-post quantitative study assessed simulated telephone communication performance of nurses and doctors when breaking bad news, before and after ISBAR Plus training. A 'yes/no' 20-point content and clarity checklist was used, together with a Global Rating Score (GRS) measuring overall communication quality. Participants completed a feedback questionnaire to evaluate the tool's practicality and perceived value. Seventy-four participants completed the study. The proportion achieving full marks for content and clarity increased from 1% pre-training to 49% post-training. Overall communication quality scores improved from 15% to 51% (p < 0.001). Participant feedback was highly positive: 99% reported that ISBAR Plus was practical and applicable to clinical practice, and 91% recommended that the training be delivered annually to staff. Implementation of the ISBAR Plus tool and structured training programme demonstrated an association between the intervention and improved performance in an educational context. A significant improvement in nurses' and doctors' performance and overall quality in delivering bad news via telephone in a simulated environment was observed. The intervention was well received and demonstrates strong potential as a practical, scalable approach to standardising and improving remote clinical communication.
Sustained attention is a core cognitive function, frequently declines with age and neurological disease, and is highly relevant for functional outcomes in geriatric populations. Electroencephalography (EEG) offers high temporal resolution for assessing attentional processes, but its feasibility in multimorbid geriatric inpatients remains insufficiently characterized. This study evaluated the procedural and methodological feasibility of EEG-based sustained-attention assessments in geriatric inpatients undergoing early rehabilitative geriatric complex treatment (ERGCT). Geriatric participants completed standardized neuropsychological testing and two computerized attention tasks, the Psychomotor Vigilance Task (PVT) and a cued Go-NoGo task, during 32-channel EEG recording, including a resting-state recording. Feasibility was assessed using procedural indicators (recruitment, task completion, follow-up participation) and methodological indicators of EEG data quality, specifically the signal-to-noise ratios (SNR) and identification of expected event-related potential (ERP) components (P100, P300). Of 173 patients referred to the ERGCT programme, 43 could be included. Of those, 38 could undergo structured cognitive testing, and resting-state EEG and task-evoked ERPs could be recorded with adequate signal quality However, procedural feasibility was limited by substantial selection and attrition, resulting in incomplete protocol completion. Exploratory analyses suggest an association between higher resting-state alpha-band signal quality and faster PVT reaction times, whereas no associations were observed with global cognition, executive function, or age. Overall, resting-state and task EEG measures of sustained attention could be acquired with adequate data quality only in a selected subgroup of geriatric inpatients, who were able to participate in structured cognitive assessments, while extended and repeated assessment protocols were constrained by procedural burden, suggesting that EEG-based follow-up assessments are difficult to implement under current clinical conditions.
Laparoscopic anatomical resection of segment IV remains challenging because of its complex anatomy and lack of reliable intraoperative landmarks [1]. We present a novel technique that uses the umbilical fissure vein (UFV) and middle hepatic vein (MHV) as primary guides to achieve accurate resection boundaries. The procedure consisted of four key steps: (1) left-sided parenchymal transection along the UFV; (2) dissection of the hilar plate from the left transection plane to individually ligate segment IV Glissonian pedicles; (3) indocyanine green fluorescence to demarcate the ischemic boundary; (4) right-sided parenchymal transection guided externally by the ischemic line and internally by the MHV. The operation was completed successfully, with no intraoperative complications and an uneventful postoperative recovery. Laparoscopic anatomical segment IV resection guided by the UFV and MHV appears safe, feasible, and effective.
Laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) involving the right posterosuperior area (segments 7 and 8) remains technically demanding because of the deep anatomical location of these lesions and their close relationship to the right hepatic vein (RHV) and inferior vena cava (IVC). This study evaluated the safety, technical feasibility, and perioperative outcomes of a novel stratified selective outflow control (SOC) technique developed to optimize vascular management during complex laparoscopic hepatectomy. A retrospective analysis was performed of 22 consecutive patients who underwent SOC-assisted LLR for HCC located in the right posterosuperior area between January 2024 and January 2026. Preoperative three-dimensional (3D) reconstruction and territory-based simulation were used to guide individualized operative planning. According to the extent of venous involvement, the SOC strategy was stratified into two anatomical approaches: the RHV Occlusion method, applied to tumors involving the RHV while sparing the IVC wall, and the Total Outflow Occlusion method, reserved for tumors involving the IVC or the RHV-IVC confluence. All procedures were completed laparoscopically without conversion to open surgery. The median operative duration was 233.0 min, and the median estimated blood loss was 200 mL. R0 resection was achieved in all patients, with a median surgical margin of 1.5 cm. Minor postoperative complications (Clavien-Dindo grade I-II) occurred in 59.1% of patients. Major complications (grade ≥ III) were limited to 9.9% and consisted of 2 cases of grade IIIa symptomatic pleural effusion requiring percutaneous drainage, both of which resolved successfully. No perioperative mortalities or 30-day readmissions occurred. SOC-assisted LLR represents a safe, technically feasible, and reproducible strategy for HCC in the right posterosuperior segments. Its stratified framework enables individualized vascular control, facilitates precise R0 resection, and supports safe management of anatomically complex tumors.
Some jurisdictions use blood delta-9-tetrahydrocannabinol (THC) thresholds of 2ng/mL and oral fluid THC thresholds of 25ng/mL for detection of impaired driving. This study assesses morning-after driving and cognitive performance following evening cannabis use in participants above or below the 2ng/mL blood and 25ng/mL oral-fluid THC thresholds. This observational study included frequent cannabis users (≥ 4 times/week) who smoked their preferred cannabis at home the evening before laboratory testing. At the visit (12-15 h post-use), participants completed driving simulation trials and underwent cognitive testing (verbal free recall and trail making test). Blood and oral fluid samples were collected at the time of testing for cannabinoid quantification. Outcomes were compared between participants above versus below the blood and oral fluid THC cut-offs, with correction for multiple comparisons. Sixty-five frequent users participated. For driving outcomes, participants with blood THC ≥ 2 ng/mL showed greater variability in following distance than those below the cut-off (Cohen's d = - 0.58), and those with oral fluid THC ≥ 25 ng/mL demonstrated slower reaction time (Cohen's d = - 0.85); however, neither effect remained statistically significant after correction for multiple comparisons. Participants with oral fluid THC ≥ 25 ng/mL performed significantly worse on Trail Making Test A and B, with large effect sizes (Cohen's d > 1.0) that remained significant after corrections, and showed worse delayed verbal free recall with medium-to-large effect sizes, which did not remain statistically significant after corrections. Blood THC cut-offs were associated with medium effect sizes on cognitive measures, but these did not remain statistically significant after correction. Per-se THC cut-offs showed subtle associations with simulated driving performance, but clearer associations with changes in cognitive performance, particularly for oral fluid THC. These findings highlight the limitations of relying solely on biological THC thresholds to infer impairment during the residual phase.
Olfactory stimulation may enhance respiratory drive in preterm infants without respiratory support. The aim of this study was to assess the efficacy of olfactory stimulation on apnea of prematurity (AOP) in preterm infants receiving nasal continuous positive pressure (nCPAP). This randomized, placebo-controlled, double-blind cross-over study enrolled preterm infants born between 23 0/7 and 31 6/7 weeks of gestation receiving nCPAP and treatment with caffeine citrate. Vanilla or strawberry odor, or an odorless placebo solution, was applied to the nCPAP masks with an odor pen. The primary outcome was the number of desaturation and bradycardia episodes. Secondary outcomes included physiological parameters and feeding tolerance. Eighty preterm infants completed the study. The median (interquartile range) number of events during the 12-hour study period was 10 (3-27) in the intervention group and 14 (3-29) in the control group (p = 0.82). No significant differences were observed in any secondary outcome measures with either vanilla or strawberry odor. This study did not demonstrate an effect of olfactory stimulation on the number of desaturation and bradycardia episodes in very preterm infants receiving nCPAP. Future research may focus on optimizing methods for delivering olfactory stimuli to infants on non-invasive respiratory support. Clinical trials have demonstrated that olfactory stimulation, using odors such as vanilla, may reduce the frequency of apnea and desaturation episodes in spontaneously breathing preterm infants. This study evaluates the effect of olfactory stimulation with vanilla and strawberry odor on the respiratory drive of preterm infants receiving nasal continuous positive pressure support - the population most severely affected by the apnea of prematurity. In this population, olfactory stimulation did not significantly reduce the number of desaturations and bradycardia. Future research may focus on optimizing delivery methods to ensure that olfactory stimuli are effectively perceived by infants on non-invasive respiratory support.
Micro-C and Region Capture Micro-C (RCMC) are developments of chromosome conformation capture (3C) genomics methods used to identify regions of the genome in close 3D proximity at nucleosome resolution. Micro-C uses in situ MNase digestion of crosslinked chromatin, biotin labeling, proximity ligation and biotin pulldown to recover ligated nucleosomal DNA fragments, with RCMC including a subsequent capture step to enrich for specific regions of the genome. This presents an advantage over previous approaches, such as Hi-C, which rely on restriction enzymes: by digesting the genome without requiring sequence motifs and performing size selection for ligated mononucleosomes, Micro-C can achieve nucleosome-scale resolution of 3D genome organization. The addition of tiled capture of a region allows for deeper sequencing of a location of interest or for experiments with many conditions to be performed while avoiding costly sequencing of the entire genome. Micro-C enables the identification of all known 3D genome features, including interactions between enhancers and promoters that have been missed by previous methods. RCMC can achieve even greater depth and the identification of even more finely resolved interactions. The Micro-C protocol can be completed in 4 d, with an extra 2 d to complete capture, and can be performed by a competent wet laboratory scientist with experience in molecular biology.
Sleep disturbances during adolescence heighten risk for physical and behavioral health problems, yet sleep physiological markers critical to health outcomes are rarely assessed in pediatric care. Wearable single-channel electroencephalography (EEG) devices may offer scalable, ecologically valid methods for assessing sleep physiology in home settings. This study evaluated whether single-channel sleep-EEG metrics were associated with physical and behavioral health in adolescents. Eighty-five community-derived adolescents (ages 11-17, 50% female) completed seven consecutive nights of at-home, single-channel sleep-EEG, physical health assessments (i.e., body mass index and blood pressure), and subjective sleep and behavioral health measures. Parents provided psychiatric diagnosis history. Odds of being overweight/obese decreased with greater REM duration (- 2.72% per minute) and higher REM percentage (- 100% per 1%). Odds of hypertension decreased with greater time spent in stage 3 (N3) (- 4.78% per minute). Multivariate analyses showed reduced N3 sleep was associated with parent-reported ADHD symptoms, whereas shorter total sleep time, lower sleep efficiency (SE), and longer sleep onset latency (SOL) were associated with higher adolescent-reported ADHD and conduct problems (p's < .05). Odds of an ADHD diagnosis increased with longer SOL (+ 1.92% per minute) and slower N3 decline (+ 89.4% per 0.01 units) but decreased with higher SE (- 7.78% per 1%). Odds of an internalizing disorder increased with higher SE (+ 12.4% per 1%) and greater wake after sleep onset (+ 3.18% per minute), but decreased with more REM sleep (- 9.62% per minute). Findings highlight the clinical value of wearable sleep-EEG for detecting sleep-related risk processes during adolescence. By capturing physiological features not accessible through self-report, at-home sleep-EEG may flag youth who could benefit from sleep-focused interventions, complementing routine care in identifying risk of future health problems. Integrating such tools into pediatric settings could support more precise, developmentally informed approaches to prevention and intervention. Sleep disturbances are common during adolescence and increase risk for physical conditions such as obesity and hypertension, as well as behavioral health problems, yet sleep physiology is rarely adequately assessed in pediatric care. Wearable single-channel EEG offers an accessible way to capture sleep architecture and continuity that subjective reports cannot provide. This study shows that EEG-derived sleep features, including REM, N3 sleep, sleep efficiency, and sleep-onset latency, are associated with physical and behavioral health outcomes above and beyond adolescent and caregiver reports. These findings highlight the potential value of integrating wearable EEG into routine care to identify sleep-related vulnerabilities and support targeted prevention efforts.
Physiological and psychological changes following childbirth can increase injury risk, and reduce physical performance in servicewomen, yet evidence to inform guidelines for preparing postpartum servicewomen to return to military service is limited. This study examined the efficacy of a rehabilitation and physical development intervention for returning servicewomen to occupational fitness postpartum. UK-based servicewomen were assigned to a training (INT; N = 17) or control (CON; N = 14) group 6-weeks postpartum in a non-randomised controlled trial. CON received standard postpartum care, whilst INT received standard care plus an 18-week rehabilitation (core and pelvic floor exercises) and supervised physical development (resistance training and HIIT) programme. Participants were assessed between 6 and 24 weeks postpartum for occupational performance (primary outcome) and pelvic health, psychological well-being, and musculoskeletal health (secondary outcomes). 11 INT and 9 CON participants completed all visits. INT participants demonstrated high adherence to core reconnection and physical development training (96%) and reported no adverse events. Significant group x time interactions favouring INT were shown for occupational performance outcomes, including mid-thigh pull, vertical jump, and 2 km run time-trial (all p ≤ 0.05, 12.7-14.5% improvements), but not for medicine ball throw (p = 0.643). INT had superior improvements over CON in body composition, pelvic health, and psychological well-being (all p < 0. 05). A combined rehabilitation and physical development programme was well-adhered to, did not result in any adverse events, and was more effective than standard postpartum care in improving occupational performance, pelvic health, body composition, and psychological well-being amongst servicewomen. These findings help inform best-practice guidelines for returning postpartum servicewomen to occupational fitness.Trial registration: ClinicalTrials.gov NCT04332757, Date 05/2021.
ENabling VISions And Growing Expectations (ENVISAGE) is a programme focused on strengths-based approaches to child development, empowering parents of children with neurodevelopmental disabilities. The established ENVISAGE-Families and ENVISAGE-Service Providers programmes have been evaluated through several studies, demonstrating positive impacts. Building on the success of these programmes, an 'integrated' version was co-developed and co-delivered to both parents and service providers through five online weekly workshops, encouraging both groups to learn with and from each other. A pilot study was conducted to evaluate ENVISAGE-Integrated. The programme was delivered in five cohorts of five to eight participants each, co-facilitated by a parent and service provider from the ENVISAGE research team. Participants completed five weekly workshop surveys and a semi-structured interview after the programme. Quantitative data from surveys were analysed using descriptive statistics and Mann-Whitney tests. Qualitative data from semi-structured interviews were explored using thematic analysis. Nineteen service providers and 11 parents of children with neurodevelopmental disabilities participated in the programme at one children's treatment centre. Survey responses indicated high levels of agreement regarding comfort, perceived learning and meaningfulness of participating with parents and service providers. Thematic analysis generated three themes that reflected the perceptions and experiences of both parents and service providers: (i) reaffirmation of the importance of collaborating and relationship-building; (ii) expansion of understanding how to work together; and (iii) appreciation for each other's realities as people first and foremost. A fourth theme relevant to parents was a sense of connection and support from other parents' shared experiences. A fifth theme relevant to service providers was validation of clinical practice through alignment of content with parent values. ENVISAGE-Integrated offered benefits by facilitating collaborative learning between parents and service providers. Although findings are promising, ENVISAGE-Integrated requires thoughtful recruitment and balanced group composition to ensure the programme benefits both parents and service providers.
The ongoing epidemic of nicotine vaping use in adolescents and young adults presents a significant health concern, yet the long-term effects of nicotine vaping remain largely unknown. The present study aimed to investigate how nicotine vapor intake early in life influences reward-seeking behavior immediately after exposure and later in adulthood. Experiment 1 was completed in 3 phases. In Phase 1, 24 male adolescent Sprague-Dawley rats (PND = 58) were passively exposed to vehicle (propylene glycol/vegetable glycerin, 50/50) or nicotine (24 mg/mL) vapor and immediately tested in a Progressive Ratio (PR) task that utilized food pellet delivery as reinforcement for 10 consecutive days. In Phase 2, the PR testing was replicated in early adulthood (PND = 140), with groups further divided into four groups: No exposure, adolescent exposure, early adulthood exposure, and both adolescent and early adulthood exposure. Lastly, in Phase 3, during late adulthood (PND = 341), all four vapor groups underwent nicotine vapor self-administration (NVSA) testing (6 mg/mL). For Experiment 2, 16 male young adult Wistar rats received vehicle or nicotine vapor deliveries during the PR task. Rats were given access to increasing concentrations of nicotine (1, 3, 6, 12, 24 mg/mL) for two days at each concentration. After the PR tests, the rats were given two additional days of NVSA (24 mg/mL) on a Fixed Ratio 1 (FR1) schedule of reinforcement. Experiment 1 revealed that adolescent but not adult exposure to 24 mg/mL of nicotine vapor, resulted in an increase in both active and inactive lever presses relative to controls. Notably, rats in the adolescent and early adulthood exposure groups displayed significant increases in active but not inactive port nosepokes later in life, when compared to rats that were not previously exposed to nicotine vapor. Experiment 2 revealed no group differences in responding for vapor deliveries in the PR task when testing young adult rats. However, there was more active port nosepoking compared to vehicle vapor controls, when testing using an FR1 schedule of reinforcement. These results demonstrate that exposure to nicotine vapor early in life may increase nicotine seeking behavior in adulthood, suggesting that restricting early e-cigarette use may reduce future nicotine intake and the negative health consequences associated with its use.
Users of semaglutide for weight management (SEMA-WM) may not follow the recommended treatment regimen. We investigated SEMA-WM treatment patterns among Danish adult users. A questionnaire-based survey was conducted across 28 Danish community pharmacies between March and May 2025. Adults redeeming a SEMA-WM prescription were invited to participate, with first-time users invited to a follow-up survey after 6 months. Of 1470 individuals invited, 767 (52%) completed the questionnaire. Forty-five percent used 1 mg as their current dose, and 8% expected to reach 2.4 mg. Ten percent reported dosing SEMA-WM by "counting clicks" on the injection pen, in contrast with official prescribing guidelines. Users treated for 1-3 months reported a median weight loss of 6% (IQR 3-7), increasing to 12% (IQR 9-14), 17% (IQR 12-21), and 20% (IQR 15-26) for those treated for 3-6 months, 6-12 months, and > 1 year, respectively. Weight loss by treatment duration was similar among 1 mg users. Twenty-four percent reported reduced/discontinued concomitant medication use following SEMA-WM initiation, especially for muscle/joint pain (30%) and antihypertensives (24%). Reduced/discontinued medication use was similar among 1 mg users. Among 42 first-time users, 83% were still using SEMA-WM after 6 months, usually 1 mg (60%). Among users who had discontinued treatment (17%), side effects were the most reported reason. Many SEMA-WM users remained on 1 mg and reported weight loss and medication reductions similar to the overall cohort. Findings indicate that some users appear to obtain the desired effect at 1 mg, underscoring the need for better guidance on individualized treatment trajectories.
Balneotherapy is a potential complementary approach for sleep problems, but its short-term sleep effects and accompanying biological changes remain unclear. We conducted a prospective single-arm, self-controlled pilot study of 30 adults with sleep disorders, who completed a 10-day residential hot spring balneotherapy program (twice daily at 09:00 and 20:00, 30 min per session, 40-42 °C) at Tianhe Hot Spring, Sichuan Province, residing on-site and receiving identical meals throughout the intervention. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and wrist-worn wearable tracking. Serum neurotransmitters, inflammatory cytokines and tryptophan-kynurenine metabolites were assayed, while 16 S rRNA-based gut microbiota profiles were profiled pre- and post-intervention. Post-intervention, PSQI scores decreased, while wearable metrics indicated longer total and nocturnal sleep duration, elevated deep-sleep duration and proportion, better sleep continuity, and a lower rapid eye movement (REM) percentage (P < 0.05). Blood pressure, anxiety/depression scores, and wearable-derived sleep-stress indices also improved. Biomarker profiling revealed elevated GABA, 5-HT, 5-HIAA, BDNF, and IL-10, alongside reduced IL-1β, IL-6, and TNF-α (P < 0.05). Trp metabolism shifted, characterized by decreased Trp and increased 3-HAA and PA (P < 0.05). Structurally, the gut microbiota exhibited an increased abundance of Blautia_A (P < 0.05), with LEfSe analysis identifying post-intervention enrichment of Turicibacter and pre-intervention predominance of Agathobacter. Cross-system network analysis further established 5-HT, IL-6, and IL-10 as the core candidate biomarker profile directly correlating with these multi-domain sleep improvements. Overall, short-term residential hot spring balneotherapy may improve subjective and wearable-derived sleep outcomes, accompanied by coordinated cardiovascular, stress-related, neuroimmune, tryptophan-metabolic, and gut microbiome changes, supporting a multi-system physiological basis for balneotherapy-related sleep improvement.
We tested the hypothesis that the oxygen uptake (V̇O2) associated with systematic changes in skin temperature (Tsk) during ramp-incremental exercise would coincide with the respiratory compensation point (RCP) and not the gas exchange threshold (GET). Thirty-eight healthy adults (16 females; 24 ± 5 years, body mass 73.0 ± 11.4 kg, height 174.8 ± 8.5 cm) completed a ramp-incremental exercise test on a cycle ergometer (20-45 W/min depending on self-reported aerobic fitness; selected to induce task disengagement within 10-15 minutes) in a climate-controlled laboratory. Throughout the protocol, ventilatory and gas exchange variables were acquired breath-by-breath using a metabolic cart and Tsk of the posterior calf was recorded revolution-by-revolution using an infrared camera. The Tsk-time relationship exhibited either an abrupt or gradual deceleration as exercise time progressed. The V̇O2 associated with this change-point was identified visually or by finding the local maximum of the second derivative of a 6th-order polynomial fit to the data. The V̇O2 at GET and RCP were determined visually. Overall, the V̇O2 at GET, RCP and Tsk breakpoint identified visually or modelled were 1884±466, 2633±747, 1969±462, and 1769±508 mL∙min-1, respectively. Compared to the V̇O2 at GET, higher values were reported when Tsk breakpoint was identified visually (p=0.04, ESg=0.3, 95%CI[1, 170 ml/min]) and lower by the second derivative (p<0.01, ESg=0.4, 95%CI[30, 199 ml/min]). Larger effect sizes were observed for RCP (visually: p<0.001, ESg=1.3, 95%CI[524, 803 ml/min]; second derivative: p<0.001, ESg=1.7, 95%CI[724, 1003 ml/min]). Intraclass correlation of V̇O2 between Tsk and GET ranged from very good-to-excellent (0.67-0.92) but were not significant for RCP. For GET, mean absolute percentage error was 12.5% (95%CI: 9.4-15.7%) and 14.5% (95%CI: 11.1-17.9%) for the visual and second-derivative methods, respectively, and for RCP, 23.2% (95% CI: 18.6-27.8%) and 31.4% (95% CI: 26.7-36.2%). Findings suggest a statistical association between intensity-dependent changes in metabolism and the Tsk response of the calf.
Individuals with incomplete spinal cord injury are at an increased risk of falls due to impaired balance control. Our group previously developed a closed-loop visual feedback balance training (VFBT) system combined with functional electrical stimulation (FES) therapy to provide standing balance therapy (FES+VFBT system). However, its clinical use has been limited by the reliance on force plates, which are costly and not widely available. The purpose of this study was to develop and evaluate a clinically accessible FES+VFBT system that uses a depth camera in place of a force plate to provide center of mass (COM) feedback. Ten neurologically intact participants (6 males, 4 female) completed three sets of four balance exercises. The COM estimates from the depth camera-based system showed very good correlation with the force plate-based system (r AP > 0.85; r ML > 0.7) and low root mean squared error, RMSE, (RMSE AP < 0.009 m; RMSE ML < 0.017 m). The stimulation profiles derived from the COM estimates from the depth camera-based system also closely matched those from the force plate system (RMSE < 1.8 mA). These results demonstrate that the proposed depth camera-based FES+VFBT system performs comparably to the original system, offering a more accessible solution for balance therapy in clinical settings.
The aim of the present study was investigating the relationship between thyroid hormone levels and cognitive function in Parkinson's disease (PD). 431 PD patients were continuously enrolled from The First Affiliated Hospital of Kunming Medical University between January 2019 and December 2024. This study classified PD patients into PDNC and PDMCI groups based on the PDMCI diagnostic criteria defined by MDS. Clinical information including age, gender, length of illness, BMI, education, and levodopa equivalent daily dose (LEDD), and the presence of underlying diseases such as hypertension and diabetes mellitus were collected from all subjects, and all subjects completed the assessment of UPDRS-III score, H-Y staging, MMSE, MoCA (Beijing version), HAMA, and HAMD scale and underwent the evaluation of thyroid hormone serum T3, T4, FT3, FT4, TSH, TG, TMab, and aTG levels. The differences in general clinical data and thyroid hormone levels between the two groups were compared, and the correlation between thyroid hormone levels and each clinical data and different cognitive domains was analyzed. Patients in the PDMCI group were older, had a higher proportion of females, had a longer disease duration but fewer years of education, and had higher UPDRS-III, H-Y staging, HAMA, HAMD scores, and LEDDs and lower TSH (all p < 0.05) than those in the PDNC group, but there were no statistically significant differences in comorbidities or thyroid-related markers. In PD patients, FT3 levels were negatively correlated with age, HAMA score, HAMD score, and H-Y staging; FT3 levels were positively correlated with the total MoCA score (p < 0.05) and attention (r = 0.165, p = 0.001), and this association remained independent and significant after multivariate adjustment and multiple-testing correction. The dose-response relationship between TSH levels and cognitive scores shows a clear inverted U-shape. This study suggests that thyroid hormone dysregulation may be associated with cognitive function in Parkinson's disease patients, though this relationship requires further investigation to confirm. This highlights the need for future research to evaluate whether therapeutic modulation of thyroid function could influence cognitive outcomes during the progression of Parkinson's disease.
Advance decisions are a key component of advance care planning (ACP) and support individuals in communicating their preferences for future medical care. Despite policy efforts to promote ACP, public awareness and engagement in completing advance decisions remain limited in many settings. Educational robots, which provide interactive and engaging learning experiences, may represent a novel strategy for delivering ACP education in community settings. This study aimed to examine older adults' acceptance of an educational robot designed to facilitate learning about advance decisions. Specifically, we investigated factors associated with their intention to continue using the robot to learn about advance decisions and their intention to recommend the robot to others for advance decisions education. A cross-sectional survey was conducted among older adults recruited from community centers in northern Taiwan. After providing informed consent, participants attended a 90-minute robot-assisted educational session introducing key concepts of advance decisions and ACP. Following the session, participants completed a self-administered questionnaire assessing human-computer trust, decisional balance (perceived pros and cons of advance decisions), personal involvement, satisfaction with the robot-assisted learning experience, intention to continue using the educational robot, and intention to recommend the robot to others. Partial least squares structural equation modeling (PLS-SEM) was used to test the proposed relationships among study variables. Human-computer trust significantly increased older adults' intention to continue using the educational robot, both directly and indirectly through satisfaction with the learning experience. Trust also influenced participants' intention to recommend the robot to others indirectly via satisfaction. Perceived benefits of advance decisions were positively associated with recommendation intention, whereas perceived barriers showed no significant effects. Neither the perceived benefits nor barriers of advance decisions significantly influenced the intention to continue using the robot. Overall, satisfaction emerged as a key mediator linking trust to behavioral intentions related to robot-assisted ACP education. Trust in the technology and satisfaction with the learning experience play critical roles in shaping continued engagement and willingness to recommend such interventions. Integrating interactive technologies into ACP education may help expand public awareness and promote broader engagement in advance care planning.
Poor dietary quality is linked to a variety of adverse health outcomes, including increased incidence of cardiovascular disease, diabetes and some cancers. However, the trait of food neophobia (FN), which is associated with rejection of novel, intense, unusual, or otherwise arousing, foods, has been found to be an obstacle to achieving dietary variety, the results of which are evident in lower overall dietary quality in high FN adults. It remains to be determined if the dietary impact of increasing FN is reflected in greater prevalence of health problems generally or indeed has a negative impact on satisfaction with health status. In this study, several large adult participant groups from the USA, UK, and Australia completed the Food Neophobia Scale and the 12-Item Short-Form Health Survey (SF-12). This scale is sensitive to the presence of a wide array of physical and psychiatric conditions, and has been found to reflect significant associations between diet and physical and mental health. Across all participant groups, significant declines in both the physical and mental health sub-scales of the SF-12 were evident with increasing FN, as well in the total SF-12 score. Other variables that have an impact on health - gender, age, education, country of residence - also influenced SF-12 scores but did not account for the impact of FN. This suggests that adult FN at moderate to high levels is a health risk factor. These data underline the importance, particularly evident in recent research, of understanding the relationship between personality factors and food preferences and choices.
Increasing work pressure has elevated burnout risk among Chinese nurses; identifying associated factors and developing predictive models are essential for early intervention. This study aims to develop a nurse burnout prediction model based on machine learning algorithms in order to assist nursing management in the future. A cross-sectional online survey of 1391 Chinese nurses (burnout rate: 75.7%) was conducted from June to September 2025 using snowball sampling. Burnout was measured by MBI-GS, and 25 candidate variables were collected. Data were split 80/20 into training/validation sets. After variable selection (Boruta ∩ Group LASSO), seven algorithms were compared. Model evaluation used AUC, PR-AUC, calibration, DCA, and SHAP. The optimal threshold (Youden index) defined three risk tiers, and a Shiny web calculator was developed. Random forest achieved the best test performance (AUC = 0.879, PR-AUC = 0.940, and sensitivity = 0.870). Key features included colleague relationship, work duration, exercise frequency, and night shift hours. SHAP analysis showed that harmonious colleague relationships, longer work duration, and regular exercise were associated with lower predicted risk, whereas longer night shifts and frequent training/exams were associated with higher predicted risk. Model calibration (HL p = 0.3505) and DCA confirmed clinical benefit. A Shiny web calculator was developed. The random forest model effectively predicts nurse job burnout with good discrimination and calibration. The Shiny web calculator developed based on this model provides a practical tool for early identification and stratified intervention in nursing management. External validation is needed to further confirm generalizability. The predictive model can be integrated into hospital human resource and nursing information systems to enable automatic assessment of burnout risk. This facilitates early identification of high-risk nurses, allowing managers to implement timely interventions such as adjusted schedules and psychological support. The deployed online calculator provides an accessible tool for dynamic monitoring and proactive management, supporting data-driven decision-making to improve nursing workforce stability and healthcare service quality. No materials from other sources were used in this manuscript that require permission. This study followed the TRIPOD + AI statement. The completed TRIPOD + AI checklist is provided as supporting information.
Charcot foot reconstruction can improve quality of life, however, patient-reported outcomes remain underreported. This was a retrospective study of patients with diabetes-associated Charcot foot arthropathy who underwent reconstruction between 2022 and 2023. Patient reported outcome measures (PROMs) collected were Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference, Physical Function, Global Health, and the Foot and Ankle Disability Index. Patients who completed surveys at all timepoints (preoperatively and 6- and 12-months postoperatively) were included. Generalized estimating equations estimated mean changes in PROM scores; multivariable models assessed the impact of clinical variables. Twenty-seven patients met inclusion criteria with median age of 59 years and median body mass index (BMI) of 36. Patients demonstrated a significant decrease in Pain Interference at 6 months, but this improvement was not sustained at 12 months. No significant differences were observed in other PROMs. Charcot reconstruction results in meaningful early improvements in patient-reported pain and functional outcomes, however, the durability of these benefits appears limited. IV, retrospective cohort study.