Search Results (761)

Background: Population ageing is a global challenge, prompting ageing-in-place policies in Hong Kong to support community-dwelling older adults while reducing healthcare costs. Yet, their impact on health-related quality of life (HRQoL) remains underexplored amid Hong Kong’s long life expectancy and growing older population. Traditional surveys are costly and time-consuming, while routinely collected registration data offers a large, efficient source for health insights. This study uses enhanced administrative data to track HRQoL trajectories and inform policy. Methods: This is a prospective, open-ended longitudinal study, enrolling adults aged 50 or older from a collaborating non-governmental organization in Hong Kong’s Southern District. Data collection, started in February 2021, occurs annually via phone and face-to-face interviews by trained social workers and volunteers using a standardized questionnaire to assess individual (e.g., socio-demographics), environmental (e.g., social support via Lubben Social Network Scale-6), biological (e.g., chronic illnesses), functional (e.g., cognition via Montreal Cognitive Assessment), and HRQoL (e.g., EQ-5D-5L) factors. A secure online system links health and service use data (e.g., service utilization like community care visits). Analysis employs descriptive statistics, group comparisons, correlations, growth modelling to identify health trajectories, and structural equation modelling to test a revised quality-of-life framework. Sample size (projected 470–580 after two follow-ups from a 2321 baseline) is based on power calculations: 300–500 for latent class growth analysis (LCGA) class detection and 200–400 for structural equation modelling (SEM) fit (e.g., RMSEA < 0.06) at 80% power/α = 0.05, simulated via Monte Carlo with a 50–55% attrition. Discussion: This is the first longitudinal HRQoL study in Hong Kong using enhanced non-governmental organization (NGO) administrative data, integrating social–ecological and HRQoL models to predict trajectories (e.g., stable vs. declining mobility) and project care demands (e.g., increase in in-home care for frailty). Unlike prior cross-sectional or inpatient studies, it offers a scalable model for NGOs, informing ageing-in-place policy effectiveness and equitable geriatric care. Full article

The Planetary Health Diet (PHD), recognized as a healthy and environmentally sustainable dietary pattern, has been promoted globally; however, its role in supporting weight change among children within structured weight management interventions remains unclear. A four-month randomized multicomponent family-based trial was conducted with 120 dyads of children with obesity (7–12 years) and their guardians. The intervention group (IG) received counseling on the PHD, portion size reduction, and strategies to increase moderate-to-vigorous physical activity, while the control group (CG) received general guidance based on the Dietary and Physical Activity Guidelines for the Brazilian Population, emphasizing the avoidance of ultra-processed foods. Dietary intake was assessed using a food frequency questionnaire, and anthropometric measurements were taken by trained professionals at baseline and during each consultation. Mixed-effects models were used to estimate BMI change in children and guardians. Most guardians were mothers with low-to-middle income. Attrition was around 40% in both groups, but most participants were followed up for four visits. No significant difference in BMI variation was observed between allocation groups; however, both groups of children reduced BMI (IG = −0.2 and CG = −0.4; p = 0.002), with no change among guardians. PHD adherence scores changed minimally overall, but consumption of nuts and fruits increased in both groups. Although the intervention did not outperform the control in reducing BMI, the overall BMI reduction among children in both groups suggests that participation in a lifestyle-focused trial, regardless of specific content, may promote weight management in children with obesity. Full article

Undergraduate life science education faces high attrition rates, especially among students from underrepresented groups. These disparities are often linked to differences in prior knowledge, self-efficacy, and interest, which are rarely addressed in traditional lecture-based instruction. This work explores the use of machine learning-based Intelligent Tutoring Systems (ITSs) to support personalized instruction in biology education by examining stochasticity in molecular systems. Accordingly, we developed and validated a Random Forest classification model and used it to assign instructional materials based on students’ prior knowledge and interests. We then applied the model in an introductory biology classroom and individually estimated the most promising instructional format. Results show that the most effective instruction can be reliably predicted from student performance and interest profiles, and model-based assignments may help reduce pre-existing opportunity gaps. Thus, machine-learning-driven instruction holds promise for enhancing equity in life science education by aligning materials with students’ needs, potentially reducing differences in achievement, self-efficacy, and cognitive load, which might be relevant to promoting underrepresented students. To facilitate a straightforward implementation for educators facing similar challenges associated with teaching molecular stochasticity, we developed an open-access ITS tool and provided a scalable approach for developing similar personalized learning tools. Full article

Massive Open Online Courses (MOOCs) have expanded global access to education but continue to struggle with high attrition rates. This study presents a comparative analysis of self-labeled Semi-Supervised Learning (SSL) algorithms for predicting learner dropout. Unlike traditional supervised models that rely solely on labeled data, self-labeled methods iteratively exploit both labeled and unlabeled instances, alleviating the scarcity of annotations in large-scale educational datasets. Using real-world MOOC data, ten self-labeled algorithms, including self-training, co-training, and tri-training variants, were evaluated across multiple labeled ratios. The experimental results show that ensemble-based methods, such as Co-training Random Forest, Co-Training by Committee, and Relevant Random subspace co-training, achieve predictive accuracy comparable to that fully supervised baselines even with as little as 4% labeled data. Beyond predictive performance, the findings highlight the scalability and cost-effectiveness of self-labeled SSL as a data-driven approach for enhancing learner retention in massive online learning. Full article

Large-format additive manufacturing (LFAM) is an enabling manufacturing technology capable of producing large parts with highly complex geometries for a wide variety of applications, including automotive, infrastructure/construction, and aerospace mold and tooling. In the past decade, the LFAM industry has seen widespread use of bio-based, glass, and/or carbon fiber reinforced thermoplastic composites which, when printed, serve as a lower-cost alternative to metallic parts. One of the highest-volume materials utilized by the industry is carbon fiber (CF)-filled polycarbonate (PC), which in out-of-autoclave applications can achieve comparable mechanical performance to metal at a significantly lower cost. Previous work has shown that if this material is recovered at various points throughout the manufacturing process for both the lab and pilot scale, it can be mechanically recycled with minimal impacts on the functional performance and printability of the material while significantly reducing the feedstock costs. End-of-life (EOL) CF-PC components were processed through industrial shredding, melt compounding, and LFAM equipment, followed by evaluation of the second-life material properties. Experimental assessments included quantitative analysis of fiber length attrition, polymer molecular weight degradation using gel permeation chromatography (GPC), density changes via pycnometry, thermal performance using dynamic mechanical analysis (DMA), and mechanical performance (tensile properties) in both the X- and Z-directions. Results demonstrated a 24.6% reduction in average fiber length compared to virgin prints, accompanied by a 21% decrease in X-direction tensile strength and a 39% reduction in tensile modulus. Despite these reductions, Z-direction tensile modulus improved by 4%, density increased by 6.8%, and heat deflection temperature (HDT) under high stress retained over 97% of its original value. These findings underscore the potential for integrating mechanically recycled CF-PC into industrial LFAM applications while highlighting the need for technological innovations to mitigate fiber degradation and enhance material performance for broader adoption. This critical step toward circular material practices in LFAM offers a pathway to reducing feedstock costs and environmental impact while maintaining functional performance in industrial applications. Full article

Previous research shows that L2 learning can cause non-nativeness in the L1 of adult learners. These effects vary across segments, even across members of the same natural class (e.g., voiceless or voiced stops) differing in the presence or absence of transfer, the direction (‘assimilation’ toward L2 or ‘dissimilation’ away from it), and the magnitude of shift. However, little is known about how multiple phonetic cues within a single segment jointly exhibit transfer, or about the cross-linguistic linkages formed at this fine-grained, cue-specific level of phonetic structure. This study investigates phonetic backward transfer by analyzing production of three cues, voice onset time, voicing during closure, and relative burst intensity, across voiced stops /b d g/. Conducted among first-generation bilingual Indian immigrants in Glasgow, it explores how their native varieties (Hindi and Indian English) are influenced by the dominant host variety (Glaswegian English) with reference to the revised Speech Learning Model and its predictions of assimilation, dissimilation, and no change. Two control groups (Indians and Glaswegians) and an experimental group (Glasgow Indians) were recorded reading in English and Hindi words containing the three voiced stops. Findings reveal cue-specific variability, highlighting the multidimensional nature of CLI and challenging segment-level generalizations in models of phonetic transfer. Full article

Lithium is the first-line treatment for bipolar disorders and a first-line augmentation option for treatment-resistant unipolar depression. Due to its narrow therapeutic window and risk of toxicity, people taking lithium require regular blood testing to monitor lithium levels in the body. However, studies have reported that only half of lithium-treated patients receive adequate lithium monitoring. This protocol describes a trial that will test the feasibility and acceptability of a point-of-care (POC) lithium blood testing programme in patients with unipolar or bipolar affective disorders taking lithium as a maintenance treatment. The primary objectives are to establish whether testing the effectiveness of POC testing is feasible, by assessing recruitment, attrition, and adherence to monitoring guidelines compared to participants randomised to testing as usual; to test whether the programme is acceptable to patients; and to measure potential contamination bias. The secondary objectives are to examine changes in health-related quality of life, the use of healthcare services, and depressive and manic symptoms to inform the design of a larger multi-site randomised controlled trial (RCT). This feasibility RCT will recruit 80 participants with affective disorders who are taking lithium. Participants will be 1:1 randomised to either POC monitoring or monitoring as usual where they will be followed up at three research visits over 30 weeks. The proportion of patients meeting guidelines for lithium monitoring will be examined, alongside measures of acceptability, wellbeing, and health economic data. POC testing has the potential to significantly improve patient safety and satisfaction with lithium treatment. Full article

The COVID-19 pandemic has profoundly amplified burnout and moral injury among nurses, exposing structural vulnerabilities in healthcare systems and accelerating workforce attrition. Beyond the acute crisis, nurses continue to face chronic staff shortages, overwhelming workloads, and unresolved ethical tensions that compromise both well-being and quality of care. Synthesis of recent meta-analyses in this review indicates that nurse burnout during the pandemic ranged between 30% and 50%, illustrating the magnitude of the problem. Particular attention is given to innovative organizational strategies that foster resilience, including workload redistribution, enhanced professional autonomy, supportive leadership, and the integration of digital technologies such as telecare. Comparative perspectives across healthcare systems illustrate how policy reforms, staffing models, and ethical frameworks can mitigate psychological distress and strengthen organizational resilience. By reframing burnout and moral injury not only as individual challenges but as systemic phenomena requiring structural solutions, this review emphasizes the imperative of multilevel interventions. Building resilient nursing workforces through innovation, leadership, and evidence-based policies is essential for sustaining high-quality patient care in the post-pandemic era. Full article

Background/Objectives: Residual symptoms—such as persistent negative or cognitive symptoms—and relapse remain common in schizophrenia (SCZ) despite the proven efficacy of antipsychotics. As a result, add-on medications are frequently prescribed in real-world clinical practice. Although these agents are often used chronically, most evidence supporting their benefits comes from short-term trials. This systematic review aimed to assess the effect of adjunctive medication on long-term clinical outcomes and relapse prevention. Methods: Following PRISMA guidelines, we searched PubMed and Scopus (2000–2025) for trials of add-on agents administered for ≥24 weeks in SCZ spectrum disorders. Eligible studies compared antipsychotic treatment as usual with and without an add-on pharmacological agent (or with an added placebo). The primary outcome was long-term symptom change evaluated via established clinical scales, while relapse was the secondary outcome. Risk of bias was assessed with the Cochrane RoB 2 tool (PROSPERO registration: CRD420251075647). Results: The 22 of 4101 selected studies were classified into a group of frequently used add-on agents in clinical practice (antidepressants, mood stabilizers) and a group of less common agents, encompassing cognitive enhancers, antibiotics and antioxidants/anti-inflammatory agents. Results regarding clinical efficacy were mixed for both groups and respective subcategories. Overall, no drug class produced robust benefits. Relapse was systematically reported in only one study, with low overall relapse rates (2.5%). Risk-of-bias assessment did not reveal significant methodological concerns, apart from high attrition (average 29.5%). Conclusions: Evidence for the long-term efficacy of add-on pharmacological treatments in SCZ is inconsistent, with no agent demonstrating reliable benefits. These findings raise concerns regarding long-term polypharmacy and also highlight the need for further investigations. Future studies should prioritize longer follow-up, relapse outcomes and realistic treatment patterns. Full article

Background: People experiencing homelessness (PEH) face significant health disparities and systemic barriers to healthcare, elevating their risk for cancer and other chronic diseases. To tackle PEHs’ challenges in accessing cancer preventive care, the CANCERLESS project implemented the Health Navigator Model (HNM)—a person-centered intervention that utilizes trained Health Navigators to provide tailored support and facilitate service access. Recognizing housing as a key determinant of health, this analysis assessed changes in housing status associated with participation in the HNM among CANCERLESS participants in Austria, Greece, Spain, and the UK. Methods: This was a secondary analysis of cross-national data collected during a single-arm interventional study. Of 652 enrolled PEH, 277 (42.5%) completed the HNM intervention follow-up and were included in the analysis. Changes in housing status from baseline to follow-up were categorized using the European Typology of Homelessness and Housing Exclusion (ETHOS) and treated as an ordered outcome. Descriptive statistics were complemented by a cumulative link mixed model with a participant random intercept to estimate the association between time (follow-up vs. baseline) and housing transitions among completers, adjusting for age, residence/legal status, and daily smoking. Results: Participants had a mean age of 47.4 (SD 13.8), primarily identified as male (64.1%), reported upper secondary education (33.9%), and were from Western European countries (39.7%), with varying housing situations. Among intervention completers, time (follow-up vs. baseline) was associated with higher odds of being in a higher ETHOS category (OR = 1.49, 95% CI = 1.02–2.20, p = 0.042), consistent with a modest improvement in housing status. Larger estimates were observed among migrants without legal documents (OR = 24.13, 95% CI = 6.41–90.89, p < 0.001), while daily smoking was associated with lower odds (OR = 0.33, 95% CI = 0.11–0.96, p = 0.041); other residence status categories were not statistically significant. Conclusions: Suggesting that tailored, navigation-based models, such as the HNM, may be linked to improved housing stability for PEH, these findings can inform piloting and context-aligned integration of the HNM within public health strategies as an alternative approach to address the complex, interconnected health and social needs of PEH. However, the lack of a comparison group and high attrition limit the results’ conclusiveness, and future evaluations should aim to include assessments of housing-associated contextual factors. Full article

Employing teachers with significant physical or sensory disabilities (PSD) is crucial for inclusion and social justice. Since beginning teachers are particularly prone to attrition, research is needed to identify challenges faced by beginning teachers with PSD and to propose potentially supportive strategies. This case study followed an online academic workshop in Israel, designed as a Community of Practice (CoP) for beginning teachers with PSD. The participants were 16 beginning teachers and three facilitators. Transcribed recordings of the workshop’s 13 meetings were analyzed using discourse and thematic analysis. Four main challenge areas emerged: relationships with school staff; student motivation and behavior management; teaching practices; and technological and bureaucratic procedures. The relationships between the challenges and the teachers’ PSD ranged from direct causation to no apparent connection. The facilitators provided emotional support and theoretical knowledge, suggested courses of action, and offered direct assistance based on the participants’ knowledge and skills. A “wrapping” phenomenon was identified where participants initially presented unresolved challenges as successfully resolved. As mutual trust and openness developed throughout the year, previously resolved challenges often resurfaced. The findings suggest that implementation of suggested solutions must be monitored, and their effectiveness should be further explored. Full article

Corneal nerves play a crucial role in maintaining ocular surface homeostasis by supporting the functional integrity of corneal epithelial, stromal, and endothelial cells; modulating tear secretion; and facilitating sensory responses essential for overall ocular health. With advancing age, these highly specialized peripheral sensory fibers undergo progressive attrition and morphologic distortion driven by the canonical hallmarks of aging including genomic instability, impaired proteostasis, mitochondrial dysfunction, and chronic low-grade inflammation. The resulting neuro-immune dysregulation reduces trophic support, delays wound healing, and predisposes older adults to dry-eye disease, neurotrophic keratopathy, and postsurgical hypoesthesia. Age-exacerbating cofactors including diabetes, dyslipidemia, neurodegenerative disorders, topical preservatives, chronic contact-lens wear, herpes zoster ophthalmicus, and ocular-surface hypoxia further accelerate sub-basal nerve rarefaction and functional decline. This review provides an overview of age-related physiological alterations in ocular surface nerves, with a particular emphasis on corneal innervation. It also discusses risk factors that speed up these changes. Given the inherently limited regenerative capacity of corneal nerves and their inability to fully restore to baseline conditions following injury or degeneration, it is critical to identify and develop effective strategies aimed at mitigating or delaying physiological nerve degeneration and promoting nerve regeneration. This review also brings up emerging therapeutic strategies, including regenerative medicine, neuroprotective agents, and lifestyle interventions aimed at mitigating age-related corneal nerve degeneration. Full article

The past two decades have seen the reemergence of research investigating the therapeutic potential of psychedelic drugs across neuropsychiatric illnesses. One condition, alcohol use disorder (AUD), is of relevance given the broad public health implications and both limited effectiveness and attrition associated with currently available treatments. While emerging research has suggested that the benefits of psychedelic drugs in the treatment of AUD may be considerable, several fundamental aspects of this work limit the conclusions that can be drawn. These limitations include those that apply to research involving psychedelics generally—including functional unblinding and the role and definition of “psychedelic assisted psychotherapy” and some unique to AUD, including the nature of the mystical experience and how it relates to the “spiritual experience” as described in the literature of Alcoholics Anonymous (AA), of which the history of psychedelic research in AUD is closely intertwined. Additionally, current mechanistic neuroimaging studies examining the therapeutic effects of psychedelics in AUD are limited by design and do not directly interrogate the cognitive and circuit-level processes likely underlying treatment response. This review describes these limitations in detail by bridging historical, conceptual, and mechanistic aspects of psychedelic research in AUD and offers suggestions for future studies, the results of which may more clearly specify the role and utility of psychedelic drugs in the treatment of AUD. Full article

The retention of educators is foundational to the provision of high-quality early childhood education and care (ECEC), yet the sector continues to face significant workforce challenges. This study explores how organisational climate and leadership influence collaborative practice and, in turn, educator retention. Using a constructivist grounded theory (CGT) approach, data were collected through focus groups and interviews with 34 educators across diverse service types in the Northern Territory, Australia. In accordance with CGT, analysis revealed two core categories—‘struggle’ and ‘hope’—reflecting the impact of workplace relationships on collaborative practice. In ECEC settings where communication was limited and psychological safety was lacking, participants described resistant behaviours and horizontal violence, which contributed to educator stress and attrition. Conversely, environments that fostered open communication, reflective practice, and trusting relationships enabled collaborative practice that supported educator wellbeing and retention. The findings suggest that intentional leadership and an organisational climate that embodies ‘care’ are essential for cultivating collaboration, enhancing job satisfaction, and improving workforce stability. This paper proposes that ‘building connection builds retention,’ highlighting the importance of relational and reflective practices in sustaining the ECEC workforce. Full article

This article examines patterns of enrollment, academic performance, and dropout among women in engineering programs at the State University of Milagro (UNEMI), Ecuador, between 2016 and 2023. Using a quantitative approach that combines descriptive statistics with exploratory factor analysis, the study identifies critical obstacles affecting the academic persistence of female students. Results show a 291% increase in female enrollment following the implementation of institutional policies focused on inclusion and the expansion of virtual education, reflecting the cumulative growth rate in female enrollment from 296 students in 2016 to 1158 in 2023. However, this growth coincided with a decline in pass rates and an increase in dropout levels. Among the main factors influencing student attrition are financial limitations associated with transportation, access to technology, and study materials. Additional elements include motivational aspects and insufficient academic preparation. The findings highlight the importance of strengthening institutional strategies that promote academic equity, create inclusive learning environments, and respond effectively to the personal and structural challenges that women face in engineering education. This study contributes empirical evidence that can inform university policies and public initiatives aimed at fostering greater participation and success for women in science and technology fields. Full article