Search Results (303)

Social-emotional and behavioural difficulties are among the most common developmental problems in childhood and adolescence and present substantial challenges for teachers and schools. Universal social and emotional learning (SEL) programmes combined with standardised diagnostic procedures have been proposed as a promising approach to addressing these issues. The present study evaluated the first implementation of a process-based diagnostic and support concept (StaFF) in everyday school practice in the Canton of Basel-Landschaft, Switzerland. Over the course of one school term, teachers (N = 173 at T1; N = 83 at T2) and pupils (N = 1072 at T1; N = 339 at T2) from kindergarten to the lower secondary level (approximately ages 4 to 16) were assessed using standardised questionnaires. Teacher outcomes included emotional exhaustion, occupational self-efficacy, subjective personal accomplishment, and attitudes towards inclusion. Pupil behaviour was assessed with the Strengths and Difficulties Questionnaire (SDQ). Data analyses comprised descriptive statistics, paired t-tests, and effect size estimates. The results indicated stable values for emotional exhaustion and attitudes towards inclusion, while occupational self-efficacy and perceived accomplishment significantly increased with medium to large effect sizes. At T1, more than one-third of pupils displayed at least one abnormal score; at T2, about one-third of these pupils no longer showed abnormal scores. The findings suggest that structured diagnostics combined with universal SEL measures can strengthen teachers’ professional agency and contribute to improvements in pupil outcomes while highlighting the need for long-term and multi-tiered implementation research. Full article

Introduction: Transient osteoporosis of the hip (TOH) is a rare, self-limiting disorder characterized by acute hip pain and reversible osteopenia. The aim of this study was to evaluate clinical outcomes following treatment with Neridronate, Clodronic Acid, Cholecalciferol, and pulsed electromagnetic field therapy (PEMF). Materials and Methods: A total of 45 patients presenting with non-traumatic hip pain were screened using a standardized diagnostic protocol. Magnetic resonance imaging (MRI) identified 8 patients (17.8%) with transient osteoporosis of the hip (TOH), who were subsequently enrolled in this analysis. Pain was evaluated using the Visual Analog Scale (VAS). Patients received a three-phase therapeutic protocol, including pharmacological therapy and PEMF. Clinical evaluations using the Harris Hip Score (HHS) were performed monthly, and follow-up MRI was conducted at the end of treatment. Results: We identified 8 cases of TOH (17.8%); the mean baseline HHS for these patients was 68.5 (range 51–83, SD 10.36). Pain reduction became evident within the first month of treatment. At the end of treatment, clinical improvement was observed in 7 patients, with mean HHS increasing to 88.0 (range 67–95, SD 8.84). Post-treatment MRI demonstrated complete resolution of bone marrow edema in all patients. One patient developed avascular necrosis despite therapy and required surgical intervention. Conclusions: TOH remains a controversial condition in terms of diagnosis and treatment. Early diagnosis and timely intervention are essential to progression to osteonecrosis. A combined therapeutic approach using bisphosphonates, vitamin D, and PEMF appears effective in reducing symptoms, promoting bone healing, and ensuring good patient compliance. Full article

The creation of simulation-ready digital twins for real-world simulations is hindered by two key challenges: the lack of widely consistent, application-ready open access terrain data and the inadequacy of conventional evaluation metrics to predict practical, in-engine performance. This paper addresses these challenges by presenting an end-to-end, open-data pipeline that generates simulation-ready terrain and procedural 3D objects for the Unity engine. A central finding of this work is that the architecturally advanced Swin2SR transformer exhibits severe statistical instability when applied to Digital Elevation Model (DEM) data. We analyze this instability and introduce a lightweight, computationally efficient stabilization technique adapted from climate science—quantile mapping (qmap)—as a diagnostic remedy which restores the model’s physical plausibility without retraining. To overcome the limitations of pixel-based metrics, we validate our pipeline using a three-axis evaluation framework that integrates data-level self-consistency with application-centric usability metrics measured directly within Unity. Experimental results demonstrate that qmap stabilization dramatically reduces Swin2SR’s large error (a 45% reduction in macro RMSE from 47.4 m to 26.1 m). The complete pipeline, using a robust SwinIR model, delivers excellent in-engine performance, achieving a median object grounding error of 0.30 m and real-time frame rates (≈100 FPS). This study provides a reproducible workflow and underscores a crucial insight for applying AI in scientific domains: domain-specific stabilization and application-centric evaluation are indispensable for the reliable deployment of large-scale vision models. Full article

Background/Objectives: Eating disorders (EDs) often affect fertility, yet many women with ED still become mothers. The pattern of ED symptoms during pregnancy and postpartum, along with their effects on maternal and child health, is not yet fully understood. This longitudinal study aimed to (1) examine the course of ED symptoms from conception to postpartum, (2) evaluate pregnancy outcomes and children’s health and developmental milestones, and (3) assess ED status approximately four years after the initial evaluation. Methods: Thirty women with a prior ED diagnosis (21 with anorexia nervosa, 9 with bulimia nervosa) were evaluated at two time points. Time 1 with the Eating Disorders Examination and the Oxford Risk Factors for Eating Disorders: Interview Schedule; Time 2, approximately four years later, with the Eating Disorders Examination and the Clinical Interview on Reproductive History and Eating Behavior that also included clinical data related to mother’s health and baby’s health and development accessed through the Pregnant Women’s Health Bulletin and the Child and Youth Health Bulletin using the national health records. Results: ED symptoms (dietary restriction, self-induced vomiting, laxative misuse) persisted from conception through postpartum. BN participants reported more severe symptoms and higher rates of pregnancy complications (hyperemesis gravidarum, gestational diabetes, preeclampsia), while premature births occurred only in AN participants. Children of mothers with AN more frequently showed delays in developmental milestones (sitting, walking, speaking, sphincter control) compared to those of BN mothers. Conclusions: A substantial proportion of women with prior ED continued to experience symptoms during and after pregnancy, and nearly half still met diagnostic criteria four years later and are still in treatment. Cognitive features such as body dissatisfaction persisted despite partial symptom remission. These findings highlight the chronicity of ED and underscore the need for systematic screening, psychological support, and interdisciplinary follow-up during pregnancy and early motherhood. Full article

Hypergolic propellants have long been central to spacecraft propulsion because of their storability, reliability and rapid ignition. Conventional systems such as hydrazine derivatives paired with oxidisers like nitrogen tetroxide deliver ignition delays in the order of a few milliseconds but pose serious risks due to extreme toxicity and handling hazards. The search for safer and environmentally friendlier alternatives has therefore become a priority in recent years. This review examines ignition delay times reported in the literature for both conventional and green propellants under ambient experimental conditions. Data were collected from published studies between 2000 and 2025 using major scientific databases, including Scopus, Web of Science, and Google Scholar, and are compared across three categories of propellants: traditional hydrazine-based systems, self-igniting ionic liquids and amines, and systems enhanced with catalytic or reactive promoters. The analysis shows that while conventional propellants remain benchmarks with ignition delays typically between 1 and 5 ms, some new formulations, particularly those containing reactive additives such as borohydrides or iodide salts, are achieving similar or improved performance in laboratory tests. The review also highlights that variability in reported ignition delays often stems from differences in test methods, droplet size, oxidiser concentration, and diagnostic approaches. Beyond performance considerations, attention is given to safety and environmental aspects since several green candidates reduce acute toxicity but introduce other challenges, such as instability or corrosive byproducts. By bringing together data in a comparative format and emphasising methodological limitations, this review aims to support the future design and evaluation of practical green hypergolic propellants. Full article

Background: Anorexia nervosa (AN) is a complex psychiatric disorder that requires a multidisciplinary approach. The World Health Organization recognizes the therapeutic value of expressive arts, including drama, in enhancing emotional, cognitive, and relational domains in severe mental illnesses such as AN. Expressive arts interventions may improve emotional intelligence, empathy, and self-awareness while reducing anxiety and alexithymia. This study evaluated the impact of an adjunctive expressive arts program on alexithymia in pediatric inpatients with AN. Methods: We enrolled patients aged 11–18 years hospitalized for AN, according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, at the Pediatric Unit of Bambino Gesù Children’s Hospital, Rome. The study period ran from December 2024 to April 2025. Participants attended drama therapy sessions and expressive arts workshops in a dedicated recreational space integrated into a multidisciplinary treatment plan. Alexithymia was assessed at admission and discharge using the Toronto Alexithymia Scale (TAS-20), with scores ≥ 61 indicating alexithymia. At the end of the program, participants completed a semi-structured satisfaction questionnaire to evaluate subjective experiences and mood. Results: Thirty patients met inclusion criteria. The TAS-20 scores were statistically different between pre-/post-theater activity (p < 0.001). The proportion of alexithymic participants declined from 73.3% at baseline to 26.7% at discharge. Most participants reported mood improvements: 66.6% “somewhat” and 26.7% “greatly.” Additionally, 90% reported improved peer relationships. Conclusions: Expressive arts, particularly drama-based interventions, may represent an effective adjunctive therapy for adolescents with AN, supporting emotional awareness, self-regulation, and social connectedness. Arts-based interventions are associated with nonverbal avenues for emotional processing and may promote neuroplasticity, representing valuable complementary strategies for AN treatment. Full article

This study investigates the asymmetric effects applying heat transfer as a diagnostic tool in dendritic networks with symmetrical branching, characterized by the geometric property of self-similarity. Using a Computational Fluid Dynamics (CFD) model, we analyze five structural isomers of a three-level dichotomous branching network to evaluate the relationship between fluid dynamics, heat transfer, and geometric configuration. The main constraints are geometrical; that is, the volume at each branching level remains constant, and homothetic relationships respect the Hess–Murray law both for diameters and angles between sister tubes. The model considers an incompressible and stationary Newtonian fluid flow with Reynolds numbers ranging from 10 to 2000 and heat transfer in the range 1 to 1000 W/m². Our results show that significant asymmetries in flow distribution and temperature profiles emerge in these symmetric structures, primarily due to the successive alignment of tubes between different branching levels. We found that the isomer with the lowest pressure drop is not the same as the one providing the most uniform flow distribution. Crucially, thermal analysis proves to be more sensitive than fluid dynamic analysis for detecting flow asymmetries, particularly at low Reynolds numbers less than 50 and q″ = 1000 W/m². While heat transfer does not significantly alter the fluid dynamic asymmetry, its application as a diagnostic tool for identifying flow asymmetries is effective and crucial for such purposes. Full article

(1) Background: Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is one of the two gold-standard tools for assessing oropharyngeal dysphagia (alongside Videofluoroscopic Swallowing Study). Although generally considered safe, concerns about complications persist, particularly in systems where FEES is not routine and professional roles differ. The aim of this study was to evaluate the safety of FEES performed by both speech-language pathologists (SLPs) and physicians, in order to provide evidence of its safety in a healthcare system where the procedure is not yet widely established and to identify patient subgroups potentially at higher risk of procedure-related complications. (2) Methods: This retrospective study analyzed 964 consecutive FEES procedures. Examinations were carried out by trained SLPs or physicians. Data included demographics, clinical status, operator qualifications, setting, and complications, classified as minor (vomiting, poor tolerance, early termination) or major (laryngospasm, epistaxis). (3) Results: The overall complication rate was 1.14% (11/964): 0.6% minor and 0.5% major. All events were self-limiting. Complication rates did not differ between SLPs (1.05%) and physicians (1.23%) or by experience, setting, drug use, penetration–aspiration scale score, or nasogastric tube. Four complications occurred in amyotrophic lateral sclerosis patients, suggesting higher risk. (4) Conclusions: FEES is safe and well tolerated when performed by either physicians or SLPs. These findings underscore the value of task sharing in dysphagia diagnostics, demonstrating that a shared model increases service capacity, reduces delays, and facilitates timely management of dysphagia. Full article

Large Language Models (LLMs) exhibit remarkable generative capabilities but remain vulnerable to hallucinations—outputs that are fluent yet inaccurate, ungrounded, or inconsistent with source material. To address the lack of methodologically grounded surveys, this paper introduces a novel method-oriented taxonomy of hallucination mitigation strategies in text-based LLMs. The taxonomy organizes over 300 studies into six principled categories: Training and Learning Approaches, Architectural Modifications, Input/Prompt Optimization, Post-Generation Quality Control, Interpretability and Diagnostic Methods, and Agent-Based Orchestration. Beyond mapping the field, we identify persistent challenges such as the absence of standardized evaluation benchmarks, attribution difficulties in multi-method systems, and the fragility of retrieval-based methods when sources are noisy or outdated. We also highlight emerging directions, including knowledge-grounded fine-tuning and hybrid retrieval–generation pipelines integrated with self-reflective reasoning agents. This taxonomy provides a methodological framework for advancing reliable, context-sensitive LLM deployment in high-stakes domains such as healthcare, law, and defense. Full article

A critical factor contributing to the burden of childhood asthma is the lack of effective self-management in homecare settings. Artificial intelligence (AI) and lung sound monitoring could help address this gap. Yet, existing AI-driven auscultation tools focus on wheeze detection and often rely on subjective human labels. To improve the early detection of asthma worsening in children in homecare setting, we trained and evaluated a Deep Learning model based on spirometry-labelled lung sounds recordings to detect asthma exacerbation. A single-center prospective observational study was conducted between November 2020 and September 2022 at a tertiary pediatric pulmonology department. Electronic stethoscopes were used to record lung sounds before and after bronchodilator administration in outpatients. In the same session, children also underwent spirometry, which served as the reference standard for labelling the lung sound data. Model performance was assessed on an internal validation set using receiver operating characteristic (ROC) curves. A total of 16.8 h of lung sound recordings from 151 asthmatic pediatric outpatients were collected. The model showed promising discrimination performance, achieving an AUROC of 0.763 in the training set, but performance in the validation set was limited (AUROC = 0.398). This negative result demonstrates that acoustic features alone may not provide sufficient diagnostic information for the early detection of asthma attacks, especially in mostly asymptomatic outpatients typical of homecare settings. It also underlines the challenges introduced by differences in how digital stethoscopes process sounds and highlights the need to define the severity threshold at which acoustic monitoring becomes informative, and clinically relevant for home management. Full article

Background/Objectives: A substantial number of adults with celiac disease (CeD) experience ongoing symptoms despite consuming a gluten-free diet (GFD), a condition labelled as non-responsive CeD (NRCD). However, many experts contest the term, viewing NRCD not as a distinct entity, but as a clinical prompt to identify a specific underlying cause. A minority develop refractory CeD (RCD), a severe complication with persistent villous atrophy, after beginning a diet excluding gluten exposure. This review synthesizes evidence to provide a practical, stepwise algorithm for managing these complex patients. Methods: A narrative review was conducted based on a targeted literature search of major databases seeking studies on adults with NRCD or RCD, focusing on diagnostic and therapeutic strategies. Results: The most frequent cause of NRCD is inadvertent gluten ingestion. Objective and systematic assessment, including expert dietitian evaluation and testing with gluten immunogenic peptides (GIPs) in stool or urine GIP testing, is essential before the investigation seeking to exclude or establish RCD. This is a critical step for evaluating adherence beyond the patient self-report. The management of confirmed RCD hinges on precise subtyping via duodenal biopsy with immunophenotyping. While RCD type I (RCD-I) typically responds to budesonide, RCD type II (RCD-II) carries a high risk of lymphoma and necessitates aggressive therapies in specialized centers. Conclusions: This review underscores the necessity of a structured, hierarchical diagnostic approach in distinguishing persistent gluten exposure from true RCD. The integration of GIP testing and specialist dietitian review is a cornerstone of modern management. The findings highlight significant evidence gaps, particularly for RCD-II, and aim to guide clinical practice and inform future research towards standardized protocols. Full article

Background and Aim: Sarcopenic obesity (SO) is a phenotype characterized by increased body fat combined with reduced muscle mass and strength. SO is prevalent among people living with HIV, especially in men (MLWH); however, the link between this phenotype and diet is still unclear in this population. For this reason, in this study, we aim to examine potential associations between self-reported macronutrient intake and SO in MLWH, and, eventually, to evaluate the diagnostic accuracy of a simple nutritional marker for screening SO. Methods: A total of 216 MLWH were selected from a large cohort who completed a total body composition measurement by dual-energy X-ray absorptiometry (DXA), muscle strength assessment by handgrip test, and nutritional recording by 24 h recall interview. The sample was categorized into SO (n = 45), non-SO (NSO) (n = 33), and non-sarcopenic non-obesity (NSNO) (n = 138). Logistic regression analysis was performed to determine the associations between different macronutrients and SO after adjusting for confounders. Receiver operating characteristic (ROC) curve analysis was used to identify discriminating cut-off points of the determined macronutrient intake to screen for SO. Results: The MLWH with SO while compared to NSO and NSNO, were of an older age and had a higher BMI, but with a lower total caloric and protein intake. However, adjusted logistic regression showed that only protein intake (g/kg/day) (OR = 0.017; 95%CI: 0.003–0.094, p < 0.05) and age (OR = 1.051; 95%CI: 1.011–1.093, p < 0.05) were significantly associated with SO. The age-adjusted ROC analysis identified the 0.98 g/kg/day of protein intake (AUC = 0.8149; p < 0.0001; sensitivity = 71%; specificity = 70%) as a cut-off point to screen for SO in the MLWH. Conclusions: We identified a new cut-off point of daily protein intake able to screen for SO in MLWH, and its use can be implemented in clinical settings. Full article

Background/Objectives: Lung and colon cancers remain among the most prevalent and fatal diseases worldwide, and their early detection is a serious challenge. The data used in this study was obtained from the Lung and Colon Cancer Histopathological Images Dataset, which comprises five different classes of image data, namely colon adenocarcinoma, colon normal, lung adenocarcinoma, lung normal, and lung squamous cell carcinoma, split into training (80%), validation (10%), and test (10%) subsets. In this study, we propose the ViT-DCNN (Vision Transformer with Deformable CNN) model, with the aim of improving cancer detection and classification using medical images. Methods: The combination of the ViT’s self-attention capabilities with deformable convolutions allows for improved feature extraction, while also enabling the model to learn both holistic contextual information as well as fine-grained localized spatial details. Results: On the test set, the model performed remarkably well, with an accuracy of 94.24%, an F1 score of 94.23%, recall of 94.24%, and precision of 94.37%, confirming its robustness in detecting cancerous tissues. Furthermore, our proposed ViT-DCNN model outperforms several state-of-the-art models, including ResNet-152, EfficientNet-B7, SwinTransformer, DenseNet-201, ConvNext, TransUNet, CNN-LSTM, MobileNetV3, and NASNet-A, across all major performance metrics. Conclusions: By using deep learning and advanced image analysis, this model enhances the efficiency of cancer detection, thus representing a valuable tool for radiologists and clinicians. This study demonstrates that the proposed ViT-DCNN model can reduce diagnostic inaccuracies and improve detection efficiency. Future work will focus on dataset enrichment and enhancing the model’s interpretability to evaluate its clinical applicability. This paper demonstrates the promise of artificial-intelligence-driven diagnostic models in transforming lung and colon cancer detection and improving patient diagnosis. Full article

Diabetic foot ulcers are among the most severe complications of diabetes mellitus, disproportionately affecting populations in low- and middle-income countries. Digital health technologies have emerged as promising tools for prevention, diagnosis, and management; however, their effectiveness, usability, and applicability within public health systems remain insufficiently defined. This systematic review aimed to critically synthesize the clinical effectiveness, perceived usability, and methodological quality of digital interventions for the care of individuals with diabetes-related foot ulcers. A comprehensive search was performed in PubMed, Scopus, Web of Science, Embase, and Google Scholar for studies published between 2012 and 2024. Eighteen studies met the inclusion criteria, encompassing mobile health applications, wearable sensor devices, artificial intelligence-based tools, and telehealth platforms. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Artificial intelligence-driven approaches demonstrated high diagnostic accuracy, with sensitivity and specificity above 90% for ulcer detection and classification. Mobile applications showed positive effects on self-efficacy, glycemic control, and adherence to preventive foot care, while usability scores were consistently high. Wearable sensor devices demonstrated potential for reducing ulcer recurrence, though supporting evidence remains limited. Across studies, recurrent methodological limitations included small sample sizes, absence of control groups, lack of economic evaluations, and barriers related to digital literacy and interoperability between systems. Most investigations were conducted in high-income countries, with limited consideration of public health contexts such as the Brazilian Unified Health System. In conclusion, digital health technologies show promise in improving the care of individuals with diabetes-related foot complications but face significant challenges regarding scalability, equity of access, and integration into public healthcare systems. Future research should prioritize context-adapted designs, robust clinical trials, and economic evaluations to inform health policies and support the rational adoption of these tools within universal health coverage frameworks. PROSPERO registration number: CRD420251023152. Full article

Background/Objectives: Voice disorders caused by laryngeal hypertension can impact volume, quality, pitch, resonance, flexibility, and stamina. The laryngeal palpation is a tactile-perceptual assessment, which is one of a few examination methods to evaluate laryngeal hypertension. Laryngeal palpation is a manual examination of the extrinsic and paralaryngeal tissues of the larynx (e.g., lateral laryngeal mobility, thyrohyoid and cricothyroid spaces, vertical laryngeal position/mobility, and pain) through the examiner’s fingers. It can be performed during rest (static assessment) or during phonation (dynamic assessment) of the individual being evaluated. This study aimed to validate a novel laryngeal palpation tool with quantitative ordinal scores by assessing its reliability and diagnostic accuracy establishing preliminary clinical cut-off values, and examining its correlations with self-reported voice disorder symptoms. Methods: In a prospective, controlled validation study, 33 participants were selected to assess the validity and reliability of the novel diagnostic tool in a clinical sample and healthy controls. The clinical sample (n = 19) comprised individuals diagnosed with voice disorders, whereas the healthy control group (n = 14) included participants with no history or symptoms of voice pathology. The novel laryngeal palpation tool was employed by two independent examiners to assess both static and dynamic laryngeal function in all participants. In addition, each participant completed the following questionnaires: Voice Handicap Index (VHI-30) with the 30-item, Vocal Fatigue Index (VFI), and the Vocal Tract Discomfort Scale (VTD). Results: Static palpatory assessment of laryngeal tension demonstrated excellent discriminatory power between groups and tension levels (AROC = 0.979), along with high intra-rater (ICC = 0.966) and inter-rater reliability (ICC = 0.866). Significant correlations were revealed between the static palpation results and the VHI scores (r = 0.496; p < 0.01) and VFI (r = 0.514; p < 0.01). For the dynamic evaluation of the palpation tool, comparable results for the validity (AROC = 0.840) and reliability (inter-rater: ICC = 0.800, and intra-rater: ICC = 0.840) were revealed. However, no significant correlations were found between dynamic palpation and self-perceived questionnaires, although some were likely found with static palpation. The validity of the total score was found to be AROC = 0.992. Conclusions: The static and dynamic assessments using the novel laryngeal palpation tool demonstrated promising reliability and diagnostic accuracy, providing initial evidence to support its clinical utility. Further studies are needed to establish broader validation. Full article