Search Results (57)

Background: Feigned restriction of shoulder joint movement for secondary gain is clinically relevant and may misdirect care, distort disability determinations, and inflate system costs. Distinguishing feigning from structural pathology and from functional or psychosocial presentations is difficult because pain is subjective, performance varies, and no single sign or test is definitive. This comprehensive review hypothesizes that the systematic integration of clinical examination, objective biomechanical and neurophysiological testing, and emerging technologies can substantially improve detection accuracy and provide defensible medicolegal documentation. Methods: PubMed and reference lists were searched within a prespecified time frame (primarily 2015–2025, with foundational earlier works included when conceptually essential) using terms related to shoulder movement restriction, malingering/feigning, symptom validity, effort testing, functional assessment, and secondary gain. Evidence was synthesized narratively, emphasizing objective or semi-objective quantification of motion and effort (goniometry, dynamometry, electrodiagnostics, kinematic sensing, and imaging). Results: Detection is best approached as a stepwise, multidimensional evaluation. First-line clinical assessment focuses on reproducible incongruence: non-anatomic patterns, internal inconsistencies, distraction-related improvement, and mismatch between claimed disability and observed function. Repeated examinations and documentation strengthen inference. Instrumented strength testing improves quantification beyond manual testing but remains effort-dependent; repeat-trial variability and atypical agonist–antagonist co-activation can indicate submaximal performance without proving intent. Imaging primarily tests plausibility by confirming lesions or highlighting discordance between claimed limitation and minimal pathology, while recognizing that normal imaging does not exclude pain. Diagnostic anesthetic injections and electrodiagnostics can clarify pain-mediated restriction or exclude neuropathic weakness but require cautious interpretation. Motion capture and inertial sensors can document compensatory strategies and context-dependent normalization, yet validated standalone thresholds are limited. Conclusions: Feigned shoulder impairment cannot be confirmed by any single test. The desirable strategy combines structured assessment of inconsistencies with objective biomechanical and neurophysiologic measurements, interpreted within the whole clinical context and rigorously documented; however, prospective validation is still needed before routine implementation. Full article

Teaching in a globalised world offers opportunities to reduce barriers, enhance understanding, and expand access for diverse learners. Blended approaches, combining in-person and online delivery, can encourage learning communities across geographical boundaries. However, disparities in access to technology, internet reliability, and conducive study environments highlight inequalities and varied learner experiences. While digital networks may support identity and belonging, some students report feeling distracted or disengaged in online settings. This study explores the experiences of first-year doctoral candidates completing the final taught module of their Doctorate in Business Administration (DBA) at the University of Gloucestershire, UK. Participants, mostly international students now based in the UK, are engaged in both in-person classes and online staff-led webinars. Data was gathered through four in-person focus groups. Engeström’s Cultural-Historical Activity Theory was applied as an analytical framework, conceptualising teaching and learning as an activity system mediated by Tools, Rules, Community, and Division of Labour. This enabled a comparison of students’ experiences in online and in-person contexts. The findings revealed contradictions within the system, identifying barriers to engagement and adaptation, and offering insights into the evolving pedagogical demands of blended doctoral education. Full article

Background: Temporary internal distraction is a safe surgical technique that has been shown to improve correction of severe scoliosis. The traditional surgical adjunct for scoliosis treatment in the perioperative period is halo gravity traction, but there are several known disadvantages of this technique. We describe the technical nuances of temporary internal distraction using the construct-to-construct technique, a surgical adjunct that utilizes two rods joined by lateral domino connectors to enact powerful internal distraction or compression forces on the spine for achieving spinal deformity correction. Methods: This study was designed as a retrospective review and illustrative surgical technique report. The primary aim was to describe the construct-to-construct internal distraction and compression technique for scoliosis correction, with illustrative models and representative clinical cases. Results: Internal distraction using the construct-to-construct configuration is performed early in the surgery to take advantage of the viscoelastic properties of the spine as gradually increasing distraction forces are applied. The surgical technique for applying internal distraction and compression using the construct-to-construct configuration is discussed in detail. Conclusions: Construct-to-construct internal distraction and compression techniques are powerful methods to correct severe scoliosis curves, serially distract traditional growing rod constructs, and close three-column osteotomies. Full article

Recently, studies on driver inattention state recognition as an advanced mobility application technology are being actively conducted to prevent traffic accidents caused by driver drowsiness and distraction. The driver inattention state recognition system is a technology that recognizes drowsiness and distraction by using driver behavior, biosignals, and vehicle data characteristics. Existing driver drowsiness detection systems are wearable accessories that have partial occlusion of facial features and light scattering due to changes in internal and external lighting, which results in momentary image resolution degradation, making it difficult to recognize the driver’s condition. In this paper, we propose a transformer based spatial temporal fusion network (STFTransNet) that fuses multi-modality information for improved driver inattention state recognition in images where the driver’s face is partially occluded by wearing accessories and the instantaneous resolution is degraded due to light scattering from changes in lighting in a driving environment. The proposed STFTransNet consists of (i) a mediapipe face mesh-based facial landmark extraction process for facial feature extraction, (ii) an RCN-based two-stream cross-attention process for learning spatial features of driver face and body action images, (iii) a TCN-based temporal feature extraction process for learning temporal features of extracted features, and (iv) an ensemble of spatial and temporal features and a classification process to recognize the final driver state. As a result of the experiment, the proposed STFTransNet achieved an accuracy of 4.56% better than the existing VBFLLFA model in the NTHU-DDD public DB, 3.48% better than the existing InceptionV3 + HRNN model in the StateFarm public DB, and 3.78% better than the existing VBFLLFA model in the YawDD public DB. The proposed STFTransNet is designed as a two-stream network that can input the driver’s face and action images and solves the degradation in driver inattention state recognition performance due to partial facial feature occlusion and light blur through spatial feature and temporal feature fusion. Full article

Truck drivers play a pivotal role in global freight transport systems, yet their occupational and behavioral risk exposures make them a priority population in road safety research. This systematic review examines the factors influencing risky driving behaviors among truck drivers and their impacts on road safety outcomes. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, the review aimed to identify hazardous driving behaviors, the internal and external factors contributing to these behaviors, and their consequences for traffic safety. Inclusion criteria targeted original research published in English between 2009 and 2024 specifically focused on truck driver behavior and road safety outcomes. Systematic searches across PubMed, Scopus, Web of Science, and IEEE Xplore yielded 104 studies meeting these criteria. The synthesis revealed prevalent risky behaviors—such as speeding, fatigue-related impairments, distracted driving, and substance use—driven by internal factors (e.g., health conditions, psychological stress) and external pressures (e.g., occupational demands, regulatory constraints). These behaviors were consistently associated with increased crash risk. Nonetheless, limitations including the exclusion of non-English studies, reliance on self-reported data, and lack of standardized metrics constrained cross-study comparability and generalizability. Effective interventions identified include fatigue management programs, driver monitoring technologies, and positive safety climates. Findings underscore the urgent need for evidence-based, multifaceted strategies to enhance truck driver safety and inform policy, industry practices, and future research. Full article

Guide dogs are primarily seen as mobility aids for people with visual impairments, but they may also influence users’ psychological well-being and social lives. Benefits of being partnered with a guide dog have been found in several countries but Scandinavian studies are sparse. This qualitative study explores the lived experiences of six Danish guide dog partners through semi-structured interviews. A reflexive thematic analysis found six primary benefits: improved mobility, increased physical activity, enhanced freedom and independence, new social interactions, a strong emotional bond with the dog, and better mental well-being. Users also reported challenges, including frequent distractions caused by the public interacting with the dog, difficulties during the initial adjustment period, increased cleaning, and occasional trouble finding care for the dog. Participants unanimously emphasized the irreplaceable value of their guide dogs and positive socioemotional dimensions of guide dog partnerships. The findings add Scandinavian voices that support existing international research and note three areas of potential improvement: better public education about guide dog etiquette, enhanced support during the adjustment period, and improved care-sharing arrangements. The study underscores the importance of considering guide dogs as both functional aids and sources of emotional and social support. Full article

Background/Objectives: Traditional dietary screeners face significant limitations: they rely on subjective self-reporting, average intake estimates, and are influenced by a participant’s awareness of being observed—each of which can distort results. These factors reduce both accuracy and reproducibility. The Guide Against Age-Related Disease (GARD) addresses these issues by applying Assembly Theory to objectively quantify food and food behavior (FFB) complexity. This study aims to validate the GARD as a structured, bias-resistant tool for dietary assessment in clinical and research settings. Methods: The GARD survey was administered in an internal medicine clinic within a suburban hospital system in the southeastern U.S. The tool assessed six daily eating windows, scoring high-complexity FFBs (e.g., fresh plants, social eating, fasting) as +1 and low-complexity FFBs (e.g., ultra-processed foods, refined ingredients, distracted eating) as –1. To minimize bias, patients were unaware of scoring criteria and reported only what they ate the previous day, avoiding broad averages. A computer algorithm then scored responses based on complexity, independent of dietary guidelines. Internal (face, convergent, and discriminant) validity was assessed using Spearman rho correlations. Results: Face validation showed high inter-rater agreement using predefined Assembly Index (A_i) and Copy Number (N_i) thresholds. Positive correlations were found between high-complexity diets and behaviors (rho = 0.533–0.565, p < 0.001), while opposing constructs showed moderate negative correlations (rho = –0.363 to −0.425, p < 0.05). GARD scores aligned with established diet patterns: Mediterranean diets averaged +22; Standard American Diet averaged −10. Full article

Background: Perioperative care is an integral part of the procedure of a surgical operation, with strictly defined rules. The need to upgrade and improve some individual long-term processes aims at optimal patient care and the provision of high-level health services. Therefore, preoperative care is drawn up with new data resulting from the evolution of technology to upgrade the procedures that need improvement. According to the international literature, a factor considered to be of major importance is high preoperative anxiety and its effects on the patient’s postoperative course. High preoperative anxiety is postoperatively responsible for prolonged hospital stays, increased postoperative pain, decreased effect of anesthetic agents, increased amounts of analgesics, delayed healing of surgical wounds, and increased risk of infections. The use of Virtual Reality technology appears as a new method of managing preoperative anxiety. Objective: This study investigates the effect and effectiveness of Virtual Reality (VR) technology in managing preoperative anxiety in adult patients. Methods: A literature review was performed on 193 articles, published between 2017 and 2024, sourced from the scientific databases PubMed and Cochrane, as well as the trial registry ClinicalTrials, with a screening and exclusion process to meet the criterion of investigating VR technology’s effectiveness in managing preoperative anxiety in adult patients. This systematic review was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Results: Out of the 193 articles, 29 were selected. All articles examined the efficacy of VR in adult patients (≥18) undergoing various types of surgery. The studies represent a total of 2.354 participants from 15 countries. There are two types of VR applications: distraction therapy and patient education. From the studies, 14 (48%) used the distraction VR intervention, 14 (48%) used the training VR intervention, and 1 (4%) used both VR interventions, using a range of validated anxiety scales such as the STAI, VAS-A, APAIS, and HADS. Among the 29 studies reviewed, 25 (86%) demonstrated statistically significant reductions in preoperative anxiety levels following the implementation of VR interventions. VR technology appears to manage preoperative anxiety effectively. It is a non-invasive and non-pharmacological intervention with minimal side effects. Conclusions: Based on the review, the management of preoperative anxiety with VR technology shows good levels of effectiveness. Further investigation of the efficacy by more studies and randomized controlled trials, with a larger patient population, is recommended to establish and universally apply VR technology in the preoperative care process as an effective method of managing preoperative anxiety. Full article

This systematic review aimed to evaluate the effectiveness of teriparatide (TP) in guided bone regeneration (GBR). An electronic search without language or date restrictions was performed in PubMed, Web of Science, Scopus, Scielo, and gray literature for articles published until June 2025. Inclusion criteria considered studies evaluating the effect of TP on bone regeneration, analyzed using SYRCLE’s Risk of Bias tool. Twenty-four preclinical studies were included, covering diverse craniofacial models (mandibular, calvarial, extraction sockets, sinus augmentation, distraction osteogenesis, segmental defects) and employing systemic or local TP administration. Teriparatide consistently enhanced osteogenesis, graft integration, angiogenesis, and mineralization, with potentiated effects when combined with various biomaterials, including polyethylene glycol (PEG), hydroxyapatite/tricalcium phosphate (HA/TCP), biphasic calcium phosphate (BCP), octacalcium phosphate collagen (OCP/Col), enamel matrix derivatives (EMDs), autografts, allografts, xenografts (Bio-Oss), strontium ranelate, and bioactive glass. Critically, most studies presented a moderate-to-high risk of bias, with insufficient randomization, allocation concealment, and blinding, which limited the internal validity of the findings. TP shows promising osteoanabolic potential in guided bone regeneration, enhancing bone formation, angiogenesis, and scaffold integration across preclinical models. Nonetheless, its translation to clinical practice requires well-designed human randomized controlled trials to define optimal dosing strategies, long-term safety, and its role in oral and craniomaxillofacial surgical applications. Full article

Background: The medical management and non-transplant surgical options for children with short bowel syndrome (SBS)are maximized as first-line treatments. The purpose of this review is to summarize the currently available evidence and new management strategies in children with SBS. Methods: A systematic review of the literature was conducted on data from the last four years, focusing on both the effectiveness and safety of intestinal lengthening procedures, as well as frameworks for the prevention of complications and the achievement of enteral autonomy. Results: Of 546 abstracts that were screened, a total of 27 relevant full-text articles published between 2021 and 2025 were reviewed. The literature that was review showed that, over the past four years, the most commonly used lengthening procedure was serial transverse enteroplasty (STEP), which resulted in a 50–70% increase in bowel length, a decrease in PN dependency in most cases, and weaning off PN in 42–73% of patients. The longitudinal intestinal lengthening technique (LILT) has been used less frequently, allowing a similar 70% increase in small bowel length and 32–52% of patients to wean off PN, but with a higher mortality rate. The main reasons for surgery in patients with SBS patients were the inability to wean off PN, intestinal dysmotility, and bacterial overgrowth. Over the last decade, several new techniques—such as induced intestinal lengthening, distraction enterogenesis, ileal lengthening through internal distraction, and double-barrel enteroplasty—have been described as options for the treatment of a limited bowel length and less invasive modalities. Conclusions: Autologous gastrointestinal reconstructive surgery, as a part of multidisciplinary management, remains vital for managing children with SBS. Full article

Background: Parent–child interactions during mealtime significantly influence social, emotional, and cognitive development in early childhood. Increasing parental use of digital technology has been linked to disruptions in these interactions, a phenomenon termed “technoference,” which is associated with relational conflicts and psychosocial difficulties in children. Feeding interactions are particularly important for fostering attachment and emotional regulation, making them a vital area for studying technology’s effects on parent–child dynamics. Aims: This study aimed to evaluate the impact of parental digital technology use during mealtime on the quality of feeding interactions and child dysregulation symptoms. Two groups were compared: mothers who used devices during mealtime (Technology Group, TG) and mothers who did not (Non-Technology Group, NTG). Methods: Participants included mother–child dyads (TG) and a matched control group (NTG) (Ntot = 174), selected from a broader research project. Mother–child pairs were observed during a 20 min midday meal using the validated Italian Scala di Valutazione dell’Interazione Alimentare (SVIA). The emotional and behavioral functioning of children was assessed with the Child Behavior Checklist (CBCL). Statistical analyses included ANOVAs and post hoc tests. Results: The TG group demonstrated significantly higher scores on all SVIA subscales, indicating greater parental affective challenges, conflict, food refusal behaviors, and dyadic distress. Additionally, children in the TG group exhibited more internalizing and externalizing problems, including dysregulation symptoms on the CBCL, compared to the NTG group. Conclusions: Parental technology use during mealtime negatively affects parent–child feeding interactions and increases dysregulation in children. These findings highlight the need for mindful parenting strategies to limit digital distractions and foster healthier family dynamics. Full article

Background/Objectives: Coping strategies are influenced by sociocultural factors, and an understanding of how the Brief-COPE functions within the Chinese student population is important for its validity and reliability. This study aimed to explore the factor structure of the Brief Coping Orientation to Problems Experienced Inventory (Brief-COPE) in Chinese nursing students. Methods: A cross-sectional study design was adopted. A total of 284 college nursing students, aged 18 years or older, were recruited from a medical university in China using convenience sampling. Exploratory factor analysis (EFA) was conducted to identify the underlying domain structure of the Brief-COPE within those students. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement. Results: The Brief-COPE demonstrated robust validity, revealing eight distinct factors: positive reframing coping, avoidant and passive coping, seeking social support, self-blame and emotional distress coping, denial and deflective coping, spirituality and humor coping, avoidance and emotional release coping, and adaptive acceptance with distraction. The scale exhibited good internal consistency, as indicated by a Cronbach’s alpha of 0.759. Conclusions: The Brief-COPE is a valid tool for assessing coping strategies in Chinese nursing students. Nursing educators could benefit from training aimed at enhancing the use of appropriate strategies. Also, culturally tailored interventions, such as peer support groups and mentorship programs, could further promote coping skills and improve the emotional well-being of these students. Full article

Moses’s great command, known to us as the Shema, taught the Jewish people that the great goal of one’s entire being must be love of God but that this outcome can be easily obscured in the face of distractions and competing pleasures. The task he describes may be understood as an exhortation to live and teach moral virtues, informed by faith in God: self-management of impulses and conditionings so that we can think clearly about the goals we pursue and love wisely. This study offers an analysis of the Shema through the lens of neurobiology. This approach supports a literal interpretation of the Shema to the extent that it provides a neurobiological explanation for the role of memory, positive emotion, and curated attention in establishing positive convictions and holding to them in the face of contrary stimuli. In doing so, it demonstrates that such applications of neurobiology can enrich our understanding of human behaviour because they offer insights into the internal dynamics at work in human choices and motivations, and into the need for coherence between our emotional responses and our convictions. Full article

The emerging paradigm of personalised bone repair embodies a transformative triad comprising bio-inspired design, digital fabrication, and the exploration of innovative materials. The increasing average age of the population, alongside the rising incidence of fractures associated with age-related conditions such as osteoporosis, necessitates the development of customised, efficient, and minimally invasive treatment modalities as alternatives to conventional methods (e.g., autografts, allografts, Ilizarov distraction, and bone fixators) typically employed to promote bone regeneration. A promising innovative technique involves the use of cellularised scaffolds incorporating mesenchymal stem cells (MSCs). The selection of materials—ranging from metals and ceramics to synthetic or natural bio-derived polymers—combined with a design inspired by natural sources (including bone, corals, algae, shells, silk, and plants) facilitates the replication of geometries, architectures, porosities, biodegradation capabilities, and mechanical properties conducive to physiological bone regeneration. To mimic internal structures and geometries for construct customisation, scaffolds can be designed using Computer-aided Design (CAD) and fabricated via 3D-printing techniques. This approach not only enables precise control over external shapes and internal architectures but also accommodates the use of diverse materials that improve biological performance and provide economic advantages. Finally, advanced numerical models are employed to simulate, analyse, and optimise the complex processes involved in personalised bone regeneration, with computational predictions validated against experimental data and in vivo studies to ascertain the model’s ability to predict the recovery of bone shape and function. Full article

Background: Limb-lengthening surgeries via nail distraction osteogenesis (DO) have become more popular lately. This provides an opportunity to study human bone that has grown longer. Case details: We present a case of a 22-year-old male who underwent internal upper and lower leg lengthening by 12 cm and 6 cm, respectively, under full weight bearing. He requested bilateral femoral shortening by 4 cm using a shortening nail, 24 months after the index surgery. The regenerated bones were harvested and analyzed. Results: Good bone quality and well-organized structure were observed in the regenerated bones compared with the native human adult bony architecture. Conclusions: This case demonstrates that bilateral bone regeneration during DO with a nail can result in a bone morphology that is comparable to that of native adult human bony macro- and micro-anatomy. This supports the effectiveness and potential of this surgical approach for limb lengthening and shortening procedures, although more investigations are necessary in this regard. Full article