Search Results (10,325)

Gilles de la Tourette syndrome (GTS) is a neurodevelopmental disorder characterized by motor and phonic tics, often including attention deficit, hyperactivity, and obsessive–compulsive behaviours. The pathophysiology involves the dysfunction of cortico-striato-thalamo-cortical circuits, primarily implicating dopaminergic hyperactivity, but also involving multiple different neurotransmitter systems. Treatment of GTS is complex, highly individualized, and influenced by considerable variability in symptom presentation. Behavioural approaches, such as Habit Reversal Therapy (HRT), play a key role, especially in milder cases. Pharmacological therapy is largely empirical and varies across countries, influenced by drug availability and the perceived risks of certain classes of drugs, particularly dopamine receptor blocking agents. Drug options for managing tics include dopamine receptor antagonists, monoamine depleting agents, and alpha-2 agonists, all of which require close monitoring for metabolic, cardiovascular, and neurological side effects. Botulinum toxin injections represent an effective solution for focal tics that are resistant to systemic treatments. Cannabinoids and antiepileptics have limited efficacy, yet they may still offer relevant therapeutic potential in selected cases. Serotonergic drugs are useful for treating obsessive–compulsive symptoms. For patients with refractory tics, deep brain stimulation (DBS) represents an intervention of last-resort; however, DBS remains off-label and consensus on optimal targets is lacking. This narrative review draws on both the relevant literature and extensive personal clinical experience to explore the complexities of managing GTS, with a focus on evidence-based treatments for tics and associated neuropsychiatric symptoms. A therapeutic algorithm is proposed, emphasizing a “start low, go slow” approach, combining pharmacological interventions with cognitive behavioural and surgical therapies, when needed. We underscore the importance of tailoring treatments to individual patient profiles and symptom variability over time, highlighting the need for further research in GTS management. Full article

(1) Background: The restoration of posterior proximal carious lesions remains a clinical challenge, particularly in achieving a correct reconstruction of the interdental contact point. The choice of matrix system significantly influences the clinical outcome. (2) Methods: A cross-sectional study was conducted using an online questionnaire distributed to a sample of 129 dental practitioners between May and June 2024. The survey assessed clinicians’ preferences and experiences regarding the use of sectional versus circumferential matrix systems in posterior restorations. (3) Results: The majority of respondents (56.6%) preferred sectional matrix systems, which were associated with a higher rate of achieving an optimal contact point (p < 0.05) and an adequate emergence profile (94.6% vs. 82.9%). Sectional matrices were also associated with fewer open contacts than circumferential systems. (4) Conclusions: Sectional matrix systems are perceived as superior in terms of achieving effective proximal contact and an optimal emergence profile. The findings support the use of these systems in Class II restorations; however, more rigorous standards are needed for evaluating interdental contact quality. Full article

Background: Hypertension is a major global public health problem whose prevalence is increasing across the world. In consideration of this, there is insufficient understanding of the barriers that hinder the taking of anti-hypertensive medication among patients. In this regard, the aim of this study was to analyze the possible barriers undermining adherence to anti-hypertensive medication among patients in private healthcare in Edenvale, South Africa. Methodology: This study used an exploratory cross-sectional research design within which quantitative data were collected through an online survey on a sample of randomly selected hypertensive patients attending private healthcare facilities in Edenvale. Participation in this study was voluntary, and informed consent was sought from each participant. Anonymity was assured during data collection through the de-identification of respondents and any data about them. The collected data were subjected to descriptive statistical analysis. Results: One hundred and twenty-two patients participated in this study. From this, 34.4% of participants revealed that lack of awareness was a barrier to a very small extent. Forgetfulness was a possible barrier to adherence to a large extent amongst 16.4% of participants, and 26.2% of the respondents had, to a large extent, doubts about their hypertension diagnosis. However, 42.6% revealed that side effects and difficulty taking medication whilst away from home (47.5%) were a barrier to a small extent. The fear of side effects (19.7%), interference of alcohol or drug use (29.5%) were challenges to a moderate extent. Conclusions: The findings of this study support that hypertensive patients in private healthcare encounter financial constraints, occasionally forget to take their medication, doubt their hypertension diagnosis, and lack awareness about the benefits of taking anti-hypertensive medication. This may be compounded by patients finding the anti-hypertensive medication regimen too complicated, feeling overburdened by having to take too many pills every day, the complexity of the medication regimens, perceived incorrect diagnosis, and lack of social support from family and friends. Understanding the extent of the barriers encountered by patients in taking anti-hypertension medication may help address adherence challenges, which may help improve health outcomes and lessen the burden on health systems in pursuing Sustainable Development Goal 3 and universal health coverage. Full article

Many athletes consume caffeine before late afternoon/evening training sessions or competition, yet the impact on subsequent sleep remains unclear. This systematic review with meta-analysis examined the effects of late afternoon/evening caffeine consumption on sleep in athletes. Ten studies (n = 128 athletes) involving randomized controlled trials and quasi-experimental designs were included if caffeine was consumed prior to late afternoon/evening training and subsequent sleep was measured. Meta-analysis followed PRISMA guidelines with risk of bias assessed using RoB-2 and ROBINS-I tools. Meta-analysis of randomized controlled trials revealed a small reduction in sleep efficiency with evening caffeine consumption: mean difference −4.87%, 95% CI −7.45 to −2.29, p = 0.04, though this effect was not robust in leave-one-out sensitivity analyses. Total sleep time showed a non-significant trend toward reduction: mean difference −32.47 min, 95% CI −69.93 to 4.99, p = 0.08, I² = 0%. Athletes consistently reported substantial subjective sleep impairment following evening caffeine intake (3–6 mg/kg BM), creating a pronounced objective–subjective disconnect. The most notable finding is that athletes consistently perceive substantial sleep disruption despite inconsistent objective changes, highlighting the importance of subjective sleep experience in athletic populations. These findings should be interpreted cautiously given the small number of studies and predominance of male participants, limiting generalisability. Full article

Background/Objectives: Weight-based stigma represents a pervasive psychosocial challenge affecting youth worldwide, with significant implications for mental and physical health. Although school-based interventions have been suggested as effective strategies to reduce weight bias, evidence regarding their content and efficacy in real-world educational contexts remains limited. The present study aimed to evaluate the effectiveness of a school-based intervention designed to reduce internalized weight stigma among Italian adolescents. Methods: A total of 539 secondary school students (Mage = 15.91 years; SD = 1.38; 51.5% males) from 10 schools in Italy were randomly assigned to either an intervention group (61.2%, n = 330) receiving the program or a minimal intervention control group (38.8%, n = 209). The intervention integrated psychoeducational modules and activities based on cognitive dissonance theory to address maladaptive weight-related attitudes and associated psychopathological outcomes. Pre- and post-intervention assessments evaluated internalized weight bias and body dissatisfaction in both groups. Results: A significant reduction in internalized weight bias was observed among students perceiving themselves as overweight following the intervention. Additionally, a marginally significant decrease in body dissatisfaction was reported in the intervention group from pre- to post-intervention. No comparable changes were found in the control group. Conclusions: These findings suggest that incorporating cognitive dissonance-based psychoeducational content within school-based programs may be a promising approach for reducing internalized weight stigma in adolescents. Further research is warranted to refine intervention strategies, explore the mechanisms underlying the observed effects, and assess the scalability and long-term impact of such initiatives in school settings. Full article

The spatial distribution of predation risk creates a landscape of fear that shapes animal behavior. Humans are typically perceived as predators, leading wildlife to adjust their space use accordingly. However, adaptable species like wild boar (Sus scrofa) can thrive in human-dominated landscapes such as cities, where they may generate conflicts. In this study, we investigated how the landscape of fear influences wild boar presence in a Mediterranean peri-urban environment in Cáceres (Spain). We quantified wild boar presence (WBp) using 112 footprint traps across three seasons and characterized fear-related variables through vegetation cover and an urbanization gradient derived from distances to the city center and urban edge. Generalized linear mixed models showed that WBp was consistently higher in Cover areas than in Open areas, while the urbanization gradient had no significant effect. Spatial modeling further revealed more localized aggregation in Cover areas. These results indicate that wild boar preferentially use vegetated refuge zones, although seasonal variation suggests that resource distribution may also shape their movements. Understanding how wild boar respond to fine-scale landscape features has key implications for managing their populations and mitigating human–wildlife conflicts in Mediterranean peri-urban contexts. Full article

Background/Objectives. This study applied the Demands-Resources-and-Individual-Effects(DRIVE)-Nurses-Model to explore and compare the experiences of nurses working in Intensive Care Units (ICUs) and in Neonatal Intensive Care Units (NICUs), by investigating the effects of the interplay (main/mediating/moderating effects) of perceived stress related to dealing with death/critically ill patients (Death-and-Dying-Stressor)—which unavoidably features in the daily life of nurses working in ICU/NICU—with further potential Stressors in Nursing (Conflicts-with-Physicians, Peers, Supervisors, Patients/their families, Uncertainty-Concerning-Treatment, Inadequate-Emotional-Preparation, Discrimination, Workload), Work-Resources (Job-Control, Social-Support, Rewards), and Coping-Strategies (Problem-focused, Seek-Advice, Self-Blame, Wishful Thinking, Escape/Avoidance) on nurses’ psychological health conditions according to the working unit (ICU/NICU). Methods. Overall, 62 critical care nurses (ICU = 35; NICU = 27) completed self-report questionnaires. Main/mediating/moderating effects were tested by using Correlational-Analyses and Hayes-PROCESS-tool by working unit. Results. Nurses working in NICU reported higher Psychological Disease than nurses working in ICU. The detrimental psychological impact of Death-and-Dying-Stressor was mediated by Conflicts-with-Supervisors-Stressor among ICU nurses and by Uncertainty-Concerning-Treatment and Conflicts-with-Physicians stressors among NICU nurses. The recourse to Self-Blame and Escape/Avoidance coping strategies exacerbated the psychological risk among ICU nurses, while perceived Work-Resources (Job-Control/Social-Support) played a protective moderating role among NICU nurses. Conclusions. The application of the DRIVE-Nurses-Model to deepen the experience of nurses working in ICU/NICU could advance the understanding of the mechanisms underlying the relationship between Death-and-Dying-Stressor and nurses’ psychological health, suggesting tailored risk profiles and accounting for key protective factors, to provide nurses with the necessary resources for adjusting to their challenging and emotionally demanding work-related duties and experiences. Full article

Background/Objectives: Aging and a sedentary lifestyle aggravate hypokinetic diseases, compromising the functional capacity of older adults. Thus, the prescription of physical exercise (PE) through mobile applications (MA) has emerged as a remote and personalized alternative. However, there are still gaps in the effectiveness of prescribing physical exercise via mobile apps for older people. This study aimed to analyze the effects of prescribing PE through MAs on the health of older adults. Materials and Methods: This systematic review included studies with older people (≥60 years) that used MAs to prescribe PE, published between 2014 and 2024, in Portuguese or English. The search strategy used the descriptors “older adults,” “physical exercise,” “mobile applications,” and “health,” combined with Boolean operators. The screening followed previously defined eligibility criteria regarding population, intervention, outcomes, and study design. Two independent reviewers extracted data, mediated by a third party in case of disagreement; they screened and extracted data from the PubMed and VHL/Medline databases from 2004 to 2024. Risk of bias was assessed according to levels of evidence, and the results were categorized. Results: Of the 2298 publications initially identified, 7 studies were eligible for this review, totaling 748 participants, predominantly female. The studies included prospective and observational clinical trials with older people suffering from Parkinson’s disease, cardiovascular disease, sarcopenia, and breast cancer. The findings showed favorable effects on adherence to the program (6 studies; n = 654), an increase in PE (5 studies; n = 502), and improvements in functional capacity (4 studies; n = 389), perceived quality of life (5 studies; n = 481), and muscle strength (3 studies; n = 298). Conclusions: The prescription of MA-mediated PE showed positive effects on the health of older people, indicating its viability as a complementary strategy in clinical practice or public health. Full article

Job satisfaction is widely acknowledged as a complex, multidimensional construct that significantly influences both employee well-being and organizational performance. Within the field of education, empirical research specifically focusing on preschool teachers’ job satisfaction remains scarce. Progress in this area is related to the availability of psychometrically robust measurement instruments. This study examined job satisfaction among Greek preschool teachers using a revised version of the Teachers’ Satisfaction Inventory (TSI), integrating theoretical frameworks emphasizing job satisfaction’s multidimensional nature and its critical role in organizational effectiveness. The present study aimed to (1) validate the TSI’s psychometric properties for preschool teachers and (2) assess satisfaction levels by incorporating two new dimensions: salary and perceived prestige. An extended version of the 30-item TSI, measuring seven dimensions, was administered to 224 Greek preschool teachers. Psychometric properties were assessed using confirmatory factor analysis (χ² = 743.33, df = 384, CFI = 0.992, RMSEA = 0.067, SRMR = 0.078), reliability (Cronbach’s α = 0.77 to 0.94) and convergent analyses (AVE = 0.661 to 0.854). Findings indicated that the revised TSI is a valid and reliable instrument with a strong seven-factor structure (factors’ correlation = 0.143 to 0.787). Results revealed high satisfaction with colleagues and students, but significant dissatisfaction with salary and prestige. The findings underscore the need for policymakers to address financial compensation and societal recognition to enhance retention and well-being in preschool education. This study contributes a validated tool for assessing preschool teachers’ job satisfaction while highlighting context-specific challenges in Greece. Full article

In vision-guided autonomous robots, object detectors play a crucial role in perceiving the environment for path planning and decision-making. However, adaptive adversarial patch attacks undermine the resilience of detector-based systems. Strengthening object detectors against such adaptive attacks enhances the robustness of navigation systems. Existing defenses against patch attacks are primarily designed for stationary scenes and struggle against adaptive patch attacks that vary in scale, position, and orientation in dynamic environments. In this paper, we introduce Ad_YOLO+, an efficient and effective plugin that extends Ad_YOLO to defend against white-box patch-based image attacks. Built on YOLOv5x with an additional patch detection layer, Ad_YOLO+ is trained on a specially crafted adversarial dataset (COCO-Visdrone-2019). Unlike conventional methods that rely on redundant image preprocessing, our approach directly detects adversarial patches and the overlaid objects. Experiments on the adversarial training dataset demonstrate that Ad_YOLO+ improves both provable robustness and clean accuracy. Ad_YOLO+ achieves $85.4\%$ top-1 clean accuracy on the COCO dataset and $74.63\%$ top-1 robust provable accuracy against pixel square patches anywhere on the image for the COCO-VisDrone-2019 dataset. Moreover, under adaptive attacks in AirSim simulations, Ad_YOLO+ reduces the attack success rate, ensuring tracking resilience in both dynamic and static settings. Additionally, it generalizes well to other patch detection weight configurations. Full article

Background/Objectives: Cast walkers (CWs) are often prescribed to offload diabetic foot ulcers (DFUs). However, their mass, the degree of ankle immobilization and the limb length discrepancy they induce may increase the energetic demands of walking, contributing to lower adherence and poorer healing. The purpose of this study was to evaluate the effects of different commercially available CW options on the metabolic costs and perceived exertion of walking, and on related spatiotemporal kinematics, in healthy young participants as an initial step to understanding factors that impact adherence in patients with DFUs. Methods: Participants walked on an instrumented treadmill at a standardized speed for six minutes under five footwear conditions: (1) athletic shoes only (control); (2) ankle-high CW on the dominant limb with athletic shoe on the contralateral limb; (3) condition two with an external lift on the athletic shoe; (4 and 5) conditions two and three with a knee-high CW. Condition 1 was performed first, after which the CW conditions were randomized. During all conditions, a portable calorimeter recorded gas exchange on a breath-by-breath basis. The metabolic cost of transport (MCoT) was quantified as the mean oxygen consumed per meter walked per kilogram body mass, after accounting for standing. After walking, participants reported perceived exertion using the Borg Rating of Perceived Exertion scale (RPE). From the treadmill data, we extracted the mean step width (SW) as well as absolute values for symmetry indices (SIs) for step length (SL) and step time (ST), all of which have associations with MCoT. For each outcome, linear mixed models compared each CW condition with the control and tested for effects of CW height (ankle-high vs. knee-high) and of the lift. Results: A total of 14 healthy young adults without diabetes participated. MCoT, RPE and SW were significantly higher for all CW conditions compared to the control, with less consistent results for asymmetry measures. MCoT was not significantly different across CW height or lift condition although an unexpected interaction between limb and CW height n was observed; MCoT was lower in the knee-high CW with vs. without a lift but did not change in the ankle-high CW based on lift status. Similarly, neither SW nor SIs changed in expected fashions across conditions. In contrast, RPE was significantly lower using the ankle- vs. knee-high CW and when using a lift vs no lift, with no significant interaction. Conclusions: Although metabolic costs were unaffected by CW design changes, which may reflect the absence of anticipated changes in kinematics that impact MCoT, perceived exertion was reduced through such changes. Unanticipated biomechanical changes may reflect a complex interaction among a number of competing factors that dictate behavior and MCoT. The differing results in perception of exertion and metabolic costs might be due to participants’ perceived exertion being sensitive to the collective impact of interacting biomechanical factors, including those not quantified in this study. Future work should seek to directly evaluate the impact of CW design changes in patients with DFU and the relationship to adherence. Full article

This study investigated the factors influencing user acceptance of the Navigate on Autopilot (NOA) functionality in new energy vehicles in China. An extended Technology Acceptance Model (TAM) was developed, incorporating additional factors such as social influence, travel scenarios, price value, perceived trust and perceived risk. A questionnaire survey was conducted in Guangzhou, China, and 260 valid responses were obtained. Structural equation modeling (SEM) was used to analyze the relationships between the factors. The results indicated that perceived ease of use, perceived usefulness, travel scenarios, price value, and perceived trust had significant positive effects on attitudes towards NOA, whereas social influence and perceived risk did not. Attitude was the primary determinant of the behavioral intention to use NOA. The findings suggest that to enhance NOA acceptance, new energy vehicle companies should emphasize specific application scenarios, reduce technology costs, provide value-added services, and strengthen user trust in the technology. This study contributes to the understanding of NOA acceptance and provides practical insights into the promotion of driver assistance systems in the context of new energy vehicles in China. Full article

This study examines the multiple determinants of public satisfaction with high-rise urban forms in Muscat, Oman, in the context of rapid urbanization and the need to protect and conserve culture. Based on a conceptual framework that included six latent variables—Cultural Harmony, Economic Benefit, Environmental Experience, Social Perception, Urban Connectivity, and Visual Appeal—data collected from city residents were analyzed using the quantitative technique of Partial Least Squares Structural Equation Modeling (PLS-SEM). The model results showed that all relationships were supported, with Urban Connectivity, Cultural Harmony, and Visual Appeal having the strongest effects on satisfaction. These findings indicate that public satisfaction with high-rise developments is influenced by the perceived integration of infrastructure, harmony with local architectural traditions, and coherently attractive views. Environmental Experience, Social Perception, and Economic Benefit had smaller, though still significant, effects, confirming the multidimensional nature of urban appraisal. This study therefore calls for a development approach that balances technical, environmental, cultural and tourism-oriented objectives. As such, this work contributes to the existing literature on urban and societal studies by examining a multifaceted model of urban satisfaction and providing beneficial recommendations to enhance the continuing debate on sustainable and contextual urbanism in the Gulf states. Full article

Seniority-based hierarchical structures in higher education may hinder innovation in hospitality and tourism (H&T) sustainability education; therefore, this study applies Social Exchange Theory (SET) to examine how these hierarchies affect curriculum development and modernization in H&T programs. We used semi-structured interviews with 22 faculty members and administrators from hospitality and tourism programs across multiple universities—including four university presidents, three deans, three department heads, one professor, four associate professors, four assistant professors, and three lecturers with work experience ranging from 3 to 30 years—and we explored social exchange dynamics including reciprocity, trust, power imbalances, and perceived obligations that influence the integration of contemporary sustainable practices. Findings indicate that rigid seniority systems impede sustainability curriculum modernization and limit the incorporation of innovative industry expertise; however, institutions implementing SET principles—characterized by equitable recognition and balanced exchange between academic tenure and industry experience—demonstrate superior adaptability and better prepare students for evolving sustainability demands. This research illuminates organizational dynamics governing educational innovation and provides SET-based recommendations for developing institutional cultures that effectively bridge academic tradition with industry relevance and sustainability imperatives in H&T education. Full article

This study investigated the effects of low-dose 1cp-LSD, a prodrug of LSD, on canine anxiety, while exploring the influence of owner psychopathology on treatment outcomes. Seven dogs exhibiting anxiety-related behaviors were recruited and received 2.5, 5, or 10 µg of 1cp-LSD orally every three days for 30 days. One additional dog, which did not meet clinical criteria for anxiety but whose owner perceived it as anxious, received a placebo (saccharin) as an observational case. Anxiety levels were assessed using validated scales at baseline, post-treatment, and one month after treatment cessation. Owners’ neuroticism and psychopathological dimensions were evaluated using the IPIP and SA-45 scales. Linear regression analyses examined associations between anxiety reduction, administered dose, and owner psychological traits. A significant reduction in separation anxiety scores was observed post-treatment (mean: 11.3 ± 3.0, p = 0.023). Higher 1cp-LSD doses correlated with greater anxiety reduction (B = −1.15, 95% CI = [−2.29, −0.003], p = 0.050). Additionally, higher owner psychoticism scores were associated with smaller improvements in canine anxiety (p = 0.035). Anxiety levels remained low one month after treatment, with significant associations between canine anxiety and the owners’ hostility, interpersonal sensitivity, and paranoid ideation. These findings support the potential role of low-dose serotonergic psychedelics in managing canine anxiety and suggest an association between caregiver psychological traits and treatment outcomes. The sustained reduction in anxiety behaviors also suggests a meaningful and lasting improvement in animal welfare. However, significant results should be interpreted cautiously due to the small sample size. Further blinded, controlled studies are needed to validate these preliminary observations and assess broader applications in veterinary behavioral medicine. Full article