Search Results (1,858)

Background/Objectives: Idiopathic intracranial hypertension (IIH) often features dural venous sinus stenosis; venous sinus stenting (VSS) improves venous outflow and intracranial pressure, but most stents are off-label, and few are engineered for intracranial venous anatomy. The aim was to synthesize animal models relevant to IIH/VSS, catalogue stents used clinically for VSS and summarize corresponding animal data, appraise current preclinical VSS research, and propose a pragmatic preclinical evaluation framework. Methods: We performed a targeted search (PubMed, Web of Science, Scopus; through to May 2025), dual-screened the records in Nested Knowledge, and extracted the model/device characteristics and outcomes as per the predefined criteria. Results: We identified 65 clinical VSS studies; most were retrospective and used off-label carotid/peripheral/biliary stents (Precise, Zilver, and Wallstent were the most frequent). Recent dedicated systems (River, BosStent) have limited animal evidence; VIVA has GLP porcine venous peripheral data demonstrating its patency, structural integrity, and benign healing outcomes. Rodent models reproduce obesity/androgen drivers with modest, sustained ICP elevation; large animal models show the technical feasibility of in sinus implantation, but no chronic focal venous stenosis model fully mirrors the IIH condition. Conclusions: Despite broad clinical uptake, the translational underpinnings of VSS in IIH remain incomplete: most devices lack intracranial venous-specific preclinical validation, and there is no existing animal model that recapitulates both IIH biology and focal sinus stenosis. Full article

Background: Post-traumatic epilepsy (PTE) is a recognized complication of traumatic brain injury (TBI), yet its risk following mild and moderate TBI remains underappreciated. Although mild TBI represents the majority of cases in clinical practice, a subset of patients develop unprovoked seizures months or even years post-injury. This review aims to synthesize current evidence on the incidence and predictors of PTE in mild and moderate TBI and to propose a clinically actionable decision-support tool for early risk stratification. Methods: We performed a narrative review of peer-reviewed studies published between 1985 and 2024 that reported on the incidence, risk factors and predictive models of PTE in patients with mild (Glasgow Coma Scale [GCS] 13–15) and moderate (GCS 9–12 or imaging-positive) TBI. Data from 24 studies were extracted, focusing on neuroimaging findings, early post-traumatic seizures, EEG abnormalities and clinical risk factors. These variables were integrated into a rule-based algorithm, which was implemented using Streamlit to enable real-time clinical decision-making. The decision-support tool incorporated five domains: injury severity, early post-traumatic seizures, neuroimaging findings (including contusion location and hematoma type), clinical and demographic variables (age, sex, psychiatric comorbidities, prior TBI, neurosurgical intervention) and EEG abnormalities. Results: PTE incidence following mild TBI ranged from <1% to 10%, with increased risk observed in patients presenting with intracranial hemorrhage or early seizures. From moderate TBI, incidence rates were consistently higher (6–12%). Key predictors included early seizures, frontal or temporal contusions, subdural hematoma, multiple contusions and midline shift. Additional risk-enhancing factors included prolonged loss of consciousness, male sex, psychiatric comorbidities and abnormal EEG patterns. Based on these features, we developed a decision-support tool that stratifies patients into low-, moderate- and high-risk categories for developing PTE. Conclusions: Even in non-severe cases, patients with mild and moderate TBI who exhibit high-risk features remain vulnerable to long-term epileptogenesis. Our proposed tool provides a pragmatic, evidence-based framework for early identification and follow-up planning. Prospective validation studies are needed to confirm its predictive accuracy and optimize its clinical utility. Full article

In an increasingly globalized world, learning foreign languages (FLs) is essential, particularly in education. Multilingualism is critical due to the multicultural and interconnected nature of societies, yet early third language acquisition (TLA) is not widely adopted in schools. This study investigates how the simultaneous learning of Spanish first language (L1), a second language (L2), and a third language (L3) impacts oral language (OL) development in L1 and whether prior L2 knowledge aids L3 acquisition. The study involved bilingual (L1 + L2) and trilingual (L1 + L2 + L3) learners. Data were collected using the Navarre Oral Language Test-Revised, which evaluates phonological, morphological–syntactic, lexical–semantic, and pragmatic competencies in oral communication. Findings revealed that trilingual learners showed better OL development in L1 compared to bilingual learners. Additionally, prior L2 knowledge facilitated L3 learning, highlighting the benefits of early trilingual education. The study demonstrates that early trilingual learning positively impacts OL development in L1. These results contribute significantly to research on TLA and the advancement of multilingual education. Full article

Digital wellbeing has been the subject of extensive research in educational contexts. Yet, there remains a paucity of studies conducted within the paradigm of generative AI, a field with the potential to significantly influence students’ sentiments and dispositions in this domain. This study analyses 474 student recommendations (information science and library science) for digital wellbeing in generative artificial intelligence. The research is based on the context of pragmatism, which rejects the differentiation between thinking and acting and ties both phenomena into one interpretive whole. The research method is thematic analysis; students proposed rules for digital wellbeing in the context of generative AI, which was followed by the established theory. The study has identified four specific areas that need to be the focus of research attention: societal expectations of the positive benefits of using generative AI, particular ways of interacting with generative AI, its risks, and students’ adaptive strategies. Research has shown that risks in this context must be considered part of the elements that make up the environment in which students seek to achieve balance through adaptive strategies. The key adaptive elements included the ability to think critically and creatively, autonomy, care for others, take responsibility, and the reflected ontological difference between humans and machines. Full article

Prenatal maternal stress (PNMS) predicts risk for autism spectrum disorders (ASD), although the mechanisms are unknown. Because ASD and autistic-like traits have been associated with both prenatal stress and DNA methylation differences, it is important to examine whether epigenetic mechanisms mediate the pathway from PNMS to later autistic-like outcomes. This study aimed to determine the extent to which DNA methylation mediates the association between PNMS from a natural disaster and autistic-like traits in offspring assessed during adolescence. Five months following the 1998 ice storm in Quebec, we recruited women who had been pregnant during the crisis and assessed their PNMS: objective hardship, subjective distress, and cognitive appraisal. At age 13, their children provided blood samples for DNA. At ages 15, 16 and 19, the youth self-reported their own autistic-like traits using the Broad Autism Phenotype Questionnaire. This longitudinal design allowed us to track the developmental pathway from prenatal exposure, through adolescent DNA methylation, to later behavioral outcomes. Analyses included youth with data on PNMS, DNA methylation, and the BAPQ (n = 27 at age 15; 22 at age 16; and 13 at age 19). Results showed that mothers’ disaster-related objective hardship and their negative cognitive appraisal of the disaster were associated with DNA methylation at age 13, which then were associated with the severity of their children’s Aloof Personality and Pragmatic Language Deficits, but not Rigid Personality, at ages 15, 16 and 19. Mediation was significant particularly through genes within the PI3K/AKT/mTOR pathway, which has been implicated in various neurodevelopmental disorders, including ASD. Interestingly, while greater PNMS predicted more severe ASD traits, the epigenetics effects were for less severe traits. Although other interpretations are possible, these results could suggest that DNA methylation, assessed in early adolescence, may protect against ASD traits at later ages, particularly when there is a mismatch between the prenatal environment (disaster) and the postnatal environment (absence of disaster). The interpretation of these findings benefits from the longitudinal design and is discussed in the context of fetal programming and the predictive adaptive response. Full article

Organic foods, functioning as credence goods in sustainable consumption, compel consumers to rely on extrinsic cues for quality evaluation. To address this challenge, this study employs a qualitative, phenomenological approach, conducting ten in-depth, semi-structured interviews with Romanian organic food consumers. The resulting data were systematically analyzed through thematic analysis to uncover decision-making patterns. The findings reveal a sequential hierarchy in which credible transnational certification (the EU organic logo) serves as a non-negotiable gatekeeper of trust, followed by country of origin—particularly local—which functions as an emotional and heuristic differentiator signaling authenticity and freshness, while price acts as a pragmatic arbiter, mediating trade-offs between ideal preferences and budget constraints. Based on these findings, this study proposes the Trust–Emotion–Pragmatism model as a nuanced framework for understanding organic food choice, suggesting that local producers can enhance competitiveness by first establishing trust through certification, then leveraging the emotional appeal of local origin, and finally adopting effective pricing strategies. Full article

We reviewed vancomycin-resistant Enterococcus (VRE) colonisation of inpatients of a spinal cord injury centre. The centre consists of one single occupancy en suite room and ten multi-occupancy rooms where two to six patients stay in a cubicle. These patients share bathroom and toilet facilities. Active screening for VRE is performed by taking rectal swabs on admission of patients to the spinal unit. The patients, who are colonised with VRE, are not isolated due to constraints in resources. During a twelve-month period (April 2024 to April 2025), 33 patients tested positive for VRE. In April 2025, 17 of 40 in-patients tested positive for VRE. During the last six 12-month periods from 2019, the number of patients testing positive for VRE has shown an upward trend from 18 during 2019–2020 to 33 during 2024–2025. No patient developed systemic infection with VRE (blood stream infection, endocarditis, meningitis, intra-abdominal sepsis, infection of a spinal implant or baclofen pump) during the study period. Twelve patients underwent implantation of a baclofen pump during 2024–2025. No patient developed VRE infection from the implant. We believe that non-isolation of patients colonised with VRE may be a pragmatic approach in a resource-poor healthcare facility. It is possible that non-isolation could have contributed to an increase in the number of patients who became colonised with VRE. Attention should be paid to infection prevention measures including hand washing and environmental cleaning to prevent the spread of VRE colonisation of inpatients and VRE infection of at-risk patients, e.g., immune-compromised individuals. Full article

Background: Family caregivers of patients with chronic diseases face high levels of burden, anxiety, and burnout, which may negatively affect both their well-being and patient outcomes. Low-cost, accessible telemedicine approaches may provide practical support in resource-limited settings. Methods: We conducted a prospective, parallel-group controlled study in Timisoara, Romania, between April 2024 and March 2025 and included 161 caregivers of older adults with chronic diseases, allocated 1:1 to receive either structured low-cost telemedicine support (weekly phone calls and SMS reminders; n = 82) or usual care (n = 79). Data were collected at baseline, three months, and six months through structured interviews. The primary outcome was caregiver burden measured by the Zarit Burden Interview (ZBI). Secondary outcomes included caregiver anxiety, burnout, satisfaction, and patient-related outcomes such as emergency room (ER) visits, hospital readmissions, and medication adherence. Analyses were performed using ANCOVA and logistic regression, adjusting for baseline values and relevant covariates. Results: At three months, caregivers in the intervention group had significantly lower burden scores compared to controls (adjusted mean difference −2.9; 95% CI −4.7 to −1.1; p = 0.002). Reductions in anxiety (−1.4; p = 0.02) and burnout (−1.6; p = 0.01) were also observed. These effects persisted at six months, though slightly attenuated. Patient outcomes favored the intervention: ER visits were lower at six months (27.50% vs. 41.02%; aOR 0.55, 95% CI 0.30–0.99; p = 0.047), while medication adherence and readmissions showed consistent but non-significant improvements. No adverse effects were reported. Conclusions: A simple, low-tech telemedicine program reduced caregiver burden, anxiety, and burnout and decreased ER visits. Improvements in medication adherence and readmissions were observed, but did not reach statistical significance. This pragmatic intervention can easily be integrated into primary care follow-up or community-based caregiver support programs, providing an affordable and low-cost technique to promote chronic disease management and caregiver well-being, especially in resource-limited health systems. Full article

Organisations are increasingly adopting the Chain of Custody (CoC) standards in the mining industry to enhance the traceability of minerals. It ensures that the minerals they have received are from credible sources and accompanied by verifiable information. However, unlikeother industries such as timber, where the effectiveness and benefits of CoC standards are mainly explored, this study subtly shifts the focus towards identifying strategic opportunities and innovation areas within the CoC standards that could extend beyond traceability. Four CoC standards were selected, and their provisions examined. It was found that implementing these requirements could not only enhance transparency but also support broader sustainability goals across the entire value chain. The study also identifies several challenges that could act as barriers to the CoC system, and these are seen as opportunities for innovative approaches to enhance the effectiveness of the standards. These are labelled as transformative innovation areas, and while they do include blockchains and analytical proof of origin technologies, this study also seeks to advocate for solutions that are more pragmatic and scalable. By identifying opportunities and areas of innovation, the findings will help improve the practical implementation of the standards and suggest areas for future evaluations of effectiveness that could consider aspects beyond traceability, such as sustainability and transparency. Full article

In Bayesian analysis, testing for linearity requires placing a prior to the entire space of potential regression functions. This poses a problem for many standard tests, as assigning positive prior probability to such a hypothesis is challenging. The Full Bayesian Significance Test (FBST) sidesteps this issue, standing out for also being logically coherent and offering a measure of evidence against H 0 , although its application to nonparametric settings is still limited. In this work, we use Gaussian process priors to derive FBST procedures that evaluate general linearity assumptions, such as testing the adherence of data and performing variable selection to linear models. We also make use of pragmatic hypotheses to verify if the data might be compatible with a linear model when factors such as measurement errors or utility judgments are accounted for. This contribution extends the theory of the FBST, allowing for its application in nonparametric settings and requiring, at most, simple optimization procedures to reach the desired conclusion. Full article

Palliative radiotherapy (PRT) is central to symptom control in advanced cancer, yet referrals are often late, and patients and clinicians frequently hold misconceptions about intent, benefits, and logistics. Patient education may address these gaps, but the PRT-specific evidence base has not been consolidated. We conducted a narrative review following SANRA guidance. We searched PubMed, Scopus, and the Cochrane Library for English-language studies from 1 January 2000 to 18 July 2025. Eligible articles evaluated structured patient-education interventions or characterized education or communication content, information needs, or decision processes among adults referred to or receiving PRT. Two reviewers independently screened and extracted data. Owing to heterogeneity of designs and endpoints, we performed a narrative synthesis without meta-analysis. Six studies met criteria: two randomized controlled trials, two prospective pre–post studies, one qualitative interview study, and one observational communication study, conducted in the Netherlands, the United States, Canada, and Hong Kong. Education at referral or consultation improved knowledge, reduced decisional uncertainty, and increased readiness to proceed with PRT. Education integrated with treatment improved symptom outcomes, including higher rates of pain control at 12 weeks and faster time to pain control when a nurse-led pain-education program accompanied PRT for painful bone metastases, and improvements in dyspnea, fatigue, anxiety, and function in advanced lung cancer. Observational and qualitative work showed low patient question-asking and persistent curative expectations; overall quality of life generally did not change. Although the evidence is limited and heterogeneous, targeted, standardized education appears to improve decision quality and selected symptoms in PRT pathways. Pragmatic multi-site trials and implementation studies are needed to define content, timing, personnel, and delivery models that are scalable in routine care. Full article

Persistent pulmonary hypertension of the newborn (PPHN) results from disrupted fetal–neonatal circulatory transition, characterized by elevated pulmonary vascular resistance (PVR), right-to-left shunting, and refractory hypoxemia. Despite improved perinatal care, PPHN remains a major source of neonatal morbidity and mortality. This review details PPHN phenotypes, pathophysiology, etiology, diagnostics including echocardiography and biomarkers like B-type Natriuretic Peptide (BNP) or N-terminal pro-B-type Natriuretic Peptide (NT-proBNP), and current therapeutic modalities, from lung recruitment and surfactant to targeted vasodilator therapy (iNO, sildenafil, milrinone, bosentan) and extracorporeal membrane oxygenation (ECMO). We emphasize the role of endothelial and molecular mechanisms in precision therapy and outline guidelines for clinical decision-making in diverse care settings. Full article

Background/Objectives: Malnutrition is common among patients with advanced chronic illnesses receiving palliative care, yet comparative data between diagnostic groups are limited. This study aimed to evaluate and compare the nutritional status of patients with end-stage chronic heart failure (CHF) and chronic respiratory disease (CRD), and to assess the clinical utility of the Controlling Nutritional Status (CONUT) score in this setting. Methods: We conducted a retrospective analysis of 80 patients (41 with CHF, 39 with CRD) enrolled in a palliative care program (mean age 77.8 ± 6.8 years, 65% male). Nutritional status was assessed using BMI (Body Mass Index), CONUT score, and routine biochemical markers. Functional and clinical variables, including the Palliative Performance Scale (PPS), were also collected. Results: Moderate-to-severe malnutrition (CONUT ≥ 5) was significantly more prevalent in patients with CHF patients (44%) than CRD patients (10%, p = 0.002). CHF patients exhibited lower BMI, cholesterol, lymphocyte counts, and prealbumin levels. Despite more frequent nutritional follow-up and protein supplementation in the CHF group, these interventions were not associated with improved nutritional classification. The CONUT score correlated more strongly with functional impairment (PPS) than with disease type alone. Conclusions: Patients with CHF receiving palliative care demonstrate higher rates of malnutrition than those with CRD. The CONUT score, derived from standard blood test, may be pragmatic screening tool for identifying nutritional vulnerability and guiding interventions. While it does not predict survival, it may help detect functional decline earlier and support care strategies aimed at maintaining quality of life in end-stage disease. Full article

Registered Respiratory Therapists (RRTs) have unique skills in managing chronic obstructive pulmonary disease (COPD) in primary care settings. With an 82% increase in COPD diagnoses between 2000 and 2010 in Canada, the fact that over 10% of Canadians aged 35 and older are living with COPD, and primary care reform in Ontario and Manitoba, we would expect an increasing number of RRTs working in this setting. However, this is not happening. Through the concept of job satisfaction, we want to investigate the barriers of integrating this allied healthcare professional into primary care settings. Using a pragmatic approach, we examined RRT job satisfaction in primary care via semi-structured interviews of 19 RRTs in Manitoba and Ontario in 2018 and 2019. A combined inductive and deductive (Mottaz framework) analysis approach allowed us to cross reference work context with job satisfaction. The context in which primary care is operationalized impacts RRT job satisfaction. In Ontario, retention of RRTs in primary care was the main issue due to lower salaries and benefits. In Manitoba, recruitment of RRTs in primary care was the main issue due to lack of human resources and funding. Efforts should be made to address gaps in job satisfaction of RRTs in primary care. To improve retention in Ontario, RRTs should be compensated similarly to their counterparts in acute care. In Manitoba, there should be increased positions for RRTs in primary care. Developing strategies for enhancing job satisfaction will ensure the delivery of high-quality, patient-centered care. This study provides both theoretical and practical contributions to primary care workforce research. Theoretically, our findings demonstrate how contextual factors moderate job satisfaction, showing that the primary care context produces various work situations and heavily impacts work satisfaction. Practically, our results offer specific guidance for healthcare policymakers and administrators, including standardizing compensation across care settings, converting part-time positions to full-time roles, and developing targeted educational initiatives to improve workforce recruitment and retention in underserved areas. Full article

The use of light at night may contribute to the inappropriate or excessive use or presence of artificial light known as light pollution. Light pollution wastes huge amounts of electricity and money and contributes to global warming as well as having significant impacts on wildlife. There is a recognition that many of the issues that drive light pollution should be engaged by local, often pragmatic, governments. Lighting policies need to manage light pollution while also providing the intended services. To achieve this, local governments could develop policies and interventions in terms of three main considerations: functionality, technology, and the behaviours that comprise social usage. To determine to what extent this is being done, the lighting policies of the local governments of greater Melbourne are investigated, along with the related Australian Standards associated with lighting. Very few of the local governments in greater Melbourne had an explicit policy addressing light pollution and none of them considered the likelihood of behavioural issues such as rebounds in energy use. The results of this study suggest that policies that reduce light pollution, with controls to avoid behavioural complications such as rebound effects, should reduce costs for local governments and reduce greenhouse gas emissions. Full article