Search Results (369)

Background/Objectives: We aimed to compare non-pharmacological (non-PHM) and pharmacological (PHM) treatment for patients with non-acute lumbar disc herniation (LDH) and determine the feasibility of a large-scale study. Methods: This was a two-armed, parallel, multicenter, pragmatic controlled trial performed in South Korea. All patients underwent magnetic resonance imaging (MRI) scans both at the screening stage and the last follow-up. Patients with LDH findings on MRI were randomly assigned to non-PHM and PHM groups. Treatment was administered twice a week for a total of 8 weeks, and follow-up assessments were performed at weeks 9, 13, and 27 post-randomization. The primary outcome was the Oswestry Disability Index (ODI) score. A linear mixed model was used for primary analysis from intention-to-treat perspectives. The incremental cost-effectiveness ratio (ICER) was calculated for economic evaluation. Results: Thirty-six patients were enrolled, and thirty-five were included in the final analysis. At Week 9, the difference in ODI scores between the two groups was 5.17 (95% CI: −4.00 to 14.35, p = 0.262), and the numeric rating scale scores for lower back and leg pains were 1.89 (95% CI: 0.68 to 3.10, p = 0.003) and 1.52 (95% CI: 0.27 to 2.77, p = 0.018), respectively, confirming greater improvement in the non-PHM group than in the PHM group. The non-PHM group showed lower costs and higher quality-adjusted life years than the PHM group. The ICER calculated using the EuroQoL-5 Dimension (EQ-5D) was USD 20,926. Conclusions: We confirm the possibility that a non-PHM strategy could be a more effective and cost-effective treatment option than PHM for patients with non-acute lumbar disc herniation. Furthermore, this pilot study confirmed the feasibility of the main study in terms of design and patient compliance. Full article

Thresholds can be an effective tool in conservation planning, as they can form a defensible target for habitat conservation or restoration. Generalized thresholds must be used with caution, however, as threshold responses may vary with species and spatial scale. The objectives of this study were to identify the scales at which forest-dwelling birds respond to both habitat availability and critical thresholds in forest cover associated with their occurrence, and to assess if life history traits relate to either scale of response or critical threshold. Using point count data from the Ontario Breeding Bird Atlas, I generated concentric buffers ranging from 100 m to 10 km radius around a random subset of point counts and described forest cover and species occurrence within each buffer. I assessed the likelihood of occurrence of each species at each scale of analysis using logistic regression and identified forest cover thresholds below which the occurrence of each species becomes unlikely using fitted regression curves and ROC plots. Species varied in their response to both landscape scale and forest cover, based on relative growth rate, clutch size, and site fidelity. The mean response to forest cover was 30.8%, with landscape scale ranging from 200 m to 9 km. Despite this range, pragmatic approaches to conservation planning are still possible. Full article

This pragmatic analysis of Richard III examines how conversational strategies, speech acts, and Gricean maxims reveal the true intentions and nature of Richard and other characters. While Shakespeare’s history plays are often explored through social, cultural, historical, and political lenses, this approach focuses on understanding characterization through linguistic cues, especially Richard’s manipulative use of language. Pragmatics, a branch of linguistics, delves into the intended meanings behind interactions using linguistic signals, emphasizing the dynamics of conversation and context. In Richard III, speech acts—encompassing not just spoken words, but also the surrounding context—are crucial for understanding Richard’s ability to deceive, manipulate, and persuade. These speech acts not only convey what is said, but also the strategies employed to achieve specific goals, such as persuasion or domination. By applying pragmatic principles and speech act theory, this analysis enhances our understanding of Shakespeare’s characters and their interactions. Gricean maxims—quality, quantity, relevance, and manner—serve as a framework for exploring how Richard often flouts or manipulates these principles to control dialogue and perceptions. This combined approach reveals the layers of meaning and strategic language use that shape Richard’s character and the broader implications of his interactions within the play. This shows that Shakespeare’s theater continues to provide a compelling lens for exploring the relationship between language, politics, and identity, enhancing our comprehension of how literature both reflects and influences the socio-political context in which it was created. Full article

Background: Complications due to frailty and injury after falls are a significant problem for people living in residential aged care. This can lead to a range of negative outcomes including poor physical, social, and psychological well-being. The Australian Royal Commission into Aged Care Quality and Safety highlighted many aspects of care in residential aged care homes requiring improvement, leading to specific recommendations aimed at improving the outcomes in this area. This contributed to four recommendations calling for increased allied health interventions to meet the unmet needs in residential aged care. This intervention aims to implement and evaluate evidence-based allied health interventions for people living in residential aged care specifically relating to frailty, preventing falls, and maintaining engagement in everyday activities. Method: This is a pragmatic, non-randomised, pre–post design study where six groups of up to 10 residents of an aged care home will start the intervention at staggered times. The EAHOP intervention is an integrated application of a suite of allied health services (occupational therapy, physiotherapy, dietetics, speech pathology, pharmacy, and optometry), with general practitioner involvement, using allied health assistants in an integrated transdisciplinary model of care. The baseline period is 6 weeks, and intervention is a maximum of 36 weeks with follow-up at 12 and 24 weeks. Primary outcomes measure changes in falls, frailty, and quality of life. A qualitative program evaluation will be completed as well as an economic analysis. Conclusion: The results of the study will provide information about the clinical, implementation, and effectiveness outcomes of this integrated, transdisciplinary allied health service model for people living in residential aged care. The results will be used to develop evidence-informed guidelines for residential aged care providers on the delivery of allied health services. Full article

A growing body of research has explored how technology can enhance the development of pragmatic competence in a second language (L2). This systematic review synthesizes 37 empirical studies published between 2015 and 2024, focusing on various technological applications such as computer-mediated communication (CMC), interactive automated dialogues, virtual environments, and digital games. The analysis highlights that these tools promote pragmatic development by providing authentic or semi-authentic interaction, contextualized learning, and personalized practices. Meanwhile, the review also uncovers key challenges from both technological constraints and individual dimensions. Based on the findings, this review suggests several directions for future research. Further studies should adopt longitudinal, multimodal, and socially situated approaches, explore emerging generative AI technologies, and examine the interaction between individual learner differences and technological affordances to increase understanding of this evolving field. Full article

The focus of manufacturers preparing for implementation of the EU HTA Regulation (HTAR) in 2025 has understandably been on their market access teams, and how they can be best equipped to adapt to this significant change. Considering the critical nature of market access in ensuring innovation reaches patients, it should be no surprise that the EU HTAR will have impacts far beyond this function. Here, we utilize published EU HTAR guidance, a pragmatic literature review, internal analysis, and insights from engagements with manufacturers, to outline some of the key cross-functional considerations arising from JSC and JCA, and how manufacturers should account for these in their EU HTAR readiness plans. Full article

In spring 2023, controversy arose over Spring Fever, an annual campaign to promote sexual and relationship education in primary schools in The Netherlands. This led to parliamentary questions and even death threats against employees of Rutgers, The Netherlands Center on Sexuality, which developed the program. This article examines how child sexuality was framed both in the Spring Fever project and in the resulting controversy. The analysis is based on newspaper articles from March to June 2023. One premise of Spring Fever is that children are seen as sexual agents able to develop their sexuality safely through age-appropriate education, which aims for children’s healthy development, including negotiating consent and experiencing pleasure. During the 2023 controversy, discourses of childhood innocence emerged in response to this, alongside accusations of focusing too much on “woke” themes, such as gender diversity. This paper concludes that, due to global anti-gender movements and local right-wing politics, the Dutch model of sex education—pragmatic, comprehensive, and evidence-based, as seen in Spring Fever—no longer maintains its depoliticizing effect. Additionally, the Spring Fever controversy signals a shift in the politics of sexual nationalism in The Netherlands. Full article

Sustainable development of the Smart Cities and Smart Regions concept is impossible without the development of a modern transport infrastructure, which must be maintained in proper condition. Inspections are required to assess the condition of objects in the transport infrastructure (OTI). Moreover, the efficiency of these inspections can be enhanced with unmanned aerial vehicles (UAVs), whose application areas are continuously expanding. When inspecting OTI (bridges, highways, etc.) the problem of improving the quality of image processing, and analysis of data collected by UAV, for example, is particularly relevant. The application of advanced methods for assessing the quantity of information and making decisions to reduce information uncertainty and redundancy for such systems is often complicated by the presence of noise there. To harmonize the characteristics of certain procedures in such conditions, authors propose conducting data processing using wavelet transform clustering in three main phases: determining the number of clusters, defining the coordinates of cluster centres, and assessing the quality and efficiency of clustering. We compared the efficiency and quality of existing clustering methods with one using wavelet transform. The research has shown that UAVs can be used for OTI inspecting; moreover, the clustering method with wavelet transform is characterised by an improved quality and efficiency of data processing. In addition, the quality assessment enables us to assess the degree of approximation of the clustering result to the ideal one. In addition, authors examined the specific challenges associated with planning UAV flights during inspections to obtain data that will enhance the accuracy of clustering and recognition. This is especially important for a comprehensive quantitative assessment of adaptation degree for image processing procedures to the tasks of inspecting OTI “Smart Cities/Regions” based on a pragmatic measure of informativeness. Full article

Pragmatics is key to communicating effectively, and its assessment in vulnerable populations is of paramount importance. Although tools exist for this purpose, they are often effortful and time-consuming, with complex scoring procedures, which hampers their inclusion in clinical practice. To address these issues, we present the Brief Assessment of Pragmatic Abilities and Cognitive Substrates (APACS Brief), a rapid (10 min), easy-to-use and freely distributed tool for evaluating pragmatics in Italian, inspired by the existing APACS test and already validated in the remote version (APACS Brief Remote). The APACS Brief test measures–with a simplified scale–the domains of discourse production and figurative language understanding and is developed in two parallel forms, each including novel items differing from APACS. Psychometric properties, cut-off scores, and thresholds for change were computed on 287 adults. The analysis revealed satisfactory internal consistency, good test–retest reliability, and strong concurrent and construct validity. Moreover, APACS Brief showed excellent discriminant validity on a sample of 56 patients with schizophrenia, who were also cross-classified consistently by APACS Brief and APACS cut-off values. Overall, APACS Brief is a reliable tool for evaluating pragmatic skills and their breakdown, with brief administration time and simple scoring making it well-suited for screening in at-risk populations. Full article

Background: Head-out aquatic training, using modalities such as water-aerobics/hydrogymnastics (HYD) and deep-water running (DWR), has been effective in improving the physical, metabolic and cognitive health of middle-aged adults. However, direct comparisons between these modalities are lacking. Aim: The aim of this study was to compare the effects of water aerobics and deep-water running on anthropometric, functional and hemodynamic outcomes in adults and older adults. Methods: An uncontrolled pragmatic trial (RBR-2txw8zy) was conducted with participants aged 30 to 80, allocated to HYD and DWR groups. The intervention consisted of 12 weeks of progressive aerobic training with weekly undulating periodization (2× week), divided into three mesocycles (4, 5, and 3 weeks), each lasting 50 min. Intensity was prescribed using the Rate of Perceived Effort (RPE), ranging from RPE 11 to 17. Outcomes assessed included the 30 s chair stand, 30 s arm curl, Timed-Up-and-Go usual (TUG-u) and maximum (TUG-m), 6 min walking test (6MWT), body mass, waist circumference, blood pressure and resting heart rate-HRrest. The analysis was conducted using generalized estimating equations, with per-protocol (PP) and intention-to-treat (ITT) analyses. Results: The study included 104 participants (HYD: n = 63, mean age 59 years, 54 women; DWR: n = 41, mean age 53 years, 33 women). ITT analysis showed improvements in waist circumference, waist-to-height ratio, and TUG-m in the HYD group, and a reduction in HRrest in the DWR group. Both modalities showed significant improvements in the 30 s chair stand, 30 s arm curl, 6MWT, waist circumference, and waist-to-height ratio in the PP analysis. Conclusions: Both modalities promoted functional improvements and favorable changes in anthropometric evaluations, with DWR showing a greater reduction in HRrest. Full article

The purpose of this research article is to perform a greenhouse gas (GHG) impact assessment using a lifecycle analysis of a cold-ironing solution for vessels at anchorage in a retrofitted barge and a marine genset combusting biomethane in dual fuel mode. A lifecycle methodology is developed based on the 4th International Maritime Organization (IMO) GHG study. Eleven impact scenarios are evaluated in terms of CO₂ and harmful pollutants (SO_x, CO, PM₁₀, PM_2.5, NMVOC, and NO_x). Vessels operated by Petronav Ship Management Ltd are examined, specifically M/T Alexandria and M/T Astraia. The scenarios reveal CO₂ reductions of up to 21% and CO increases of up to 60% due to the combustion of biomethane in dual fuel mode, alongside SO_x reductions of up to 20% with increasing biomethane energy substitution. Particulates and NO_x decrease due to the utilization of biomethane. This article presents a pragmatic solution for cold ironing for vessels at anchorage with proven lower GHG emissions with the exception of increased CO emissions, therefore the benefits outweigh the drawbacks. Full article

This narrative review evaluates the curtail components of data maturity in manufacturing industries, the associated challenges, and the application of industrial data science (IDS) to improve organisational decision-making. As data availability grows larger, manufacturing organisations face difficulties comprehending heterogeneous datasets of varying quality, which may lead to inefficient decision-making and other operational inefficiencies. It underlines that data appropriate for its intended application is considered quality data. The importance of including stakeholders in the data review process to enhance the data quality is accentuated in this paper, specifically when big data analysis is to be integrated into corporate strategies. Manufacturing industries leveraging their data thoughtfully can optimise efficiency and facilitate informed and productive decision-making by establishing a robust technical infrastructure and developing intuitive platforms and solutions. This study highlights the significance of IDS in revolutionising manufacturing sectors within the framework of Industry 4.0 and the Industrial Internet of Things (IIoT), demonstrating that big data can substantially improve efficiency, reduce costs, and guide strategic decision-making. The gaps or maturity levels among industries show a substantial discrepancy in this analysis, which is classified into three types: Industry 4.0 maturity levels, data maturity or readiness condition index, and industrial data science and analytics maturity. The emphasis is given to the pressing need for resilient data science frameworks enabling organisations to evaluate their digital readiness and execute their data-driven plans efficiently and effortlessly. Simultaneously, future work will focus on pragmatic applications to enhance industrial competitiveness within the heavy machinery sector. Full article

In response to the challenges posed by an aging society, the field of gerontechnology has evolved, integrating technology with gerontology to enhance designs tailored for the elderly. Recent developments in the silver economy have underscored the substantial demand for these products, yet their development is frequently impeded by the absence of holistic design frameworks that encompass system design, technology, business strategy, and emotional considerations. To bridge this gap, our study employs a standardized Grounded Theory methodology to analyze product data and customer reviews from e-commerce platforms, supplemented by insights from interviews with four leading product designers in this sector. This analysis led to the creation of the ‘Silver Model’ for gerontechnology product design. This model integrates essential design aspects across eight domains, offering a comprehensive framework that harmonizes technological capabilities with the expectations of elderly users. This research advances the theoretical foundations of gerontechnology and furnishes a pragmatic blueprint for enhancing product design in the silver market, significantly contributing to the advancement of age-friendly technology and promoting both social and economic sustainability. Full article

Background: In 2020, HOHM Foundation launched Homeopathy Help Now (HHN), a network of professional homeopathy telehealth practitioners, administrative volunteers, and independent researchers to work collaboratively in order to respond to the urgent need of care for the ever-growing number of COVID-19 cases in the United States. Methods: in this pragmatic case series study, cases of positively testing or probable COVID-19 (n = 3495) are analyzed using conventional quantitative analysis. The sample includes clinical data collected from clients who attended the clinic between 23 March 2020 and 31 December 2023. Results: The youngest client at the clinic was less than one year old, and the eldest was 92. Many of the participants at this clinical facility were adults (58.1%), with fewer (41.9%) aged 0–17. Many were female (61.7%), while fewer were male (32.4). Most clients found their symptoms improved at final contact (83.6%), and the majority of individual remedy responses improved symptoms (73.7%) over the course of their care. Discussion: Health Services and Public Health research projects are warranted to investigate the ways in which such a necessary stop-gap clinical service as HHN could become implemented in early- and later-phase response to pandemics. HHN’s collaborative, horizontally integrated team structure was essential for the creation of the novel approach needed to address the serious symptoms of COVID-19. Moreover, HHN’s organizational model draws on a mutual aid structure, whereby dynamic, flexible systems are created that empower a community to meet emerging needs, especially when more formal structures are strained, failing or simply unavailable. Further research is urgently needed into the implementation and benefits of innovative, flexible healthcare structures, such as the one used in this study, that can meet the unpredictable and fluctuating public health needs in our changing world. Full article

A novel solid oxide fuel cell (SOFC)-based cogeneration system is proposed here, integrating an organic Rankine cycle for waste heat recovery. Technical–economic and parametric analyses are conducted, and a multi-objective optimization is carried out. The results reveal that the net electrical efficiency, investment cost, and payback time are 56.6%, USD 2,408,256, and 3.27 years, respectively. The parametric analysis indicates that the current density should be limited between 0.3 A/cm² and 0.9 A/cm², and the stack temperature should be controlled between 675 °C and 875 °C. After the operational optimization of η_ele-Cost_TCI, the investment cost and the net electrical efficiency are obtained as USD 2,164,742 and 62.1%. After the η_ele-PBT optimization, the payback period and the net electrical efficiency are 3.22 years and 58.9%. The heat transfer network optimization achieves the highest efficiency and reduces the cold utilities by 43 kW, but three additional heat exchangers should be added to the system. This research provides practical reference and pragmatic guidance for the integration, analysis, operation, and heat transfer network optimization of SOFC-based cogeneration systems. Full article