Stress research in sports tends to focus on athletes, with sports officials typically being overlooked. In the current study, baseline, pre-game, and post-game cortisol levels among a sample of softball umpires were measured to assess the pattern of stress responses and determine if umpire performance (pass/fail) and position on the diamond (plate/field) could be predicted from cortisol levels. Nine male and four female participants aged 25–68 years (N = 13, M = 47.06 ± 15.65 years) each provided saliva samples on multiple occasions prior to and after officiating games at two Australian National Softball Championships. Data from 65 games were analysed. Performance was assessed using Softball Australia’s official umpire assessment tool. Cortisol levels increased significantly from baseline to pre-game (p < 0.001, d = −0.69) and declined significantly from pre-game to post-game (p < 0.001, d = 0.47). Umpiring performances were correctly classified as pass or fail from baseline and pre-game cortisol levels in 61.5% of cases and umpire position on the diamond from pre-game cortisol in 63.1% of cases. Findings suggest that stress management strategies should be recommended to softball umpires for performance enhancement and to safeguard their mental health. Full article

We studied the effects of vertical vibrations on a water drop that was pinned to the sharp edges of a rectangular post. By varying the frequency and amplitude of the vertical displacement, distinct resonance peaks were observed using a simple optical technique. The vibrational spectra of the first two modes exhibited two closely spaced peaks, which corresponded to standing waves that exist along the major and minor contour lengths of the drops. The values of the resonance frequencies can be explained rather well by a simple model, which was originally proposed for axially symmetric drops. Full article

Corrosion and wear issues of motion components exposed to water-based corrosion mediums, e.g., naval vessels and oil extraction equipment, pose challenges for the lifespan and reliability of the motion systems. In this work, epoxy-based coatings modified with polytetrafluoroethylene (PTFE) and cuprous oxide (Cu₂O) nanoparticles were prepared. The anti-corrosion performance of the coatings was comparatively investigated by electrical impedance spectroscopy and Tafel tests in sterile and sulphate-reducing bacteria (SRB) mediums. Moreover, the tribological behaviors of the coatings were examined under water lubrication conditions. Our results demonstrate that the epoxy coatings lower significantly the corrosion current density i_corr and the charge transfer resistance of the electrical double layer R_ct of the carbon steel substrate. Interestingly, the hybrid coatings filled with both PTFE and Cu₂O exhibit excellent anti-corrosion and anti-wear performance. After being immersed in the SRB medium for 18 days, the i_corr of the pure EP coating and hybrid coatings are 1.10 × 10⁻⁷ A_mp/cm² and 0.3 × 10⁻⁷ A_mp/cm², and the R_ct values are 1.04 × 10³ Ω·cm² and 3.87 × 10³ Ω·cm², respectively. A solid tribofilm forms on the stainless steel counterface sliding against the hybrid coating, which is surmised to be essential for the low friction coefficients and wear. The present work paves a route for formulating the dual-function coatings of anti-biocorrosion and anti-wear. Full article

During the long nineteenth century, Western publics experienced the invention and proliferation of commercial games for children. Card games, board games, and other parlor games were no longer for adults only; these new offerings formalized some aspects of what it meant for a child to engage in play. Many games centered travel, becoming sites for children to simulate adult agency in movement through space. This paper examines the stories told by narrative card games and board games about travel, especially travel within and between urban centers. The games present the city as microcosm of the world. Child players are invited to construct multiple national and ethnic identities as they pretend to be city travelers. The games attempt to teach children, and their caregivers, how to travel. I argue that the structures and aims of the games evolve over time, keeping pace with new mores surrounding work and leisure travel. I also argue for connections between games and the “set moves” of narrative fiction and theatre. Full article

Climate warming has already influenced the distribution, community composition, and phenology of European Odonata. Trithemis annulata had been confined to the southern regions of Italy for over 150 years. In only four decades, it has expanded its range and has recently been observed inhabiting several alpine valleys. A dataset of 2557 geographical distribution data points spanning the years 1825–2023 was compiled using various resources, with the aim to analyse the chrono-story of the expansion of T. annulata. A further aim was to investigate the climatic conditions that best explain its current and future distribution. Over a period of 43 years, the species steadily extended its northern range margin at an approximate rate of 12 km/year. Once it reached the Po Plain, the expansion accelerated to an average speed of 34 km/year. However, its northward shift lagged behind the warming climate as we estimated an average speed of 28 km/year. In the future, the area suitable for T. annulata is expected to significantly increase in Italy. Surprisingly, we did not observe any consistent upward shift. Trithemis annulata has considerably expanded its distribution due to human-induced climate warming. The northernmost populations now inhabit Alpine valleys, potential gateways to central Europe. Full article

The studies of thymic structure were performed predominantly in cohorts of younger individuals. Here, we established a cohort of body donors whose age at the time of death ranged from 57 to 103 to study the relationship between thymic structure and factors that, in the younger subjects, have shown to affect the organ’s anatomy, including the presence of the organ’s capsule, its weight, size of the left and right lobes, and a transverse diameter. We explored the relationships between these thymic parameters and the subjects’ age, sex, and cause of death (COD), asking how the thymus in the elderly differed from the organ’s macro-anatomy in a broader and younger human population, and whether age, sex, COD, and BMI could influence the thymic parameters in the elderly. Our analyses revealed that the thymic size but not thymic weight in the KYCOM cohort differed significantly from the younger individuals. The size of the thymus in males progressively decreased, but in females, the size of the right lobe increased. The encapsulated thymus was detected with a higher frequency in females than males. We found no associations between thymic parameters and the person’s COD, age, or sex. However, the person’s BMI was associated with thymic weight, suggesting that obesity may influence the aging of the immune system. Full article

The ongoing SARS-CoV-2 pandemic has underscored the urgent need for versatile and rapidly deployable antiviral strategies. While vaccines have been pivotal in controlling the spread of the virus, the emergence of new variants continues to pose significant challenges to global health. Here, our study focuses on a novel approach to antiviral therapy using DNA aptamers, short oligonucleotides with high specificity and affinity for their targets, as potential inhibitors against the spike protein of SARS-CoV-2 variants Omicron and JN.1. Our research utilizes steered molecular dynamics (SMD) simulations to elucidate the binding mechanisms of a specifically designed DNA aptamer, AM032-4, to the receptor-binding domain (RBD) of the aforementioned variants. The simulations reveal detailed molecular insights into the aptamer–RBD interaction, demonstrating the aptamer’s potential to maintain effective binding in the face of rapid viral evolution. Our work not only demonstrates the dynamic interaction between aptamer–RBD for possible antiviral therapy but also introduces a computational method to study aptamer–protein interactions. Full article

To verify the feasibility of applying dry flue gas desulfurization ash (DFGDA) to asphalt pavement materials, the asphalt mastic (filler and asphalt composition) prepared by adding different proportions of DFGDA and LSP (limestone powder) into 70# matrix asphalt was studied experimentally. The asphalt mastics were subjected to the penetration test, the softening point test, and the ductility test. Moreover, the rheological properties of asphalt mastic were evaluated with dynamic shear rheometer (DSR) tests and bending beam rheometer (BBR) tests. An interaction ability index C-value based on the Palierne model was proposed to evaluate the interaction ability between DFGDA and asphalt. The influence of DFGDA asphalt on the interaction ability of matrix asphalt was observed and evaluated using Fourier transform infrared spectroscopy (FTIR) and scanning electron microscopy (SEM). The results showed that with the increasing proportion of DFGDA, the penetration of asphalt mastic gradually decreased, the softening point increased, and the ductility slightly decreased. At the same temperature, the dynamic shear modulus G* of the asphalt mortar significantly increased with increasing DFGDA content. The incorporation of DFGDA negatively affected the low-temperature plastic deformation resistance of asphalt, but the impact was weakened with the growing DFGDA amount and the powder mastic ratio. The combination mode of DFGDA and matrix asphalt depends on the physical blending, and their interaction ability mainly depends on the miscibility between DFGDA and matrix asphalt. In conclusion, DFGDA can be utilized as a novel filler in asphalt pavement materials. Full article

Nitrogen and fecal indicator bacteria (FIB) in runoff from concentrated animal feeding operations (CAFOs) can impair surface and groundwater quality. Bioretention systems are low impact nature-based technologies that can effectively treat CAFO runoff if modified with an internal water storage zone (IWSZ) or amended with biochar. In this study, the performances of four pilot-scale modified bioretention systems were compared to assess the impacts of (1) amending bioretention media with biochar and (2) planting the systems with Muhlenbergia. The system with both plants and biochar amendment had the best performance, with an average of 5.58 log reduction in E. coli and 98% removal of total nitrogen (TN). All systems treated the first pore volume well as new runoff flushed the treated water from the IWSZ. Biochar improved TN and FIB removal due to its high capacity to adsorb or retain ammonium (NH₄⁺), dissolved organic nitrogen, dissolved organic carbon, and E. coli. Planting improved performance, possibly by increasing rhizosphere microbial activity. Full article

In holometabolous insects, such as Drosophila and Bombyx, prothoracicotropic hormone (PTTH) is well established to be critical in controlling developmental transitions and metamorphosis by stimulating the biosynthesis of ecdysone in the prothoracic glands (PGs). However, the physiological role of PTTH and the receptor Torso in hemimetabolous insects remains largely unexplored. In this study, homozygous PTTH- and Torso-null mutants of the brown planthopper (BPH), Nilaparvata lugens, were successfully generated by employing clustered regularly interspaced short palindromic repeats/CRISPR-associated 9 (CRISPR–Cas9). Further characterization showed that both NlPTTH^−/− and NlTorso^−/− mutants exhibited prolonged nymphal duration and increased final adult size. Enzyme-linked immunosorbent assay (ELISA) revealed that NlPTTH^−/− and NlTorso^−/− mutants exhibited a significant reduction in 20-hydroxyecdysone (20E) in fifth-instar nymphs at 48 h post-ecdysis compared to Wt controls. Furthermore, our results indicated that both NlPTTH^−/− and NlTorso^−/− mutants had shortened lifespan, reduced female fecundity, and reduced egg hatching rates in adults. These findings suggest a conserved role for the PTTH–Torso signaling system in the regulation of developmental transitions by stimulating ecdysone biosynthesis in hemimetabolous insects. Full article

Disorders/differences of sex development (DSDs) are defined as broad, heterogenous groups of congenital conditions characterized by atypical development of genetic, gonadal, or phenotypic sex accompanied by abnormal development of internal and/or external genitalia. NR5A1 gene mutation is one of the principal genetic alterations implicated in causing DSD. This review outlines the role of NR5A1 gene during the process of gonadal development in humans, provides an overview of the molecular and functional characteristics of NR5A1 gene, and discusses potential clinical phenotypes and additional organ diseases due to NR5A1 mutations. NR5A1 mutations were analyzed in patients with 46,XY DSD and 46,XX DSD both during the neonatal and pubertal periods. Loss of function of the NR5A1 gene causes several different phenotypes, including some associated with disease in additional organs. Clinical phenotypes may vary, even among patients carrying the same NR5A1 variant, indicating that there is no specific genotype–phenotype correlation. Genetic tests are crucial diagnostic tools that should be used early in the diagnostic pathway, as early as the neonatal period, when gonadal dysgenesis is the main manifestation of NR5A1 mutation. NR5A1 gene mutations could be mainly associated with amenorrhea, ovarian failure, hypogonadism, and infertility during puberty. Fertility preservation techniques should be considered as early as possible. Full article

Awkward hand-arm posture and overhead work increase the risk of musculoskeletal symptoms. These adverse health effects can also be caused by additional workloads such as hand-arm vibration exposure while carrying or holding a power tool. This pilot trial investigated posture and muscle activity of 11 subjects while using an impact wrench for three working directions: upwards, forwards and downwards. Although the vibration exposure did not show notable differences in the magnitude (4.8 m/s² upwards, 4.4 m/s² forwards and 4.7 m/s² downwards), postural behavior and the muscle activity showed significantly higher workloads for working upwards compared to forwards direction. The muscle activity results for working downwards also showed elevated levels of muscle activity due to the awkward wrist posture. The results demonstrate that not only the working direction but also more importantly the arm, wrist and head posture need to be considered while investigating hand-arm vibration exposure. Full article

Adiponectin is primarily known for its protective role in metabolic diseases, and it also possesses immunoregulatory properties. Elevated levels of adiponectin have been observed in various inflammatory diseases. However, studies investigating adiponectin levels in the serum of COVID-19 patients have yielded conflicting results. This study aimed to assess serum adiponectin levels in 26 healthy controls, as well as in 64 patients with moderate and 60 patients with severe COVID-19, to determine a potential association between serum adiponectin and the severity of COVID-19. Serum adiponectin levels in severe COVID-19 patients were significantly lower than in those with moderate disease and healthy controls, who exhibited similar serum adiponectin levels. Among patients with moderate disease, positive correlations were observed between serum adiponectin and C-reactive protein levels. Of note, serum adiponectin levels of severe COVID-19 cases were comparable between patients with and without dialysis or vasopressor therapy. Superinfection with bacteria did not exert a notable influence on serum adiponectin levels in patients with severe disease. Patients who were diagnosed with severe COVID-19 and vancomycin-resistant enterococci bacteremia showed a significant reduction in their serum adiponectin levels. An analysis conducted on the entire cohort, including both moderate and severe COVID-19 patients, showed that individuals who did not survive had lower serum adiponectin levels when compared to those who survived. In summary, this study highlights a decrease in serum adiponectin levels in severe COVID-19 cases, indicating the potential utility of adiponectin as an additional biomarker for monitoring disease severity in COVID-19 or critical illnesses in general. Full article

The memory-enhancing activity of Matricaria chamomilla hydroalcoholic extract (MCE) is already being investigated by behavioral and biochemical assays in scopolamine-induced amnesia rat models, while the effects of scopolamine (Sco) on cerebral glucose metabolism are examined as well. Nevertheless, the study of the metabolic profile determined by an enriched MCE has not been performed before. The present experiments compared metabolic quantification in characteristic cerebral regions and behavioral characteristics for normal, only diseased, diseased, and MCE- vs. Galantamine (Gal)-treated Wistar rats. A memory deficit was induced by four weeks of daily intraperitoneal Sco injection. Starting on the eighth day, the treatment was intraperitoneally administered 30 min after Sco injection for a period of three weeks. The memory assessment comprised three maze tests. Glucose metabolism was quantified after the 18F-FDG PET examination. The right amygdala, piriform, and entorhinal cortex showed the highest differential radiopharmaceutical uptake of the 50 regions analyzed. Rats treated with MCE show metabolic similarity with normal rats, while the Gal-treated group shows features closer to the diseased group. Behavioral assessments evidenced a less anxious status and a better locomotor activity manifested by the MCE-treated group compared to the Gal-treated group. These findings prove evident metabolic ameliorative qualities of MCE over Gal classic treatment, suggesting that the extract could be a potent neuropharmacological agent against amnesia. Full article

Background. Cancer is the leading cause of disease-related death among children of more than 1 year of age. However, childhood cancer risk factors and etiology are yet to be fully understood. The goal of this study is to identify geographic variation among children and adolescents diagnosed with pediatric tumors between 2001 and 2018 in the province of Quebec. Methods. We analyzed pediatric patients less than 15 years of age from the Cancer in Young People in Canada (CYP-C) surveillance system who were diagnosed between 2001 and 2018 with cancer in the province of Quebec. The age-standardized age-adjusted incidence rates (AAIR) per 100,000 person years were calculated for all childhood cancers by cancer subgroups, Quebec Health regions, and age groups. Results. Overall, 3904 pediatric patients less than 15 years old were diagnosed with cancer in the province of Quebec in 2001–2018. The overall incidence rate (IR) in the province of Quebec was 16.14 (95%CL [15.56–16.73]) per 100,000 person years. For childhood cancers, regions that presented a higher AAIR were Chaudière-Appalaches and Capitale-Nationale with 18.2 and 17.5 per 100,000 person years, respectively. The incidence rates (IRs) in Chaudière-Appalaches (95% CI 1.0439–1.3532) and in Capitale-Nationale (95% CI 1.0124–1.2942) were statistically higher than the incidence in the province of Quebec (p = 0.0090 and p = 0.0310, respectively). When comparing the AAIR of the CNS tumor subgroup in Chaudière-Appalaches and in Capitale-Nationale, with the provincial average, we noticed a statistically higher incidence in Chaudière-Appalaches and a trend for Capitale-Nationale (p < 0.0001 and p = 0.0602, respectively). Conclusion. There is evidence of spatial clusters in Chaudière-Appalaches and Capitale-Nationale as areas for all childhood cancers. Further studies should be performed to investigate potential risk factors in these regions. Full article

The use of hypofractionated radiotherapy in prostate cancer has been increasingly evaluated, whereas accumulated evidence demonstrates comparable oncologic outcomes and toxicity rates compared to normofractionated radiotherapy. In this prospective study, we evaluate all patients with intermediate-risk prostate cancer treated with ultrahypofractionated (UHF) MRI-guided radiotherapy on a 1.5 T MR-Linac within our department and report on workflow and feasibility, as well as physician-recorded and patient-reported longitudinal toxicity. A total of 23 patients with intermediate-risk prostate cancer treated on the 1.5 T MR-Linac with a dose of 42.7 Gy in seven fractions (seven MV step-and-shoot IMRT) were evaluated within the MRL-01 study (NCT04172753). The duration of each treatment step, choice of workflow (adapt to shape-ATS or adapt to position-ATP) and technical and/or patient-sided treatment failure were recorded for each fraction and patient. Acute and late toxicity were scored according to RTOG and CTC V4.0, as well as the use of patient-reported questionnaires. The median follow-up was 12.4 months. All patients completed the planned treatment. The mean duration of a treatment session was 38.2 min. In total, 165 radiotherapy fractions were delivered. ATS was performed in 150 fractions, 5 fractions were delivered using ATP, and 10 fractions were delivered using both ATS and ATP workflows. Severe acute bother (G3+) regarding IPS-score was reported in five patients (23%) at the end of radiotherapy. However, this tended to normalize and no G3+ IPS-score was observed later at any point during follow-up. Furthermore, no other severe genitourinary (GU) or gastrointestinal (GI) acute or late toxicity was observed. One-year biochemical-free recurrence survival was 100%. We report the excellent feasibility of UHF MR-guided radiotherapy for intermediate-risk prostate cancer patients and acceptable toxicity rates in our preliminary study. Randomized controlled studies with long-term follow-up are warranted to detect possible advantages over current state-of-the-art RT techniques. Full article

In Saccharomyces cerevisiae, the Rpd3L complex includes the histone deacetylase Rpd3 and the DNA binding proteins Ume6 and Ash1 and serves as a transcriptional silencer or enhancer. In S. cerevisiae, the transcription of PDR5, which encodes a major drug efflux pump, and pleiotropic drug resistance (PDR) are hyperactivated by the transcription factor Pdr3 in ρ^0/− cells, which lack mitochondrial DNA. We previously showed that RPD3 and UME6 are required for the activation of PDR5 transcription and PDR in S. cerevisiae ρ⁰ cells. Here, using real-time PCR analysis, we revealed that RPD3 and UME6 are responsible for the activated basal expression of the ABC transporter-encoding genes SNQ2, PDR15, and PDR5 in S. cerevisiae ρ⁰ cells. Furthermore, using real-time PCR analysis and a spot dilution assay, we found that Ume6 increases the basal expression of PDR5 and PDR15 and induces PDR in a manner dependent on RPD3 and PDR3 in ρ⁰ cells. This finding may contribute to the elucidation of the relationships between the molecules required for the activation of ABC transporter genes in S. cerevisiae ρ^0/− cells and in pathogenic Candida species. Full article

Despite their relatively low incidence globally, central nervous system (CNS) tumors remain amongst the most lethal cancers, with only a few other malignancies surpassing them in 5-year mortality rates. Treatment decisions for brain tumors heavily rely on histopathological analysis, particularly intraoperatively, to guide surgical interventions and optimize patient outcomes. Frozen sectioning has emerged as a vital intraoperative technique, allowing for highly accurate, rapid analysis of tissue samples, although it poses challenges regarding interpretive errors and tissue distortion. Raman histology, based on Raman spectroscopy, has shown great promise in providing label-free, molecular information for accurate intraoperative diagnosis, aiding in tumor resection and the identification of neurodegenerative disease. Techniques including Stimulated Raman Scattering (SRS), Coherent Anti-Stokes Raman Scattering (CARS), Surface-Enhanced Raman Scattering (SERS), and Tip-Enhanced Raman Scattering (TERS) have profoundly enhanced the speed and resolution of Raman imaging. Similarly, Confocal Laser Endomicroscopy (CLE) allows for real-time imaging and the rapid intraoperative histologic evaluation of specimens. While CLE is primarily utilized in gastrointestinal procedures, its application in neurosurgery is promising, particularly in the context of gliomas and meningiomas. This review focuses on discussing the immense progress in intraoperative histology within neurosurgery and provides insight into the impact of these advancements on enhancing patient outcomes. Full article

(1) Background: Bacterial contamination has been shown to occur during angiographies, although data on its frequency and relevance are sparse. Our aim was to evaluate the incidence of bacterial contamination of syringes used under sterile conditions during neuroangiographies. We sought to differentiate between contamination of the outside of the syringes and the inside and to detect the frequency, extent and germ spectrum of bacterial contamination. (2) Methods: We prospectively collected 600 samples from 100 neuroangiographies. Per angiography, fluid samples from the three routinely used syringes as well as the syringes themselves were analyzed. We analyzed the frequency and extent of contamination and determined the germ spectrum. (3) Results: The majority of samples (56.9%) were contaminated. There was no angiography that showed no contamination (0%). The outer surfaces of the syringes were contaminated significantly more frequently and to a higher extent than the inner surfaces. Both the frequency and extent of contamination of the samples increased with longer duration of angiographic procedures. Most of the bacterial species were environmental or skin germs (87.7%). (4) Conclusions: Bacterial contamination is a frequent finding during neuroangiographies, although its clinical significance is believed to be small. Bacterial contamination increases with longer duration of angiographic procedures. Full article

Remote video imagery using shoreline edge detection is widely used in coastal monitoring in order to acquire measurements of nearshore and swash features. Some of these systems are constrained by their long setup time, positioning requirements and considerable hardware costs. As such, there is a need for an autonomous low-cost system (~EUR 500), such as Timex cameras, that can be rapidly deployed in the field, while still producing the outcomes required for coastal monitoring. This research presents an assessment of the effect of the sampling strategy (time-lapse intervals) on the precision of shoreline detection for two low-cost cameras located in a remote coastal area in western Ireland, overlooking a dissipative beach–dune system. The analysis shows that RMSD in the detected shoreline is similar to other studies for sampling intervals ranging between 1 s and 30 s (i.e., RMSD_mean for Camera 1 = 1.4 m and Camera 2 = 0.9 m), and an increase in the sampling interval from 1 s to 30 s had no significant adverse effect on the precision of shoreline detection. The research shows that depending on the intended use of the detected shorelines, the current standard of 1 s image sampling interval when using Timex cameras can be increased up to 30 s without any significant loss of accuracy. This positively impacts battery life and memory storage, making the systems more autonomous; for example, the battery life increased from ~10 days to ~100 days when the sampling interval was increased from 1 to 5 s. Full article

Melatonin (MLT), a natural compound found in the animal and vegetable kingdom, participates in several physiological processes. MLT exerts antioxidant and anti-inflammatory activities, among others, but information about its action on lipid metabolism is still scarce. For this reason, mice deficient in apolipoprotein E (ApoE^−/−) fed a Western diet (WD) were intragastrically treated with different concentrations of MLT (2 and 9 mg/kg) for 12 weeks. The lipid parameters were quantified, and, since links between cardiovascular risk and immune function and oxidative stress have been established, we also analyzed the population of leukocytes and the oxidative stress status. Although there was no change in the weight of the mice, a significant reduction in low-density lipoprotein cholesterol (LDL-C) was observed in mice treated with the higher concentration of MLT tested in this study. Additionally, an improvement in cardiovascular risk indexes was observed. A reduction in the hepatic total cholesterol (TC) and LDL-C levels was also observed in the treated mice. Finally, a decrease in leukocytes and lymphocytes in particular, as well as an increase in the antioxidant status, were shown in MLT-treated mice. In conclusion, MLT is a promising candidate that could be considered as a possible functional ingredient capable of preventing cardiovascular risk. Full article

Post-injury confusional state is a common phenomenon following acquired brain injury. A multi-faceted approach for decreasing confusion is recommended, but there is a paucity of research related to non-pharmacological management. The main objective was to present a conceptual model of multi-faceted approaches for confusion, and secondly to investigate the rehabilitation outcome following these approaches. The setting is a specialized ward for rehabilitation of patients with severe cognitive difficulties following acquired brain injury. The conceptual model encompasses neurobehavioral strategies, pharmacological treatment, engagement in meaningful occupations, next of kin involvement, organizational demands, the physical environment, along with differential diagnostics. Patient cases are provided to illustrate the impact of each approach. A total of 141 of 281 patients were in a confusional state at admission. At discharge, 62% had emerged from the confusional state. Patients in a confusional state due to traumatic brain injury and subarachnoid hemorrhage had clinically important differences of >22 points in the functional independence measure from admission to discharge, following rehabilitation efforts based on the conceptual model. No clinically important difference was seen in patients with non-SAH stroke and patients with other types of brain injuries. The proposed conceptual model should be further evaluated in complex intervention studies. Full article