Search Results (58)

Background and Objectives: Adolescent pregnancy is associated with biological, behavioral, and healthcare-related vulnerabilities that are incompletely captured by structured datasets. This study aimed to characterize selected maternal vulnerability indicators derived from narrative clinical documentation and to examine their exploratory associations with documented prenatal care deficiency and neonatal outcomes. Materials and Methods: We conducted a retrospective cohort study including 759 singleton adolescent pregnancies managed at a Romanian secondary obstetric center between 2020 and 2024. Narrative clinical observations were reviewed to extract maternal vulnerability indicators, including smoking, anemia, infection, hypertensive disorders, obesity, Rh incompatibility, and documented prenatal care deficiency. Associations between extracted variables, documented prenatal care deficiency, and neonatal outcomes were evaluated using contingency analyses, Kendall’s tau-b correlations, and multivariable logistic regression models. Results: Among pregnancies with available narrative observations, documented prenatal care deficiency was identified in 612/692 (88.4%), maternal anemia in 207/692 (29.9%), and smoking during pregnancy in 186/692 (26.9%). Validation performance differed across categories, with a sensitivity of 57.1% (95% CI 18.4–90.1%) for hypertensive disorders and wide confidence intervals for rare categories. Correlations between extracted variables were weak, indicating limited clustering of maternal risk factors. Hypertensive disorders (aOR 0.31, 95% CI 0.10–0.95, p = 0.038) and maternal obesity (aOR 0.39, 95% CI 0.16–0.98, p = 0.044) were associated with lower odds of documented prenatal care deficiency. Significant neonatal associations were observed primarily for low birth weight. Hypertensive disorders were independently associated with increased odds of low birth weight (aOR 3.56, 95% CI 1.33–9.54, p = 0.011), whereas documented maternal anemia was associated with lower observed odds of LBW (aOR 0.45, 95% CI 0.24–0.82, p = 0.009). No significant associations were identified for preterm birth or Apgar score < 7 at 5 min. Conclusions: Narrative clinical documentation allowed the identification of heterogeneous maternal vulnerability indicators that showed weak interrelationships and selective associations with prenatal surveillance patterns and low birth weight. These exploratory findings should be interpreted in the context of healthcare engagement and documentation practices. Full article

International evidence positions the built environment as an active component of the quality of life of older adults; however, the empirical quantification of that relationship and its hierarchization to guide design decisions in Latin American geriatric residences remain a persistent gap. Against this background, the present study examined how biophilic architecture relates to the quality of life of older adults residing in a geriatric residence in the Cercado de Lima district, adopting a single-case study approach. A quantitative approach with a non-experimental, cross-sectional, and correlational design was adopted. The sample comprised 81 proxy informants, relatives in close and ongoing contact with the residents, recruited by non-probabilistic convenience sampling. A structured questionnaire of 25 Likert-scale items, each with five response categories, was used to gather the data, administered through the QuestionPro platform. Content validity was established through the judgment of three architecture specialists; reliability was confirmed through Cronbach’s alpha coefficient ($\alpha$ = 0.943). Given that the data did not follow a normal distribution (Shapiro–Wilk, p < 0.05 in 9 of 10 variables), the inferential analysis relied on Spearman’s rho coefficient, with Kendall’s Tau-b as a complement. The results revealed a positive, statistically significant, and large-magnitude association between biophilic architecture and quality of life ($\rho$ = 0.792, p < 0.001). Dimensional analysis identified a hierarchical pattern organized in two statistically distinguishable levels. In biophilic architecture, a first level comprised the nature of the space ($\rho$ = 0.792) and sensory stimulation ($\rho$ = 0.783), and a second significantly lower level comprised natural analogs ($\rho$ = 0.621) and nature in the space ($\rho$ = 0.605). In quality of life, a first level comprised physical health ($\rho$ = 0.763), social relationships ($\rho$ = 0.753), and psychological health ($\rho$ = 0.720), and a second level comprised environment ($\rho$ = 0.564); coefficients within each level did not differ significantly, whereas the difference between levels was significant. The obtained empirical hierarchization was translated into evidence-informed design orientations, offering architects and facility managers a non-prescriptive guide for setting design priorities where infrastructure is limited, in alignment with Sustainable Development Goals (SDGs) 3 and 11. The study was conducted through proxy informants, family members with direct and sustained contact with the resident, a methodological configuration recognized in the specialized literature on institutionalized older adults and whose perceptual mediation remains as a residual consideration of the design when interpreting the findings. As a single-case study, the findings characterize the analyzed institutional context and constitute transferable hypotheses to be verified in further residences rather than generalizations to the broader population of geriatric residences. Full article

Background: Burn injuries are increasingly being recognized as chronic conditions with long-term physical, emotional, and social consequences. As survival after acute burn trauma improves, greater attention has shifted toward health-related quality of life (QoL) in survivors, particularly in regions where data remain limited. Methods: This study included burn survivors treated between January 2022 and December 2023 in the Department of Plastic Surgery and Reconstructive Microsurgery of the Emergency Clinical Hospital “Bagdasar-Arseni,” Bucharest, Romania. Patients who survived hospitalization and follow-up were invited to complete a Romanian-adapted version of the Burn Specific Health Scale-Brief (BSHS-B). Demographic and clinical data were collected from medical records, including burn type, total body surface area (TBSA), burn depth, burn localization, and access to rehabilitation services. Statistical analysis included descriptive methods, chi-square tests, t-tests, Kendall’s tau-b, Cramer’s V, Cronbach’s alpha, and exploratory factor analysis. Results: Thirty-eight patients were included. Most burns were thermal (94.74%), while burns involving <10% TBSA were most frequent (60.53%). Functional outcomes were generally favorable, with most patients reporting no difficulty in basic daily activities such as bathing, dressing, and writing. However, fine motor activities and return to previous work were more frequently affected. Emotional recovery appeared less complete, with persistent mild-to-moderate loneliness, sadness, and emotional distress reported by many participants. Women reported higher levels of loneliness (p = 0.015), while third-degree burns were associated with more frequent depressive symptoms (p = 0.008). Depressive symptoms were also significantly associated with functional limitations (such as getting dressed, p = 0.002) and work impairment (p < 0.001). The adapted functional and emotional subscales showed excellent internal consistency. Conclusions: Post-burn recovery extends beyond physical healing. Although most patients regained functional independence, emotional distress and occupational difficulties often persisted. These findings support the need for multidisciplinary long-term burn care integrating physical rehabilitation, psychological screening, and psychosocial support. Full article

International students in Saudi universities face academic and adaptation challenges shaped by emotional, cognitive, linguistic, and sociocultural factors. This study examined whether emotional intelligence and cognitive flexibility predicted academic success and adaptation outcomes among international students in Saudi public universities. A quantitative cross-sectional survey was conducted with 410 international students using structured measures of emotional intelligence, cognitive flexibility, academic success, adaptation outcomes, Arabic proficiency, and sociodemographic characteristics. Data were analysed using descriptive statistics, chi-square tests, Kendall’s tau-b correlations, hierarchical regression, and observed-variable path analysis. Duration of residence was significantly associated with Arabic proficiency, χ²(8) = 82.40, p < .001. Arabic proficiency was positively associated with GPA, τ = 0.62, p < .001, and adaptation outcomes, τ = 0.48, p < .001. In hierarchical regression, sociocultural covariates and psychological predictors explained substantial variance in academic success, R² = 0.53, and adaptation outcomes, R² = 0.53. Emotional intelligence and cognitive flexibility remained positive predictors of both outcomes after accounting for Arabic proficiency, duration of residence, region of origin, and language of instruction. Findings suggest that international student success in Saudi universities reflects an interaction of emotional, cognitive, linguistic, and contextual resources. Universities should strengthen integrated support for emotional regulation, adaptive thinking, Arabic-language development, and culturally responsive academic guidance. Full article

Background/Objectives: Although urban greening interventions are increasingly implemented to improve livability, environmental quality, and adaptation capacity in cities, their evaluation still predominantly relies on physical outputs rather than validated, resident-centered outcomes. This study examined whether the five-item attachment dimension of the Urban Green Attachment Scale (UGAS) can reliably indicate the social integration of newly introduced greenery in an SDG 11-oriented evaluation context. The present adaptation of the UGAS captures the perceived importance of the planting, its contribution to well-being, anticipated loss, willingness to protect it, and aesthetic appreciation. Methods: Data were collected through two independent face-to-face surveys conducted among residents of the same housing estate shortly after a greening intervention in May 2025 (n = 150) and September 2025 (n = 191). The first sample was used for exploratory factor analysis (EFA) and the second for confirmatory factor analysis (CFA). Reliability was assessed using Cronbach’s α and McDonald’s ω; inter-item associations were estimated using Kendall’s tau-b; and construct validity was examined through known-groups comparisons with theoretically relevant appraisals and stewardship-related indicators. Results: The adapted UGAS demonstrated high internal consistency, low floor and ceiling effects, and moderate to strong inter-item associations. Exploratory factor analysis supported a unidimensional solution with high loadings and 65.7% explained variance, and confirmatory factor analysis corroborated this structure after minor, theory-guided localized refinements. Higher UGAS scores were consistently observed among residents who reported stronger calming and home-related effects, perceived healthier local conditions, expressed willingness to help care for the plants, and demonstrated a readiness to cooperate in improving the area. Conclusions: The results support the five-item UGAS attachment score as a compact, psychometrically adequate measure of residents’ attachment to newly planted urban greenery. Rather than replacing official SDG indicators, the UGAS can complement them at the project level by determining if urban greening becomes socially meaningful and accepted and if it supports stewardship. In this sense, UGAS offers municipalities a practical tool for linking physical greening outputs with resident-centered outcomes relevant to inclusive public spaces, participatory urban development, and the long-term social durability of urban greening interventions. Full article

Background and aims: Hepatocellular carcinoma (HCC) patients frequently present with comorbidities that limit therapeutic options and increase mortality. This study evaluated the performance of the Charlson Comorbidity Index (CCI) and a modified CCI (mCCI) in stratifying patients with HCC to predict treatment allocation and survival. Methods: A retrospective single-center cohort study analyzed 401 patients with de novo HCC (74% male, median age 68 years, 80% Child–Pugh-Turcotte (CPT) A, 65% viral etiology, 70% Barcelona Clinic Liver Cancer stage (BCLC) 0/A). CCI and mCCI (with points related to HCC and chronic liver disease excluded), were calculated at diagnosis for each patient. The primary endpoint was overall survival (OS) estimated by Kaplan–Meier method and compared across mCCI classes; Cox uni/multivariable models were applied to identify predictors of mortality. The secondary aim was evaluating the association between mCCI and treatment allocation. Results: While CCI classified 94% of patients as “high-risk”, mCCI reclassified patients into “high-risk” (21%), “intermediate-risk” (48%), and “low-risk” (31%), demonstrating better stratification whilst maintaining a strong correlation with CCI (Kendall’s tau-b = 0.57, p < 0.001). BCLC B patients with “high-risk” mCCI exhibited significantly lower access to first-line curative treatment (14% vs. 47%, p = 0.03). Moreover, “high” or “intermediate-risk” patients according to mCCI experienced significantly shorter OS compared to “low-risk” (median OS 36 vs. 49 vs. 74 months, p < 0.001). “High-risk” and “intermediate-risk” mCCI classes were independent predictors of mortality, alongside alpha-fetoprotein, CPT and BCLC stage. Considering the items composing mCCI, age and cardiovascular diseases were independent predictors of mortality. Conclusions: mCCI provides a more accurate assessment of comorbidities than the standard CCI and is associated with survival, hence it can contribute to designing patient-tailored therapeutic strategies. Full article

Background/Objectives: In the context of nursing research and interventions, caregiver preparedness emerges as a pivotal concept. Informal caregivers play a central role in providing older adults with the vital nursing and social support they require. The present study evaluated the psychometric performance of the Caregiver Preparedness Scale (CPS) and tested the hypothesis that CPS scores differentiate between theoretically relevant known groups, including caregiving exposure and relationship-based indicators. Methods: A cross-sectional, face-to-face survey was conducted in June 2025 among the general population of Czechia. A total of 1024 interviews were included in the analysis. The sample was randomly split for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The internal consistency of the scale was assessed using Cronbach’s α and McDonald’s ω, while inter-item associations were evaluated with Kendall’s tau-b. The known-groups validity was assessed through nonparametric group comparisons across caregiving exposure, relationship indicators within the caregiver–senior dyad, caregivers’ self-rated health, and their life satisfaction. Results: The CPS demonstrated high internal consistency (Cronbach’s α = 0.944; McDonald’s ω = 0.944), robust item–total correlations (0.730–0.863), and acceptable floor and ceiling effects. The EFA supported a dominant one-factor solution (eigenvalue = 5.749), which explained 71.9% of the variance and had strong loadings (0.750–0.894). The CFA demonstrated a good fit (RMSEA = 0.069, SRMR = 0.0155, CFI = 0.990, and TLI = 0.980) after allowing for a limited number of conceptually justified residual covariances. Known-groups analysis supported the sensitivity of the scale when the CPS scores were higher among primary (M = 25.30) and secondary (M = 22.73) caregivers in comparison to non-caregivers (M = 18.38). Moreover, statistically significant differences were observed among those who provided care during the past five years (M = 24.30) compared to those without such experience (M = 18.12). CPS scores also exhibited variation in relationship-focused indicators in the anticipated directions, and were lower among respondents reporting poorer health and lower life satisfaction. Conclusions: The study provided consistent evidence that CPS is a reliable, unidimensional measure with robust known-groups validity. The CPS can be regarded as a suitable research instrument for nursing research and for evaluating interventions aimed at supporting informal caregivers. Full article

Introduction: Smile esthetics play a central role in social interaction, self-esteem, and self-confidence, and may influence individuals’ perception of orthodontic treatment need. Understanding how patients evaluate their own smile and how this perception relates to treatment demand is increasingly relevant for patient-centered orthodontic care. This study aimed to examine the associations between demographic factors, self-perception of smile esthetics, psychosocial behaviors, and perceived need for orthodontic treatment. Materials and Methods: A cross-sectional study was carried out using a questionnaire, yielding 303 valid responses. The questionnaire assessed demographic characteristics, satisfaction with smile appearance, smile-related avoidance behaviors, awareness of dental esthetics, and self-perceived orthodontic treatment need. Associations between variables were analyzed using Chi-square tests, Kendall’s tau_b, Spearman’s rho, and Cramer’s V coefficients. Multinomial logistic regression was performed to identify factors associated with perceived treatment need. Results: Gender was significantly associated with satisfaction with smile appearance, concern about dental esthetics, and awareness of the importance of aligned teeth (p ≤ 0.001), with weak to moderate effect sizes. Age showed statistically significant but weak correlations with smile-related behaviors and perceived treatment need (|τ| ≈ 0.11–0.12; p < 0.05). Lower satisfaction with one’s smile was moderately associated with a higher perceived need for orthodontic treatment (τb = −0.20; p < 0.001). Avoidance of smiling and covering the mouth while speaking were positively associated with perceived treatment need (p < 0.01). Discussions: Regression analysis confirmed that dissatisfaction with smile esthetics, smile-avoidance behaviors, and belief in the esthetic benefits of dental alignment were significant predictors of perceived orthodontic treatment need. Self-perception of smile esthetics and related psychosocial behaviors are significantly associated with individuals’ perceived need for orthodontic treatment. Conclusions: These findings underscore the importance of incorporating patient-reported perceptions and psychosocial factors into orthodontic assessment and shared decision-making. Full article

Background: Borderline Personality Disorder (BPD) often emerges during adolescence and young adulthood, a period marked by heightened vulnerability to impulsivity and affective dysregulation. While impulsivity is a core feature of BPD, its multidimensional expression in this age group remains insufficiently documented. This study examined impulsivity traits in young adults with BPD, their associations with depressive and anxiety symptoms, and their links to risk behaviors. Methods: A total of 160 participants aged 16–25 were recruited in Belgium between 2021 and 2023: 44 with BPD from inpatient and outpatient psychiatric services and 116 healthy controls from schools and universities. Assessments included the short UPPS-P, Beck Depression Inventory-II (BDI-II), State-Trait Anxiety Inventory (STAI-T), and the Diagnostic Interview for Borderlines–Revised (DIB-R). Logistic regressions with robust errors and Kendall’s tau-b correlations were used. Results: Compared with controls, individuals with BPD scored higher on all UPPS-p subscales except Sensation Seeking (e.g., Negative Urgency: 14 vs. 10, p < 0.001). Logistic regression identified Negative Urgency (OR = 5.31, 95% CI: 2.07–13.62, p = 0.001) and Positive Urgency (OR = 3.26, 95% CI: 1.37–7.75, p = 0.007) as independent predictors of BPD. Within the BPD group, depressive and anxiety symptoms correlated with several UPPS-P dimensions, notably Negative Urgency and Lack of Perseverance. Suicide attempts were associated with the DIB-R total score, BDI-II, and STAI-T, while substance use was linked to the DIB-R impulsivity subscale and STAI-T. Conclusions: Emotional impulsivity—particularly Negative Urgency—emerges as a central feature of BPD in emerging adulthood. Its interplay with depressive and anxiety symptoms, and its associations with suicidal and addictive behaviors, support a dual-level conceptualization of impulsivity as both a dispositional trait and a state-dependent clinical risk factor. Full article

Hyperechoic vertical artifacts are an essential feature of lung ultrasound (LUS) arising from various pathological states. Those that meet the criteria for B-lines have the most significant diagnostic value and should be differentiated from other hyperechoic vertical artifacts of unspecified clinical importance. Although numerous studies have assessed the impacts of transducer type on the appearance of B-lines in human medicine, comparative studies in veterinary medicine are limited and conflicting. This study compares three transducer types for the assessment of hyperechoic vertical artifacts in dogs. We hypothesize that there is high-level reviewer agreement in the assessment of HVA image quality and characteristics, and that the image quality/characteristics differ between the three transducers. Dogs (n = 8) with HVAs and sonographic absence of lung consolidations, pleural effusion, and/or pneumothorax were enrolled. Twenty-four cine-loops (5 s) containing HVAs were retrospectively and independently reviewed by two reviewers, who were blinded to the case details but not transducer type. The reviewers assessed the cine-loops for the following: whether HVAs meet the B-line criteria, ease of counting HVAs, and overall image quality. Paired cine-loops from the same patient using different transducers were then presented for HVA quality comparison. Inter-rater concordance was determined using the Kappa coefficient, Kendall’s tau, and Pearson correlation coefficient, while characteristics were compared using chi-square and Kruskal–Wallis tests (level of significance, α = 0.05). The overall concordance of image quality was good (Pearson’s coefficient = 0.82). The PA transducer scored lower in image quality (p < 0.001), HVA blending (p = 0.014), graininess (p < 0.001), and clarity of edges (p < 0.001) when compared with the microconvex and linear transducers, and the identification of B-line criteria differed between transducers (p = 0.024). Furthermore, the PA scored lowest in the comparison of paired cine-loops regarding the image and HVA quality (p < 0.001). Although more HVAs failed to reach the far field with the linear transducer (10/16, 62.5%) compared with the microconvex (8/16, 50%) and PA (3/16, 18.5%) transducers, the linear transducer scored higher than the microconvex and PA transducers regarding its ability to count B-lines (p < 0.001). This study demonstrates that the type of transducer significantly impacts the characteristics of HVAs, with the PA transducer producing lower-quality images compared with the microconvex and linear transducers. Full article

Background: The COVID-19 pandemic has had a profound impact on nurses’ mental health and overall wellness, both during and after the crisis. Objectives: This study aims to explore overall wellness during and after the pandemic, and the long-term psychological effects of the relationship between psychological distress and the eight dimensions of well-being among nurses in the post-pandemic era. Methods: A cross-sectional research design was used to conduct the study among 288 nurses from two regional hospitals in Albania. Participants were recruited using purposive sampling, selecting nurses based on availability and relevance to the study criteria. Data were collected through self-administered questionnaires using the DASS-21 scale and the Personal Assessment of the Eight Dimensions of Wellness. Descriptive statistics and Kendall’s Tau-b correlation were used to assess associations, followed by ordinal regression to explore the influence of demographic and professional variables. Results: Findings revealed persistent levels of psychological distress among nurses, especially related to anxiety and stress. Significant negative correlations were found between wellness dimensions particularly emotional and occupational wellness and psychological distress. Age and department assignment emerged as predictors of post-pandemic stress and depression. Conclusions: The study highlights the need for institutional strategies to support mental health and promote comprehensive well-being among nurses in the post-COVID-19 period. Investing in long-term psychological support and wellness training is essential for building a resilient nursing workforce. Full article

The evaluation of large language models (LLMs) increasingly relies on other LLMs acting as automated judges. While this approach offers scalability and efficiency, it raises serious concerns regarding evaluator reliability, positional bias, and ranking stability. This paper presents a scalable framework for diagnosing positional bias and instability in LLM-based evaluation by using controlled pairwise comparisons judged by multiple independent language models. The system supports mirrored comparisons with reversed response order, prompt injection, and surface-level perturbations (e.g., paraphrasing, lexical noise), enabling fine-grained analysis of evaluator consistency and verdict robustness. Over 3600 pairwise comparisons were conducted across five instruction-tuned open-weight models using ten open-ended prompts. The top-performing model (gemma:7b-instruct) achieved a 66.5% win rate. Evaluator agreement was uniformly high, with 100% consistency across judges, yet 48.4% of verdicts reversed under mirrored response order, indicating strong positional bias. Kendall’s Tau analysis further showed that local model rankings varied substantially across prompts, suggesting that semantic context influences evaluator judgment. All evaluation traces were stored in a graph database (Neo4j), enabling structured querying and longitudinal analysis. The proposed framework provides not only a diagnostic lens for benchmarking models but also a blueprint for fairer and more interpretable LLM-based evaluation. These findings underscore the need for structure-aware, perturbation-resilient evaluation pipelines when benchmarking LLMs. The proposed framework offers a reproducible path for diagnosing evaluator bias and ranking instability in open-ended language tasks. Future work will apply this methodology to educational assessment tasks, using rubric-based scoring and graph-based traceability to evaluate student responses in technical domains. Full article

Considering the complexity of laser cutting technology, and difficulties and limitations when applying traditional multi-criteria decision-making (MCDM) methods, this study proposes a fuzzy MCDM methodology for the analysis of the fibre laser cutting process, assessment of alternative cutting conditions and selection of favourable cutting conditions. The experiment in fibre laser cutting of mild steel was based on a Box–Behnken design by considering three input parameters (focus position, cutting speed and oxygen pressure) and four relevant criteria for the assessment of cutting conditions (kerf width on a straight and curved cut, surface roughness and surface productivity). The proposed fuzzy MCDM methodology makes use of expert knowledge and experimental data for criteria evaluation and decision matrix development, respectively, while three fuzzy MCDM methods (fuzzy TOPSIS, fuzzy WASPAS and fuzzy ARAS) were used to determine the complete ranking of alternatives. Kendall’s tau-b and Spearman’s rho correlation tests were applied to compare the obtained ranking lists, while the stability of the ranking was assessed with the application of the Monte Carlo simulation. Finally, to approximate the fuzzy decision-making rule, a second-order model was developed to reveal the significance of process parameters and identify favourable laser cutting conditions. Full article

Background/Objectives: Healthcare professions impose high physical and mental demands, potentially affecting health. Despite advocating for active lifestyles, many physiotherapists do not meet recommended physical activity levels (PALs). This study explores physical activity patterns and recreational engagement among practicing physiotherapists. Methods: A cross-sectional correlational design examined the relationship between physical activity and recreational participation among 60 physiotherapists (38 females, 22 males, mean age 38.62 ± 9.78 years). Data were collected using the International Physical Activity Questionnaire—Short Form (IPAQ-SF) and the Pittsburgh Enjoyable Activities Test (PEAT). The analysis focused on bivariate correlations between PAL, energy expenditure (MET), recreational habits (PEAT score), and sociodemographic and anthropometric variables. Results: The IPAQ-SF results indicated that 38.3% of participants had a low PAL, 40.0% a moderate level, and 21.7% a high level. Average energy expenditure was 1927.62 ± 1479.73 MET-minutes/week. PEAT data indicated moderate engagement in recreational activities (mean score: 22.63 ± 7.76), with participants predominantly involved in low-intensity, passive leisure. Significant positive correlations were observed between PEAT scores and both MET values (Kendall’s tau-b = 0.669, p ≤ 0.01) and PALs (Kendall’s tau-b = 0.804, p ≤ 0.01), indicating that higher engagement in recreational activities is associated with greater energy expenditure and overall physical activity levels. Conclusions: Despite the physical demands of their profession, many physiotherapists report low activity levels. The positive correlations between physical activity, energy expenditure, and recreational engagement highlight the need for structured exercise to support both personal health and professional integrity. Future research should include larger samples and objective assessments. Full article

Objectives: The purpose of this study was to analyze image quality and radiation exposure of thoracic computed tomography angiography (CTA) in children with congenital heart diseases (CHDs) using either manual contrast medium (CM) injection or automated power injectors with bolus tracking. Methods: A total of 137 thoracic CTAs of 120 consecutive pediatric patients were included in this retrospective study. We analyzed the method of CM administration (power injection with bolus tracking (PI) or manual injection (MI)), injection routes, volumes and flow rates of CM. For the evaluation of objective image quality, attenuation values in the heart chambers and great thoracic vessels were determined by region-of-interest (ROI) analysis and signal-to-noise (SNR) and contrast-to-noise (CNR) ratios calculated thereof. Visual image quality was assessed by two blinded readers (four-point Likert-scale) analyzing the presence of artifacts and the depiction of relevant anatomical structures. Effective radiation doses were calculated with dose length products and specific conversion factors. Results: CM administration was performed using PI in 119/137 CTAs, whereas MI was conducted in 18/137. The smallest size of peripheral venous cannulas was 24 gauge in 36/137 (26.3%) cases. Overall mean CM volume was 17 mL ± 16 mL (mean ± SD). In PI, the mean flow rate of CM was 1.52 ± 0.90 mL/s with a range between 0.5 and 5.0 mL/s. When comparing the overall PI population and an age-, size- and weight-matched PI subpopulation (18 cases) with the MI population, attenuation values in Hounsfield units (HU) and CNR values were significantly higher in the PI groups than in the MI group for each relevant cardiac structure (left ventricle, right ventricle, ascending aorta and pulmonary trunk, p = 0.02–0.001). Overall image quality and depiction of cardiac structures were rated significantly better in CTAs with PI (interquartile ranges: “good” to “excellent” (Likert 3–4)) in PI compared with CTAs acquired with MI (interquartile ranges: “fair” to “good” (2–3)) in MI by both readers (p < 0.001). The inter-observer reliability was strong, with a Kendall’s Tau-b correlation coefficient of τ = 0.802 (p < 0.001). The mean effective radiation dose (E) did not differ significantly when comparing the stratified samples (i.e., the matched PI subgroup and the MI group; 0.5 (±0.3) mSv in both, p = 0.76). There were no complications associated with the CM injections for both application approaches. Conclusions: Automated contrast agent applications with power injectors and bolus tracking ensure better image quality in pediatric CTA, even when low volumes and flow rates need to be applied. There is a slight increase in radiation associated with bolus tracking. This approach represents a suitable imaging technique for the work-up of congenital heart disease. Full article