Search Results (4,024)

Background/Objectives: Proficiency in moral reasoning is essential for healthcare providers to successfully navigate ethically challenging decision-making. It is critical that student dentists about to enter practice have well-developed moral reasoning skills to ensure optimal patient care. The aim of the present study was to investigate the moral reasoning ability of students undertaking their final year of the undergraduate Bachelor of Dental Surgery (BDS) programme at the University of Adelaide (UofA) in Australia. Methods: Sixty-six final-year BDS students were invited to participate in an e-survey which included the Defined Issues Test 2 (DIT-2), a validated instrument for measuring moral reasoning. Calculated DIT-2 scores incorporatedthe postconventional (P) score and N2 score. Data analysis of demographic details and scores related to the DIT-2 included the use of t-tests, Mann–Whitney and the Spearman rank correlation coefficient tests. Results: A response rate of 45.5% (n = 30) was recorded. The mean (95% CI) P and N2 scores were 37.80 (32.04, 43.56) and 42.12 (37.72, 46.53), respectively. Scores for females and for those who had undertaken the majority of their pre-BDS studies outside of Australia and New Zealand were higher, but the differences were not statistically significant (p > 0.05). A Spearman Correlation Coefficient test indicated that age was moderately associated (r = 0.41; 95% CI: 0.01, 0.65; p = 0.04) with N2 scores. Conclusions: Moral reasoning scores were comparable to studies among similar cohorts conducted in other countries but were less than the scores considered optimal for a healthcare provider to proficiently manage challenges to ethical decision-making. Consideration should be given to the introduction of appropriate formal training in ethics to better manage these challenges. Full article

Objective: This study aimed to evaluate peri-implant tissue changes during early osseointegration using a combined approach of digital radiographic analysis, RGB pseudocolorization, and histomorphometry in a sheep tibia model. Materials and Methods: Thirty titanium implants were placed in the tibiae of six adult sheep and evaluated at 14 and 28 days post-implantation. Digital periapical radiographs were acquired, grayscale values and RGB channel intensities were measured using Fiji/ImageJ, and compared with histological parameters (bone tissue, collagen, and medullary spaces) quantified from picrosirius–hematoxylin-stained sections. Manual overlay of radiographic and histological images was performed to ensure spatial correspondence of regions of interest. Statistical analyses assessed differences over time and correlations between image data and histological composition. Results: Radiographic grayscale values and histologically measured bone and collagen increased significantly from 14 to 28 days (p < 0.01), while medullary spaces decreased (p < 0.001), indicating progressive bone formation and matrix maturation. RGB analysis revealed significant increases in green channel intensity and decreases in red channel intensity (p < 0.05), while the blue channel remained stable. At 14 days, strong correlations were observed between blue channel intensity and bone tissue (r = 0.81; p = 0.015), and between green channel intensity and collagen (r = 0.98; p < 0.001). Visual overlays demonstrated alignment between radiographic high-density zones and histologically dense bone regions. Conclusions: RGB pseudocolorized radiographic analysis, correlated with histological findings, offers a non-invasive and reproducible method for early detection of peri-implant tissue maturation. This feasibility correlation study provides a foundation for future investigations integrating imaging, histology, and biomechanical testing. Full article

Improving nitrogen efficiency in dairy cattle requires a better understanding of the dietary and ruminal factors that regulate nitrogen partitioning. This meta-analysis evaluated the effects of ruminal pH and dietary characteristics on microbial nitrogen (MN), non-microbial non-ammonia nitrogen (NANMN), and NAN flows to the small intestine in lactating cows. A dataset was assembled from 44 peer-reviewed in vivo studies (163 data points), with dietary intake and ruminal variables standardized across trials. Mixed linear models were developed for each N fraction, and the relative contribution of each predictor to the explained variance was assessed using semipartial coefficients of determination (pR²). Efficiency of microbial protein synthesis (EMPS), rumen undegraded protein intake (RUPI), and organic matter truly digested in the rumen (OMTDR) were the most relevant predictors of NANMN and NAN. Although the ruminal pH itself was not statistically significant in the models, the dietary components that influenced pH, starch concentration, physically effective fiber, and RUP supply were strongly associated with nitrogen flow profiles. Nitrogen utilization was not affected by ruminal pH, but rather by the combination of fermentable substrates and the supply of rumen-degradable and undegraded protein. Full article

Multilayer packaging materials are extensively used in food packaging, particularly for powdered products. In alignment with sustainable development goals, packaging design should aim to minimize material usage while maintaining the protective properties necessary to preserve food quality and safety, thereby reducing environmental impact. A key strategy is to simplify multilayer structures to enhance recyclability. This study aims to evaluate the potential of sustainable alternative packaging materials with reduced metal and plastic content and improved recyclability for pudding powder packaging, as substitutes for conventional films. Four packaging structures were tested: a conventional three-layer laminate (polyethylene terephthalate (PET)/aluminum foil (Al-foil)/low-density polyethylene (LDPE)), two two-layer structures (AlO_x-coated PET/LDPE and Al-coated PET/LDPE), and a monolayer metallized biaxially oriented polypropylene (MetBOPP). Samples were stored under accelerated conditions (38 °C and 90% relative humidity) for 180 days, and changes in moisture content, water activity, caking degree, glass transition temperature, color, and sensory attributes were monitored. The experimental data were examined for their agreement with various sorption models by creating adsorption isotherms. The acceptable storage period was estimated using the constants calculated from these models. Statistically significant differences (p < 0.05) were observed among the packaging types, primarily associated with their water vapor permeability, affecting moisture content, water activity, caking degree, and color stability. In terms of moisture content, water activity, and caking degree, the conventional PET/Al-foil/LDPE (Polyethylene terephthalate/Aluminum foil/Low density polyethylene) structure demonstrated the best performance, followed by PET.AlO_x/LDPE (AlO_x-coated Polyethylene terephthalate/Low density polyethylene), MPET/LDPE (Metallized polyethylene terephthalate/Low density polyethylene), and MBOPP (Metallized biaxially oriented polypropylene), respectively. The sensory analysis scores followed the same ranking; however, all samples maintained scores above the threshold value of 3 throughout the storage period, indicating that they remained acceptable. Caking degree increased moderately (from 0.61% to 0.89%) and was negatively correlated with appearance scores (R² = −0.89, p < 0.01). Despite slight darkening (Browning Index increased from 18.16 to 20.37), sensory scores for appearance, odor, and taste remained above the acceptable threshold (score > 3.0). Based on the WVTR values of the packaging materials and the application of the GAB model, the estimated shelf lives were 800.32 days for PET/Al-foil/LDPE, 577.92 days for PET.AlO_x/LDPE, 407.58 days for MPET/LDPE, and 229.26 days for MBOPP. In conclusion, the longest shelf life was achieved with PET/Al-foil/LDPE, and it was observed that as the WVTR of the packaging materials increased, the shelf life of the cocoa-based pudding powder decreased; PET.AlO_x/LDPE and MPET/LDPE could be considered for medium-term storage (up to about 1–1.5 years), while MBOPP appeared suitable only for shorter durations (6–8 months). Full article

Background: The purpose of this study was to examine the relationship between qualitative characteristics and quantitative parameters from contrast-enhanced ultrasound (CEUS) and microvessel density (MVD) in hepatoblastoma (HB), as well as to investigate whether CEUS could be utilized as a non-invasive method for predicting HB progression. Methods: This retrospective analysis was carried out in one medical center and included 34 children with histopathologically confirmed HB. Both grayscale ultrasound and CEUS results were reviewed. Lesions were evaluated using time–intensity curve (TIC) analysis software to extract quantitative parameters. Postoperative tissue specimens were stained with CD34 immunohistochemistry, and MVD was quantified as the reference standard. Statistical analyses were conducted to assess the correlation between CEUS findings and MVD. Results: Lesions were separated into high (n = 21, 61.76%; MVD ≥ 41) and low (n = 13, 38.24%; MVD < 41) MVD groups, using the median microvessel density of 41 vessels per high-power field (HPF) as the cutoff. High MVD lesions exhibited a significantly higher incidence of penetrating vessels compared with low MVD lesions (p < 0.05). Elevated MVD levels were significantly associated with increased Adler-grade blood flow (p < 0.05). Both TIC-derived and relative quantitative parameters exhibited significant intergroup differences. Among the relative parameters, the relative wash-out rate (rWoR) was significantly higher in the low MVD group (p < 0.05). Moreover, the Receiver Operating Characteristic (ROC) curve analysis indicated that an rWoR threshold of ≥1.36 could serve as a predictor for low MVD, resulting in 76.9% sensitivity and 81.0% specificity (AUC = 0.802; 95% CI: 0.634–0.970; p = 0.003). Conclusions: CEUS revealed an association with MVD, supporting its potential as a non-invasive tool to characterize tumor vascularity. Full article

This study examines the exposure of the U.S. insurance sector to climate-related risks using a two-step approach combining factor modeling and Extreme Value Theory. The analysis first constructs a climate risk factor from transition-sensitive sectors and estimates its impact on the SPDR S&P Insurance ETF using a standard factor model. The resulting residual, termed Insurance Climate Risk, isolates climate-driven excess returns by controlling for market-wide effects. To assess the sector’s sensitivity to extreme events, the study applies both the Peaks Over Threshold method using the Generalized Pareto Distribution and the Block Maxima Method using the Generalized Extreme Value distribution. The findings reveal statistically significant climate sensitivity, especially in daily and weekly data, and confirm the presence of heavy tails in the loss distribution. VaR and CVaR estimates indicate heightened risk over longer horizons and under block maxima modeling. Notably, peak over threshold daily returns yield a 95% VaR of 1.33% and CVaR of 2.28%, while block maxima CVaR exceeds 5%. These results show the importance of incorporating tail-risk-aware metrics in insurance risk management and highlight the growing influence of climate-related financial shocks. Full article

This study investigates how increasing prompt complexity affects the performance of Large Language Models (LLMs) across multiple Natural Language Processing (NLP) tasks. We introduce an incremental evaluation framework where six tasks—JSON formatting, English-Italian translation, sentiment analysis, emotion classification, topic extraction, and named entity recognition—are progressively combined within a single prompt. Six representative open-source LLMs from different families (Llama 3.1 8B, Gemma 3 4B, Mistral 7B, Qwen3 4B, Granite 3.1 3B, and DeepSeek R1 7B) were systematically evaluated using local inference environments to ensure reproducibility. Results show that performance degradation is highly architecture-dependent: while Qwen3 4B maintained stable performance across all tasks, Gemma 3 4B and Granite 3.1 3B exhibited severe collapses in fine-grained semantic tasks. Interestingly, some models (e.g., Llama 3.1 8B and DeepSeek R1 7B) demonstrated positive transfer effects, improving in certain tasks under multitask conditions. Statistical analyses confirmed significant differences across models for structured and semantic tasks, highlighting the absence of a universal degradation rule. These findings suggest that multitask prompting resilience is shaped more by architectural design than by model size alone, and they motivate adaptive, model-specific strategies for prompt composition in complex NLP applications. Full article

Background/Objectives: Psychosocial factors (e.g., adherence, substance use) contribute to increased morbidity and mortality after heart transplantation. We investigated alcohol consumption patterns and their associations with psychosocial factors in adults, who underwent heart transplantation surgery (HTX recipients). Methods: Our cross-sectional study was conducted at the Semmelweis University Heart and Vascular Centre between 2023 and 2025. In total, 201 HTX recipients (75.6% male, mean age: 56.33 ± 11.46 years) completed the Alcohol Use Disorders Identification Test (AUDIT), Brief Health Literacy Screening Tool (BRIEF), Medication Adherence Report Scale (MARS-5) modified to immunosuppressive medication, and 9-item Beck Depression Inventory (BDI-9). Statistical analysis included Pearson’s correlation tests and Multivariate Regression Analyses. Results: The AUDIT had a higher proportion of non-evaluable responses than other questionnaires (AUDIT 19.9% vs. 5.5–9%), with 41.0% of the participants abstinent, 54.7% low-risk, 4.3% medium-risk, and 6.5% at-risk drinkers. AUDIT correlated negatively with MARS-5 (r = −0.326; p = 0.000) and positively with BDI-9 (r = 0.208; p = 0.010). At-risk drinking was associated with a lower MARS-5 (r = −0.231; p = 0.002). Multivariate regression models significantly predicted the AUDIT (F = 5.106; p < 0.001, R² = 0.216) and AUDIT-C (F = 3.804; p = 0.002; R² = 0.146), with sex and adherence as independent predictors. Conclusions: The high proportion of non-evaluable AUDIT responses suggests limitations in multi-questionnaire use but does not diminish its clinical relevance. The presence of 6.5% at-risk and 4.3% medium-risk drinkers highlights the relevance of consumption pattern screening, beyond diagnosing alcohol use disorder. Associations between AUDIT, MARS-5, and BDI-9 emphasize the necessity for multidisciplinary care. Full article

Peat mosses of the genus Sphagnum are keystone species in peatland ecosystems and play critical roles in carbon sequestration, nitrogen fixation, and hydrological regulation. Indeed, these ecological functions are largely mediated by endophytic bacteria associated with Sphagnum. Here, five populations of the endemic Chinese moss species, S. multifibrosum, were sampled across southern China in peatland (PH) and rock habitats (RH). High-throughput sequencing of 16S rRNA and nitrogenase (nifH) genes was applied to characterize overall endophytic bacterial diversity and diazotroph diversity associated with S. multifibrosum, respectively, alongside host microsatellite genotyping. Proteobacteria was the dominant endophytic bacterial phylum. The bacterial communities exhibited significant spatial separation between eastern and western communities and community dissimilarities significantly increased with increasing geographic distances. Environmental heterogeneity and host genetics jointly shaped endophytic bacterial community assemblage. Climate was the most important determinant influencing bacterial composition, followed by host genotype and habitat type. Temperature, precipitation, and nitrogen deposition were the primary environmental factors that influenced composition. Bacterial diversity and composition exhibited no statistically significant differences between the two habitats. Further, the richness and abundances of diazotrophs and methanotrophs from PH communities were higher than in RH communities. Co-occurrence network analysis suggested that RH bacterial networks had lower connectance but were more modularized and exhibited higher complexity than PH networks. These results highlight the ecological functions of peat mosses in carbon and nitrogen cycling and suggest a need to prioritize the conservation of S. multifibrosum in peatland environments under global climate change. The results also provide a framework to help future wetland management and biodiversity conservation efforts in China. Full article

Currently, intelligent algorithms are becoming a reliable alternative source of data analysis in many areas of human activity. In materials science, the integration of machine learning methods is effectively applied to predictive modeling of building materials properties. This is particularly interesting and relevant for predicting the strength properties of building materials under aggressive environmental conditions. In this study, machine learning methods (Linear Regression, K-Neighbors, Decision Tree, Random Forest, CatBoost, Support Vector Regression, and Multilayer Perceptron) were used to analyze the relationship between the strength properties of heavy concrete depending on the freeze–thaw cycle, the average area of damaged areas during this cycle, and the number of damaged areas. The Random Forest and CatBoost methods demonstrate the smallest errors: deviations from actual values are 0.27 MPa and 0.25 MPa, respectively, with an average absolute percentage error of less than 1%. The determination coefficient R² for both models is greater than 0.99. High values of this statistical measure indicate that the implemented models adequately describe changes in the observed data. The theoretical and practical development of intelligent algorithms in materials science opens up vast opportunities for the development and production of materials that are more resistant to aggressive influences. Full article

This study evaluates the applicability of Sentinel-1 Persistent Scatterer Interferometry (PSI) data from the Ground Motion Service Germany (BBD) for monitoring dams by comparing it with terrestrial measurements at dams of the Ruhrverband in North Rhine-Westphalia (NRW), Germany. The analysis focuses on the accuracy and reliability of BBD data in detecting movements, considering two observation periods and two satellite observation geometries (Ascending and Descending orbit). BBD data showed high correlations with in situ measurements, particularly for long-term deformation trends. However, weak correlations are observed, especially in the Ascending direction. These inconsistencies highlight the influence of structural characteristics of the dams, observation conditions like incidence angles and changes of the study period on data reliability. Key findings show that BBD data provides valuable insights for observing long-term deformation trends (r up to 0.7) but has limitations in capturing short-term deformations due to its annual update rate. A clear difference was observed when extending the observation period by one year, from 2015–2020 to 2015–2021: although the number of PS (Persistent Scatterers) decreased by up to 60%, the PS showed an improved agreement with in situ measurements, indicating higher data quality (r up to 0.8). However, the precision of BBD data depends on inherent factors from the PSI method such as the satellites’ observation geometry, observation period, and site-specific conditions, underscoring the importance of tailored feasibility assessments. The BBD offers a complementary tool to support the maintenance and safety of dam infrastructures. The study follows an observational multi-site design with predefined, DIN-aligned evaluation criteria and statistical tests and is intended as an assessment of operational support rather than a full operational qualification, outlining conditions under which BBD PSI can complement standards-aligned monitoring. Full article

Accurately understanding the impact of Significant Wave Height (SWH) on mariculture productivity is crucial for developing a sustainable blue economy and mitigating the effects of increasing marine extreme events under climate change. However, a significant research gap exists in macroscale empirical tools capable of quantifying the complex, non-linear, and spatially non-stationary relationships between SWH and mariculture yield. Addressing this, our study focused on the Bohai and Yellow Seas, a critical mariculture region in China. We developed five novel SWH indices (LSDI, MSDI, HSDI, RSI, NDSI) to statistically link SWH with the Unit Area Yield (UAY) using buoy-calibrated ERA5 reanalysis data and regional fishery statistics. Geographically Weighted Regression (GWR) was further employed to uncover the spatial heterogeneity of this relationship. Results demonstrated that the Normalized Difference SWH Index (NDSI) most effectively captured the SWH-UAY relationship (r = 0.61, R² = 0.37), as its non-linear form integrates the positive effects of low SWH conditions and the negative effects of high SWH conditions. GWR analysis revealed significant spatial non-stationarity, with the SWH impact on yield being stronger in the eastern and southern open waters of the Yellow Sea and weaker in the northern semi-enclosed Bohai Sea. The index framework and spatial analysis method developed in this study provide a transferable tool for quantifying the impact of physical oceanographic processes on mariculture productivity at a macro scale, which can offer a scientific basis for climate-resilient mariculture zoning and adaptive management. Full article

Background/Objectives: Obesity is a well-established risk factor for endometrial cancer and presents challenges for surgical management. Robotic-assisted surgery offers a minimally invasive approach with potential benefits for obese patients. This study sought to assess the impact of body mass index (BMI) on surgical performance and short-term outcomes in patients undergoing robotic surgery for early-stage endometrial cancer, focusing on follow-up and perioperative treatment. Methods: A retrospective analysis was conducted on 54 patients with early-stage endometrial cancer who underwent a robotic total hysterectomy, bilateral salpingo-oophorectomy, and indocyanine green sentinel lymph node biopsy between January 2021 and December 2024 at two tertiary centers. Patients were stratified by body mass index. Surgical variables, sentinel lymph node detection rates, peri- and postoperative complications, length of hospital stay, and short-term oncologic outcomes were assessed. Statistical comparisons were performed using ANOVA, chi-square tests, and Pearson’s correlation analysis. Results: The mean patient age was 59.7 years, with a mean BMI of 31.1 kg/m². Bilateral sentinel lymph node detection was successful in 87% of cases, with no significant differences between BMI groups. Console time, hospital stay, and complication rates were comparable across BMI categories. Console time positively correlated with the number of lymph nodes removed (r = 0.302, p = 0.026), but not with BMI. At a mean follow-up of 24.4 months, no recurrences were observed. Conclusions: Robotic surgery for early-stage endometrial cancer is safe and effective regardless of BMI, including in patients with Class III obesity. BMI does not negatively impact surgical or short-term oncologic outcomes, supporting robotic surgery as an optimal approach in obese endometrial cancer patients. Full article

Objectives: There is currently a lack of research on coronal Computed Tomography (CT) attenuation measurements. This study aimed to evaluate a coronal CT attenuation measurement method for osteoporosis screening at the proximal femur and compare its performance with the conventional axial approach. Methods: A retrospective analysis was conducted on 708 patients who underwent both proximal femur CT and dual-energy X-ray absorptiometry (DXA) within a 6-month period between January 2013 and December 2023. The axial and coronal CT attenuation values for these patients were measured. The correlation, agreement, and efficacy in screening osteoporosis of the two methods were further evaluated and compared. Results: Both measurement methods demonstrated excellent inter-observer reliability. Axial measurements yielded slightly higher HU values than coronal measurements (mean difference: 3.93 Hounsfield unit (HU), p < 0.001), and the Bland–Altman analysis showed a Coefficient of Repeatability (CR) = 9.09 HU (95% CI: 8.63 to 9.61) between the two methods. A strong correlation was observed between the two measurements (Pearson’s coefficient (r) of 0.919 (95% CI: 0.907–0.930, p < 0.001)). Coronal measurements showed comparable correlation with femoral T-scores to axial measurements (0.766 (95% CI: 0.730–0.808) vs. 0.736 (95% CI: 0.697–0.771), p = 0.195). Coronal and axial measurements exhibit good predictive performance for osteoporosis diagnosis, with no statistically significant difference in AUC values between the two methods (0.850 vs. 0.864, p = 0.097). Conclusions: The coronal CT attenuation measurement method provides a reliable and complementary diagnostic tool for opportunistic osteoporosis screening, demonstrating strong correlation with axial measurements and comparable diagnostic accuracy. Full article

Tourism enterprises are increasingly pressured to align competitiveness with sustainability, yet limited evidence exists from Central and Eastern Europe. This study investigates the role of eco-friendly orientation as a determinant of customer satisfaction and perceived competitiveness in the Visegrad Four (Slovakia, Czech Republic, Poland, and Hungary). Empirical research was conducted on a sample of 478 enterprises, including hotels, guesthouses, spas, agritourist facilities, and travel agencies. Data were collected between January and June 2025 using a standardized questionnaire and analyzed through descriptive statistics, factor analysis, Pearson correlation, multiple regression, and ANOVA. The findings demonstrate that enterprises adopting more extensive environmental practices report significantly higher customer satisfaction (r = 0.43, p < 0.01) and perceived competitiveness (r = 0.38, p < 0.01). Factor analysis identified three key dimensions of environmental orientation: ecological operations, ecological innovations, and ecological marketing. Regression analysis highlighted ecological marketing, particularly the adoption of certifications and eco-labels, as the strongest predictor of competitiveness. ANOVA revealed significant cross-country differences, with Slovak and Czech enterprises outperforming Polish and Hungarian counterparts. The results suggest that ecological initiatives are essential for long-term competitiveness, providing both strategic guidance for managers and policy implications for fostering supportive regulatory and financial frameworks across the region. This study makes a novel contribution by offering one of the first large-scale empirical analyses of the link between sustainability and competitiveness in Central and Eastern Europe, a region where such research is still scarce. Theoretically, it extends the application of Ecological Modernization Theory to the tourism sector, while practically it provides actionable recommendations for managers and policymakers on integrating eco-certification and ecological marketing into their strategies. These insights underline the dual role of environmental orientation as a driver of both customer satisfaction and competitive advantage. Full article