Search Results (13,847)

Background: Irreversible brachial plexus injury can leave patients with a painful, insensate, and nonfunctional flail limb, often after failed reconstructive attempts and with limited remaining surgical options. This study describes a modified transhumeral amputation technique incorporating a passive biceps brachii traction sling to improve residual limb stability and prosthetic readiness in this challenging setting. Methods: This retrospective, uncontrolled five-case series assessed the feasibility, perioperative safety, descriptive clinical outcomes, and early prosthetic integration of transhumeral amputation with a biceps brachii-based traction sling. Eligible patients had irreversible brachial plexus palsy, complete loss of useful upper-limb function, chronic shoulder instability or traction-related symptoms, pain, and persistent distress related to the paralysed limb as a burdensome nonfunctional appendage. Outcomes included the Disabilities of the Arm, Shoulder and Hand (DASH) score, Visual Analog Scale (VAS) for pain, and SF-36 Physical Functioning and Emotional Well-Being domains. Results are reported descriptively as individual values and medians without hypothesis testing. Results: All five patients completed follow-up, which reached 30 months. After combined transhumeral amputation, biceps sling construction, RPNI, rehabilitation, and prosthetic fitting, patient-reported scores changed in this small uncontrolled series as follows. The median DASH score changed from 64 preoperatively to 50 postoperatively; in this context, DASH reflects global perceived disability and may be influenced by pain relief, altered expectations, prosthetic compensation, psychosocial adaptation, and the removal of a burdensome limb rather than restoration of upper-limb function. Median VAS pain score changed from 7 to 0; VAS captured overall pain intensity only and did not separately measure phantom limb pain, mechanical pain, neuropathic pain, deafferentation pain, or traction-related symptoms. SF-36 Physical Functioning changed from 75 to 100, and Emotional Well-Being from 75 to 100. Four patients were fitted with a myoelectric prosthesis, and one elected to use a cosmetic prosthesis. No postoperative surgical complications, socket-related complications, prosthesis abandonment, clinical shoulder dislocation, or obvious failure of the construct were observed. Two Paralympic athletes returned to competitive sport after rehabilitation. Conclusions: The combined procedure was technically feasible in five highly selected patients and was not associated with observed surgical or prosthetic complications during follow-up. After combined transhumeral amputation, biceps sling construction, RPNI, rehabilitation, and prosthetic fitting, patient-reported scores improved in this small uncontrolled series. The specific contribution of the biceps sling relative to amputation itself, RPNI, prosthetic rehabilitation, and patient selection remains unknown. Larger prospective studies with objective assessment of shoulder and stump stability are needed to validate these preliminary findings and refine patient-selection criteria. Full article

Railway station buildings increasingly operate as civic landmarks, public interiors, and cultural interfaces as well as mobility infrastructure. This study asks how architectural design integrates transport performance, public-space formation, and cultural meaning. A qualitative multiple-case study examines St Pancras International (London, United Kingdom), Rotterdam Centraal (Rotterdam, the Netherlands), Liège-Guillemins Station (Liège, Belgium), and Hong Kong West Kowloon Station (Hong Kong, China). Cases were selected for maximum variation in design logic and documented evidence. Official, heritage, practice, and scholarly sources were triangulated; documented features were deductively coded through a Node–Place–Narrative protocol and then compared across cases. Node captures movement and connectivity, Place captures public use and urban integration, and Narrative captures the meanings attributed to heritage, structure, materiality, landscape, and arrival. The analysis identifies four mechanisms: heritage reactivation, urban legibility, structural symbolism, and landscape-civic integration. Across the cases, transport performance is a necessary enabling condition, whereas cultural distinctiveness emerges when public-space and narrative strategies are spatially integrated. The study extends the node-place model at the building scale, clarifies the boundary between place performance and narrative interpretation, and offers transferable—but context-dependent—principles for culturally responsive transport architecture. Because the evidence is documentary rather than user-based, the framework supports analytical comparison rather than performance scoring. Full article

When a large language model (LLM) answers a question using retrieved documents, retrieval-augmented generation (RAG) is the standard approach. Retrieving more documents improves answer accuracy but increases cost and response time; retrieving fewer documents saves resources but may miss critical information. Most existing RAG systems sidestep this dilemma by applying the same retrieval setting to every query, regardless of how simple or complex the question is. This wastes budget allocation on easy questions and under-serves hard ones. This paper introduces Cost-Aware RAG (CA-RAG), a routing framework that solves this problem by treating each query individually. For every incoming question, CA-RAG selects the most suitable retrieval strategy from a fixed menu of four options, ranging from no retrieval to fetching the top $k=10$ most-relevant documents. The selection is driven by a scoring formula that balances expected answer quality against predicted cost and response time. The weights in this formula act as dials: adjusting them shifts the system toward speed, savings, or quality without any retraining. CA-RAG is built on Facebook AI Similarity Search (FAISS) for document retrieval, OpenAI gpt-4o-mini for generation, and text-embedding-3-small for dense retrieval embeddings. We evaluate CA-RAG on a benchmark of 28 queries. The router assigns different strategies to different queries, achieving 26% fewer billed tokens compared to always using heavy retrieval and 34% lower response time compared to always answering without retrieval, while maintaining answer-quality parity in both cases. Further analysis shows that most savings come from simpler queries, where heavy retrieval was unnecessary. All results are reproducible from logged comma-separated value (CSV) files. CA-RAG demonstrates that a small but well-designed set of retrieval strategies combined with lightweight per-query routing can meaningfully reduce the cost and latency of LLM deployments without compromising answer quality. Full article

Plain Language seeks to enhance the clarity and comprehensibility of legal and administrative communication; while Natural Language Processing (NLP) offers promising tools for assessing text complexity, most Plain Language classification studies focus exclusively on English, leaving low-resource languages underexplored. This study presents the first systematic evaluation of transformer-based models for sentence-level Plain Language classification in Hungarian tax administrative texts. We benchmarked zero-shot prompting with GPT-4o against fine-tuned open-weight and proprietary models, including huBERT, XLM-RoBERTa, GPT-4o-mini, and Gemini 1.0 Pro, and contextualized these results against previously established lightweight machine learning baselines based on term frequency-inverse document frequency with a support vector machine (TF-IDF + SVM) and fastText. To address data scarcity, we applied translation-based data augmentation using parallel Hungarian–English corpora. The best-performing model achieved a macro-average F1-score of 0.79. Mid-sized models also delivered competitive results, combining accuracy with feasible inference speed and deployment flexibility. Beyond classification performance, we conducted local and aggregated interpretability analysis based on Shapley-values to identify linguistic patterns influencing model decisions. This revealed alignment with known Plain Language features, such as nominalizations and syntactic complexity, as well as biases introduced by frequent domain-specific terms. Our findings demonstrate that Plain Language classifiers can be effectively adapted to low-resource legal–administrative domains. The results support the development of real-time feedback tools that promote linguistic accessibility and contribute to the broader goal of Access to Justice. Full article

Background/Objectives: Diet-disease-related knowledge (DDRK) is theorized to foster healthier lifestyles; however, the structural interconnectedness between nutritional knowledge and personal biomarker awareness is not well understood. This study aimed to identify independent predictors of DDRK and cardiovascular health (CVH) literacy among Lebanese adults using a psychometric framework. Methods: A cross-sectional convenience-sampled online survey was conducted among 406 Lebanese adults. Standard validated questionnaires were used, including the GNKQ-Section 4, GPAQ, and MEDAS. CVH literacy was computed as the total awareness of five main CV biomarkers: total cholesterol, LDL, HDL, triglycerides, and HbA1c. Data were analyzed through multivariable logistic regression and EBICglasso network analyses. Results: Overall, the prevalence of cardiovascular (CV) biomarker unawareness was 65.5% across participants. Fully adjusted regression models showed that a continuous DDRK score was a significant factor independently associated with lower odds of CV biomarker unawareness (aOR = 0.878, 95% CI [0.824–0.936], p < 0.001), followed by a higher MEDAS score (aOR = 0.842, p = 0.003) and aging (aOR = 0.961, p < 0.001). The network model was dense (sparsity = 0.133) and showed DDRK–CVH literacy as the strongest conditional edge (r_partial = 0.202). The conditional associations of BMI (r = 0.000) and physical activity (r = 0.036) with CVH literacy collapsed after conditioning on DDRK and MEDAS. Centrality indicators showed that DDRK had the highest closeness and strength (both = 1.000). Conclusions: DDRK shows strong conditional network associations with Mediterranean diet adherence and CVH literacy. These exploratory findings generate hypotheses for future longitudinal or interventional research. Full article

Digital rural construction is a key component of China’s agricultural and rural transformation, as well as a means to improve rural productivity and strengthen the coordinated development of urban and rural areas in the Yangtze River Delta, which requires the backing of an efficient policy framework. Based on this, the research object is the 145 digital village policies issued by the Yangtze River Delta, and 16 of them are selected for evaluation after content mining. The findings are as follows: (1) Sixteen policies have an average PMC index of 8.42; four policies are excellent, 12 are good, and the quality of policies is generally good. (2) At the administrative level, there is a characteristic that the quality of provincial policies is superior to that of municipal policies. Among regions, the policy quality advantages represented by Zhejiang are obvious, presenting a pattern of “Zhejiang leading, Jiangsu steady, Anhui catching up, and Shanghai waiting for improvement”. (3) Except for the “policy function”, although the absolute scores of some indicators (such as policy field, policy content, policy evaluation) are at a high level, there is still a significant gap compared to the outstanding performance of the policy function (0.98). Moreover, from the perspective of the requirement for comprehensive and coordinated development of policies, the attention and investment in these dimensions are slightly insufficient, resulting in policies not fully exerting their expected comprehensive effectiveness, which is the main reason restricting the overall quality of policies. (4) It is recommended to increase the regulatory and advisory nature of the policy; Expand the scope of policy audiences; Take into account the forward-looking and long-term nature of policy formulation; Refine the execution plan to ensure the implementation of policies; The content of the construction of fiscal taxation, laws and regulations will be increased to provide a scientific basis for the rural transformation; Encourage local exploration and innovation, combine with local conditions, and form replicable and promotable development models. Full article

Using panel data from 282 prefecture-level and above cities in China, this study employs a difference-in-differences (DID) model to examine the impact of the National Sustainable Development Plan for Resource-Based Cities on carbon emission efficiency, as well as its underlying mechanisms and heterogeneous effects. The results indicate that the implementation of the Plan significantly improves carbon emission efficiency. This conclusion remains robust after a series of robustness tests, including the propensity score matching difference-in-differences (PSM-DID) approach. Mechanism analysis further reveals that technological innovation, industrial upgrading, and reductions in energy consumption constitute the primary channels through which the Plan enhances carbon emission efficiency. In addition, economic growth pressure and the degree of marketization exert negative and positive moderating effects, respectively, on the relationship between the Plan and carbon emission efficiency. Heterogeneity analysis shows that the positive effect of the Plan is significant only in resource-based cities located in eastern China, southern China, or southeast of the Hu Huanyong Line. In terms of city size, the positive effect is observed only in medium-sized cities and Type II large cities. Full article

Background and Objective: Romosozumab carries a warning for potential severe cardiovascular events, while denosumab is widely used for osteoporosis but requires safety considerations in advanced chronic kidney disease (CKD). Given the limited direct real-world evidence comparing these treatments, in this study, we aimed to compare the cardiovascular and survival outcomes associated with romosozumab versus denosumab in adults with CKD. Materials and Methods: In this retrospective propensity score-matched cohort study, we utilized de-identified electronic health records from the TriNetX Global Collaborative Network, where eligible participants were adults aged 40 to 90 years with CKD who initiated either romosozumab or denosumab. Patients with bone/bone marrow malignancies or recent acute cardiovascular events were excluded. Following 1:1 propensity score matching based on demographics, diagnoses, medications, and laboratory characteristics, patients were followed for up to 1095 days. The primary outcome was a composite cardiovascular measure (all-cause mortality, acute myocardial infarction, or cerebrovascular event), while secondary outcomes included the individual components of the composite outcome and acute heart failure. Outcomes were evaluated using fixed-window cumulative risks, risk ratios (RRs), odds ratios, and hazard-ratio estimates. Results: After 1:1 propensity score matching, 1201 patients remained in each cohort; the mean age was 74.1 years in the romosozumab cohort and 74.2 years in the denosumab cohort, and 94.9% and 93.8%, respectively, were women. Romosozumab was associated with lower 1095-day cumulative risk of the composite cardiovascular outcome than denosumab (12.6% vs. 18.8%; RR, 0.668 [95% CI, 0.553–0.808]), as well as lower cumulative risk of cerebrovascular event (5.0% vs. 7.0%; RR, 0.714 [95% CI, 0.518–0.985]), all-cause mortality (6.6% vs. 9.5%; RR, 0.693 [95% CI, 0.526–0.913]), acute myocardial infarction (3.8% vs. 6.2%; RR, 0.613 [95% CI, 0.429–0.878]), and heart failure (2.7% vs. 6.1%; RR, 0.438 [95% CI, 0.292–0.659]). Conclusions: In this propensity score-matched EHR cohort of adults with CKD, cardiovascular and survival estimates associated with romosozumab versus denosumab varied by follow-up window and analytic approach. Although 1095-day fixed-window cumulative risks were lower in the romosozumab cohort, corresponding time-to-event estimates were neutral or directionally inconsistent. These findings should not be interpreted as evidence of cardioprotection or causal superiority but rather as showing no clear and consistent excess cardiovascular risk signal for romosozumab compared with denosumab. Full article

Background/Objectives: This cross-sectional observational study investigated factors associated with emergency room (ER) utilization for dental pain in a rural inland region of Portugal. The main objective was to examine the relationship between access to dental care, sociodemographic characteristics, oral health behaviors, and clinical outcomes with the use of emergency room services for dental problems. Methods: The study sample comprised 423 participants from the districts of Bragança and Vinhais, in Trás-os-Montes, aged 4 to 90 years, who attended their first dental medicine consultation. Participants completed a structured questionnaire addressing sociodemographic characteristics, general health, oral health behaviors, and dental prosthetic use, and underwent oral examination for assessment of the Decayed, Missing, and Filled Teeth (DMFT) index. Associations with reported ER utilization due to toothache were analyzed using Fisher’s exact test and the Mann–Whitney U test. Results: Overall, 28.4% of participants reported having visited the ER due to dental pain, and most cases were managed with medication followed by discharge. ER utilization was significantly associated with behavioral risk factors such as smoking, as well as poorer oral hygiene practices, including less frequent tooth brushing. In addition, participants who sought ER care presented higher DMFT scores, indicating a greater burden of untreated dental decay and tooth loss. Conclusions: These findings suggest that limited preventive dental care and unfavorable oral health behaviors are associated with to avoidable ER visits for dental pain in rural settings. This study reinforces the need to strengthen access to preventive oral health services and to advance the integration of dental care into Portugal’s National Health Service (SNS), particularly in underserved inland regions. Full article

Background/Objectives: This study aimed to assess oral health values, oral hygiene habits, preventive dental attendance, and lifestyle-related risk factors among students at the University of Osijek and to compare findings between students enrolled in health-related and non-health-related study programs. Methods: A cross-sectional survey was conducted among 331 students (186 health-related and 145 non-health-related). Participants were recruited using a convenience sampling approach. Data were collected using an anonymous questionnaire comprising demographic information, oral health–related behaviors, and the Croatian version of the Oral Health Values Scale (OHVS-CRO). Group differences were analyzed using nonparametric statistical tests. Results: Students enrolled in health-related study programs reported significantly more favorable oral hygiene behaviors, including more frequent toothbrushing, greater use of dental floss, interdental brushes, and mouthwash, as well as more regular preventive dental attendance (all p < 0.05). They also achieved significantly higher OHVS-CRO scores across all domains and on the total scale (median total score: 42 vs. 40; p < 0.001). No significant differences were observed regarding smoking, alcohol consumption, or refined sugar intake. Conclusions: Students enrolled in health-related study programs demonstrated higher oral health values and more favorable oral health-related behaviors than students enrolled in non-health-related study programs. These findings suggest an association between educational orientation and oral health values and behaviors and may inform future oral health promotion initiatives targeting university students. Full article

Background/Objectives: The Integrated Palliative Outcome Scale (IPOS) was developed for use in patients with advanced, life-limiting conditions. This study aimed to apply the IPOS in an inpatient hospice setting in Poland, incorporating both patient- and healthcare staff-reported perspectives in cancer and non-cancer populations. Methods: Patients’ needs were assessed in 112 individuals (86 patients with cancer [C] and 26 with non-cancer diagnoses [nC]) using the Polish version of the IPOS. Assessments were conducted twice: within 24 h of admission (A1) and after 7 days (A2). Results: The mean age of the study population was 73.9 ± 11.9 years, and 63 patients (56.2%) were male. At A1, the total IPOS score reported by staff was significantly lower than that reported by patients (p < 0.01), primarily due to lower scores in the psychosocial domain (p < 0.001), while somatic domain scores were comparable. At A2, no significant changes were observed in total IPOS scores or in any domain in either patient- or staff-reported assessments. At A1, total IPOS scores did not differ significantly between C and nC groups. However, psychosocial domain scores were higher in the nC group (p < 0.01). Patients with non-cancer conditions reported higher levels of anxiety (p < 0.05), as well as greater needs related to feeling at peace (p < 0.01), sharing feelings (p < 0.05), and access to information (p < 0.05). Conclusions: Our findings underscore the multidimensional nature of suffering and highlight the need for more comprehensive recognition and assessment of psychosocial needs in palliative care patients, particularly those with non-cancer diagnoses. Full article

This paper examines the long-run relationship between subjective well-being and digital transformation in the six Gulf Cooperation Council (GCC) countries—Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates—over the period 2011–2025 using a balanced country-year panel dataset. Subjective well-being is measured by the national average Cantril Ladder score from the Gallup World Poll as reported in the World Happiness Report. Explanatory variables include a binary AI Readiness Period Indicator (AI) distinguishing the pre-AI-readiness phase (2011–2018, AI = 0) from the post-AI-readiness phase (2019–2025, AI = 1), anchored by the Oxford Insights Government AI Readiness Index, Internet penetration from the International Telecommunication Union (ITU), and real GDP per capita. After accounting for cross-sectional dependence and non-stationarity, the analysis employs a panel autoregressive distributed lag (ARDL) framework estimated via the Pooled Mean Group (PMG) approach. The results indicate the existence of a stable long-run cointegrating relationship among the variables. The baseline PMG estimates suggest positive long-run associations between GDP per capita and the AI Readiness Period Indicator with subjective well-being, and a negative association between Internet penetration and well-being in a high-connectivity regional context. Short-run effects are generally weak, while the error-correction term confirms adjustment toward the long-run equilibrium. Robustness checks based on alternative estimators confirm the positive long-run effect of income, while the estimated effects of the AI Readiness Period Indicator and Internet penetration show sensitivity in sign and significance across specifications and should therefore be interpreted as indicative rather than definitive. Overall, the findings suggest that digital transformation is not a homogeneous driver of subjective well-being. Instead, the AI Readiness Period Indicator and Internet penetration operate through distinct mechanisms, with potentially different welfare implications in highly connected rentier-state economies. Full article

The HEROn magazine was created as an innovation project by the S-TEAM team for the 2024/2025 SUBMERGED season of the FIRST^® LEGO^® League Challenge category. The primary aim of the HEROn project was to implement game-based learning methods to enhance environmental awareness, particularly concerning the protection of our water resources. This initiative is designed to engage individuals from ages 9 to 99 in a creative and enjoyable manner. At the core of the HEROn project is a well-known game that challenges players to find the differences between two photos. This activity not only provides entertainment but also educates participants about the importance of protecting and preserving the aquatic environment. By discovering subtle differences between images, players become more attuned to environmental issues, which promotes a deeper understanding and appreciation of water conservation. The chapters of the HEROn magazine are thoughtfully organised into themes, each focusing on various aspects of water’s importance, its protection, and sustainable usage. Additionally, a random sample of participants was surveyed to gather opinions and feedback on HEROn magazine as part of the project and this research. This feedback is invaluable for assessing the magazine’s impact and for improving future editions to better serve the goals of raising environmental consciousness. The online HEROn questionnaire consisted of 10 items and employed a 5-point Likert scale for responses. Data were collected over a three-month period (28 January–28 April 2025), with 630 Hungarian respondents participating in the survey. The HEROn magazine was generally well received, with mean scores ranging from 4.2 to 4.6. Age-group differences were examined using nonparametric Kruskal–Wallis tests, with Dunn–Bonferroni post hoc comparisons. These analyses show statistically significant differences between adults (30–89) and the younger cohorts for aggregated awareness, design/engagement, and branding measures, while teenagers (9–15) and young adults (16–29) did not differ significantly from each other. The Find-the-Difference game showed the greatest variability across groups, with young adults giving the lowest mean. Full article

Hellenic Open University has developed Onlabs, a virtual biology laboratory for its students to be trained before they use its on-site lab. The evaluation of the user’s performance in the virtual lab with respect to a particular experimental procedure is done with a scoring algorithm specifically designed for this purpose. For the calculation of the user’s overall progress score, an Artificial Neural Network (ANN) is used. The ANN, trained with data from random plays evaluated by biology experts, achieves significant convergence. Yet, when the trained ANN is used for the real-time evaluation of the user’s performance, it produces unrealistic scores, that is, incompatible with human experience, such as unscaled score values as well as a high increase in score with the execution of secondary actions. To overcome this problem, the ANN’s weights are fine-tuned with the use of a Genetic Algorithm (GA) and two algorithms of Swarm Intelligence (SI), Whale Optimization Algorithm (WOA) and Firefly Algorithm (FA). Among those, GA achieves successful optimization of the ANN’s weights, resulting in a more realistic score mechanism. Full article

Traffic signal control increasingly faces disturbed operating conditions such as incidents, abrupt demand surges, sensing degradation, and abnormal driving patterns. Under these nonstationary regimes, classical fixed-time and actuated strategies may exhibit slow recovery, while purely data-driven controllers can be brittle when disturbance characteristics shift. This paper proposes an LLM-in-the-loop architecture for disturbed traffic signal control that integrates (i) deep learning for disturbance detection and short-horizon traffic forecasting, (ii) a disturbance-aware candidate generation and scoring layer (template/retrieval-based), and (iii) a constrained large language model (LLM) that selects or minimally repairs signal plans only within constraint-screened action templates. A deterministic validator enforces safety and operational constraints, including minimum/maximum greens, cycle feasibility, and clearance rules, by checking action feasibility before execution. The method is formulated as constrained decision making under uncertainty, where disturbance estimates and predictive confidence shape both retrieval/scoring and LLM supervision. The originally reported SUMO evaluation considered multiple disturbance categories, including capacity drops, demand shocks, and sensing dropouts as well as reported network delay, queue spillback, recovery time, and switching stability. Within the originally reported SUMO scenarios, descriptive results suggest that among the selected baselines, the proposed DL + LLM framework reported lower mean values of delay, spillback frequency, and recovery time than the fixed-time, actuated, and retrieval-only baselines. The reported validator-detected action-feasibility violations were zero; this result concerns timing-action feasibility rather than an absence of traffic-state risks such as spillback. Full article