Search Results (5,191)

Objectives: Medullary thyroid carcinoma (MTC) is a rare but biologically aggressive neuroendocrine tumor for which reliable preoperative prognostic biomarkers are still lacking. This study aimed to evaluate the association between preoperative blood immunological markers and disease recurrence in patients with MTC undergoing curative surgery. Methods: We conducted a retrospective cohort study at a single tertiary academic center including 52 consecutive patients who underwent curative surgery for MTC between January 1999 and December 2023. The study size was determined by including all eligible consecutive patients meeting predefined inclusion/exclusion criteria within the study period. Preoperative inflammatory indices (MLR, NLR, PLR, SII, SIRI) were calculated from standardized complete blood count tests performed within 30 days before surgery. Disease-free survival (DFS) was calculated using the Kaplan–Meier method. Cox proportional hazards regression analysis with a backward stepwise selection based on the Akaike Information Criterion was used to identify independent predictors of recurrence, adjusting for potential confounders. Results: The mean age was 55.0 years (range 31–75), and 73% of patients were female. The ROC-derived cut-off for preCT was 181 pg/mL. Locally advanced disease (T3-T4) was observed in 12% of cases, and cervical node metastases in 27%. With a mean follow-up of 75.48 months, the 3- and 5-year DFS rates were 91% and 86%, respectively. On multivariable Cox regression, a high monocyte-to-lymphocyte ratio (MLR ≥0.37), positive surgical margins, and pathological nodal involvement remained independently associated with worse DFS after confounder adjustment (HR 9.73, 10.78, and 17.71, respectively). Conclusions: Elevated MLR, histological node metastases, and positive surgical margins independently predict recurrence in MTC after curative treatment. Preoperative MLR may represent a simple, inexpensive, and reproducible biomarker to improve preoperative risk stratification and personalize surgical and follow-up strategies: patients with MLR ≥0.37 may benefit from more aggressive management and/or closer follow-up. Full article

Sports have progressively incorporated technological advances, yet while the impact on performance and broadcasting is remarkable, the application of Artificial Intelligence (AI) in sports refereeing appears residual. A closer examination of prior research suggests that this limited development reflects deeper conceptual patterns within the field. While existing research on AI in sports officiating has predominantly conceptualized the field under an accuracy-optimization paradigm (focusing on decision precision, visual attention patterns, referee fatigue, and performance enhancement), there is a systematic lack of theoretical and empirical work that frames officiating as a broader socio-technical ecosystem. In particular, the literature does not provide conceptual models addressing (i) AI-assisted risk prevention and athlete safety as a core officiating function, (ii) human–AI task redistribution in cognitively overloaded and hybrid evaluative environments (e.g., disciplines such as artistic gymnastics or bodybuilding, where technical execution and aesthetic judgment are simultaneously assessed), and (iii) the redefinition of the referee’s role when AI operates as an anticipatory or real-time alert system rather than merely as a post hoc verification tool. Thus, the gap is not only one of application but of knowledge production: the dominant paradigm optimizes decision accuracy, yet it leaves the question of how AI can transform refereeing responsibilities, cognitive load distribution, and safety governance within competitive ecosystems under-theorized. This exploratory study adopts a Human–Computer Interaction (HCI) perspective to contrast existing initiatives with the practical expectations of professional referees. The methodology comprises two pillars: a systematic literature review following PRISMA guidelines and qualitative experimentation involving professional referees using focus groups and affinity diagrams techniques. From an initial total of 1251 records retrieved across five academic databases (2019–2025), 1122 articles were analyzed after applying strict inclusion/exclusion criteria. The findings provide preliminary support for our hypothesis of a significant underutilization gap, showing that research is concentrated on accuracy systems, while high-potential areas identified as critical by experts, such as athlete safety, represent only 0.6% of the analyzed literature. The study contributes a conceptual framework based on five categories established by experts, according to the identified use cases, providing guidance for future AI integration and interdisciplinary research in the sports officiating ecosystem. Based on the results, we point to future applications and lines of research aimed at integrating AI as a tool for sports refereeing. Full article

Type 1 diabetes (T1D) constitutes a chronic metabolic disorder attributed to the autoimmune destruction of insulin-producing pancreatic β cells, which most frequently occurs in childhood. Long-term complications of T1D are expected to occur mainly in adult life, whereas cognitive dysfunction can also occur in children and adolescents with T1D. Most studies demonstrate mild cognitive impairment, especially in the domains of memory, attention and executive functions, all of which affect academic performance, which may also negatively influence adherence to appropriate glucose monitoring and insulin treatment in children and adolescents with T1D. As a result, mild cognitive dysfunction can be an obstacle to both optimal glycemic control during childhood and adolescence and academic achievements for young individuals with T1D. The major metabolic changes occurring around the onset of diabetes, such as severe hyperglycemia and diabetic ketoacidosis, may have a negative impact on brain plasticity during this vulnerable period of neurodevelopment, especially in children diagnosed at a younger age. The pathophysiological mechanisms involved are closely related to increased oxidative stress and the accumulation of advanced glycation end products in the brain, thus leading to neuron cell damage and apoptosis. On the other hand, hypoglycemic episodes and glucose fluctuations may also impair neuronal integrity. The aim of the current narrative review is therefore to present the existing literature data on the clinical aspects, risk factors and molecular mechanisms associated with cognitive dysfunction in children and adolescents with T1D. Full article

The tourism and hospitality sector in Saudi Arabia is undergoing rapid sustainability transformation under the strategic direction of Vision 2030. This study examines the maturity of Sustainability Actions (SAs), their key drivers, and implementation barriers, comparing the perceptions of industry practitioners and academic experts. Using a qualitative abductive research design based on 20 in-depth semi-structured interviews with industry and academic experts in Saudi Arabia, followed by thematic analysis using a machine learning Qualcoder 3.7 software, the findings reveal both convergence and divergence between the two groups. While both recognize Vision 2030 as the primary catalyst and acknowledge financial costs and knowledge gaps as major barriers, industry experts emphasize operational efficiency and short-term performance outcomes, whereas academics advocate systemic transformation grounded in circular economy principles and long-term socio-ecological regeneration. The results demonstrate that sustainability adoption in Saudi Arabia is shaped not only by market demand but also by a strong government-led institutional framework that accelerates sectoral change. The findings are structured across environmental, social, and economic sustainability dimensions, offering differentiated implications for industry practitioners and academic stakeholders within emerging tourism economies. The study contributes to sustainability and tourism and hospitality literature by offering a comparative multi-perspective analysis and by conceptualizing sustainability transition as a hybrid model combining policy direction, market incentives, and knowledge collaboration. Managerially, the findings highlight the need for regulatory clarity, targeted financial mechanisms, capacity building, and stronger industry–academia integration to institutionalize sustainability practices in emerging tourism economies. Full article

Student employment has become an increasingly common feature of higher education, yet research on international students has predominantly approached paid work as an economic necessity. This article examines student employment as a culturally embedded social practice among international students in Hungary, focusing on employment patterns and cultural value orientations. The study applies a mixed-methods design, combining a focus group interview with an online questionnaire survey conducted among international students at a Hungarian university (N = 61). Cultural value orientations were measured using Hofstede’s Values Survey Module, and differences between working and non-working students were analyzed using inferential statistical methods. The results show that international students’ employment is dominated by flexible, low-entry-threshold jobs, particularly platform-based delivery work, while study-related or professional positions remain less common and are associated with higher income levels. Employment participation was significantly related to gender and academic year, with male students and those in higher years of study being more likely to work. Regarding cultural value orientations, a statistically significant difference between working and non-working students emerged only along the masculinity–femininity dimension, with working students displaying more performance-oriented values. The findings highlight that international student employment is associated with both structural constraints and culturally grounded value orientations. Full article

Ensuring the crashworthiness of heavy-duty truck cabs is essential for reducing occupant fatalities and improving passive safety in commercial vehicles. Regulatory frameworks such as UNECE Regulation No. 29 (R29) define structural integrity requirements through full-scale destructive impact tests, which are costly and limit iterative design. In this study, an integrated experimental–numerical methodology is presented for the impact assessment of a real Iveco Eurocargo 120E18 truck cab reconstructed using high-resolution 3D scanning. The scanned geometry was used to generate a dimensionally accurate CAD model of the load-bearing cab structure, which was analysed using explicit finite element simulations in ANSYS Academic Mechanical and CFD Teaching package under impact conditions compliant with UNECE R29 and implemented according to the Swedish regulation VVFS 2003:29. In parallel, a full-scale physical pendulum impact test was performed on the same cab using a cylindrical impactor with a diameter of 580 mm, a length of 1800 mm, and a mass of approximately 1000 kg, impacting the upper region of the A-pillar. The experimental setup was instrumented using high-speed optical measurements and an accelerometer to capture impact kinematics and structural response. The numerical predictions showed good agreement with experimental results in terms of acceleration–time histories, absorbed energy evolution, and structural deformation, with differences generally below 6%. Critical regions susceptible to local buckling and plastic collapse were consistently identified in both approaches, while preservation of the driver survival space was confirmed. The results demonstrate that scan-based finite element models, when properly calibrated and validated, can reliably reproduce certification-level impact behaviour. The proposed workflow provides a robust and cost-effective framework for regulatory pre-validation, structural optimisation, and digitalisation of crashworthiness assessment for heavy-duty truck cabs. Full article

Public Open Spaces (POSs) on university campuses play a vital role in promoting student well-being, fostering social interaction, and enhancing academic engagement. Yet, in Indian technical institutions, these spaces are often underutilized due to poor design integration, lack of thermal comfort, and minimal user-centered planning. This study applies the Campus Open Space Index (COSI) to assess the functionality, inclusivity, and experiential quality of POSs at two premier Indian institutions, IIT Delhi and IIT Roorkee. COSI evaluates campus POSs across five dimensions: Physical Planning, Engagement, Need Perception & Behavior, Thermal Comfort, and Management. Through a mixed-methods approach involving surveys (n = 522), field observations, and spatial mapping, six open spaces from each campus were analyzed. The aspect-wise COSI results indicate that IIT Delhi performs better in Management (75.84%) and Thermal Comfort (60.56%), while IIT Roorkee performs better in Engagement (71.68%); both campuses show deficits in universal accessibility and climate responsiveness. The study reveals that POS effectiveness depends not only on spatial layout but also on user behavior, comfort, and perceived safety. COSI provides a replicable and scalable assessment model that supports data-driven decision-making for campus planners and administrators. This research advocates for participatory, student-centric planning approaches to transform campus POSs into more inclusive, responsive, and sustainable environments aligned with educational and social goals. Full article

Background: In contemporary societies, the pursuit of performance and the experience of urgency emerge as dominant forces shaping individual lives. In this context, delaying behaviors assume particular significance, especially for university students, who are immersed in environments that seem to prioritize speed and efficiency as the main routes to adulthood. The pressure to be flawless and fast, coupled with uncertainty about the future, calls for reflection on procrastination, its impact on psychological well-being, and the role of educational institutions. This study explored university students’ opinions and experiences regarding academic procrastination. Methods: Ten focus groups were conducted with 89 students enrolled in a Bachelor’s degree program. All focus groups were recorded and transcribed verbatim. The corpus was analyzed using Thematic Analysis of Elementary Contexts and Reflexive Thematic Analysis. Results: The former, a cluster-based thematic procedure, identified seven clusters capturing both the organizational aspects of university life and the experience of being a student in contemporary society. The secondary thematic analysis further explored these dimensions, emphasizing themes such as social pressure and concerns about the future. Conclusions: Findings suggest that understanding the dynamics underlying procrastination can inform university policies attuned to young adults’ developmental needs and well-being. Full article

Procrastination is commonly conceptualized as a maladaptive self-regulatory failure associated with impaired performance and reduced control over task execution. However, recent research suggests that procrastination may also assume a functional form, referred to as active procrastination, characterized by intentional delay combined with preserved control and effectiveness. The present study aimed to examine the relationship between the level of procrastination and perceived control over academic tasks among psychology students, as well as to explore differences according to gender, study level, and mode of study. A quantitative cross-sectional pilot study was conducted using an online self-report survey administered to 300 psychology students aged 18–30 years from universities in southern Poland. An author-developed questionnaire with good internal consistency (Cronbach’s α = 0.84) was used to assess procrastination behaviors, perceived task control, and self-reported academic functioning. The results indicated a high prevalence of procrastination behaviors alongside high levels of declared task control, timely task completion, and satisfaction with task quality. Women reported significantly lower levels of procrastination than men, while no significant differences were observed with respect to study level or mode. The findings support the existence of a functional paradox of procrastination and provide evidence consistent with the concept of active procrastination, suggesting that perceived control may buffer the negative consequences of delaying academic tasks. Full article

Background/Objectives: Academic engagement plays a central role in students’ learning outcomes and persistence in higher education. However, the mechanisms through which amotivation influences engagement remain insufficiently understood, particularly within conditional self-regulation frameworks. The present study examined a conditional self-regulation model in which amotivation predicts academic engagement through forethought and self-reflection under different levels of perceived performance control. Methods: Data were collected from 530 university students from Western Romania. A moderated parallel mediation model (PROCESS Model 59) was estimated to test whether forethought and self-reflection mediate the relationship between amotivation and academic engagement and whether perceived performance control moderates these pathways. Results: The results indicated that amotivation maintained a robust direct association with academic engagement across levels of performance control. Perceived performance control moderated the amotivation–forethought pathway, while self-reflection showed conditional indirect effects depending on control levels. Conclusions: These findings suggest that motivational deficits operate within a context-sensitive regulatory architecture in which control beliefs shape the activation of self-regulatory processes. The results contribute to understanding academic adaptation under motivational constraints and highlight the role of perceived performance control in students’ self-regulation systems. Full article

Objectives: In the perspective of an increasingly widespread application of precision medicine in rheumatoid arthritis (RA), this study aimed to compare efficacy and safety of ultrasound-guided synovial biopsy (US-SB) performed in an experienced rheumatology and community hospital setting. Methods: A post hoc analysis of R4RA, STRAP and STRAP-EU trials was performed, comparing US-SB performed in a radiology department of a community hospital without experience in RA (n = 14), versus a rheumatology academic centre with a high expertise in RA management and US-SB (n = 16). Suitability of specimens for histological and transcriptomic analysis (tissue and RNA quality) was analyzed as the main outcome. Results: Demographic and clinical features of the two patients’ groups were similar, except of disease duration (p < 0.05). No differences were recorded regarding site and ultrasound of the biopsied joint. Suitability for histological (% of gradable tissue) and transcriptomic analysis (RIN >3) was similar in the two cohorts (both 85.7% vs. 87.5%, p = 0.88). Proportion of gradable biopsies in total (59.2% vs. 59.5%, p = 0.96) and for each patient (52% vs. 56.15%, p = 0.77), were similar in both cohorts. Adverse events were rare (two in community hospital cohort, one in rheumatology cohort, p = 0.54), none considered severe. Seven patients in the community hospital experienced mild or severe pain, only two referred the same in the rheumatology cohort (p = 0.04). Conclusions: US-SB can be safely and effectively performed in a community hospital without experience in RA. A larger diffusion of this technique could allow to pursuit a tailored approach also in ordinary rheumatology outpatient clinics. Full article

Educational sustainability necessitates a holistic development paradigm where academic resilience and physical literacy are mutually reinforcing. Within the framework of the United Nations Sustainable Development Goals (specifically SDG 3: Good Health and Well-being and SDG 4: Quality Education), this study investigates the predictive capacity of kinesthetic profiles—encompassing both intelligence and learning styles—on sports attitudes and academic achievement among adolescents. Employing a quantitative cross-sectional design, data were collected from a substantial sample of 695 adolescents. The regression analyses revealed a critical pedagogical distinction: unlike kinesthetic intelligence, the kinesthetic learning style (β = 0.612), emerged as the paramount predictor of sports attitudes explaining a substantial 42.3% of the total variance. Furthermore, a significant positive correlation was identified between kinesthetic traits and academic performance, challenging the traditional dichotomy between physical and cognitive development. These findings advocate for a strategic paradigm shift from “one-size-fits-all” instruction to kinesthetic-based pedagogies that align with students’ sensory preferences. Consequently, integrating movement-oriented strategies into curricula is proposed not merely as an instructional choice, but as a vital sustainable education strategy to foster both academic excellence and the lifelong physical and mental well-being of the next generation. Full article

Purpose: Cachexia, characterized by involuntary weight loss, muscle wasting, and metabolic dysfunction, is prevalent in advanced cancer and chronic illnesses. Despite its impact, outpatient treatment models in the U.S. remain limited and unstandardized. Here, we aim to describe the structure, implementation, patient characteristics, and real-world clinical trajectories of a multidisciplinary clinic for cancer cache as well as other forms of unintentional weight loss clinic within an academic endocrinology practice. Methods: We conducted a retrospective observational cohort study of 103 patients referred to a single-center unintentional weight loss clinic over five years. Patients received comprehensive assessments (weight trajectory, nutrition status, 5× sit-to-stand test, handgrip strength) and personalized interventions including nutrition counseling, resistance training, and pharmacologic therapies. Results: Among 103 patients (median age 69.7 years; 53% male), 64% had cancer, while 36% were referred for non-malignant causes of weight loss or cachexia. Reduced appetite or food intake was reported in 43%, and functional impairment was common, with low handgrip strength in 47% and impaired 5× sit-to-stand performance in 79% of assessed patients. Systemic abnormalities were frequent, including elevated hs-CRP (57%), elevated neutrophil-to-lymphocyte ratio (43%), and hypoalbuminemia (26%). Among patients with available paired follow-up data, the median rate of weight change shifted from −0.5 kg/month prior to enrollment to 0.0 kg/month three months after the initial visit (p < 0.0001). Five-times sit-to-stand performance improved modestly at three months (p = 0.042), while handgrip strength was unchanged. Half of patients that engaged with the clinic returned for at least follow-up, but there was no identifiable difference between the population of patients that returned versus those that did not. Conclusions: A structured, multidisciplinary unintentional weight loss clinic in an endocrinology setting was associated with stabilization of weight and modest changes in physical function in this single-center cohort among patients who engaged in follow-up. These findings highlight the successful implementation of integrated outpatient care models and provide practice-based context for future interventions and therapeutic evaluations. Full article

Recent advances in large language models (LLMs) have made automated multiple-choice question (MCQ) generation increasingly feasible; however, reliably producing items that satisfy controlled cognitive demands remains a challenge. To address this gap, we introduce ReQUESTA, a hybrid, multi-agent framework for generating cognitively diverse MCQs that systematically target text-based, inferential, and main idea comprehension. ReQUESTA decomposes MCQ authoring into specialized subtasks and coordinates LLM-powered agents with rule-based components to support planning, controlled generation, iterative evaluation, and post-processing. We evaluated the framework in a large-scale reading comprehension study using academic expository texts, comparing ReQUESTA-generated MCQs with those produced by a single-pass GPT-5 zero-shot baseline. Psychometric analyses of learner responses assessed item difficulty and discrimination, while expert raters evaluated question quality across multiple dimensions, including topic relevance and distractor quality. Results showed that ReQUESTA-generated items were consistently more challenging, more discriminative, and more strongly aligned with overall reading comprehension performance. Expert evaluations further indicated stronger alignment with central concepts and superior distractor linguistic consistency and semantic plausibility, particularly for inferential questions. These findings demonstrate that hybrid, agentic orchestration can systematically improve the reliability and controllability of LLM-based generation, highlighting workflow design as a key lever for structured artifact generation beyond single-pass prompting. Full article

Background: Early cardiopulmonary resuscitation (CPR) and timely use of automated external defibrillators (AEDs) are critical determinants of survival following out-of-hospital cardiac arrest (OHCA). University students enrolled in healthcare degree programs represent a strategic target population for the dissemination of basic life support and defibrillation (BLS-D) skills. However, evidence on their level of knowledge, attitudes, and perceived preparedness remains limited in Southern Italy. Methods: A cross-sectional observational study was conducted between mid-December 2025 and 15 January 2026 among undergraduate healthcare students at the Magna Graecia University of Catanzaro (Italy). Data were collected using a structured, self-administered questionnaire assessing socio-demographic characteristics, CPR/AED knowledge, attitudes, and perceived confidence. Composite knowledge scores were calculated and categorized as poor, sufficient, good, or excellent. Statistical analyses included chi-square tests, Cramér’s V, and Spearman’s rank correlation. Results: A total of 604 students were included (mean age 24.4 ± 6.7 years; 69.9% female), of whom 46.4% reported prior BLS-D training. Knowledge levels were heterogeneous: myocardial infarction was widely recognized as a cause of cardiac arrest (81.1%), whereas recognition of non-shockable rhythms, including asystole and pulseless electrical activity, remained low (<25%). Procedural knowledge, particularly regarding the chain of survival and chest compression rate, improved with academic year and prior BLS-D training. Conversely, ventilation skills and correct AED pad placement were consistently inadequate. Attitudes toward CPR were largely positive; however, perceived confidence in performing resuscitation was moderate to low, especially in complex scenarios. More than 80% of students expressed strong interest in further training and supported mandatory BLS-D education. Conclusions: Healthcare students demonstrated favorable attitudes toward CPR but insufficient and uneven knowledge, particularly in rhythm recognition, ventilation, and AED use. Academic progression and structured BLS-D training were associated with improved competencies, although critical gaps persisted. Integrating mandatory, hands-on BLS-D training with regular refresher sessions into healthcare curricula should enhance preparedness and potentially reduce OHCA-related mortality, especially in high-risk regions such as Calabria. Full article