Search Results (1,328)

Background/Objectives: There is a growing need for autism spectrum disorder (ASD) assessment tools that are diagnostically aligned, clinically usable, and accessible across diverse service contexts. The Diagnostic Autism Spectrum Interview—Version 2 (DASI-2) is a freely available, semi-structured clinical interview mapped directly to DSM-5 and ICD-11 criteria. This pilot study aimed to adapt DASI-2 into Hungarian and explore the (1) acceptability of DASI-2 administration, (2) agreement with prior clinical ASD diagnoses, and (3) relationship between DASI-2 observational ratings and ADOS-2 classifications. Methods: Following a multistep translation procedure, DASI-2 was administered to seven children previously assessed for ASD in a multidisciplinary Hungarian clinical setting. The assessment included a parent interview, direct assessment with the child or young person, and completion of the DASI observational record (OR1–OR4). DASI diagnostic outcomes were compared with prior clinical decisions, and OR scores were analyzed in relation to ADOS-2 classifications. Results: All participants completed the DASI-2 interview in full. Agreement with prior clinical diagnosis was found in six of seven cases (κ = 0.70, indicating substantial agreement). When exploring the one non-aligned case, the divergence in diagnostic outcome was due to broader contextual information considered by the initial clinical team which influenced clinical opinion. The five participants diagnosed with ASD showed substantially higher DASI observational scores (mean = 15.26) than the two who were not diagnosed (mean = 1.57), mirroring ADOS-2 severity classifications. Conclusions: These findings support the acceptability and preliminary validity of DASI-2. Its inclusive structured observational record may provide a practical complement to resource-intensive tools such as the ADOS-2; however, further validation in larger and more diverse samples is needed. Full article

The modified Rankin Scale (mRS) is a widely used outcome measure for assessing disability in stroke care; however, its administration is often affected by subjectivity and variability, leading to poor inter-rater reliability and inconsistent scoring. Originally designed for hospital discharge evaluations, the mRS has evolved into an outcome tool for disability assessment and clinical decision-making. Inconsistencies persist due to a lack of standardization and cognitive biases during its use. This paper presents design principles for creating a standardized clinical assessment tool (CAT) for the mRS, grounded in human–computer interaction (HCI) and cognitive engineering principles. Design principles were informed in part by an anonymous online survey conducted with clinicians across Canada to gain insights into current administration practices, opinions, and challenges of the mRS. The proposed design principles aim to reduce cognitive load, improve inter-rater reliability, and streamline the administration process of the mRS. By focusing on usability and standardization, the design principles seek to enhance scoring consistency and improve the overall reliability of clinical outcomes in stroke care and research. Developing a standardized CAT for the mRS represents a significant step toward improving the accuracy and consistency of stroke disability assessments. Future work will focus on real-world validation with healthcare stakeholders and exploring self-completed mRS assessments to further refine the tool. Full article

The concept of “platinum sensitivity” has long guided prognostic assessment and treatment selection in recurrent ovarian cancer. However, the emergence of targeted agents, such as bevacizumab and poly (ADP-ribose) polymerase inhibitors, has complicated its clinical utility. In contrast, emerging evidence suggests that platinum sensitivity may also be applicable to recurrent endometrial cancer. As in ovarian cancer, a prolonged platinum-free interval (PFI) in recurrent endometrial cancer is associated with an improved efficacy of subsequent platinum-based chemotherapy. The PFI is linearly correlated with the response rate to platinum re-administration, progression-free survival, and overall survival. Patients are typically classified as having platinum-resistant or platinum-sensitive disease based on a PFI cutoff of 6 or 12 months. However, unlike in ovarian cancer—where the duration of response to second-line platinum-based chemotherapy rarely exceeds the prior PFI (~3%)—approximately 30% of patients with recurrent endometrial cancer exhibit a sustained response to platinum rechallenge that extends beyond their preceding PFI. Despite the incorporation of immune checkpoint inhibitors into the treatment landscape of endometrial cancer, the role of platinum sensitivity in clinical decision-making—particularly regarding treatment sequencing and drug selection—remains a critical and unresolved issue. Further research is warranted to elucidate the mechanisms underlying platinum resistance and to guide optimal therapeutic strategies. Full article

CAPOX and FOLFOX are widely used chemotherapy regimens for colorectal cancer (CRC). The superiority of one regimen over the other in a real-world setting (RWE) could have significant clinical implications given their common use, but such RWE is limited. This study analyzed provincial database records of 13,461 Canadian patients treated from 2005 to 2017. The primary outcomes were rates of Emergency Department visits and/or hospitalizations (ED/H) and overall survival (OS). CAPOX was used less frequently (8.4%) than FOLFOX (91.6%), often in older patients (p < 0.003 for Stage I–III; p < 0.001 for Stage IV). CAPOX recipients had shorter treatment durations (median 15 vs. 20 weeks, p = 0.002) and higher unadjusted ED/H rates (60.8% vs. 50.9%, p < 0.001), though this difference was nonsignificant on multivariate analysis (MVA) (HR 1.05 (0.92, 1.20), p = 0.466). Patients receiving CAPOX had worse OS than those on FOLFOX, (5-year OS 70.1% vs. 77.2% (p < 0.001) non-metastatic; 16.6% vs. 33.2% (p < 0.001) metastatic). MVA confirmed inferior OS with CAPOX (HR 1.42, p < 0.001). Other predictors of shorter OS included older age, male sex, comorbidities, rural residence, and lower income. This administrative data is at risk of bias but highlights the need for careful patient selection and informed treatment decision making. Full article

Much U.S. research supports the effectiveness of parenting education delivered via the home visiting method. Home visitors are essential to reaching fathers in this context, but not all have favorable attitudes toward father engagement or feel confident working with fathers. Given that father involvement is important for a wide range of child and adolescent outcomes and that fathers benefit from parenting education, it is important to better understand the forces that shape home visitors’ attitudes toward fathers, and thus their subsequent efforts to include them in publicly funded programming. Using survey data from 95 home visitors in Tennessee, this study explores whether home visitors’ beliefs about fathers and attitudes toward father engagement vary as a function of home visitor or agency characteristics. Results suggest training in social work, reporting father-friendly organizational attitudes and behaviors at one’s agency, and reporting supervisor support specifically for father engagement relate to various favorable fathering attitudes. Home visitors’ strategies to engage fathers in home visiting are presented, including strategies for before, during, and after the home visit. Overall, family service agency administrators are in key positions to make decisions that can improve agency father-friendliness, home visitor attitudes toward fathers, and subsequent outcomes for fathers, mothers, and children. Full article

In a European context, facing pressure to digitalize public administration, the integration of artificial intelligence (AI) at the local level remains a deeply uneven and empirically poorly understood process. This study investigates the degree of adoption of artificial intelligence (AI) in local public administrations in Germany, exploring territorial disparities and institutional factors influencing this transition. Based on a national sample of 347 municipalities, this research proposes a composite AI adoption index, built by integrating six relevant indicators (including the use of conversational bots and the automation of internal and decision-making processes). In the simulations, local administration profiles were differentiated according to factors such as IT staff (with a weight of 30%), the degree of urbanization (25%), and participation in digital networks (20%), reflecting significant structural variations between regions. The analysis model used is a multilevel one, which highlights the combined influences of local and regional factors. The results indicate a clear stratification of digital innovation capacity, with significant differences between eastern and western Germany, as well as between urban and rural environments. The study contributes to the specialized literature by developing a replicable analytical tool and provides public policy recommendations for reducing interregional digital divides. Full article

Introduction: Near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) is now widely regarded as a valuable aid in decision-making for complex hepatobiliary procedures, with increasing support from recent studies. Methods: We performed a systematic review following PRISMA guidelines, utilizing PubMed, CINAHL, and EMBASE databases to locate studies on the perioperative use ICG in pediatric hepatobiliary surgeries. Two independent reviewers assessed all articles for eligibility based on predefined inclusion criteria. We collected data on study design, patient demographics, surgical indications, ICG dosing, timing of ICG injection, and perioperative outcomes. Results: Forty-three articles, including 930 pediatric patients, from 1989 to 2025 met the inclusion criteria for narrative synthesis in our systematic review, of which 22/43 (51.2%) were retrospective studies, 15/43 were case reports (34.9%), 3/43 (7.0%) were experimental studies, and the other three were prospective comparative studies (7.0%). The current clinical applications of ICG in hepatobiliary pediatric surgery include bile duct surgery (cholecystectomy, choledochal cyst, biliary atresia), reported in 17 articles (39.5%), liver tumor resection, reported in 15 articles (34.9%), liver transplantation, reported in 6 articles (14.6%), and liver function determination, reported in 5 articles (12.2%). Conclusions: ICG fluorescence navigation in pediatric hepatobiliary surgery is a highly promising and safe technology that allows for the intraoperative localization of anatomic biliary structures, aids in the identification and resection of liver tumors, and can accurately determine hepatic function. The lack of comparative and prospective studies, and the variability of the dose and timing of administration are the main limitations. Full article

Background/Objectives: The oral cavity represents a convenient route of administration for drugs that exhibit significant hepatic first-pass extraction. In this study, the mucosal permeation properties of selected active pharmaceutical ingredients (APIs) incorporated into oral cavity drug products that are approved by the U.S. Food and Drug Administration were quantified using the human-derived sublingual HO-1-u-1 and buccal EpiOral™ in vitro tissue models. Methods: Epithelial barrier properties were monitored using propranolol and Lucifer Yellow as prototypic transcellular and paracellular markers. APIs were dissolved in artificial saliva, pH 6.7, and transepithelial flux from the apical to the basolateral compartment was quantified using HPLC. Results: Apparent permeability coefficients (Papp) calculated for these APIs in the sublingual HO-1-u-1 tissue model varied from Papp = 2.72 ± 0.06 × 10⁻⁵ cm/s for asenapine to Papp = 6.21 ± 2.60 × 10⁻⁵ cm/s for naloxone. In contrast, the buccal EpiOral™ tissue model demonstrated greater discrimination power in terms of permeation properties for the same APIs, with values ranging from Papp = 3.31 ± 0.83 × 10⁻⁷ cm/s for acyclovir to Papp = 2.56 ± 0.68 × 10⁻⁵ cm/s for sufentanil. The tissue-associated dose fraction recovered at the end of the transport experiment was significantly increased in the buccal EpiOral™ tissue model, reaching up to 8.5% for sufentanil. Conclusions: Experimental permeation data collected for selected APIs in FDA-approved oral cavity products will serve as a training set to aid the development of predictive computational models for improving algorithms that describe drug absorption from the oral cavity. Following a robust in vitro–in vivo correlation analysis, it is expected that such innovative in silico modeling strategies will the accelerate development of generic oral cavity products by facilitating the utility of model-integrated evidence to support decision making in generic drug development and regulatory approval. Full article

This article identifies the nature of Traditional Owners’ interests in Sea Country and addresses issues associated with all offshore energy projects—gas and wind. Exploring the impacts of offshore development on First Nations’ cultural heritage, the article proposes integration of free, prior and informed consent (FPIC) and the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP), into the regulatory and legislative offshore environment. In the Australian context, this particularly regards administrative and regulatory reforms to overcome uncertainty arising from recent decisions in the Federal Court. The international focus on new energy has fast-tracked many processes that sideline First Nations’ rights, hitherto understood within the onshore minerals extraction regimes. The reforms proposed in this article recognise an international commitment to enact the principles contained in the UNDRIP and other relevant international law. Full article

Background/objectives: In some cases of concomitant use of direct oral anticoagulants (DOAC) and certain anticancer medications, pharmacokinetic interactions are expected; however, clinical data is scarce. This report reviews the recommendations on the use of DOAC concurrently with anticancer drugs according to different clinical decision support systems and sources, with a focus on discrepancies. Methods: We reviewed the recommendations from the American Heart Association (AHA), European Heart Rhythm Association (EHRA), summary of product characteristics (SPC) in FASS (Swedish medicine information portal), the Swedish clinical decision support system Janusmed, and information from the Food and Drug Administration (FDA) on the concomitant use of apixaban, edoxaban, and rivaroxaban (activated factor X (FXa) inhibitors) and 80 anticancer drugs from 11 categories (240 drug pairs). Results: No warnings of expected pharmacokinetic drug interactions between FXa inhibitors and anticancer drugs were found for 155 drug pairs (65%) across all sources. The remaining 35% of drug pairs were flagged as having possible interactions with FXa inhibitors according to at least one source. Discrepancies in the recommendations from the different sources were reported. The reported discrepancies were, for the most part, associated with different assessments of the mechanism and the extent of pharmacokinetic interactions of each anticancer medication. Also, knowledge sources have different approaches to reporting potential interactions, in some cases reporting clinically relevant strictly pharmacokinetic interactions, whereas others include even patient-specific factors. Conclusions: The lack of clinical data and different recommendations can make clinical decisions on the concomitant use of DOAC and anticancer drugs difficult. Our compilation is meant to assist clinicians in making decisions based on the available evidence, even if it is scarce. Full article

Background: Sex differences play a significant role in the epidemiology, biology, and outcomes of many cancers, including glioblastoma (GB), the most common and aggressive primary brain tumor. GB is more frequent in males, while females tend to have longer survival, though the underlying reasons for these differences remain poorly understood. Potential contributors include hormonal influences, sex-specific risk factors, and treatment disparities. Understanding these differences is critical for optimizing personalized treatment strategies. Methods: We conducted a retrospective analysis of patients with gliomas from a neuro-oncological database, with a primary focus on GB cases. Variables collected included sex, age, tumor type, molecular biomarker, and treatment modalities. The primary objective was to assess sex-based differences in tumor characteristics and outcomes, while the secondary objective was to identify predictors of time to progression and mortality. Results: The cohort comprised 125 GB, 48 astrocytomas, and 16 oligodendrogliomas, with no significant sex-based differences in age or tumor type distribution. Among GB patients, multifocality was more prevalent in females (14% vs. 8%; p = 0.01); also, EGFR amplification was more frequent in females (25.5% vs. 52.5%; p = 0.007). Males received chemotherapy (80% vs. 63%; p = 0.04) and radiotherapy (84% vs. 67%; p = 0.03) more frequently than females. Survival was positively associated with MGMT methylation (p = 0.002) and negatively associated with TERT mutation (p = 0.01). Multivariable analysis identified TERT mutation as a predictor of increased mortality (HR = 4.1; 95% CI: 1.2–14; p = 0.025), while multifocality predicted both mortality (HR = 2.3; 95% CI: 1.3–3.9; p = 0.003) and reduced time to progression (HR = 3.3; 95% CI: 1.02–10.6; p = 0.04). Conclusions: This study underscores the importance of sex and molecular profiling in GB management, revealing distinct patterns in tumor characteristics and treatment administration between males and females. Our findings advocate for the integration of sex-specific considerations and molecular profiling into clinical decision-making to improve outcomes for GB patients. Full article

The digital transformation of the Architecture, Engineering and Construction sector is accelerating the adoption of digital platforms as critical enablers of data integration, stakeholder collaboration and process optimization. This paper presents a systematic review of 125 peer-reviewed journal articles (2015–2025), selected through a PRISMA-guided search using the Scopus database, with inclusion criteria focused on English-language academic literature on platform-enabled digitalization in the built environment. Studies were grouped into six thematic domains, i.e., artificial intelligence in construction, digital twin integration, lifecycle cost management, BIM-GIS for underground utilities, energy systems and public administration, based on a combination of literature precedent and domain relevance. Unlike existing reviews focused on single technologies or sectors, this work offers a cross-sectoral synthesis, highlighting shared challenges and opportunities across disciplines and lifecycle stages. It identifies the functional roles, enabling technologies and systemic barriers affecting digital platform adoption, such as fragmented data sources, limited interoperability between systems and siloed organizational processes. These barriers hinder the development of integrated and adaptive digital ecosystems capable of supporting real-time decision-making, participatory planning and sustainable infrastructure management. The study advocates for modular, human-centered platforms underpinned by standardized ontologies, explainable AI and participatory governance models. It also highlights the importance of emerging technologies, including large language models and federated learning, as well as context-specific platform strategies, especially for applications in the Global South. Full article

In the context of emergency management, individual or household decisions to engage in risk mitigation behaviors are widely recognized to be influenced by a benefit–cost perception (perceived applied value (PAV) vs. perceived economic value (PEV), respectively). To better understand how such decisions are made, we conducted a mail survey (N = 211) of households living in the Red River of the North Basin, North Dakota, in 2018. The survey is aimed at understanding the overall experience of households with flooding and their behavior toward advanced protective strategies against future floods by analyzing household PEV—their willingness to pay for the National Aeronautics and Space Administration’s (NASA) Satellite Enhanced Snowmelt Flood Prediction system. This paper presents a mediation model in which various predictors (flood risk, experience, flood knowledge, flood risk perception, flood preparedness, flood mitigation, and flood insurance) are analyzed in relation to the PAV of the new Satellite Enhanced Snowmelt Flood Predictions in the Red River of the North Basin, which, in turn, may shape the PEV of this product. We discuss the potential implications for both the emergency management research community and professionals regarding the application of advanced risk mitigation technologies to help protect and sustain communities across the country from floods and other natural disasters. This paper provides a greater understanding of the economic and social aspects of sustainability in the context of emergency management and community development. Full article

Some of the most intense thunderstorms and extreme weather events on Earth occur in the Hindu Kush Himalaya (HKH) region of Southern Asia. The need to provide end users, stakeholders, and decision makers with accurate forecasts and alerts of extreme weather is critical. To that end, a cutting edge weather modeling framework coined the High Impact Weather Assessment Toolkit (HIWAT) was created through the National Aeronautics and Space Administration (NASA) SERVIR Applied Sciences Team (AST) effort, which consists of a suite of varied numerical weather prediction (NWP) model runs to provide probabilities of straight-line damaging winds, hail, frequent lightning, and intense rainfall as part of a daily 54 h forecast tool. The HIWAT system was first deployed in 2018, and the recently released model archive hosted by the Global Hydrometeorology Resource Center (GHRC) Distributed Active Archive Center (DAAC) provides daily model outputs for the years of 2018–2022. With a nested modeling domain covering Nepal, Bangladesh, Bhutan, and Northeast India, the HIWAT archive spans the critical pre-monsoon and monsoon months of March–October when severe weather and flooding are most frequent. As part of NASA’s Transformation To Open Science (TOPS), this data archive is freely available to practitioners and researchers. Full article

Generative artificial intelligence (AI) is rapidly transforming healthcare systems since the advent of OpenAI in 2022. It encompasses a class of machine learning techniques designed to create new content and is classified into large language models (LLMs) for text generation and image-generating models for creating or enhancing visual data. These generative AI models have shown widespread applications in clinical practice and research. Such applications range from medical documentation and diagnostics to patient communication and drug discovery. These models are capable of generating text messages, answering clinical questions, interpreting CT scan and MRI images, assisting in rare diagnoses, discovering new molecules, and providing medical education and training. Early studies have indicated that generative AI models can improve efficiency, reduce administrative burdens, and enhance patient engagement, although most findings are preliminary and require rigorous validation. However, the technology also raises serious concerns around accuracy, bias, privacy, ethical use, and clinical safety. Regulatory bodies, including the FDA and EMA, are beginning to define governance frameworks, while academic institutions and healthcare organizations emphasize the need for transparency, supervision, and evidence-based implementation. Generative AI is not a replacement for medical professionals but a potential partner—augmenting decision-making, streamlining communication, and supporting personalized care. Its responsible integration into healthcare could mark a paradigm shift toward more proactive, precise, and patient-centered systems. Full article