Search Results (20,822)

Schools in Sweden support multilingual students’ language and knowledge development in various ways, including through pedagogical collaboration among multiple professionals. Despite the recognized benefits, however, little is known about how such pedagogical collaboration is understood and practiced by classroom teachers in Sweden. The purpose of the present study is to deepen the understanding of how teachers in the early years of schooling collaborate with heritage language teachers, Swedish as a second language teachers, and special educational needs teachers, in order to support language and knowledge development in second language learners. Individual semi-structured interviews were conducted with 15 Swedish teachers working in the early years of schooling, i.e., from reception year to Grade 3. The interviews were analyzed thematically. Results showed that teachers generally perceive collaboration with other professionals as beneficial. They conceptualized varying forms of pedagogical collaboration, encompassing frequent and flexible collaboration with close colleagues, interdependent collaboration with heritage language teachers (often complicated by structural constraints), and regular, structured collaboration within the student health team. Identified opportunities associated with pedagogical collaboration included the provision of holistic support for second language learners, as well as opportunities for professional development and collegial support. At the same time, several challenges were highlighted, including time-related and structural constraints that hinder collaboration, as well as language barriers and the influence of individual characteristics. Student health teams were highlighted as important for integrating expertise; however, limited teacher insight and the infrequent inclusion of Swedish as a second language teachers were reported to result in multilingual perspectives being overlooked. This study therefore recommends greater consideration of multilingual expertise in assessments of special educational needs and calls for further research on the role of student health teams in supporting second language learners. Full article

Electric vehicle (EV) transport by ship is expanding beyond industrial logistics centred on automobile production, trade, and pure car and truck carriers (PCTCs) into daily transportation for island tourism, commuting, and essential mobility. According to Korea Maritime Transportation Safety Authority (KOMSA) vessel status data as of March 2026, 104 of 146 domestic passenger ships were car-ferry passenger ships, accounting for 71.2% of the fleet and operating on 75 of 99 designated routes nationwide. Korea Shipping Association (KSA) operational records show that the EV transport rate on these routes increased from 0.76% in 2024 to 1.21% in 2025, with some routes exceeding 2.0–4.7%. Unlike enclosed multi-deck PCTC vehicle spaces, Korean coastal car-ferry passenger ships generally have single-tier open vehicle decks and bow ramp gates. Crosswinds on open decks may reduce smoke detector activation probability by 60–75%. Although Article 97 of the Standard for Ship Fire-Fighting Appliance newly requires dedicated EV fire-fighting equipment for car-ferry ships, it remains primarily equipment-prescriptive and does not yet provide open-deck-specific performance requirements for wind-resistant detection, fixed EV-zone cooling, EV-designated stowage arrangements, or passenger–operator safety management obligations. This study applies the five-step International Maritime Organization (IMO) Formal Safety Assessment (FSA) procedure to support improvements to EV fire-fighting equipment standards for coastal car-ferry passenger ships. Hazard identification (HAZID) was conducted with a 15-member advisory panel, and probability elicitation was performed through a Delphi survey with 10 core experts, showing strong consensus (Kendall’s W = 0.74, p < 0.01). Fault tree analysis (FTA) and event tree analysis (ETA) probabilities were derived from the Delphi results and the international literature. H-07, representing wind-induced smoke dilution, was identified as the dominant single-point vulnerability within the detection-failure branch. Monte Carlo-based FTA–ETA analysis (n = 10,000) estimated annual fire frequencies of 5.9 × 10⁻², 1.8 × 10⁻¹, and 2.9 × 10⁻¹ yr⁻¹ at EV loading ratios of 10%, 30%, and 50%, respectively, with 2.47 expected fatalities per fire. Risk entered the IMO ALARP band above a 30% EV loading ratio and exceeded the maximum tolerable crew risk above 50%. The combined application of risk control options (RCOs) 2, 3, and 4 reduced annual expected fatalities by 85.6%. Based on these results, six RCOs and institutional recommendations are proposed, including strengthened safety management obligations for passenger ship operators. Full article

This study critically addresses the challenge of selecting optimal insulation materials for contemporary, energy-efficient building envelopes, a decision with profound environmental, structural, and occupational health consequences. The paper responds to the growing demand for sustainable, resilient solutions by comparing wool, a bio-based, regenerative material, and expanded polystyrene (EPS), a synthetic polymer widely implemented in the construction industry, and advanced laboratory testing (thermal conductivity, moisture buffering, freeze–thaw resistance) is discussed in a comprehensive synthesis of the recent literature. Also, field evaluations from European retrofits and pilot projects (UK, Denmark, Finland, Iceland, Norway, Sweden, Germany and France) further contextualize performance outcomes, and life cycle impacts are considered. Recent results reveal that wool insulation achieves a moisture buffering value (MBV) between 1.8 and 2.7 (g/m²) % RH, minimal vapor resistance (mvr = 1–2), and preserves functional and structural integrity through more than 100 freeze–thaw cycles, leading to significant stabilization of the interior microclimate and enhanced durability. In contrast, EPS delivers lower thermal conductivity (0.032–0.037 (W/mK), critical for reducing heating/cooling demand, but exhibits limited vapor permeability (lvp = 60–150 MN·s/(g·m)), increased risk of condensation and mold, and reduced compressive strength (<22% after 30 cycles), especially when ventilation details are inadequate. Hybrid envelope systems leveraging both EPS and wool are demonstrated to optimize energy efficiency (up to 23% seasonal savings) and reduce interior humidity fluctuations, while lifecycle and recycling assessments show wool panels to be markedly superior in carbon footprint reduction and circularity. The stratification of insulation layers incorporating wool for vapor and moisture control, and EPS for pure thermal resistance is emerging as best practice in sustainable retrofit and new-build projects. Recommendations highlight the necessity for rigorous laboratory validation, international standards alignment, and integrated material design for robust hygrothermal comfort and environmental performance. The review also covers wool- and EPS-based hybrid composites, showing how natural fibers can improve key mechanical properties without compromising thermal insulation performance or environmental benefits. Full article

Soil amendments are widely applied for water conservation in urban turfgrass, yet whether establishment-phase benefits persist into a mature-stand remains unclear. This study evaluated biochar, biosolids, and greenwaste on tall fescue (Schedonorus arundinaceus) over a 108-day mature-stand trial under deficit (50% ET₀) and moderate (85% ET₀) irrigation, both below full replacement. Canopy performance was assessed by visual quality and NDVI, with van Genuchten soil-water retention modeling. Unlike the establishment-phase advantages reported for the organic amendments in Part I, the second-year results reversed sharply: moderate biochar (12.36 t ha⁻¹) was most hydraulically stable, holding the highest plant-available water (PAW ≈ 0.18 cm³ cm⁻³, above the control and organic amendments) and the most stable canopy. High-rate biochar (24.71 t ha⁻¹) underperformed the control under deficit irrigation, indicating constraints beyond water retention at the highest rate. Greenwaste and biosolids raised volumetric water content but provided lower PAW than moderate biochar. For greenwaste, a reduced field capacity offset this; for biosolids, an elevated permanent wilting point limited the extractable fraction. Biosolids failed to maintain acceptable quality even under the 85% ET₀. Because first-year success does not guarantee mature-stand resilience, amendment stability and rate optimization, rather than application volume, emerge as long-term management priorities under water-limited conditions. Full article

Menopause marks a complex biopsychosocial transition defined by the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. South Asian women tend to experience menopause earlier (45–47 years) than North American women, yet limited culturally appropriate interventions exist to address their symptoms. While hormone replacement therapy can reduce discomfort, its associated risks and limited cultural feasibility restrict its use in this population. There is a growing need to explore non-pharmacological and culturally relevant alternatives. Physical activity has been associated with potential well-being benefits during menopause. This study examined the prospective acceptability of a pedometer-based walking intervention, encouraging 10,000 steps daily, among South Asian immigrant women. The study was conducted in 2024 and completed within approximately seven months. A cross-sectional survey was conducted with 64 South Asian women aged 40–70+ years, who completed a questionnaire assessing the prospective acceptability and perceived barriers to participation. Overall, participants reported moderate to high levels of acceptability of the proposed walking intervention. Some participants perceived potential benefits for well-being; however, given the study design, effectiveness and symptom management outcomes were not assessed. Sociocultural factors—such as family responsibilities, modesty concerns, and limited access to supportive environments—were identified as potential barriers to participation. These findings suggest that a pedometer-based walking intervention may be acceptable to some South Asian immigrant women, though acceptability was not uniform and may be influenced by contextual factors, including opportunity costs. Further research using longitudinal or interventional designs is needed to evaluate feasibility, uptake, and effectiveness. Full article

Cancer patients receiving systemic therapy experience substantial treatment-related symptoms. Nurse-led digital health interventions, e.g., interactive voice response systems, web platforms, mobile apps, and telehealth, have emerged as strategies to strengthen supportive care. To evaluate its effectiveness, this systematic review summarizes evidence exclusively from randomized controlled trials (RCTs). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, four databases were searched from inception to January 2025 for eligible RCTs involving adults undergoing anticancer therapy; evaluating nurse-led or nurse-co-led interventions using digital or telecommunication technologies; reporting validated symptom or health-related quality of life (HRQoL) outcomes. Risk of bias was assessed. Nine RCTs (N = 3344) met criteria; seven had low risk of bias. Interventions using telephone systems, web portals, mobile apps, or videoconferencing reduced symptom burden and improved HRQoL. The Symptom Care at Home system reduced symptom burden by ~43%, with greatest effects from combined automated monitoring and nurse practitioner follow-up. Additional benefits included improved anxiety, self-efficacy, patient participation, fewer severe toxicities and hospitalization days. In conclusion, nurse-led digital interventions effectively reduce symptom burden and support HRQoL during systemic therapy. Multicomponent models integrating automated monitoring with structured nursing follow-up and decision support appear most beneficial. Full article

Background: Biliary tract cancers (BTCs), encompassing cholangiocarcinoma and gallbladder carcinoma, are aggressive malignancies with poor prognosis and increasing incidence in selected regions worldwide. Advances in imaging, biomarker profiling, immunotherapy, and targeted therapies have improved treatment options but have also increased the economic pressure on health systems. Understanding the economic evidence on BTC is therefore important for resource allocation and health technology assessment. Methods: We systematically searched PubMed/MEDLINE, Embase, Scopus, and Web of Science for peer-reviewed economic studies of BTC published from January 2010 to March 2025. Eligible studies included cost-effectiveness, cost–utility, cost–benefit, cost-of-illness, and resource-use analyses. The review followed PRISMA reporting principles. Reporting completeness was assessed using CHEERS 2022, and methodological credibility was appraised using the Drummond framework. Results: Twenty studies were included: 13 cost-effectiveness or cost–utility analyses and seven cost-of-illness or resource-use studies. Conventional chemotherapy strategies, including gemcitabine plus cisplatin in some settings and other cytotoxic combinations in selected jurisdictions, generally produced more favorable economic results than newer systemic therapies, although findings varied by country, threshold, comparator, and price assumptions. First-line immunotherapy combinations and biomarker-directed targeted therapies frequently produced ICERs above jurisdiction-specific willingness-to-pay thresholds at current prices, often requiring substantial price reductions to approach cost-effectiveness. Real-world studies showed high resource use and costs, particularly with hospitalizations and later treatment lines. Evidence on screening and prevention was limited, with one study suggesting that ultrasound surveillance may be cost-effective in a liver fluke-endemic region of Thailand. Discussion: The available economic evidence suggests that affordability and jurisdiction-specific value assessment are central to BTC policy decisions. Current prices for several immunotherapy and targeted agents limit cost-effectiveness in published models, while evidence on prevention, early detection, and care-pathway interventions remains sparse and context-specific. Full article

Background: Minimally invasive surgery (MIS) for hallux valgus (HAV) correction may benefit from using the medial eminence to enhance lateral capital fragment translation. This study investigates whether osteotomy placement through the medial eminence correlates with improved HAV and forefoot width (FW) correction. A retrospective analysis of 20 patients who underwent MIS bunion correction was performed. Pre- and postoperative radiographs were reviewed to assess hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), sesamoid position, osteotomy location, osteotomy angle, capital fragment shift, and forefoot width. Pearson correlation and multivariable linear regression were used to identify associations. Chart review was performed at the one-year mark for complications (recurrence, infection, non-union, hardware failure). Significant correlations were found between DMAA and HVA (r = 0.883, p < 0.001), DMAA and IMA (r = 0.573, p = 0.008), and HVA and capital fragment shift (r = 0.541, p = 0.014). Osteotomy location and angle were not significantly associated with correction. Multivariable analysis showed DMAA was independently associated with HVA correction (β = 0.679, p < 0.001), and both capital fragment shift and metatarsal head angulation were associated with FW narrowing. Additionally, no patients in this cohort experienced complications. Use of the medial eminence in MIS osteotomy was not associated with improved HAV or FW correction. Angular deformity parameters and lateral fragment shift were more predictive of radiographic outcomes. Full article

This study addresses the multi-objective optimization of characterizing a flat glass processing plant. To assess the operational conditions required for a flat glass processing small and medium-sized enterprise (SME) to become a prosumer compatible with renewable energy community (REC) participation. This work is motivated by the presence of more than 300 SMEs in Italy, like this, where RECs represent one of the few viable strategies for achieving the European Union’s 2050 decarbonization targets. The research is carried out in two scenarios; Scenario-I includes Stage-i and Stage-ii with the mutual goal of forecasting and optimizing. Forecasting is used in Stage-i to optimize the factory load, and in Stage-ii to shift and curtail energy loads based on the forecast, considering the Italian national energy price and the regional price bands (“fasce orarie”) F1, F2, and F3. Forecasting and the indicators of environmental and social performance are the means to ensure the best energy utilization and management, as they prove that the reduction in CO₂ emissions and benefits on the community level can be both obtainable. Subsequently, the techno-economic analysis and evaluation of prosumer-readiness conditions are carried out through the optimization of industrial energy demand: three optimization objectives are assessed in this study (i) energy cost, (ii) carbon emission, and (iii) load curtailment. Four algorithms are put into effect to solve the tri-objective optimization: multi-objective particle swarm optimization (MOPSO), multi-objective ant nesting algorithm (MOANA), non-dominated sorting genetic algorithm (NSGA-II), and multi-objective grey wolf optimization (MOGWO). The algorithms are validated in Stage-ii to find the desired optimum in the cost of energy, reduce peak formation, and carbon emissions. To achieve this goal, a stochastic approach based on Monte Carlo simulations and VIKOR is used to optimally select the results. The findings show that the NSGA-II, MOPSO, and MOANA are more effective in solving the problem, while the MOGWO algorithm more quickly finds the optimal solution. Based on the defined objectives, a new configuration for the energy community is introduced, together with a community well-being index and an evaluation of the resulting benefits for the factory. In Scenario-II, the PV plants’ installation on the factory is sized, and the excess energy shared with the grid is evaluated. The Scenario-II results show that 497.184 MWh (33.9%) of energy is shared with the grid. Both results suggest how optimized industrial demand profiles improve SME participation in future RECs. Full article

Background: Rosacea is a chronic inflammatory dermatosis characterized by vascular dysregulation, immune dysfunction, neurovascular alterations, and microbial involvement. Recent advances in understanding its pathophysiology have led to the development of targeted therapeutic strategies addressing multiple disease mechanisms. This systematic review aimed to evaluate contemporary evidence regarding emerging and established treatment approaches for rosacea. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, and Web of Science were searched for studies published between 2016 and 2025. Original human studies evaluating therapeutic interventions for rosacea were included. Study selection, data extraction, and risk-of-bias assessment were performed independently by two reviewers. Methodological quality was assessed using Joanna Briggs Institute (JBI) critical appraisal tools appropriate for each study design. Results: Fifteen studies involving 537 patients with rosacea and 77 controls (614 participants in total) met the eligibility criteria. Evaluated interventions included vascular-targeted therapies, topical anti-inflammatory agents, systemic and immunomodulatory treatments, and microbiome-oriented approaches. Oxymetazoline, pulsed-dye laser, platelet-rich plasma, ivermectin, azelaic acid, dapsone, sulfur preparations, and metronidazole demonstrated clinical benefits in reducing erythema, inflammatory lesions, or overall disease severity. Emerging therapies, including tofacitinib and oral ivermectin, showed promising results in refractory disease. Microbiome-related interventions, particularly Demodex-targeted therapies and Helicobacter pylori eradication, were also associated with clinical improvement. Risk-of-bias assessment identified two studies with low risk of bias, twelve with moderate risk of bias, and one study with high risk of bias. Conclusions: Current evidence supports a multimodal and mechanism-based approach to rosacea management, integrating vascular, inflammatory, immunological, and microbiological targets. However, the available evidence remains limited by small sample sizes, heterogeneous methodologies, short follow-up periods, and a predominance of non-randomized study designs. Large, well-designed randomized controlled trials are needed to establish optimal evidence-based treatment strategies and define the long-term efficacy and safety of emerging therapies. Full article

Melatonin occupies a paradoxical position in contemporary sleep medicine: despite its physiological role as a regulator of circadian timing, it is frequently used and perceived as a nonspecific “natural” hypnotic. Although melatonin demonstrates modest benefits for sleep initiation and clearer efficacy in circadian rhythm sleep–wake disorders, its clinical use is often undermined by diagnostic imprecision, inappropriate dosing, mistimed administration, inconsistent formulations, and inadequate patient counseling. Circadian disorders can be misclassified as primary insomnia, leading to symptomatic treatment approaches that fail to address the underlying phase misalignment. At the same time, supraphysiological doses and reflexive bedtime administration have become normalized despite evidence that melatonin acts primarily as a chronobiotic whose effects depend more on timing than dose. Regulatory inconsistencies and substantial variability in over-the-counter preparations further complicate safe and reproducible use. These factors contribute to avoidable treatment failure, inaccurate labeling of nonresponse, and persistent misconceptions regarding melatonin’s mechanism of action. Therefore, melatonin should be approached as a pharmacological intervention requiring the same diagnostic rigor, individualized dosing, and longitudinal assessment expected of other sleep therapeutics, particularly when integrated with behavioral and circadian interventions. Full article

Objectives: Three stability-indicating analytical methods featuring outstanding sensitivity, selectivity, and precision were set up for the quantification of salicylamide (SAD) and ascorbic acid (ASC) in the presence of salicylic acid (SAL), which represents a possible impurity and degradation product of SAD. The aim was to develop sensitive, selective, precise, and eco-friendly assays appropriate for routine quality control of pharmaceuticals. Methods: Method (A) was a spectrophotometric technique of a successive derivative of ratio spectra built upon a two-step derivatization of ratio spectra utilizing double-distilled water as a solvent. SAD was quantified at 247.2 nm and 257.0 nm, and ASC at 251.8 and 259.8 nm, while SAL was quantified at 305.6 nm. Technique (B) relied on ratio spectra for the mean centering analytical process applied via two sequential stages, where the amplitudes derived after the second ratio spectra of the mean centering have been recorded on 291.0, 266.0, and 241.0 nm for SAD, ASC, and SAL, in that order. Method (C) involved TLC densitometric analysis, in which the separation was carried out upon plates of silica gel with chloroform–hexane–methanol–acetone–formic acid (5:3:2:1:0.2, in volumes) as a mobile phase, monitored by densitometric detection at 240 nm. The linear relationships were observed over concentration ranges of (0.2–2 µg/band) for SAD with ASC and (0.1–1 µg/band) for SAL. Validation of the presented techniques was performed in accordance with ICH strategies. Results: These developed techniques have been effectively analyzed for SAD with ASC in pharmaceutical dosage forms with non-interfering ingredients. A statistical comparison with the previously used HPLC technique revealed no considerable difference in terms of accuracy and precision. Greenness assessment using the AGREE platform produced scores of 0.72 for the spectrophotometric approach (benefiting from aqueous solvent) and 0.62 for HPTLC (limited by chloroform). Practical applicability (BAGI = 80 for both spectrophotometry and HPTLC) and overall quality indices (CACI = 83 for spectrophotometry; 80 for HPTLC) supported routine QC suitability. Conclusions: The three developed stability-indicating methods are accurate, precise, and selective for simultaneous assay of SAD and ASC in the presence of SAL and are suitable for quality control use. The spectrophotometric procedures combine high analytical performance with an improved environmental profile, while HPTLC offers comparable analytical reliability with slightly lower greenness due to organic solvent use. Full article

Background/Objectives: Probiotic and synbiotic supplementation has been proposed as a preventive strategy against respiratory tract infections (RTIs) in early childhood, although evidence in infants and young children remains inconsistent. This systematic review and meta-analysis aimed to evaluate the effects of probiotic or synbiotic supplementation administered during the first 24 months of life on respiratory infection outcomes. Methods: PubMed/MEDLINE, Embase, and Scopus were systematically searched for randomized controlled trials published between January 2015 and 30 September 2025. Eligible studies included infants and children aged ≤24 months receiving oral probiotics or synbiotics compared with placebo, no intervention, or standard care. The primary outcome was the incidence of at least one upper respiratory tract infection (URTI), while the secondary outcome was the incidence of any RTI. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects models. Risk of bias was assessed using the Cochrane RoB 2 tool, and certainty of evidence was evaluated according to the GRADE approach. Results: Nine randomized controlled trials were included. Probiotic or synbiotic supplementation did not significantly reduce the risk of URTI (OR 0.95, 95% CI 0.47–1.95; I² = 78%). A non-significant trend toward a reduced risk of any RTI was observed (OR 0.66, 95% CI 0.35–1.25; I² = 69%). Exploratory subgroup analyses suggested possible strain-specific effects, with signals observed for Bifidobacterium longum subsp. infantis in relation to URTI prevention and Lactiplantibacillus plantarum ATCC 202195 for reduction in any RTI. However, these findings were based on a limited number of studies and should be interpreted cautiously. No serious adverse events attributable to supplementation were reported. Conclusions: Current evidence does not support the routine use of probiotic or synbiotic supplementation for the prevention of respiratory infections in children aged ≤24 months. However, potential strain-specific benefits warrant further investigation in adequately powered randomized trials. Full article

Multiple Myeloma (MM) is a hematological malignancy characterized by the clonal proliferation and survival of neoplastic plasma cells (PCs) within the bone marrow (BM), where disease progression is critically supported by interactions with the BM tumor microenvironment (TME). Despite significant advances in therapeutic strategies, MM remains incurable, underscoring the need for improved preclinical models to better understand the disease biology and therapeutic response. This review summarizes current and emerging MM treatment approaches and critically examines the development of models designed to more accurately recapitulate interactions between MM-PCs and the surrounding BM niche. We describe established and emerging modeling platforms, with emphasis on advanced three-dimensional (3D) culture systems and highlight their unique contributions to the preclinical assessment of both existing and novel therapies. The advantages of 3D models, including in vitro and in silico systems, over traditional two-dimensional (2D) models are discussed, alongside a comparative evaluation of scaffold-free and scaffold-based approaches. In addition, the benefits and recent advances in the customization of BM niche simulation using microfluidic technologies and organ-on-a-chip platforms are reviewed. The application of 3D models in MM research is increasingly enabling the study of disease pathogenesis, progression, drug resistance and precision-medicine approaches (informed by biomarker discovery). Although standardized preclinical approaches for evaluating MM therapeutics are currently lacking, the growing imperative to reduce reliance on preclinical animal models highlights the importance of alternate systems. Consequently, the development and adoption of physiologically relevant models that accurately recapitulate MM-PC interactions with the BM TME will be critical for advancing future therapeutic strategies in MM. Full article

Background: AI-supported game-based learning (AI-GBL) integrates artificial intelligence mechanisms, including adaptive difficulty adjustment, large language model (LLM) scaffolding, intelligent non-player characters (NPCs), and stealth assessment, into game-based educational environments. Objective: This systematic review synthesizes the empirical evidence on AI-GBL effectiveness, adaptive mechanisms, and intelligent assessment approaches across diverse educational contexts. Method: Following PRISMA 2020 guidelines, 55 peer-reviewed empirical studies (2021–2026) were identified from Web of Science and Scopus databases. Two independent reviewers screened records (κ = 0.89; 100% consensus on disagreements), extracted data using a standardized coding scheme, and assessed methodological quality using a five-criterion rubric. A thematic synthesis approach was adopted due to the heterogeneity of the evidence base. Results: The reviewed studies generally suggest promising positive effects of AI-GBL on knowledge acquisition, intrinsic motivation, and affective engagement under a range of educational conditions. LLM-based scaffolding reduces cognitive load but risks fostering passive dependency; adaptive difficulty adjustment benefits depend critically on the direction and magnitude of adaptation; AI NPCs function as credible instructional partners in both EFL and STEM contexts; stealth assessment achieves AUCs of 0.848–0.913. Challenges include algorithmic bias in assessment models, LLM latency, over-reliance risks, and a near absence of longitudinal evidence. Conclusions: AI-GBL’s effectiveness rests on principled alignment between AI mechanisms and learning theory rather than algorithmic sophistication per se. Equity-by-design approaches and longitudinal evidence constitute the field’s priority research needs. Full article